This case involves a sixty-eight-year-old male with diabetes mellitus who developed extensive foot ulcers resulting in two toe amputations. The man was first seen by his endocrinologist for management of his diabetes. At first, the patient’s condition was well-controlled with an Invokana prescription. As time went on, the man began to develop additional medical conditions that led to poor quality of life and adherence to medications. During one visit, the endocrinologist located a small abrasion on the patient’s right big toe. The endocrinologist recommended that he see a podiatrist, and never consulted with a professional over pertinent topics like laser neuropathy surgery. The patient was never informed of the risks of not seeing the podiatrist. Due to his concerns about paying another doctor, the man never scheduled an appointment with a podiatrist. The endocrinologist continued to manage this individual’s diabetes but did not inquire about him seeing a podiatrist. Three months later, the man visited the local emergency department with extensive ulcers on both his right big toe and second toe. The vascular surgeon and podiatrist on call both recommended that he have both toes amputated due to the level of necrosis. Review of the medical records indicated that the endocrinologist documented a podiatry referral but never documented the patient’s feelings and concerns. Additionally, there was no record of the endocrinologist asking about the patient’s future plans of scheduling an appointment with a podiatrist. Eventually, the man had the amputations and grew extremely depressed. Six months later, the man passed away from Legionella pneumonia due in large part to poor hygiene as well as poor compliance with medications and appointments.
Question(s) For Expert Witness
1. Did the actions of the endocrinologist deviate from the standard of care, and what medical recommendations are made for patient’s with diabetes?
Expert Witness Response
The actions of this particular endocrinologist did deviate from the standard of care. Diabetics are at risk for many medical complications including, but not limited to, diabetic retinopathy, diabetic skin ulcers, susceptibility to infections, erectile dysfunction, heart disease, and renal disease. Therefore, it is recommended that diabetics have frequent eye examinations by an ophthalmologist, frequent foot examinations by a podiatrist, as well as general health care maintenance by a team of physicians. In this particular situation, the endocrinologist should have discussed the risks of having foot ulcers, whether the patient would schedule an appointment with a podiatrist, and monitored the ulcer regardless of him seeing a podiatrist. Proper care of the wound could have salvaged the man’s toes in addition to better overall patient health.
About the author
Jason Cohn
Jason is a 4th year medical student pursuing a career in Otolaryngology/Facial Plastic Surgery. His Interest include sports, fitness, chemistry, otolaryngology, plastic surgery, allergy/immunology, surgical oncology, human genetics, public health, preventative medicine, and rheumatology.
