A male patient was diagnosed with type 2 diabetes mellitus and began insulin treatment. He had many other co-morbidities, including chronic kidney disease, hypertension, previous MI and non-proliferative diabetic nephropathy.
He developed a blister on the ball of his big toe, for which his GP prescribed erythromycin as the patient was allergic to penicillin. The patient attended the practice nurse for dressing changes and was seen by GPs at the practice for review. He continued to suffer blisters on his foot, which became infected. He was prescribed more erythromycin and the infection largely cleared. However, it returned shortly after completion of the course of antibiotics. When the patient was seen again by the practice nurse and the GP, the wound was indurated, weepy and red. He was prescribed clindamycin.
It was alleged that on a balance of probabilities, the transmetatarsal amputation would have been avoided if an earlier referral had been made.
Some 10 days later, the patient attended the GP again. No infection was identified and a non-urgent referral was made. A few days afterwards, the patient attended another GP who sent a second referral letter.
A week later the patient attended the practice nurse for a dressing change and another a few days later. The nurse noted that the infection had cleared with antibiotics but the wound was leaking fluid and the foot was swollen and inflamed. Another course of erythromycin was prescribed.
Soon afterwards, the patient was seen in the podiatry clinic and was sent to A&E and admitted to hospital. He was discharged eight days later.
Over the months that followed, the patient's condition did not improve, despite undergoing debridement of the foot. Subsequently, he underwent a transmetatarsal amputation of the left foot and a skin graft.
The claim which followed alleged failure to refer the patient urgently to secondary care. It was alleged that on a balance of probabilities, the transmetatarsal amputation would have been avoided if an earlier referral had been made.
The MDU commissioned several expert reports which highlighted vulnerabilities in the clinical management of the patient. It was agreed by the experts that an earlier referral should have been made, in which case the left metatarsal amputation might have been avoided. All healthcare practitioners involved were vulnerable to criticism.
With the member's consent, the claim was settled on behalf of all involved for a six-figure sum, including the claimant's costs.
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