24 Trial Lawyer • Summer 2023 By Marilyn Heiken OTLA Guardian As Jean hopped out of her new red Miata convertible, she smashed her thumb in the car door. Four days later, the 70-year-old was dead from necrotizing fasciitis. Her husband came to us to investigate a wrongful death claim against the hospital and doctors who botched her treatment. Time is the key to surviving necrotizing fasciitis, and it was critical to put together a minuteby-minute timeline of what happened from the medical records. Based on a review of the medical records first made available to us, it appeared the medical providers had necrotizing fasciitis on their differential diagnosis, and their exams and assessments were reasonable. The medical records showed Jean arrived at the emergency Marilyn Heiken department at 10:13 a.m. on Saturday morning. Her husband explained to the emergency room doctor that two days earlier she smashed her thumb in the car door, and it was now quite swollen and painful. She seemed fine until that morning when she said there were goats and sheep in the kitchen. Although the ED doctor did not suspect necrotizing fasciitis, he did order various lab tests and prepared to admit the patient for what he thought was sepsis from a bladder infection. He called for the hospitalist to come admit the patient to treat her for sepsis about six hours after her arrival at the ER. When the hospitalist arrived at about 4:30 p.m., she immediately focused on Jean’s swollen and discolored hand (see photo). “THAT is the source of the problem,” she noted. She was alarmed and immediately suspected necrotizing fasciitis. The hospitalist admitted Jean to the hospital and urgently entered several orders into the electronic medical record (EMR): a CT scan “for possible necrotizing fasciitis,” an “urgent” orthopedic surgical consult for “necrotizing fasciitis” and a critical care consult for “suspicion of necrotizing fasciitis.” In her assessment, she identified sepsis and “possible necrotizing fasciitis” as problem RECORDS DO NOT LIE how an AUDIT TRAIL can Lead to Truth Jean’s family took a photo of her thumb when she first went to the hospital.
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