Expert Opines on Lapses in Decubitus Ulcer Care

This case involves an elderly Wyoming man who passed away due to multi-organ system failure following surgery – the Plaintiff had an underlying diagnoses of congestive heart failure as well as diabetes, which was being treated with Onglyza. The patient was referred to the Defendant physician from his family physician due to complaints of significant back pain. He was offered a lumbar interbody fusion, which he underwent and was discharged to rehab. He returned for a wound check a few days after surgery, complaining of pain and weakness. He was readmitted to the hospital, where they found that a wound had opened up. The patient suffered from a fever, mental status change, and a urinary tract infection. A following MRI showed a large fluid collection suggestive of possible abscess or decubitus ulcer. He was discharged to rehab on with a diagnosis of post-op wound infection. The plaintiff continued to decline, and was readmitted with a diagnosis of urosepsis and altered mental status. A lumbar puncture was performed along with a new MRI showed continuing evidence consistent with arachnoiditis and ventral epidural infection as well as abnormal fluid posterior to the laminectomy, and the man was discharged to rehab. The patient was then transferred to a hospital for continuing cognitive decline. The doctor performed a wound washout with evacuation of the epidural abscess and a resection of the epidural phlegmon. He was discharged to a nursing facility on and was readmitted roughly a month later where he passed away due to multi-organ failure.

Question(s) For Expert Witness

1. When postoperative MRIs showed fluid collection, was it below the standard of care not to aspirate and test the fluid?

2. Were the various discharges from the hospital below the standard of care given the findings at the time of discharge?

3. When it was stated that the noted lumbar wound infection was being adequately treated, and that the change in his mental status was not due to her lumber infection, was this opinion below the standard of care?

Expert Witness Response E-006894

I definitely see some issues from what I have learned so far. For example, when postoperative MRIs showed fluid collection, they should have tested the fluid. It appears that the man's treating physicians missed multiple opportunities to take a more aggressive direction insofar as treatment is concerned, which could possibly have produced a more favorable outcome. In my current position as the Director of the Division of Infectious Diseases at a large University-affiliated medical center, and the Director of the Fellowship program in Infectious Diseases at the same academic institution, I am intimately familiar with the standard of care required for patients in this situation.