Wondering what options are available with a Careless Doctor

[diamondell]

My son broke all of his toes in an accident back in September 2011. He went to the hospital and subsequently to an orthopedic doctor. We were told everything was all lined up and in place - He was in a cast from Sept. through Nov. and off work the entire time. After the cast was removed the doctor told him everything looked great even though he told the doctor that his two toes weren't touching the ground when he stood. The doctor told him it would just take time and everything would be fine. He recently went back to the doctor for a check up with the same complaint. This time the doctor realized they never took an x-ray from the side angle and now realizes that the two toes he's been complaining about weren't lined up and in fact are displaced. He now needs to have them re-broke and the tendons cut which will require surgery plus at least 8 weeks non-weight bearing. So he will be off work AGAIN for at least 8 weeks if not longer. What are his options - We do have good medical coverage but he can't afford to lose work and pay again all because the doctor didn't take the necessary x-rays in the first place.

 

[ecmst12]

He would have needed the same surgery if the x-ray had been taken and the problem found right after the cast came off, so I'm not sure what you think the damages are. You don't know that it's anything the doctor did wrong that caused the misalignment, for one thing, and it doesn't seem like things are any worse for the delay in diagnosis.

 

[tranquility]

No damages? What about the eight weeks of pain and suffering which will be repeated?

I don't know if x-rays are required for toe fractures, but I don't recall when an orthopedic surgeon ever didn't get x-rays when a break was possible. Also, early correction will usually lead to better results than to try and correct growth errors.

I'd see a med/mal attorney. Shop it around to see if there is anything to do. The thing is, medical malpractice suits are expensive so are reserved for profound damages. I'm not sure the damages rise to that level here (unless we can add in some of the off work costs), but there are thousands of dollars on the table and I'd certainly see an expert to determine if son is going to be able to grab some of them.

 

[ecmst12]

The additional surgery was needed when the cast first came off and it's still needed now. And it appears they DID take x-rays, just not from one angle. Perhaps the doctor was hoping the issue of the toes not touching the ground would resolve itself once the cast was off for a while and the muscles got back into shape. But the displacement present now was present then, it was just a delay in diagnosis that happened. And again, strictly from what was posted, there is no evidence that the displacement was caused by anything the doctor did or did not do.

 

[tranquility]

The additional surgery was needed when the cast first came off and it's still needed now.

The surgery was needed before the toes were cast in the first place. Proper x-rays would have shown the doctor that. The son suffered eight weeks of pain and suffering and being off the job unnecessarily and is statistically less likely to get optimal results from the surgery now as opposed to if it had been done when the problem was presented. I don't know if the failure to do side xrays was below the standard of care or not. If it was, the pain and suffering is compensable (perhaps the income too) AND if the eventual result is not optimal, there could be a problem as well.

 

[ecmst12]

That's not necessarily true and I didn't get that from the post at all. My understanding is the bones were set properly prior to casting and somehow they shifted while the cast was on (possibly due to the patient's non-compliance with staying off his feet). If your interpretation is correct and the proper x-ray was not taken prior to casting, then I agree there MAY be a case....either way I would put the first step as a review of all applicable records by another doctor and depending on what that reveals, a consult with a lawyer too.

 

[Adam G]

My son broke all of his toes in an accident back in September 2011. He went to the hospital and subsequently to an orthopedic doctor. We were told everything was all lined up and in place - He was in a cast from Sept. through Nov. and off work the entire time. After the cast was removed the doctor told him everything looked great even though he told the doctor that his two toes weren't touching the ground when he stood. The doctor told him it would just take time and everything would be fine. He recently went back to the doctor for a check up with the same complaint. This time the doctor realized they never took an x-ray from the side angle and now realizes that the two toes he's been complaining about weren't lined up and in fact are displaced. He now needs to have them re-broke and the tendons cut which will require surgery plus at least 8 weeks non-weight bearing. So he will be off work AGAIN for at least 8 weeks if not longer. What are his options - We do have good medical coverage but he can't afford to lose work and pay again all because the doctor didn't take the necessary x-rays in the first place.

What state is this in?

 

[tranquility]

Not authoritative, but a persuasive guide is at:
http://www.aafp.org/afp/2003/1215/p2413.html

How should the x-rays be taken?

Radiographic Findings

Radiographic studies of a toe should include anteroposterior, lateral, and oblique views (Figure 1). A combination of anteroposterior and lateral views may be best to rule out displacement. However, overlying shadows often make the lateral view difficult to interpret (Figure 1, center). In many cases, anteroposterior and oblique views are the most easily interpreted (Figure 1, top and bottom).

How difficult to reduce the toe if caught early?

DISPLACED FRACTURES OF LESSER TOES

Most displaced fractures of the lesser toes can be managed by family physicians if there are no indications for referral. Although adverse outcomes can occur with toe fractures,3 disability from displaced phalanx fractures is rare.5

After anesthetizing the toe with ice or a digital block, the physician holds the tip of the toe, applies longitudinal traction, and manipulates the bone fragments into proper position. In most cases, this is done by simply adjusting the direction of traction to correct any shortening, rotation, or malalignment. To unlock fragments, it may be necessary to exaggerate the deformity slightly as traction is applied or to manipulate the fragments with one hand while the other maintains traction. Following reduction, the nail bed of the fractured toe should lie in the same plane as the nail bed of the corresponding toe on the opposite foot. If it does not, rotational deformity should be suspected. Unless it is fairly subtle, rotational deformity should be corrected by further manipulation.

The reduced fracture is splinted with buddy taping. Fracture position ideally will be maintained when traction is released, but in some cases the reduction can be held only with buddy taping. Referral is indicated if buddy taping cannot maintain adequate reduction.

DISPLACED FRACTURES OF THE FIRST TOE

Displaced fractures of the first toe generally are managed similarly to displaced fractures of the lesser toes. To minimize the possibility of future disability, the position of the bone fragments after reduction should be as close to anatomic as possible. If the reduction is unstable (i.e., the position is not maintained after traction is released), splinting should not be used to hold the reduction, and referral is indicated.

To check proper alignment, radiographs should be taken immediately after reduction and again seven to 10 days after the injury (three to five days in children).4 In patients with potentially unstable or intra-articular fractures of the first toe, follow-up radiographs should be taken weekly for two or three weeks to monitor fracture position. At the conclusion of treatment, radiographs should be repeated to document healing.

If those actually are the standard of care, the OP(son) may have a case. However, the "side" view may not always be within the standard of care if it usually doesn't show anything.

 

[arsenic]

I've seen side Xrays of toes, and usually went, "yep, they are toes, probably human". (I.e., it is very difficult to see anything on side views of toes.) Yes, the doctors missed something, and you may get a few thousand - or not. Depends on your locale. Shop it around your local medmal attorneys. They are in the best position to advise you. I kinda doubt that you will get much, if anything.

 

[armstrong1988]

The doctor missed the xray for that particular angle, as far as I know when you are practicing medical treatment you should see all the aspect specially if its fracture you need to see all the angle for the assurance that you did not missed something that may cause the patient more problem. In this case the I see negligence cause by the doctor.

 

[angrymom35]

doctors are not always rite

for some people he would not have to miss work if everything was taken care of back when the cast was removed .so yes the doctor is to blame......

 

[Ladyback1]

The doctor missed the xray for that particular angle, as far as I know when you are practicing medical treatment you should see all the aspect specially if its fracture you need to see all the angle for the assurance that you did not missed something that may cause the patient more problem. In this case the I see negligence cause by the doctor.

It's not about seeing all aspects of a fracture or possible fracture--it's what is the USUAL and ACCEPTED STANDARD of CARE.

If the usual standard of care is to NOT get xrays of every possible angle, then the physician was well within his/her right to provide treatment as indicated.

One other thing to consider: you get 5 doctors in a room, you are most likely gonna get 3-5 different opinions about how an xray is read! Furthermore, there is no guarantee that if the xrays you say should have been taken had been taken, the fracture wouldn't have healed "funky". It happens!

 

[armstrong1988]

I far as i known as a doctor you must be aware of everything when it comes to your patient so he must need to look all the angles.

 

[ecmst12]

As far as you know is not very far.

 

[paigepaige19]

ecms12

Could you be any more rude? Geez.. it is the drs job to know which angles to look at, surely in his profession he has fixed more than one set of broken toes before, so should do his job like he is supposed to. You don't need to be rude. Comments are welcome by anyone, not just anyone that agrees with you.