• Pre-op. Mr. Standley was not a candidate for TKA because of his
multiple knee surgeries and history of osteomyelitis.
• Intraop. Dr. Rech failed to provide appropriate perioperative
antibiotics.
• Post-op. Dr. Rech failed to properly manage the infection once it
occurred.
Additionally, Dr. Rech's records didn't include a complete history of
Mr. Standley's previous surgeries or osteomyelitis — despite a report
of such by another doctor who performed pre-op medical clearance
— and no indication that a bone scan, MRI or CT was performed
before surgery. The surgery, done in 2 stages over 3 months, included
arthroscopy, meniscectomy, chondroplasty and removal of hardware.
Complications accelerate
Two weeks after the final surgery, Mr. Standley presented to Dr.
Rech's office for post-op evaluation. The doctor ordered Keflex
(cephalexin) for infection prophylaxis, which Mr. Standley's complaint
alleged "indicates that infection was in Dr. Rech's thought process,"
court records show.
Eleven days later, Mr. Standley went to an ER with complaints of
severe left knee pain and drainage. An ER doctor noted that the surgi-
cal site had surrounding erythema and warmth. Lab tests showed ele-
vations in white blood cell count, sedimentation rate and C-reactive
protein. Mr. Standley was admitted for cellulitis and "possible infected
hardware." However, Dr. Rech visited the patient the next day and
wrote a progress note that said there were no indications of infection
and that the patient "may be treated on an outpatient basis," after
which Mr. Standley was discharged.
The next night, however, Mr. Standley was back in the ER, reporting
knee pain and swelling. He was admitted with a diagnosis of infection
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