Med malpractice claimed after finger surgery results in later amputation. Defense. Riverside County.

Facts and Background

• Facts and Background:

  Plaintiff fell while playing tennis and suffered a volar plate avulsion fracture of her left ring finger. Two months later she sought care from defendant orthopedist James Chao, M.D. who performed surgery on Friday, April 17, 2015.

  The following morning, Saturday, April 18th, plaintiff developed severe pain in her left hand (10 on a scale of 10) and, after failing to reach Dr. Chao by telephone, presented to the Temecula Valley Hospital where she was seen by emergency room physician Gabriella Minera, M.D. Dr. Minera contacted Dr. Chao who suggested that the surgical dressings may have been wrapped too tightly. Dr. Minera loosened a portion of the dressings but did not examine the surgical wound. She administered morphine and discharged the plaintiff.

  Plaintiff returned to the Temecula Valley ER the next day, Sunday, April 19th, again complaining of 10 out of 10 pain in her left hand. She was seen by defendant emergency room physician Heather Bruner, M.D., who reviewed Dr. Minera's notes from the day before, performed a vascular exam of plaintiff’s left hand, adjusted her pain medication dosage, and discharged her home with instructions to see Dr. Chao the next day. Dr. Bruner did not recall or chart whether she examined the surgical site and did not contact Dr. Chao.

  Plaintiff saw Dr. Chao the following day, Monday, April 20th. After removing the dressings, Dr. Chao noted that the surgical site was engorged and blood flow was compromised. He treated the condition conservatively, reassuring plaintiff and instructing her to return in two weeks. The following day, Tuesday, April 21st, the plaintiff was shaking uncontrollably and complaining of 10 out of 10 left-hand pain. Dr. Chao saw her emergently, noted increased swelling at the surgical site, and admitted her to the hospital for four days of pain management and hyperbaric therapy.

  Following discharge, Mrs. Hill left Dr. Chao’s care and sought treatment from hand surgeon Reid Abrams, M.D., a former partner of Dr. Chao with whom he had an ongoing business dispute. Under Dr. Abrams’ care, plaintiff's left finger remained extremely painful and stiffness began to compromise the range of motion of her other fingers. As a result, and only three months after Chao's surgery, plaintiff elected to undergo a ray amputation of the finger. Postoperatively, the stiffness in the left hand and fingers continued and plaintiff developed even more pain. She was ultimately diagnosed with Complex Regional Pain Syndrome (CRPS). 

• Plaintiff's Contentions:

  Plaintiffs contended that Dr. Chao wrapped the surgical dressings too tightly and was negligent for failing to return Mrs. Hill's phone calls or examine her over the weekend. They further alleged that Dr. Bruner failed to completely loosen the dressings, examine the finger, or contact Dr. Chao. Plaintiffs asserted that, as a result of the defendants’ negligence, Mrs. Hill required amputation of the left ring finger and developed CRPS, rendering her permanently disabled and unable to work at her drug and alcohol rehabilitation business.

• Defendant's Contentions:

  Defendants Chao and Bruner contended that plaintiff's residual hand problems were the result of an unsuccessful surgery rather than any postoperative vascular compromise and that they acted reasonably and within the standard of care in their treatment of Mrs. Hill.

  At trial, the defendants introduced excerpts from the social media accounts of plaintiff’s family and friends including photos and videos as well as sub rosa surveillance video showing that Mrs. Hill was disabled, but not to the extent she claimed. Dr. Laura Audell, the defense pain management expert, also opined that Mrs. Hill was not pursuing effective therapy and was likely addicted to opioid painkillers which were not controlling her pain and were inhibiting her ability to return to work.