Potential Elder Abuse in Mismanagement of Lower Extremity Gangrene

Case Overview

This case involves a 91-year-old female with an extensive medical history, including arteriosclerosis and previous venous bypass surgery on the right leg. The patient also had a history of dry gangrene on two right toes.
Following a fall-induced left femur fracture, the patient was admitted to the hospital and underwent successful surgery. Post-operatively, the patient was transferred to a skilled nursing rehabilitation facility and administered anticoagulation therapy.

During her stay at the rehabilitation facility, the patient experienced acute pain and discoloration in her right foot. Despite these alarming symptoms and an arterial study indicating reduced foot circulation, no immediate action was taken by the vascular surgeon, who stated there was nothing to do. The patient's condition rapidly deteriorated, with worsening right foot swelling and discoloration. The facility again contacted the surgeon, who maintained there were no interventions.

The patient was later admitted to the hospital with a gangrenous right leg and severe sepsis, ultimately succumbing to cardiopulmonary arrest.

Questions to the Geriatrics expert and their responses

Please describe your experience with elder abuse patients.

In my 23 years of practice, I have encountered numerous instances of elder abuse. These range from instances where family members have sought to expedite the death of an elderly relative by withholding care or essential treatments, to hospitals advising older patients with reversible illnesses to opt for hospice care.

Generally, what aspects of a patient's records who died from complications related to gangrene of the lower extremities are significant in determining if elder abuse was present?

In cases, where the alleged abuse is coming from the doctor, it is crucial to review all available records thoroughly. Key documents include angiograms, past medical history, descriptions of the patient’s cognitive and physical status and documentation of conversations between doctors, patients, and family members, as well as staff comments.

Have you ever reviewed a similar case? If yes, please elaborate.

Yes, I have reviewed similar cases where decisions about an elderly patient’s care were made without considering their wishes, or the patient’s interests. In this case, I am particularly concerned about why the vascular surgeon stated there was ‘nothing to do’ despite clear signs of a worsening condition.

About the expert

This expert is a seasoned professional in geriatric medicine with over two decades of experience. They are board-certified in internal medicine and hold a certification as a medical director, having completed their education at prestigious institutions. Their extensive career includes serving as the medical director at a retirement community for 15 years. Currently, they hold positions as a contracted physician at a medical group, the medical director of a nursing and rehabilitation center, and the president and geriatric consultant at a consultancy group.