Posted on 05/25/2016 2:19:04 PM PDT by nickcarraway
Mario Guzman lived to race. For the last two decades Guzman ran in marathons, half marathons, and competed in multiple ironman triathlons. “It was a passion. It wasn’t a hobby, it was a passion,” Guzman said.
That all changed more than three years ago when Guzman went to the doctor after injuring his ankle during a run. “We were very puzzled about his symptoms,” said Ludmila Parada, Mario’s wife. “My husband has a fever, he feels very ill and the foot that was completely unremarkable the day before was all swollen and red and he couldn’t put weight on it.”
The doctor at Kaiser Permanente Santa Clara Medical Center treated Guzman for a sprained ankle and the flu, but it was later determined his symptoms were related to a common bacterial infection that Guzman believes could have been treated with antibiotics.
Guzman says he believes the misdiagnosis allowed the infection to spread and by the time he went to the emergency room, just three days after his original diagnosis, he was in septic shock. “It was horrible,” Parada said. “He ended up leaving the hospital as a multiple amputee, a quadriplegic.” Septic shock is the result of complications from an infection and can cause gangrene in the arms, legs, fingers, and toes.
Doctors ultimately amputated his right foot, his left arm, two fingers on his right hand, and all the toes on his left foot, leaving him confined to a wheelchair.
“It’s like they steal your life away from you,” Guzman said tearfully. kes that result in devastating injuries can keep practicing without facing any discipline.
Guzman and his wife tried going after Kaiser for medical damages, but lost their arbitration case. “We are confident the care provided was appropriate,” said Karl Sonkin, spokesperson for Kaiser Permanente. “This conclusion was upheld when the family unsuccessfully pursued their claim in arbitration, and the decision was entirely in Kaiser Permanente’s favor.”
The family then turned to the California Medical Board, the state’s consumer protection agency that was created to investigate and discipline physicians. An investigator with the Department of Consumer Affairs, which oversees the Medical Board determined the doctor’s “treatment fell below the standard of care.”
“It was like vindication for us,” Guzman said. “Here’s the proof. We were right all along.” That jubilation didn’t last. While the medical board made that determination, by law, it relies on the California Attorney General’s Office to pursue disciplinary actions against a doctor. The medical board hires their attorneys to take on disciplinary cases against physicians.
In Guzman’s case, the Attorney General’s office opted not to take any action. “They did nothing,” Parada said. The family received a letter from the Attorney General that said “the matter was closed based on insufficient evidence.”
Guzman’s doctor still has a clean disciplinary record and continues to see other patients.
State law requires lawyers from the AG’s office to work alongside the California Medical Board to determine which doctor’s should be referred to the AG’s office for possible disciplinary action. With this model, the AG’s office should be able to prosecute just about every case referred by the Board since its own staff helped move the case forward. “Not enough evidence is a strange thing to say at the end of the case when the lawyer has been involved from the beginning,” said Ed Howard, an attorney with the Center for Public Interest Law, which is a non-profit that acts as watchdog over California’s state boards and agencies. “If you have disagreements between the Attorney General and the medical board about what kinds of cases are worth bringing, that by definition means there is something screwed up.”
The executive director of the California Medical Board, Kimberly Kirchmeyer, acknowledges the two agencies can do a better job at working together. “As with any system there can always be improvement and we believe that there should be some in this model,” Kirchmeyer said. She recently recommended that her staff and lawyers with the Attorney General’s office undergo more team training in hopes of reducing the number of cases that the Attorney General’s office closes.
Guzman’s case is rare. Last year, the California Medical Board referrd 471 doctor complaints to the Attorney General’s Office, of those 27 were never pursued. “Once they get the full file in front of them and they start piecing everything together, they may determine that they can no longer meet that burden of proof,” said Kirchmeyer. “We do push back on cases,” While investigators may pushback, the Attorney General’s Office still has the final say on whether to pursue a case.
California sets a high bar when it comes to what kind of conduct legally constitutes disciplinary action for doctors. “Our burden of proof according to the law is clear and convincing evidence, so it’s a lot higher than what malpractice cases are,” said Kirchmeyer.
It’s also not enough for a physician to have committed one mistake. It has to be “repeated negligence” or conduct so egregious that it’s considered “gross negligence.”
The specific reasons behind the Attorney General’s decisions on whether to pursue a case are kept confidential so Guzman has no way of knowing why the Attorney General’s office never took action with his case. “It’s like a slap in the face,” said Guzman. “Not only did they do nothing, they don’t tell you why or give you your file.”
In a statement the Attorney General’s office said every case is conducted on its own merits, but wouldn’t comment on specific cases.
And yet we want them to behave as Gods..........will never happen. They're human just like you and I.
I say that from a standpoint that I have a number of family members who are in the medical profession........
Precisely.
Unless someone has crumped cases like this can be tough
Yep. My experience was in February 1982. Never again.
And this is why, under no circumstances, you should get involved in any way with the medical-industrial complex. The thought alone keeps me healthy (I actually believe this to be true).
Hospitals are the most dangerous place on earth.
” under no circumstances, you should get involved in any way with the medical-industrial complex. “
That makea absolutely no sense.
.
I am confused. He said he injured his ankle during a run but then was puzzled about it being swollen and red a day later? That’s not really unusual for a bad sprain or even from something like tendonitis.
I once took a hard fall in my rather steep driveway, sort of falling forward and sideways at the same time and turning my ankle in the process. I heard and felt a popping and as I was lying face first, the wind knocked out of me, my first thought was that I had broken it. When I finally got up, my ankle felt OK, no real pain, just a bit sore and stiff, but I was able to put weight on it and figured it was fine. It wasn’t until about 12 hours later that the pain started and another 12 hours before it started swelling, swelling big time, my ankle swelled to the size of a softball and with now a lot of visible redness and bruising and I could no longer put any weight on it.
I got in to see my doctor the next morning and she thought it was sprained but couldn’t rule out a fracture without an x-ray. No fractures that she could see on the x-ray but she still sent me to an orthopedic because of the extreme swelling, redness and bruising and concerns that I might have torn a muscle and or some ligaments. The Ortho diagnosed it as a severe sprain, telling me that the recovery time was sometimes longer for such a bad sprain than would be for a break. I was on crutches for over a month and it took almost a year before it was completely back to normal – got back full range of motion and completely free of any stiffness and soreness.
According to this Daily Mail article, after going back to the hospital three days later he was diagnosed with the bacterial infection Streptococcus Pyogenes that I assume turned into necrotizing fasciitis.
https://en.wikipedia.org/wiki/Streptococcus_pyogenes
I can understand why the doctor(s) may not have picked up on that diagnosis initially if his main complaint when going to the ER was an ankle injury, likely related to his running and also with some perhaps vague symptoms consistent with the flu – fever and perhaps a sore throat? But if there were no obvious signs of a rash consistent with a bacterial infection or signs of a wound, a break in the skin or something like insect bite, particularly a spider bite, the doctor would not necessarily have a reason to suspect Streptococcus Pyogenes and probably saw it (the ankle and the flu like symptoms) as two separate and unrelated issues.
His wife believes this could have been avoided if doctors had offered him a blood test, which costs just $30.
A diagnosis of an ankle injury and the flu wouldn’t indicate a blood test. Seriously, on one hand, many people complain about doctors and hospitals ordering unnecessary tests as to inflate medical bills but then in hind sight (hind sight is always 20/20), after the correct diagnosis, anyone can come up with any number of tests or treatments that might have been done earlier.
While very unfortunate and so very sad that the delay in diagnosis “perhaps” caused his very bad outcome, it doesn’t necessarily rise to being a case of malpractice. And it appears that when he returned to the hospital that they did diagnose the actual problem very quickly and treated it very aggressively – unfortunately that eventually involved amputations, but amputations that FWIW saved his life.
There is also no guarantee that he might not have faced a similar outcome even if diagnosed with Streptococcus Pyogenes on his first visit. This type of bacterial infection can be very aggressive and hard to treat even with anti-biotics.
My older brother was visiting with his son here in PA Thanksgiving two years ago and on the Saturday before he left to go back NJ, he started complaining about pain and some redness and swelling in his ring finger, an achy pain in his right hand. It got worse after he got home that Sunday and first thing Monday morning he saw his primary care doctor. By now his hand was not only very swollen and red and painful, but there also were several lines of redness going up his arm, nearly up to his elbow. His doctor seeing this sent him straight to the ER, called ahead and my brother was very quickly admitted to the hospital, his doctor telling him this was a life threatening situation.
https://en.wikipedia.org/wiki/Cellulitis
He was diagnosed with having cellulitis resulting from a Streptococcus infection causing necrotizing fasciitis and sepsis. He was immediately put on intravenous anti-biotics and they had to cut open his finger and several places on his hand and arm to debride the wounds (remove the necrotized – i.e. dead tissues) and drain the infection and they had to do this more than once. He also received hydrotherapy.
But even with his quick diagnosis, he spent well over a month in the hospital, was on a constant IV antibiotics and still came very close to needing the amputation of his finger or of his entire hand (for several days it was a close call, at one point he was even prepped for surgery) and had to stay on an IV drip at home for several weeks after his hospital discharge. His ring finger is now severely deformed and he has little feeling or motion in it or use of it, but as his doctors told him, it could have been much worse - he could have not only lost his finger or his hand, he could have died.
While they couldn’t be 100% sure, the infectious disease specialist thought that it was possible if not likely that my brother’s infection was the result of a spider bite, perhaps from a something like brown recluse spider. A few days prior to having any symptoms, he’d been doing yard work, raking leaves, clearing twigs and small branches that had fallen on his wooded property after a storm and wasn’t wearing work gloves as he usually wore. He had noticed a very small red spot on his ring finger but he didn’t recognize as it perhaps being a spider bite, thinking it was just an abrasion or a small cut from not using gloves while doing the yard work.
Almost thought too long to read. Glad I took the time. Happy your brother is doing better
You hit the nail on the head.
Diagnosing is tricky under good circumstances.
The tell for me is when it said he went in three days later in full sepsis While sepsis is fast moving he would have felt and looked like crap during tha time. He should have gone back sooner and pounded on the table.
It has always been true that the patient must be proactive in their own care
I recently had lunch with my niece who is an emergency room doctor. When I showed her a photo of a huge spider a friend had taken in Rochester Michigan, she told me one of the things she had to learn was how to identify poisonous spiders and their bites since the bite symptoms vary with each spider and thus the respective treatments.....
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