and inflammatory reaction due to internal joint prosthesis. Wound cul-
tures showed moderate growth of E. coli, and an indium white blood
cell scan suggested osteomyelitis. He was transferred to another hos-
pital, where a doctor advised Mr. Standley to "strongly consider the
possibility of amputation" given the poor wound conditions and the
extensive rehab that would be required if they could eliminate the
infection. The doctor performed an excisional arthroplasty, antibiotic
spacer insertion and deep wound closure. About 3 months later, Mr.
Standley returned for revision of the spacer, and an infectious disease
doctor recommended 2 more months of antibiotics. Five weeks later,
he returned for evaluation, where he was informed that due to his
extensive osteomyelitis, "nothing further could be offered to him from
the orthopedic standpoint except amputation."
The jury deliberated for less than an hour before returning the ver-
dict. Dr. Rech didn't attend the trial and is reportedly no longer in
practice. His counsel, Jay S. Weiss, withdrew before the trial once he
saw there was no chance of a settlement.
Take-home points
The surgeon's duty to comply with the standard of care begins at the
first moment of the patient encounter. The pre-op visit is when the
surgeon determines whether a patient is an appropriate candidate
for a proposed procedure. It's also when the surgeon educates the
patient on the procedure so that the patient may give, or withhold,
his informed consent.
In this case, the plaintiff's attorney and his expert witness argued
that Mr. Standley was not a knee replacement candidate because of
his multiple knee surgeries and history of osteomyelitis.
Contraindication to surgery is the most powerful plaintiff argument,
as it explicitly means that the patient could not possibly have suffered
Medical Malpractice
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