MAINE LAW FIRM HELPING CLIENTS WITH LIMB AMPUTATION DUE TO MEDICAL MALPRACTICE
We often bring medical malpractice cases on behalf of clients who have lost limbs due to medical negligence. There are two mechanisms through which our clients tend to suffer limb loss. The first is that they develop blood clots, which cuts off blood flow to the limbs, causing them to die. Alternatively, limbs can become infected, then necrotic and gangrenous, before ultimately necessitating amputation. In some cases, both mechanisms can occur at once.
Limb Ischemia from Blood Clots
Most people are familiar with the idea that our blood is designed to form clots when there is an insult or injury as a means of preventing us from bleeding to death after minor cuts or bruises. However, this same clotting mechanism can itself cause great harm if a clot forms somewhere in the body that constricts the flow of oxygenated blood to tissues that need this blood supply to live. For example, blood clots can constrict the flow of blood to the heart or the brain, leading to a heart attack or stroke.
In the same way, blood clots can form in the vessels that supply blood to the upper or lower extremities, resulting in death of muscle tissues in the arms and legs. If not addressed promptly, this can lead to limb amputation. The restriction of blood flow is called ischemia. When this reduced blood flow develops gradually over time, it is called chronic limb ischemia. When the lack of blood flow develops rapidly, it is called acute limb ischemia. It is also possible to have an acute on chronic ischemia, where an underlying process suddenly becomes chronic.
Chronic Versus Acute Limb Ischemia
Chronic limb ischemia is a condition that is relatively common, particularly in people with type two diabetes, obesity, or a history of smoking. With chronic limb ischemia, atherosclerotic plaque in the arteries may construct or block the flow of blood to a limb. Because the process occur over a long period of time, the patient typically develops collateral flow, through which the blood flow circumvents the blockage and manages to get to the limb through new collateral vessels that supply the same area. Many patients with chronic limb ischemia have no symptoms at all, although some develop claudication (limb pain). A patient with chronic limb ischemia must be regularly monitored to identify any rapid progression, but otherwise may not need any medical treatment. One can live for many years—or even the entirety of his adult life—with chronic limb ischemia without it progressing to a limb-threatening disease.
By contrast, acute limb ischemia is a medical emergency. Unlike chronic limb ischemia develops rapidly over a very short time (minutes, hours, or the course of a day). Because the constriction of blood flow develops rapidly, the circulatory system does not have time to adjust through the development of collateral flow, so the acute process begins to threaten the limb immediately.
Doctors are trained to identify the signs and symptoms of acute limb ischemia using the “6P’s.” These are pain (in the affected limb), pallor (change in color of the affected limb), polycythemia (temperature change to a cold limb), pulselessness (weak or absent pulses in the affected limb), paresthesias (sensory changes in the form of numbness and tingling) and paralysis (lack of motor function in the affected limb). Four signs and symptoms–pain, power, polycythemia, and pulselessness—tend to be earlier indications of acute limb ischemia, while the remaining two— sensory and motor loss—come later.
In the case of acute limb ischemia, prompt medical treatment within hours may be necessary to prevent limb loss. Thus, if a doctor suspects acute limb ischemia, the doctor is required to take immediate steps to confirm or rule out the diagnosis. Studies, like a doppler ultrasound, can measure blood flow, or the use of a blood pressure cuff to compare the blood pressure in the legs and the arms are a good first step toward confirming the diagnosis. More advanced studies like a CT angiogram can provide a clearer picture of the places where blood flow is restrictive, providing a roadmap to treatment.
Where acute limb ischemia is suspected, the expertise of a vascular specialist is invariably required. A vascular surgeon will determine the best treatment approach, considering such options as prescribing anticoagulation medication, thrombolysis (a procedure in which a catheter is inserted into the affected blood vessel and clot-busting medication is infused), thrombectomy (surgery in which the restrictive blood clots are mechanically removed) or bypass grafting (where the surgeon places a blood vessel, grafted from some other part of the body as an alternative route for blood to supply at the limb, bypassing the blockage). A clot that creates a blockage and leads to acute limb ischemia may form in an area where the artery has already been compromised or injured by atherosclerotic plaque. A clot that forms in a place like this is referred to as a thrombosis.
Alternatively, a clot can develop in one part of the body and then travel through the bloodstream and lodge in another location, which is referred to as an embolism. For example, if a person suffers from atrial fibrillation—an electrophysiological condition in which the upper chambers of the heart (the atria) do not beat in rhythm with the lower chambers (the ventricles)—clots can form in the heart and then be pumped to other parts of the body where they create a blockage. Similarly, a clot may form at the area of a junction between large blood vessels—for example, in the area of the knee—and then smaller pieces of that clot can break off and float downstream into the smaller vessels of the toes, forefoot, and ankle (shower emboli). In this manner, chronic limb ischemia caused by constriction in one location can become acute as clots break off and embolize, causing acute limb ischemia downstream of the original constriction.
Medical malpractice cases involving limb loss typically involve a delay in diagnosing acute or acute chronic limb ischemia. The patient presents with risk factors along with some of the 6P symptoms of limb ischemia, but medical providers perform no testing or further evaluation to rule out that diagnosis. Consequently, the patient goes days or weeks without treatment, and by the time they get into the care of a vascular specialist, there is advanced tissue death to the point where the limb can no longer be salvaged.
Limb Ischemia from Infection
A similar situation may occur if a patient develops an infection in a limb. Often, infection in a limb begins with some type of wound or other skin breakdown that allows bacteria to enter the body. Initially, this presents as dermatitis, cellulitis, or an infected blister or ulcer. However, left untreated, this can progress to deeper muscle or bone infection. This, in turn, can ultimately gangrene that necessitates limb removal.
As with ischemia, the key to appropriately and successfully treating an infection in a limb is early diagnosis and intervention. The failure to intervene early and aggressively can form the basis of a medical malpractice claim.
It goes without saying that limb amputation is a serious, life-altering injury. With the use of expensive prosthetic devices, our clients who have lost limbs often do recover to a significant level of functioning. Through litigation, we are often able to secure the funding needed to pay for those prosthetic devices for the rest of the patient’s life, greatly improving their mobility, work capacity, and overall quality of life.