Shelley: Arm Accident Leads to Foot Amputation

It was bad enough that Shelley lost both of her arms in a farm machinery accident. But to have her lower right leg amputated because of hospital system errors was preventable and unnecessary.  

Improper Hospital Monitoring Results in Additional Severe Injuries

In a rural part of the Willamette Valley one October day, Shelley was using a power auger to dig holes for fence posts.  Her clothing got caught up in the power tool, and her arms were traumatically injured to an extent that required their amputation.  She needed emergency, surgical, and critical care services. There are only two Level I trauma hospitals in our state. She was rushed by air ambulance to one of those, a hospital in Portland.  That hospital advertises that it is a direct provider of the type of emergency, surgical, and critical care services that Shelley required. 

A Level I trauma hospital should provide the highest level of comprehensive care for severely people who have multi-system trauma. A Level I facility is a regional resource trauma center that is supposed to have the capability of providing total patient care for every aspect of injury.  An emergency physician, general surgeon, anesthesiologist, and nursing and other medical personnel who can start immediate surgery are in-house and available upon the injured person’s arrival to the emergency department. A broad range of specialists are on-call and are to be promptly available, and systems are to be in place to handle a wide range of trauma cases.  

At the trauma hospital, a  doctor placed an IV catheter in the femoral vein in Shelly’s right leg. Unfortunately, it was improperly installed and went entirely through the vein and severely damaged the important nearby femoral artery.  An experienced physician would probably feel the difference between a catheter insertion that was done correctly and one that tore through a blood vessel wall and into another blood vessel. The physician in this case was not experienced, and did not realize what had happened.  The arterial injury, because it was not recognized at the time, was not treated.

Afterward, the hospital staff responsible for monitoring Shelley did not pay attention to signs of artery damage and loss of blood supply, and so did not treat the artery injury at that time. As a result, blood clots developed (thrombosis), and Shelley had an extended time with restricted blood circulation in her leg (with ischemia, causing a shortage of oxygen to the tissues in the leg). That damaged her right lower leg severely enough to later require amputation of the foot and lower leg. 

During the weeks that Shelley laid in a hospital bed recovering from her injuries, the hospital staff responsible for her did not properly monitor her head as it rested against the hospital bed.  Shelley developed a pressure sore and skin breakdown on the back of her head. 

Hospital Errors Need Legal Help

Shelly fully acknowledged the farm machinery accident was her fault, but as she put it, “I went in with two good legs and I came out with one!”  With her two arms gone, Shelly needed fully functioning feet and legs more than ever.  After the hospitalization, her right foot was still attached, but no longer worked, and was at risk for needing to be amputated.  Shelly reached out to several law firms for help. Cases like Shelly’s are difficult, risky, and expensive. All of those law firms declined her case.  

Shelley finally got in touch with Corson & Johnson, who after some initial expert reviews, thought she had a legitimate case for hospital system failures causing her leg injury.  Don Corson recalls meeting Shelley for the first time, noting, “I loved her candor and straightforwardness; she accepted responsibility for her part in the machinery accident right away.”

Corson & Johnson worked extensively with emergency medicine experts, vascular surgeons, amputation surgeons, nurses, and other witnesses.  With the help of experts, Corson & Johnson was able to show how the hospital’s substandard care broke basic patient safety rules, and was also able to determine the level and cost of care Shelley would need as a result of her new injuries. 

The provision of acceptable medical care at a Level I trauma hospital is uniquely important to the life and health of trauma patients, such as Shelley, who are brought there to receive the high level of care they need.  Oregon law required the hospital to provide reasonable medical treatment to the patients who were brought to it for medical treatment, and made it responsible for the quality of care rendered in the facility. The hospital had a duty to ensure that its trauma patients receive reasonable medical care consistent with applicable standards. 

The physicians gave monitoring orders, but the hospital did not follow them.  The hospital staff noticed a deterioration in the condition of Shelley’s lower leg, but for an extended period of time did not report that decline to a physician.  Her leg became colder. The color changed. Key lower leg artery pulses could no longer be detected. After long delays, a vascular surgeon was finally brought in.  The surgeon was heartbroken: if he had been called earlier, he could have saved Shelly’s lower leg, but given the delays, it was then too late. 

The medical expert evaluations showed that this hospital did not meet applicable standards in the following ways:

• In failing to timely diagnose or otherwise recognize the injury to Shelleys femoral artery;
• In failing to adequately monitor Shelley after the placement of the femoral lines,
• Especially in not adequately monitoring her foot and leg pulses in light of the increased risk of thrombosis (blood clots) and ischemia (decreased blood flow) when femoral lines have been placed;
• In failing to promptly report to a responsible physician the change in condition of the loss of an arterial pulse in Shelley’s right foot;
• In failing to timely diagnose or otherwise recognize thrombosis and ischemia in Shelley’s right leg;
• In failing to follow physician orders regarding patient monitoring;
• In failing to timely and adequately treat or provide for treatment of Shelley after indications of thrombosis and/or ischemia of the right leg were discovered; and
• In failing to adequately monitor, assess, and treat the skin of Shelley’s head to prevent the development of skin breakdown and pressure sores.

These hospital system errors caused Shelley to sustain serious and permanent injuries, including arterial ischemia of the right lower leg and related damage, loss of tissue, skin breakdown, permanent nerve damage, loss of mobility, loss of range of motion, loss of muscle control, and loss of sensation. The injuries required numerous surgical and medical procedures, including the eventual amputation of her lower right leg.  

The pressure sores were minor in comparison to the rest of the harms done to Shelley, but they were symptoms of a larger problem, a lack of hospital staff attention and monitoring.  Pressure sores should virtually never occur in a hospital setting. They are so unacceptably preventable that Medicare will not even pay a hospital’s charges for treating a pressure sore that the hospital allowed to happen. 

Some Memories about Shelly and Her Case

The insurance company for the hospital, as is typical, vigorously defended the case.  Teams of defense lawyers, motions, depositions, and other court proceedings followed. At the same time Shelly’s legal team was preparing to prove the hospital system failures, they also had to prepare to show the jury the harms and losses Shelly suffered.  It was important keep separate the harms from the loss of her arms, which were not the hospital’s fault, from the loss of her lower leg, which was.

One of the kinds of experts Corson & Johnson worked with were life care planners.  Life care planners are typically nurses or physicians who have specialized training and experience in mapping out the future care needs of an injured person.  They look at such things as what kind of physician services will be needed, what kind of assistive care, what kind of medications, what kind of medical devices, and so on.  For most items, the life care planner determines the cost of each item, and the frequency of the need for that item, eventually preparing a comprehensive plan. That plan addresses the minimum amount needed to humanely address the injured person’s care needs specifically related to the injury, for the rest of the person’s life.

During negotiations, when Corson & Johnson disclosed the amount of the life care plan to the defense lawyers hired by the hospital’s insurance company, the defense legal team was highly skeptical.  So Corson & Johnson retained a second life care planner, and asked that expert to independently prepare a life care plan, without ever disclosing that a plan had previously been developed. In other words, the second life care planner’s work was completely separate from the first.  When the second plan was completed, it was within a few percentage points of the cost of the first plan. Both life care plans confirmed that Shelly’s lifetime of future care needs was truly substantial.

Shelly’s case was settled before trial for a strictly confidential amount. One of the needs of a person missing a foot is to live in a house where everything is on one level, and which can accommodate a wheelchair.  It was so satisfying when some of the settlement funds were used to buy Shelly a wonderful house that accommodated her special needs and which was set in the Oregon countryside that Shelly loved. The settlement allowed Shelly to live a decent life, and she lived life as fully as she could.  Don Corson still remembers one of his visits with Shelley when they wanted to look up something on the computer. Shelley sat down at her desk, the computer mouse on the floor, and using her one remaining foot on the mouse she was able to look something up on the internet as fast as Don could with his smartphone.  The house, the computer, the therapy to get Shelly to that point, were all made possible by Shelly’s case.