Attorneys for Ellen Wadsworth brought a medical malpractice lawsuit after a physician’s assistant at Houston Medical Center, misdiagnosed her as having cellulitis, a skin infection caused by bacteria, and failed to diagnose blockages in her arteries behind both knees.
Ms. Wadworth, 61 at the time, was transported by ambulance to Houston Medical Center with complaints of pain in her feet. Ms. Wadworth told the triage nurse that her pain was an eight on a scale of one to 10. Gregory Howland, MD ruled out vein problems when he felt a weak pulse in her feet. He did not order an arterial ultrasound because he believed the pulse indicated that blood was flowing to her feet. Howland prescribed pain medication and antibiotics and was told to apply ice to only one leg.
Ms. Wadworth was discharged from the emergency department, even though she couldn’t walk. “She begged to be admitted. Her son begged for her to be admitted,” said Virgil Adams, who represented Ms. Wadworth in the suit. “They said they never saw the doctor. They only saw a physician’s assistant. The doctor stuck his head in the door and said, ‘We don’t admit people for cellulitis.’ ”
Ms. Wadsworth returned to the hospital later that night, after she was found unresponsive in her home by her son. A blockage was found and both legs were amputated below the knees a few days later.
Attorneys for Ms. Wadsworth argued that her legs could have been saved had tests been performed to detect a blockage in her arteries. Instead, Wadsworth was told she had what amounted to a skin rash, said Adams.
The defense claimed that Wadsworth’s blood clots weren’t present when she first visited the emergency room the morning of Nov. 27, 2008, but had manifested after her initial discharge. According to the defense outline of the case in the pre-trial order, they “contend that Ellen Wadsworth’s condition was completely different during the two emergency room visits and that her later condition was caused by subsequent events which were not present and were not foreseeable.”
Caroline Herrington, who also represents Ms. Wadworth said defense based its case on the idea that Howland did his duty because he checked for blockages in his physical examination. “The physician’s assistant testified that as long as he could feel a pulse, that’s all he had to do to rule that blockage out,” Herrington said.
The case went to trial before a Gwinnett County jury last week. Gwinnett County State Court Judge Joseph Iannazzone allowed the jury to decide whether the defendants were liable of gross negligence or ordinary negligence, which have different standards of proof under Georgia’s 2005 tort reform law.
A key point in the trial came when defense expert, vascular surgeon Dr. Daniel McDevitt, acknowledged during cross-examination that tests to determine whether there was an arterial blockage should have been done during Ms. Wadsworth’s initial emergency room visit.
“Their own experts even testified on cross-examination that you can have a partial occlusion but still have a pulse,” Adams said. “What blew up their whole defense was the evening of the next day, well after everyone had diagnosed the blockage in both legs, there’s a doctor’s report from the Medical Center of Central Georgia saying that she felt faint pulses on the top of the right foot and the back of her right ankle.”
After six days of testimony, the jury, composed of nine women and three men, awarded Ms. Wadworth $5 million. The presence of the pulse showed the jury that more testing should have been done to detect a blockage, Adams said.
Gross Negligence v. Ordinary Negligence for Emergency Room Care:
Georgia law requires clear and convincing evidence that a physician or health care provider showed gross negligence when providing emergency medical care, which is more difficult to prove than the preponderance of the evidence standard for ordinary negligence used in other medical-malpractice cases.
Gross negligence means serious and perhaps wanton and even deliberate carelessness which must be proved by clear and convincing evidence. This increased burden of proof makes the successful handling of emergency room negligence cases extremely difficult.
In this case, plaintiff’s attorney persuaded the jury that the lower standard should be applied to Ms. Wadsworth because the law excludes non-urgent patients in stable condition from the definition of emergency medical care.
“A lot of defense attorneys argue that just because it happens in an emergency room, it’s gross negligence, and that’s not what the statute says,” said Adams, referring to O.C.G.A. § 51-1-29.5. “The jury determined that the care-if you want to call it that-Ms. Wadsworth received was not emergency medical care.”