Plaintiff Vs. Dr. Jon's Urgent Care, Martinsville, VA

* Skip to the bottom for an Update

Almost a couple of years ago, I was contacted by an attorney with a request to review some medical records and for my opinion about the medical care she had received at Dr. Jon's Urgent Care in Martinsville VA.  The attorney that contacted me had found an article I had published in 2001 while I was completing my Masters in PA Studies that was appropriate to the cause of death in this case.

In seems that a young woman had received a trauma to her right lower leg when she was inadvertently hit by a crate of heavy photographic equipment.  On the day of the injury, she was seen at a clinic on the site of the injury and followed up the next day.  The young woman had a significant blow the the right calf, and was pain, even though she was still able to ambulate on the leg.  (Now, any clinician with any diagnostic and prognostic ability worth squat already should have an idea of what happened in this case, so just write it done now so there will be surprise at the end.)

She rode an hour from the site of the injury to Atlanta, took a relatively short flight to Charlotte, and then a 2+ hour car trip to Martinsville, VA.  During the next several days, she sent text messages to her friends and relatives around her leg, still being in significant pain, despite taking elevating her leg and taking Tramadol.  Eight days after the injury, she was seen again in follow-up at another work-site clinic where it was documented that her symptoms were not improving and referred her to Dr. Jon's Urgent Care clinic, where she was seen the same day.

The complaint was right foot and ankle pain with history of the injury as noted above.  She was seen by the attending PA, an exam was performed and it was noted that the patient had bruising and moderate pain in the calf with tenderness on palpation.  (If you still don't now what happened, you might consider going back to school).   An Xray was performed and closely scrutinized until  a possible small avulsion fracture of the talus was diagnosed, but apparently all the soft-tissue trauma and swelling to the injured calf readily apparent on the Xray was overlooked entirely.  So she was splinted, placed on crutches and suffered a fatal pulmonary embolism less than 72 hours later.

In my review of the patient's visit to Dr. Jon's Urgent Care, it was my opinion that the patient way at high risk for DVT and tha she should have been referred to the ER for further evaluation (i.e. an ultrasound of the affected limb).  I don't like being in the posiiton of being critical of a colleague's care, but if I said that consideration of of the possibility of a DVT was not reasonable in this case, then I would have been intellectually dishonest.  Not only was it possible, but it was very high on the list.  That it wasn't even considered at all, is incomprehensible to me.

A suit was brought on behalf of her estate by her mother, and I participated in the proceedings as an expert witness for the plaintiff.  The defense contention is that they never considered the possibility of this patient having a DVT, despite having the obvious risk factor of a serious trauma to a lower extremity, with continuing pain for 8 days that was "not improving," according to the work-site clinic that saw her earlier the same day.  An employee Jon's as well as the evaluating PA claimed that the patient has insisted that only her ankle was hurting and that she didn't want her calf examined (how likely is that since she was sent there because her leg was "not improving" and despite her multiple text messages about her leg pain though-out the week, despite being on Tramadol.  Did I neglected to mention that she was on NuvaRing.  Of course none of this was recorded in Dr. Jon's medical record of the patient's care and has all being asserted post-mortem.

I will admit that the defense attorney leading the case is smart and skillful.  Her attempts to excuse the oversight of the significance of the patient's injury and the failure of the clinician involved were based on trying to confuse the jury.  The inferences were that if the patient didn't have  a coagulapthy, cancer, CHF, age over 60 or any of a litany of established risks, then the clinician had no reason to suspect a DVT.   However, the  patient has a lower extremity trauma, the pain is persisting, she has a bruised, swollen and tender calf, and she's on NuvaRing, a contraceptive that has a higher-than-average association with DVT that traditional oral contraceptives. This, to me literally screams DVT. However, jurors are not well-versed in medicine, have no understanding of how the practice of medicine is conducted, and they are easily misled by a bright attorney being well-paid to misdirect them.

Only this evening, I was informed that the verdict was returned in favor of Dr. Jon's Urgent Care. I should not be surprised by this for the reasons I stated above, but I can also say with all honestly that I am not completely surprised.  These same people that complain about a long wait, or the fact that they were not given water in a timely manner or that they're lab work is taking too long...the one's that don't understand and are easily misled, are the same people that, 75% of the time, will give a provider a free-pass for missing  a condition that ultimately resulted in an untimely and clearly preventable death.  I suppose that should give providers some re-assurance that, if we make a similar mistake, we can also get the same free pass that Dr. Jon's Urgent Care got in this decision.

My sympathies to the family in this case.

Update:  I was informed by the Plaintiff's attorney that the court had vacated the defense verdict and that the case will be re-tired.  Hopefully, the new jury will make a more informed decision.  When sloppy or incompetent medicine contributes to the death of a healthy young life, someone needs to be held accountable.