Dr K, 58, was a sole practitioner in an area with a high prevalence of diabetes. His practice was heavy on patient education and stressed the value of empowering patients by helping them understand their conditions. The physician found this method worked well, although there were always some patients who could not be reached in this manner.

One such patient was Mr. X, a 64-year-old African-American man who had been seeing Dr. K for nearly 15 years. Mr. X had diabetes, and despite Dr. K’s attempts to educate him on the importance of lifestyle modifications, medication compliance, and regular check-ups, he was generally noncompliant and mostly disinterested, and as a result his diabetes was not well controlled. The patient seemed less interested in managing his diabetes and staying healthy than he did in waiting until there was a problem and then coming in for a “quick fix.”

Untreated foot ulcers

One morning, Mr. X showed up complaining of foot pain. Upon examination, Dr. K discovered an open sore on the patient’s right foot. The physician explained to Mr. X the importance of routine foot inspections, and warned him that untreated foot ulcers could lead to very serious consequences. He prescribed an eight-day course of cefdinir, and verbally instructed the patient to return in seven days.

Mr. X did not return in a week as directed. Two and a half weeks after the initial appointment, however, he turned up with additional lesions on his right foot. “Did you take your antibiotics as directed?” asked Dr. K. “Uh, yeah, sure,” the patient answered. “I guess they didn’t work.”

Dr. K again explained to the patient the necessity of taking the antibiotics as prescribed, and returning for appointments promptly. Different antibiotics were prescribed and the foot was cleaned and soaked. The physician instructed Mr. X to keep the foot elevated and to return in three days.

The patient did not return in three days, but four days after his visit with Dr. K, he went to the emergency department of the local hospital to have his foot wounds treated again. Two days later, his right foot was amputated below the ankle.

Dr. K was disturbed to hear about the patient’s outcome, but felt that he had done all he could for him. Mr. X did not concur, and once he was released from the hospital he located a plaintiff’s attorney who agreed to take his case. A lawsuit was instituted against Dr. K alleging that he was negligent in his treatment of Mr. X’s foot ulcers.

The defense attorney provided by Dr. K’s insurance company felt that he had a good chance of winning at trial, and they decided not to try to settle the case.

The trial lasted five days. The patient took the stand first, describing the loss of his foot and how it impacted his life. He could no longer run around with his grandchildren, he told the jury. He was ashamed of his prosthetic foot and had to go to hours of physical therapy just to be able to walk haltingly.

He stated that Dr. K never told him to return in a week after he began taking the antibiotics, and he only returned because his foot was getting worse. “Dr. K should have sent me to the hospital when he saw my foot,” said Mr. X to the jury. “If he’d done that, I would still have a foot.”

On cross examination, the defense attorney questioned Mr. X about his diabetes, specifically whether he took his medications as prescribed, whether he visited his physician regularly, and about his efforts to control his blood sugar. The attorney’s skillful cross-examination forced the patient to admit that he did not refill his prescriptions on time and was not particularly compliant with his doctor’s instructions.

Mr. X claimed to have taken all of the antibiotics prescribed for his foot, but when asked specific details about what day he started and what day he finished, he was unable to remember.

The plaintiff introduced a surgical expert who testified that had Mr. X been sent to the hospital sooner, his wound could have been treated in a more supervised environment, and the foot would likely have been saved.

The defense introduced its own medical expert who testified that Dr. K had met the appropriate standard of care in treating the patient, and that it appeared that the patient did not take his initial antibiotics as prescribed. Had he done so, opined the expert, the wound should have healed and certainly not gotten worse.

Dr. K took the stand and insisted that he instructed the patient to return in a week, even though it was not written in his notes. He testified that he had stressed the importance of caring for the wounds and that he believed the patient understood the necessity of taking his medications as prescribed in order to control the foot ulcer.

The jury deliberated for five hours, and finally returned with a verdict in favor of Dr. K.