Failed Diagnosis of Sepsis Results in Amputation

This case takes place in North Dakota and involves a male patient who presented to Emergency Room with gout in his left foot. He was given the appropriate medication and discharged. Four days later he presented to another ER with worsening symptoms. He was again diagnosed with a flare up of his gout and no workup was ordered. The defendant doctor allowed the patient to leave and he later presented to a third hospital, where he was found to have sepsis. As a result, the patient required amputation of his left leg.

Question(s) For Expert Witness

1. Do you routinely treat patients similar to the one described in the case? Please explain.

2. Have you ever had a patient develop the outcome described in the case? If so, please explain.

3. Do you believe this patient may have had a better outcome if the care rendered had been different?

Expert Witness Response E-008958

I've cared for patients suffering from gout flares as well as those suffering from acute bacterial arthritis (septic joints). Differentiating between which patient has a “simple gout flare” vs. those who need extensive workups can be challenging early in the patient’s clinical presentation. Though, a second presentation for the same complaint within days of the first should automatically raise the suspicion of the treating team. This is a tenet of emergency medicine practice. It is appropriate to say that the second presentation with worsening of symptoms and the patient’s overall clinical picture would warrant additional evaluation. The outcome of this additional evaluation would theoretically have allowed the treating team to identify the seriousness of the situation and possibly intervene sooner.