1. Preventing Potential Claims of Negligence – Just Because You Can, Should You? Ross E. Taubman, DPM PICA President and Chief Medical Officer 2012 APMA YOUNG PHYSICIANS’ INSTITUTE May 18-19  Crystal Gateway Marriott  Crystal City, VA

2. Case Presentation Number 1 The Defendant (our Insured): – Graduated from Podiatric Medical School in 2002 – 3-Year Residency Completed in 2005 – Began practice in a rural part of a Southwestern state in 2005 – Not Board Certified – Only 3 Physicians in town – General Practitioner, General Surgeon, our DPM

3. Case Presentation #1 The Plaintiff (thePatient): First Visit in Early 2008 – 59 year old diabetic male, employed as attorney – Previous PVD diagnosis by two other physicians – Charcot Arthropathy with chronic ulceration – Failed conservative care lead to decision for surgery

4. Planned Procedure Tendo-Achilles Lengthening Multiple Mid-foot Arthrodesis with Osteotomy Secondary Repair of Extensor Tendon Partial Ostectomy X 3 Application of Multi-Plane External Fixator Application of Bone Stimulator

5. What are the Potential Issues? Diabetic Patient Diagnosis of PVD Medical Clearance with Laboratory Evaluation Rural Locations without Availability of Other Specialists Familiarity and Experience with Procedure

6. What Happened? Staff received abnormal Labs but failed to report to DPM Post-Operatively Wound failed to heal MRSA Infection which resulted in Osteomyelitis, BKA X 2, septicemia leading to Renal Failure and Myocardial Infection After all said and done: – Settlement with Plaintiff = $2,000,000

7. Case #1 - Lessons Learned Look in the Mirror Mind the Store Location, Location, Location Don’t Carry the Coffin Alone

8. Case Presentation #2 The Defendant: – Graduated from Podiatric Medical School in 1997 – 3-Year Residency Completed in 2000 – Fellowship in Reconstructive Foot & Ankle Surgery Completed in 2001 – Began Private Practice in the Midwest 2001 – ABPS Certified - RRA

9. Case Presentation #2 The Plaintiff: First Visit Early 2004 – 34 year old married female with two dependent children – Charcot-Marie-Tooth Disease – Multiple prior back and extremity surgery – Painful Cavovarus foot deformity secondary to CMT that failed conservative care leading to decision for surgery

10. Planned Procedure Midtarsal Arthrodesis with Internal Fixation Plantar Fasciotomy Application of External Ring Fixation Application of Bone Stimulator

11. What are the Potential Issues? Charcot-Marie-Tooth Disease Familiarity and Experience with Procedure Documentation and Informed Consent Scope of Practice

12. What Happened? Patient Developed Post-operative infection with ultimate Osteomyelitis which required BKA Allegations – Failure to Diagnose Infection –Defensible – Failure to Obtain Informed Consent – Indefensible – Battery and Practicing Outside the Scope of Practice – Indefensible After all is said and done: – Settlement with Plaintiff = $850,000

13. Lessons Learned Case #2 Take a Letter, Maria “Toto, We’re Not in Kansas Anymore” Look in the Mirror – AGAIN!

14. Questions? Ross E. Taubman, DPM 615-984-2005 rtaubman@picagroup.com