The Expert: Dr. Paul Collier, a vascular surgeon based in Pennsylvania, testifies concerning the fact that a catheter’s improper placement in the patient’s femoral artery caused damage that led to the loss of her leg, and the fact that the limb could have been salvaged if a vascular consult had been ordered earlier.
Testifying in a 2019 Georgia medical malpractice trial, Dr. Paul Collier, a vascular surgeon from Pennsylvania, speaks on the issue of a healthcare provider’s alleged negligence contributing to the eventual need to amputate a patient’s leg.
This case revolves around the probable poor placement of a femoral artery catheter with subsequent blockage of blood flow to the patient’s leg, and the failure of the healthcare providers to obtain a timely vascular surgery consult once it was obvious that there was a blood flow problem in that leg.
Collier first explains, with the help of props and drawing, the anatomy and difference in the size of the common femoral artery and its two smaller branches, the superficial femoral and deep femoral arteries. He notes that the latter two are significantly smaller in diameter than the former. Holding up the actual type of catheter that was placed, he points out that a properly placed catheter would not come close to totally occluding the common femoral where it should have been placed, yet would significantly block the smaller superficial femoral artery if it was placed there. Alternatively, the placement of the catheter may have torn the interior wall layer of the artery raising an intimal flap. This flap could have increased in size as the blood passing it pushes it further into the center of the arterial lumen, or such a flap could lead to blood clotting once the muscular layer of the artery was exposed. In any of these scenarios, this improper placement causes the blood flow to the patient’s lower leg to be significantly and acutely impaired leading to ischemia, or a lack of oxygen in her lower leg, foot and toes.
The defendant had been apprised of the malpositioned catheter on Februrary 23, and the ischemia became noticeable by February 24. No vascular consultation was obtained, but the defense offered that a cardiology consult had been obtained. Collier points out that this consultation was requested before the ischemia was noted, it was requested for reasons other than the ischemia, and that a cardiologist is not the appropriate physician to deal with acute limb ischemia anyway. Indeed, there was never mention in the chart or orders for a vascular consultation on February 25 or 26 either. Finally, on February 27, the defendant’s PA mentions the need for this consultation, and the doctor cosigns that note, yet no order for a vascular surgery consultation was given. Collier states unequivocally that “this should have been done way sooner.”
Taking this statement further, the expert opines that even at this late in the stage of events, it would be appropriate to obtain vascular surgical consultation, as treatment options still existed to optimize the patient’s chance of saving some parts of her lower extremity and limit the damage. By the time that she was transferred to another facility on March 3, nine days after the ischemia was first noted, her right leg was no longer salvageable according to the surgeon who saw her at the new facility. Collier says that the post mortem examination of the leg confirms that opinion.
Based upon this expert’s testimony, there was a verdict for the plaintiff for $4.7 million and the jury found the doctor that failed to order a vascular consult was 27% at fault. He settled for $1 million soon after the verdict.
Gary Gansar, MD, is residency-trained in general surgery. He served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Touro Infirmary and Mercy Hospital in New Orleans, LA. Dr. Gansar was Board Certified in general surgery while in active practice. He joined AMFS in 2015 as a Physician Medical Director.
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