This case involves a female patient who reported to the hospital for a hernia evaluation, at which point doctors noted reduced renal function and elected to keep the patient in the hospital for an extended period of observation. The patient was monitored by an internist, to whom the patient frequently complaint of pain and numbness in the shoulder and hand. No testing was done to investigate these complaints. Once the patient was ultimately discharged, she visited a primary care physician, who initially believed she was suffering from amyloid polyneuropathy, but additional evaluation led to a diagnosis of an aneurysm in a major blood vessel going to the arm. The patient was transferred to another hospital, where she underwent an amputation of the arm. It is alleged that the patient could have had a better outcome had a more timely diagnoses been made.
Question(s) For Expert Witness
- 1. Do you routinely treat patients similar to the one described in the case?
- 2. Please explain. Have you ever had a patient develop the outcome described in the case?
- 3. Do you believe there may have been a deviation in the standard of care that contributed to this patient's poor outcome?
Expert Witness Response
As an Internist, I routinely treat patients with similar complaints of numbness and pain of the shoulder. It is important to keep vascular abnormalities in the differential diagnosis of unexplained pain, especially when accompanied with symptoms of paresthesia (tingling of hand). In my workup of such patients, it is not unusual to order upper extremity ultrasound to ensure that there is neither an arterial abnormality or a venous occlusion in the process of isolating the source of pain. From this brief synopsis there appears to be a gap in care. I have served as a medical expert on a similar vascular occlusive case that has resulted in bilateral upper extremity amputations and that case is proceeding well. Having worked with upper extremity amputees for over a decade at a major medical center, I truly understand the struggle this patient will face every day.