Post-op staph infection negligence/leg amputation

[Cypher84x]

What is the name of your state (only U.S. law)? Nevada

A few months ago my mother (55y/o diabetic) broke her foot. She had to have an operation to attempt to repair the bones. The surgury required inserting pins and screws into the foot. After initially being told that it was a success the hospital changed their story a day later saying it was not a success and she would need another surgery involving fusing the bones and putting a halo around it. 2 weeks ago she went to see the foot specialist (that did the initial surgery) after having worn a special foot brace for more than a month and he said that her foot was looking good and that she should try walking on it occasionally. Good news for her. 3 days later she had a doc appt elsewhere and was fine when I dropped her off. About 4 hours later I picked her up and she was seriously ill. She is prone to get sick if she overexerts herself, so she didn't think much of it. After 2 days of her leg being in pain and running a fever she called an ambulance and went to the hospital. After 2 days of examinations the doctors determined she had staph infection and a serious abscess in her foot. They said the infection was definitely from her initial surgery and originated most likely from the screws inserted in her foot. She was transferred to the hospital that did the initial surgery again and after a few days was going to have another surgery to rid the infection. Same surgeon, same hospital. They took her right leg from below the knee to our surprise. I asked the surgeon about the infection and why they amputated. He told me that the infection did originate from the initial surgery (most likely the screws) and based on the severity of the infection and it getting into the bones and the damage done to her foot amputation was the best course of action.

My question is about the sanitation procedures prior to invasive surgery and the post-op follow-up inspections checking for signs of infection. I could understand if she got staph (not MRSA) from the community (external sources), but she got it from the equipment used internally. Shouldn't the doctor have noticed the swelling and puss at the appointment the week prior to this happening? What procedures are taken to sanitize operating personnel, equipment, and area prior to and during surgery especially for high risk patients such as diabetics? And finally, technicalities aside, is this not negligence on the part of the hospital or surgeon? I understand the risk of infection, but she didn't get it from laying in bed at home and the hospital admits that. Is this a case I should pursue in court with my mother? Thank you.

[You Are Guilty]

It's entirely possible that the infection was not the result of any negligence on the doctors'/hospital's part. Amputation is quite prevalent amongst diabetics (I vaguely recall 5% as being the number affected). Does mom smoke? Is she overweight?

[Cypher84x]

I am aware of the amputation rate of diabetics. My concern is with the infection. She didn't lose her leg simply because she is diabetic and got an infection. She lost it because it was HA-SA acquired from unsanitary conditions. Staph doesn't just appear out of nowhere. It's a bacteria. The infection had almost 2 months to incubate and spread before anybody caught it. She had been to several doc appts between the time she had surgury and ended up losing the leg. Her surgeon even admitted to me that it was from the initial surgery and screw and the reason they amputated wasn't just because of the condition of the broken bone but because the infection was so severe in that area. This same surgeon told her a week prior the bones look good (x-ray) and she should try walking on it. I don't see how someone can get an internal infection in their leg (diabetic or otherwise) at the site of surgery from a screw and there not be negligence on anybody's part. Someone didn't sanitize properly. Someone didn't inspect the foot post-op during her appointments properly. The infection was left unchecked for way too long. And this is all admitted by the staff directly involved.

[Cypher84x]

And no she does not smoke nor is she seriously overweight. She weighs about 150lbs.

[ecmst12]

If she had no symptoms of infection before 2 days prior to the infection being found, how do you think her doctors should have found it sooner.

If the bacteria had been in her system for that whole time, her symptoms would have manifested much sooner. The screws/incision provided a point of entry for the bacteria, but it just doesn't make sense that the infection could have been "incubating" in her foot for all that time without any symptoms at all.

[Cypher84x]

I should have explained better in the original post. She had symptoms (nausea, foot swelling, pain, headaches, etc). She didn't have severe symptoms until later. We didn't realize it was infection earlier because we figured it was normal after surgery. The day she really started feeling sick was when I dropped her off for an appointment. She was fine when I dropped her off, but ill when I picked her up. She had been walking on it that day since the foot specialist told her to walk on it occasionally. She must have irritated it at that point. That is when severe symptoms occurred. As for how long it was infected is not contested among medical staff. The swelling she had was a severe abscess at the point of initial surgery. It had been swollen like that for quite a while including the morning I dropped her off at the foot specialist when he told her it looked good. Naturally we weren't concerned about it after he said that.

[lya]

Originally Posted by Cypher84x

I am aware of the amputation rate of diabetics. My concern is with the infection. She didn't lose her leg simply because she is diabetic and got an infection. She lost it because it was HA-SA acquired from unsanitary conditions. Staph doesn't just appear out of nowhere. It's a bacteria. The infection had almost 2 months to incubate and spread before anybody caught it. She had been to several doc appts between the time she had surgury and ended up losing the leg. Her surgeon even admitted to me that it was from the initial surgery and screw and the reason they amputated wasn't just because of the condition of the broken bone but because the infection was so severe in that area. This same surgeon told her a week prior the bones look good (x-ray) and she should try walking on it. I don't see how someone can get an internal infection in their leg (diabetic or otherwise) at the site of surgery from a screw and there not be negligence on anybody's part. Someone didn't sanitize properly. Someone didn't inspect the foot post-op during her appointments properly. The infection was left unchecked for way too long. And this is all admitted by the staff directly involved.

My intent is not to be rude or condescending in any manner; however, your post shows a total lack of understanding of the diabetic-foot injury process, how an operating room functions and surgery is performed, and how infection presents.

During surgery, the skin remains on all involved: the patient, the doctors, the nurses, the anesthesist, et al. Where there is skin, there is staph. The presence of staph does not imply the presence of an infection.

During surgery, no person actually touches the screws or other instruments. Instruments are passed between personnel who are as surgically sterile as possible. Packets of screw are opened over a sterile field and dropped onto the sterile field where they are picked up by instruments or sterile gloved hands. The instruments and hardware, as the screws are called, are placed into the body of a real human with real skin staph that can't be removed and can't be sterilized away.

Once the surgical site is closed, sterile procedure ends except for dressing changes when and if sterile dressing changes are required. Regardless, there is now a deep incision from skin to bone, an incision that has been sewn, stapled, and glued together, but remaining with openings that microscopic bacteria can use to enter the wound.

In a diabetic, bacteria are provided with a smorgasborg of sugar on which to dine, circulation-impaired tissue to invade, innervation-deprived tissue to destroy without the patient's experiencing pain and other "normal" signals of tissue distress. The body is trying to send more blood to the area in order to heal and with every delivery of blood comes more sugar to feed the bacteria.

A fractured foot in a diabetic often leads to amputation of the foot or the leg at or above the knee. The cause is not the organism identified in a wound culture but is the diabetic process whereby the microcirculation and tissue innervation has died years ago. These micro vessels and nerves are damaged and ultimately die each and every time a diabetic's blood sugar goes above normal.

It is a reasonable statement to say that the infection developed at the time of the initial surgery. It is not reasonable to say the infection developed because of unsanitary conditions. To reasonably state the latter, you'd have to prove the hospital and medical personnel have a known and documented history of post-op infections that has been directly tied to an identified area of unsanitary practice or conditions.

Amputations in diabetics often occur in stages. The surgeon may opt to try and save the foot; it depends on the status of the circulation and innervation of the most distal portion of the leg. (distal meaning furtherest away from the heart) If adequate circulation and innervation is not found in the most distal portion of the leg, more of the leg must be removed. The surgeon identifies adequate circulation and innervation in a more proximal area of the leg (closer to the heart). This may be below the knee or above the knee due to the knee's having a major artery running 'behind' and through it. An attempt at a below the knee amputation may be made and subsequent surgery may be needed to perform an above the knee amputation if the BKA fails.

The goal is to save the patient, not the foot or the leg.

If none of the above-mentioned surgical approaches 'works', most likely the patient will succumb to one or more systemic infections. The patient's death will still be due to diabetic issues and not to negligence.

In your original post, you describe the follow-up appointments and examinations the patient received; yet, a month later is when the infection presented. The infection did not reveal itself for a month but it was not a matter of a physician's not looking for signs and symptoms of an infection; it was a matter of presentation, not negligence.

You need to learn more about diabetes, especially if you are going to continue in any capacity as a caregiver for a diabetic.

Edited to add: Swelling and redness and increased heat and pain are part of the normal healing process. The body sends more blood to the area, which is the cause of the swelling, redness, heat, and pain. Walking on the foot is probably what caused the infection to present; the area of infection probably erupted into neighboring tissue and into the bloodstream which is why the patient became ill in such a short period of time as was the visit to the MD.

[Cypher84x]

Thank you Iya. I have been helping my mother with this now. I am aware of the amputation rate for diabetics and how diabetes works. Not just a general understanding. Many people I am around on a daily basis are diabetic. My understanding is just fine. I am also aware that bacteria is ever-present on us and don't always cause infection. I am aware that an open wound, especially in a diabetic, is a high risk for bacterial infection. I am aware that infections such as folliculitis are normally caused by staph because it is present in most places. I am merely stating facts of the situation. I am currently investigating the hospital's reputation and history of infection. Just because my mother is diabetic doesn't mean there is no negligence in this case. There are strict procedures hospitals take to ensure patients don't get infections. If everything was properly sanitized, including the area around the incisions, and everybody was taking these precautions, I don't see how the area around the screws in the bone could have been contaminated by the SA bacteria. Does SA grow IN our bodies? Now, as for how I care for my mother, I provide a clean environment for her to live in and make sure she gets the things she needs and her blood-sugar levels stay on track. She wasn't stuck in bed all the time either. This shouldn't have even been an issue in the discussion. I am simply asking if negligence could have been a suspect in this instance and what could have been done to prevent this. Rats don't grow from dirty rags.

[RRevak]

Originally Posted by Cypher84x

Thank you Iya. I have been helping my mother with this now. I am aware of the amputation rate for diabetics and how diabetes works. Not just a general understanding. Many people I am around on a daily basis are diabetic. My understanding is just fine. I am also aware that bacteria is ever-present on us and don't always cause infection. I am aware that an open wound, especially in a diabetic, is a high risk for bacterial infection. I am aware that infections such as folliculitis are normally caused by staph because it is present in most places. I am merely stating facts of the situation. I am currently investigating the hospital's reputation and history of infection. Just because my mother is diabetic doesn't mean there is no negligence in this case. There are strict procedures hospitals take to ensure patients don't get infections. If everything was properly sanitized, including the area around the incisions, and everybody was taking these precautions, I don't see how the area around the screws in the bone could have been contaminated by the SA bacteria. Does SA grow IN our bodies? Now, as for how I care for my mother, I provide a clean environment for her to live in and make sure she gets the things she needs and her blood-sugar levels stay on track. She wasn't stuck in bed all the time either. This shouldn't have even been an issue in the discussion. I am simply asking if negligence could have been a suspect in this instance and what could have been done to prevent this. Rats don't grow from dirty rags.

Staph can be found on the skin outside the body. More than likely this was not from the screws themselves but rather introduced some time after the screws had been in place and the wound was stapled. Even with dressings this serves as a haven for bacteria and it only takes one to start the fire so to speak. With surgery there comes risk of infection, many types of infection. Thats just an unpleasant risk one takes when undergoing surgical procedures. I am well aware of the extreme cares that are taken in operating rooms and can mimic Lya here when I say that this was most likely an after the fact infection that was magnified by the diabetes, not a result of negligent procedures on behalf of the operating staff.

[lya]

Originally Posted by Cypher84x

Rats don't grow from dirty rags.

and medmal lawsuits don't arise from a diabetic's surgical foot's requiring a BKA.

A medmal lawsuit MUST have damages solely attributable to the act(s) of negligence and from no other cause.

I read your reply and I reiterate that you need to learn more about diabetes and diabetic care. You mention several good qualities of basic care such as providing a clean environment and physical activity and blood sugar monitoring. None of these qualities of care have an effect on what diabetes does to the body. Without knowing the effects of diabetes on the body, you will continue to suffer shock and awe at the damage and deterioration that your mother will experience.

On a side note, your mother is the only one with any legal right to pursue a medmal claim. If she has not legally appointed you as her representative, you have no right to look into her records or her care or to seek a medmal lawsuit.

Your mother may want to call a couple of medmal attorneys to learn the statute of limitations that will apply and to learn the merit(s) of her claim. I believe that will resolve the issue at hand.

[ecmst12]

Short of completely nukeing the OR, which would defeat the whole purpose of having the surgery, it is impossible to kill every single bacteria on the patient. They can only follow standard sterilization procedures and hope for the best, because as mentioned, staph is everywhere. Even if procedures were adhered to perfectly, it's still quite possible for an infection to occur, especially in a person with compromised healing capabilities like a diabetic.

[Cypher84x]

I know screws don't carry bacteria. Contamination after the fact is what is in question. And as for opening a case, I am my mother's power of attorney and consent with her on the matter. I am not naive to law. The purpose of this post was to get insight on the matter from many sources. And again, Iya, I am not surprised or "shocked" by the breakdown I see in the diabetic process. Again you think that I am just acquainted with the disease. Aside from providing these amenities for my mother and monitoring her overall health and taking necessary steps to get them fixed and prevent anything else from afflicting her if possible what else can I do. I'm not rich and I'm not a healthcare provider nor is my house a hospital. I'm open for suggestions, but not criticism in this post. I thank you all for your input and found it quite helpful. Ecmst12, Rrevak, You Are Guilty, and Iya have a great day and thank you again.