This case involves a 42-year-old man who was undergoing occupational therapy for a severed a tendon he sustained from a severe German Shepherd bite. During the course of his therapy, the supervising occupational therapist allowed a student therapist to conduct a tendon exercise on the patient. Following the exercise, the patient ruptured his tendon and required additional surgeries and grafts. It was alleged that these exercises were too advanced to be conducted by a student. An expert in occupational therapy who specializes in hand treatment was sought to opine on whether the supervising occupational therapist was negligent in allowing the student to conduct these exercises.
Question(s) For Expert Witness
- 1. Please describe your background in occupational therapy.
- 2. Do you supervise students as part of your practice? Please explain.
- 3. Would you allow a student to work with a patient who presented with these conditions?
Expert Witness Response E-105501
I am a professor and full-time faculty member of the occupational therapy department at a well-respected university in the Midwest. I often supervise students as part of my practice. In addition to my teaching duties, I also have a clinic day and work in an outpatient hand therapy setting. I supervise students on my clinical day frequently and have also served as a preceptor for full-time clinical rotations for occupational therapy students in the past. I also advise students who are currently on Level II (final clinical rotations for occupational therapy students) and provide support for complex patients encountered in the clinic. I have reviewed similar case studies and integrated case studies into my course content regarding safe and effective interventions as well as precautions/contraindications based on clinical presentation/situation to avoid soft tissue damage or rupture. This case represents a clinically complex diagnosis and tenuous post-operative status requiring specialized expertise. This is not a patient that I would allow a student without extensive experience and high-level clinical reasoning to work with, if at all.
Expert Witness Response E-104853
I supervise students as part of my practice as a skilled occupational therapist and certified hand therapist. Each state has a certain set of rules in the practice act specific to student supervision. In general, I use the state practice guidelines as a reference and be sure I do my job as a supervising therapist and instruct and supervise the student according to the complexity of the diagnosis. Tendon repair/rehabilitation is a complicated topic in the field of hand therapy. Many medical and therapeutic have researched the healing and complexity of rehab related to the healing tendons in the hand. The rupture rate of flexor tendons is higher as compared to extensor tendons. The likelihood of dense scar formation/adhesions is more commonly noted to be in the Zone II area of the flexor tendon system. I have reviewed therapy performed for flexion tendon rehabilitation and I personally would not allow a student to complete a treatment session with a flexor tendon repair patient. There is a high level of expertise required to manage such conditions as there is always the concern of rupture, particularly during the first 6 weeks following repair.