2012 APMA Young Physicians’ Institute May 18-19  Crystal Gateway Marriott  Crystal City, VA

1. Preventing Potential Claims of Negligence – Just Because You Can, Should You?Ross E. Taubman, DPMPICA President and Chief Medical Officer 2012 APMA Young Physicians’ Institute May 18-19  Crystal Gateway Marriott  Crystal City, VA

2. Case Presentation Number 1 • The Defendant (our Insured): • Graduated from Podiatric Medical School in 2002 • 3-Year Residency Completed in 2005 • Began practice in a rural part of a Southwestern state in 2005 • Not Board Certified • Only 3 Physicians in town – General Practitioner, General Surgeon, our DPM

3. Case Presentation #1 • The Plaintiff (thePatient): First Visit in Early 2008 • 59 year old diabetic male, employed as attorney • Previous PVD diagnosis by two other physicians • Charcot Arthropathy with chronic ulceration • Failed conservative care lead to decision for surgery

4. Planned Procedure • Tendo-Achilles Lengthening • Multiple Mid-foot Arthrodesis with Osteotomy • Secondary Repair of Extensor Tendon • Partial Ostectomy X 3 • Application of Multi-Plane External Fixator • Application of Bone Stimulator

5. What are the Potential Issues? • Diabetic Patient • Diagnosis of PVD • Medical Clearance with Laboratory Evaluation • Rural Locations without Availability of Other Specialists • Familiarity and Experience with Procedure

6. What Happened? • Staff received abnormal Labs but failed to report to DPM • Post-Operatively Wound failed to heal • MRSA Infection which resulted in Osteomyelitis, BKA X 2, septicemia leading to Renal Failure and Myocardial Infection • After all said and done: • Settlement with Plaintiff = $2,000,000

7. Case #1 - Lessons Learned • Look in the Mirror • Mind the Store • Location, Location, Location • Don’t Carry the Coffin Alone

8. Case Presentation #2 • The Defendant: • Graduated from Podiatric Medical School in 1997 • 3-Year Residency Completed in 2000 • Fellowship in Reconstructive Foot & Ankle Surgery Completed in 2001 • Began Private Practice in the Midwest 2001 • ABPS Certified - RRA

9. Case Presentation #2 • The Plaintiff: First Visit Early 2004 • 34 year old married female with two dependent children • Charcot-Marie-Tooth Disease • Multiple prior back and extremity surgery • Painful Cavovarus foot deformity secondary to CMT that failed conservative care leading to decision for surgery

10. Planned Procedure • MidtarsalArthrodesis with Internal Fixation • Plantar Fasciotomy • Application of External Ring Fixation • Application of Bone Stimulator

11. What are the Potential Issues? • Charcot-Marie-Tooth Disease • Familiarity and Experience with Procedure • Documentation and Informed Consent • Scope of Practice

12. What Happened? • Patient Developed Post-operative infection with ultimate Osteomyelitis which required BKA • Allegations • Failure to Diagnose Infection –Defensible • Failure to Obtain Informed Consent – Indefensible • Battery and Practicing Outside the Scope of Practice – Indefensible • After all is said and done: • Settlement with Plaintiff = $850,000

13. Lessons Learned Case #2 • Take a Letter, Maria • “Toto, We’re Not in Kansas Anymore” • Look in the Mirror – AGAIN!

14. Questions? Ross E. Taubman, DPM 615-984-2005 rtaubman@picagroup.com