is there any negligence on 2nd hand surgery?

[fcobarr]

What is the name of your state? NJ

I was in a poly trauma car accident on Thanksgiving 06 in Canada. Canadian doctor did surgery on my broken pelvis and on my right wrist (fractured ulna and radius bones by the wrist). Wrist fractures were stabilized with plate and screws in the ulna and the radius with an external fixator securing the radius to the ulna.

Fast forward…transferred back to NJ, under the care of a local orthopaedic surgeon. He did some x-rays and determined the external fixator was ready to be removed and advised me that he would be manipulating my wrist to break up the scar tissue while I was sedated. Fixator removed and he does his manipulation from which I awoke in tears due to the pain. Dr. sends me to OT and PT.

After 3 weeks of OT (occupational therapy) on the wrist (after the fixator was removed), I go back to the orthopaedic sugeon for another check up and he does some x-rays of the wrist. After comparing x-rays of the wrist with the external fixator on to x-rays right after the manipulation, you can see that the ulna has been reinjured and displaced. Why he didn’t pick that up at the hospital I don’t know. Well, at the 3 week visit he says the plate is now twisted and I need to see a hand surgeon. Visited hand surgeon and he advised that another surgery will be necessary, at the very least to readjust the ulna and plate.

I conclude the new fracture and the plate being bent occurred during the manipulation. Other than going to therapy per his prescription (which probably did more harm than good with the bent plate) 3x a week, I do little else due to all the injuries sustained from the accident (broken foot, vertebrae fractures, etc.)

Do I just write this off as a mistake or is there some negligence involved on the part of the Dr who did the manipulation? He told me, that after he took the fixator off he turned my wrist fully palm-up and palm-down as well as fully wrist up and wrist down.

Having this additional surgery is causing me to exhaust my medical coverage on the auto insurance policy (only method of insurance). Should I tell my claims adjustor what I suspect may have happened, or will they not pay for the second procedure?

Thanks for your input.

 

[seniorjudge]

Present your facts to a personal injury lawyer for evaluation.

 

[ecmst12]

Was the accident your fault? Is it your insurance that's been paying so far? Normally auto accidents are handled according to the state laws where the accident occurs (regardless of the state of residence) but since yours happened in Canada, I don't know how that works. I am just asking to find out if you could have any coverage from the other driver's insurance, if the accident was not your fault. If the accident was your fault or there is no other driver involved (hit and run or uninsured etc) then your insurance will pay until your benefits are exhausted and that's it. IF there was some negligence involved (which only a medical expert could answer) in the second surgery, then that surgeon might be willing to write off some or all of his charges...but the hospital/anesthesia/therapy charges will all still apply, so in the end it wouldn't be that much less money (though it might help some). It sounds like you are unable to work due to your injuries, you could see if you qualify for Medicaid that could pay for any future treatment.

Your suspicions should not affect the payment of your claims by your insurance though; whether you tell them or not, their primary concern is whether additional surgery is medically necessary, not whether or not the last surgeon was negligent. IF you have a valid medmal claim and IF you successfully pursue the claim and are awarded money, you may have to reimburse your insurance for some or all of what they paid for that procedure, but in that case you'd have a lawyer who could explain those obligations to you (if any).

 

[ellencee]

What is the name of your state? NJ

I was in a poly trauma car accident on Thanksgiving 06 in Canada. Canadian doctor did surgery on my broken pelvis and on my right wrist (fractured ulna and radius bones by the wrist). Wrist fractures were stabilized with plate and screws in the ulna and the radius with an external fixator securing the radius to the ulna.

Fast forward…transferred back to NJ, under the care of a local orthopaedic surgeon. He did some x-rays and determined the external fixator was ready to be removed and advised me that he would be manipulating my wrist to break up the scar tissue while I was sedated. Fixator removed and he does his manipulation from which I awoke in tears due to the pain. Dr. sends me to OT and PT.

After 3 weeks of OT (occupational therapy) on the wrist (after the fixator was removed), I go back to the orthopaedic sugeon for another check up and he does some x-rays of the wrist. After comparing x-rays of the wrist with the external fixator on to x-rays right after the manipulation, you can see that the ulna has been reinjured and displaced. Why he didn’t pick that up at the hospital I don’t know. Well, at the 3 week visit he says the plate is now twisted and I need to see a hand surgeon. Visited hand surgeon and he advised that another surgery will be necessary, at the very least to readjust the ulna and plate.

I conclude the new fracture and the plate being bent occurred during the manipulation. Other than going to therapy per his prescription (which probably did more harm than good with the bent plate) 3x a week, I do little else due to all the injuries sustained from the accident (broken foot, vertebrae fractures, etc.)

Do I just write this off as a mistake or is there some negligence involved on the part of the Dr who did the manipulation? He told me, that after he took the fixator off he turned my wrist fully palm-up and palm-down as well as fully wrist up and wrist down.

Having this additional surgery is causing me to exhaust my medical coverage on the auto insurance policy (only method of insurance). Should I tell my claims adjustor what I suspect may have happened, or will they not pay for the second procedure?

Thanks for your input.

Before you make unfounded accusations, go to the hospital and review your records from the surgical removal of the fixator. An x-ray was most likely taken after the surgery/manipulation.

From your description of events, I suspect you are using your wrist too much and/or PT and/or OT is using your wirst too much.

You should say nothing to your insurance carrier as your suspicions are just that--suspicions. If you have a valid medmal claim, any award you receive will be used (in part or in whole) to reimburse your insurance carrier for any charges that were a result of the medmal.

If you don't have a personal injury attorney, get one now.

EC

 

[fcobarr]

Thanks for the advice. To answer a few questions which were asked:

I was a passenger in the at-fault parties car. At fault insurance has been paying the medical bills in the states and in Canada.

Ellencee,

I do have a PI attorney which has been handling my claim against at fault party. I don’t think he is a medmal attorney…but maybe he can recommend someone who can review the details of my situation.

The treating surgeon (who removed the fixator) was so concerned that I needed aggressive OT (he even stated it that way on the Rx), that I had my OT eval the same day…literally, drove from the hospital after having the fixator removed to the therapists office, and had my first OT session the day after. He wanted my wrist to move as much as I could take to “break up the scar tissue”. My wrist will only move with external forces acting on it. I am unable to “use” my wrist as you put it. Therefore I couldn't have been using it too much.

Should I discuss this with my PI attorney even though he may not do medmal?

Thanks for any additional info. Appreciate all who take the time to post free advice here.

 

[ellencee]

Thanks for the advice. To answer a few questions which were asked:

I was a passenger in the at-fault parties car. At fault insurance has been paying the medical bills in the states and in Canada.

Ellencee,

I do have a PI attorney which has been handling my claim against at fault party. I don’t think he is a medmal attorney…but maybe he can recommend someone who can review the details of my situation.

The treating surgeon (who removed the fixator) was so concerned that I needed aggressive OT (he even stated it that way on the Rx), that I had my OT eval the same day…literally, drove from the hospital after having the fixator removed to the therapists office, and had my first OT session the day after. He wanted my wrist to move as much as I could take to “break up the scar tissue”. My wrist will only move with external forces acting on it. I am unable to “use” my wrist as you put it. Therefore I couldn't have been using it too much.

Should I discuss this with my PI attorney even though he may not do medmal?

Thanks for any additional info. Appreciate all who take the time to post free advice here.

I was quite sincere when I advised you to review your records for x-ray report after surgery. If the bones are aligned at that point, aggressive PT and OT is part of the process that improves your chances of having use of your hand. If aggressive PT and OT do not release the scar tissue and the tendons that have lost flexibility due to immobility, then surgical release of the scar tissue and tendons will be required.

You can't claim negligence when doing what is needed yields a bad result.

If the surgeon removed the hardware without having physical evidence that the bones were aligned, then you may have reason to claim negligence. After the hardware was removed, if the surgeon did not ascertain placement, hopefully with an x-ray, then the surgeon cannot prove the alignment was correct before the next step of treatment.

What you will not be able to prove is that you should not have been sent for aggressive PT and OT, because you should have been and you were.

Many PI attorneys also represent medmal claims. Ask your attorney if he, or she, does medmal or if you need an additional attorney.

My gut feeling is there is no medmal claim, just as there is no magic wand that prevents people from being injured and requiring prolonged and protracted treatment or unsuccessful treatment. Bad things happen to good people; it is part of life.

Best wishes,
EC

 

[fcobarr]

I will follow up with the hospital and get any and all films and reports that are on file from when the fixator was removed.

I have no problem with aggresssive OT... but what appears to be a healed fracture a week prior to fixator removal (evident on xrays) from Jan 18 now appears to be visibly fractured and the plate which was placed accross the fracture on the the ulna is twisted. So, clearly, at this point, there is a misalignment that needs to be corrected. The twisted plate doesn't twist with the bone. It is in a permanent state of staying twisted. What no one can or will tell me is how the metal plate twisted? That's what I want to know...how and why did the plate twist? I didn't twist it.

And if the plate did twist from OT, then I must question the purpose of the plate to begin with or was the bone not healed enough and the fixator shouldn't have been removed when it was?

Something isn't right, and I can't figure it out on my own. Frustrating, and doctors seem to cover each other and aren't direct with blame and causes.

Thanks again.

 

[ellencee]

I will follow up with the hospital and get any and all films and reports that are on file from when the fixator was removed.

I have no problem with aggresssive OT... but what appears to be a healed fracture a week prior to fixator removal (evident on xrays) from Jan 18 now appears to be visibly fractured and the plate which was placed accross the fracture on the the ulna is twisted. So, clearly, at this point, there is a misalignment that needs to be corrected. The twisted plate doesn't twist with the bone. It is in a permanent state of staying twisted. What no one can or will tell me is how the metal plate twisted? That's what I want to know...how and why did the plate twist? I didn't twist it.

And if the plate did twist from OT, then I must question the purpose of the plate to begin with or was the bone not healed enough and the fixator shouldn't have been removed when it was?

Something isn't right, and I can't figure it out on my own. Frustrating, and doctors seem to cover each other and aren't direct with blame and causes.

Thanks again.

If you don't know how it twisted, how the hell is anyone else supposed to know? You would be the one who noticed a functional difference or an increase in pain.

As you saw fitting to close with an insult to the medical profession, I am through with you.

EC

 

[fcobarr]

Ellencee

Exactly my point…it didn’t twist from anything I did, I think I would have felt a plate twist and the bone re-break if it happened while I was awake…wouldn’t you agree? That’s why I think it happened during the manipulation in the hospital…and if you read the original post…”I awoke crying and in tears from the fixator removal procedure”. Even in OT, I never had the palm fully turned up or down. Only the surgeon indicated that he achieved total palm-up and palm-down during his manipulation. Presently, rotating my palm up, I only achieve 15 deg and that’s all I’ve been doing with OT for the past 3 weeks.

My intent was not to insult the medical profession as a whole. I’m sorry. I have a wonderful team looking after me and helping me recover. And for that I am extremely grateful. It’s just that where I am at, it has been difficult to get the proper answers I am looking for, and I feel an entitlement to straight answers. That’s all. I am as guilty as anyone else to be reluctant to accept responsibility when I should. That’s just human nature, but at some point we’re all accountable…and the consequences can’t always be avoided.

Thanks again. Even if you’re “through with me”, I still wanted to apologize.

 

[ellencee]

Ellencee

Exactly my point…it didn’t twist from anything I did, I think I would have felt a plate twist and the bone re-break if it happened while I was awake…wouldn’t you agree? That’s why I think it happened during the manipulation in the hospital…and if you read the original post…”I awoke crying and in tears from the fixator removal procedure”. Even in OT, I never had the palm fully turned up or down. Only the surgeon indicated that he achieved total palm-up and palm-down during his manipulation. Presently, rotating my palm up, I only achieve 15 deg and that’s all I’ve been doing with OT for the past 3 weeks.

My intent was not to insult the medical profession as a whole. I’m sorry. I have a wonderful team looking after me and helping me recover. And for that I am extremely grateful. It’s just that where I am at, it has been difficult to get the proper answers I am looking for, and I feel an entitlement to straight answers. That’s all. I am as guilty as anyone else to be reluctant to accept responsibility when I should. That’s just human nature, but at some point we’re all accountable…and the consequences can’t always be avoided.

Thanks again. Even if you’re “through with me”, I still wanted to apologize.

Aw, shucks. It's OK; all is forgiven and forgotten.

I wish I could give you the straight answer you are seeking and I wish I could tell you who is able to give you that answer. Unfortunately, the answer is not going be a straightforward answer unless by some miracle the pre-op x-ray shows proper alignment and bone growth sufficient for fixator removal and the post-op x-ray shows misalignment.
If the post-op x-ray was taken before the surgeon manipulated your wrist and no further x-rays were taken before discharge from the hospital, proving when it happened is going to be a process of deductive reasoning.

I love working in recovery. It is a challenging and often quite humerous place to be; patients say the darndest things when they are waking up from anesthesia and it is not uncommon for patients to awaken crying. The cause can be the anesthesia and it can be from pain. Bone pain is some serious pain. I've had a broken bone and I can't think of any pain that I've had that was worse; it's my 10 on my pain scale of 1-10.

Of course the bones in your wrist/hand hurt after the fixation device was removed. You could not have withstood the pain of the removal and forced manipulation if you had been 'awake'. It does not prove the forced manipulation caused the misalignment and even if it did, it does not equal negligence because it is a required part of the treatment.

A medmal claim requires four elements:
1. duty (the surgeon had a duty to provide care at the minimum standard of care)

2. breach of duty (you have to prove that one; from your description, I don't see it)

3. negligent act(s) that the provider knew or should have known would result in signifcant damage(s). (damage equals injury translated into $) (you have to prove that one; I don't see it)

4. significant damages that are the direct and proximal result of the act(s) of negligence and cannot be attributed to any other cause. (you have to prove 2 and 3 before you can prove this requirement)

Signifcant damages translates into enough money to pay for the lawsuit and provide an award to the plaintiff (patient).

Medmal claims take an average of five years from the time of intial consult with the attorney to resolution. The frustration and mental anquish usually takes quite a toll on the plaintiff because the claim moves forward and then months go by with no activity. Then, it moves forward again and stops for months. This goes on for years and in the meantime, the plaintiff receives no money, no satisfaction of any kind.

If you get the x-ray reports, be sure to get copies of the actual x-ray films, too. You will need an expert radiologist and an expert orthopedic surgeon to review your records. You're looking at somewhere around $7-10,000. Now, if you hire a Legal Nurse Consultant for the intial review, you will save about half of that, maybe lots more!

I hope in some way that my response has helped and I do sincerely wish I could at least point you in the direction of the straight answer you seek.

EC

 

[fcobarr]

Thanks for the write-up. That gives me some direction and things to think about.