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35-year old male did not receive proper medical care while in government custody resulting in below-the-knee amputation

Type of Injury: Amputation
Type of Case: Medical Malpractice
Settlement Amount: $450,000.00

On October 26, 2006, M-35 was in the custody of Federal Bureau of Prisons (“BOP”) at the Metropolitan Correctional Center in Chicago. On October 27th, the “admit” note indicates that Plaintiff had been a chronic ulcer (3 months) on his left big toe and peripheral neuropathy. Plaintiff was prescribed a daily foot soak with solution of warm water and Betadine.

On November 8th, Plaintiff suffered an iatragenic 2nd degree burn to his left foot due to the temperature of water/Betadine solution that was dangerous and/or too hot. On November 9th, Dr. Arthur Hoffman (then-clinical director of the Health Services Unit at the MCC) sent Plaintiff to Thorak Memorial Hospital (a BOP contracted-with medical provider). Dr. Hoffman’s plan included an MRI of the left toe to rule out osteomyelitis.

While at Thorak, Plaintiff was given 5-6 days of parenteral (IV) antibiotics for the suspected osteomyelitis. Although both an MRI and a triple-phase bone scan were ordered at Thorak, neither were performed. When he was discharged on November 17th back to the MCC, Plaintiff was given two oral antibiotics (Cipro and Doxycycline), neither of which were identified as sensitive in the culture and sensitivity test dated November 9, 2006. This was a multi-resistant Staphylococcus aureus infection. The medical staff of the MCC was aware of the lack of MRI, Plaintiff’s prescriptions, and the November 9th culture and sensitivity test. Yet, they followed and adopted the course of care. Another wound culture, dated 12/4/06, confirmed the Staphylococcus aureus infection and that it was not sensitive to Cipro and Doxycycline, but that prescription continued at the MCC.

Plaintiff, finally, had an open MRI on February 23, 2007. Although the report indicated that “[t]here is preservation of normal bone marrow signal intensity within the great toe to exclude a suggestion of underlying osteomyelitis,” it also indicated “[t]here is fusiform enlargement of the soft tissues of the forefoot which is most pronounced dorsally.” This later comment required further follow up as it was suggestive of continued infection. As late as March 26th, a podiatrist at Thorak still suspected chronic osteomyelitis left hallax, even though the wound appeared to be healing. Nevertheless, Plaintiff was never given a four to six week course of IV antibiotics.

Plaintiff was transferred to the Federal Correctional Center in Forrest City, Arkansas. On May 15th, Plaintiff was admitted to Forrest City Medical Center (FCMC), which is a private, contracted-with provider. His left foot was swollen with a scar from the burn and large ulcer in the dorsum on the plantar surface of the foot with another crack, laceration, on the base of the left big toe. At that time, Plaintiff refused to have his left great toe amputated and he was discharged on May 21st. On June 19th, Plaintiff was re- admitted to FCMC. On June 20th, Dr. Henein T. Iskander performed an amputation of the left big toe and metatarsal bone due to osteomylelitis. When the infection did not resolve with surgery, on October 11th, Dr. Iskander performed a transmetatarsal amputation of the left second and third metatarsal bones.

On November 14th, Plaintiff was transferred from Forrest City Medical Center and admitted to Saint Francis Hospital in Memphis, Tennessee. He underwent six weeks of therapy with vancomycin and Zosyn. This was the first time anyone provided a meaningful course of IV antibiotics, but it was too late. The patient’s MRI of the foot revealed progression of osteomyelitis with significant involvement and abscess formation. On December 4th, Dr. Jay Saenz performed a left below-knee amputation.

Plaintiff was released from the custody of the Bureau of Prisons in June 2009. The medical malpractice claim was filed under the Federal Tort Claims Act (“FTCA”).

Injuries: Due to the alleged medical negligence of the defendant, Plaintiff underwent multiple surgeries (6/20/07; 10/11/07; 12/4/07) that culminated in a left below-knee amputation. Plaintiff contends that the medical care administered by was under the direct supervision and monitoring of the BOP medical staff and that earlier and proper intervention would have likely saved Plaintiff from having any amputation and, at worse, resulted in amputation of the forefoot (which would have, importantly, preserved the ankle). Additionally, it was a breach in the standard of care to, with the assistance of Plaintiff’s health care professionals, to fail to properly designate Plaintiff to a BOP facility that would allow him to obtain IV antibiotic treatment that complied with the standard of care.

Defendant contends that the infection that was observed during Plaintiff’s May 15-21, 2007 admission to Forrest City Medical Center was a new, different onset of an osteomyelitis infection and that Plaintiff’s refusal to have his left big toe amputated during that admission allowed the infection to progress. Defendant, also, contends that Plaintiff’s comorbidities (i.e., diabetes, peripheral vascular disease, obesity) made the osteomyelitis more difficult to get rid of when it surfaced in May 2007. The BOP is responsible for delivering medically necessary health care to inmates. When the BOP’s internal resources cannot fully meet inmates’ health care needs, the BOP awards comprehensive and individual contracts to supplement its in-house medical services. In this case, Thorak, FCMC, and Saint Francis Hospital were all contracted-with medical providers. Defendant further asserts that the FTCA “does not include any contractor with the United States” as they are not an employee of the government under 28 U.S.C. § 2671. As such, to the extent any medical malpractice was committed by a non- employee (Thorak, FCMC, and Saint Francis Hospital), the defendant is not liable for that conduct.

Specials: Medicals: N/A Lost Income: N/A Occupation: N/A

What Each Defendant Paid: United States of America ($450,000.00)

Insurance Company: United States of America is self-insured.

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