-> Appellate Court Rules Nursing Home Not Liable for Amputation Occurring Six Months After Accident
8 May 2014
In August 2006, a wheelchair-bound 60 year old man residing in a nursing home was injured when he was being transferred into his wheelchair and his left ankle hit the wheelchair’s footrest. The man had an extensive medical history including diabetes and peripheral vascular disease which caused him to develop ulcerations on his lower extremities. When his left ankle struck the footrest, an old ulcer that was scabbed over was re-opened. The wound expanded and worsened over time, eventually becoming gangrenous. Six-months following the incident, the man required a below the knee amputation.
The man filed suit against the nursing home. The man’s prior medical history indicated that following an injury to the left pretibial area sustained in October 2005, the man was treated at a hospital in Florida, where he was diagnosed with “necrotic eschar with ulceration down to the tibial bone” and the “possibility of limb loss given the extent of the disease” was discussed with the man. In July 2006, the man returned to the Florida hospital “for non-healing ulcer in the left proximal leg and knee region.” A diagnosis of “left proximal tibial osteomyelitis with significant soft tissue compromise in a patient with multiple comorbidities” was given and man advised to undergo an above-the-knee amputation. The prognosis for salvaging the leg was not favorable because of poor circulation and significant soft tissue compromise and because co-morbidities including diabetes and peripheral vascular disease prohibited healing.
The man was discharged from the Florida facility in August 2006 against medical advice and began treatment at a Queens hospital. The man was then discharged to the defendant nursing home where the subject injury occurred. In 2007, the below the knee amputation occurred.
The defendant nursing home moved for summary judgment. The defendant’s expert witness opined that the amputation “was inevitable long before [the man] was admitted to [the nursing home].” The expert also opined that the defendant nursing home promptly responded to the wound’s reopening with medically. The expert also noted that the amputation had been recommended seven months prior to the subject accident.
The plaintiff’s expert casually related the amputation to the subject injury. However, he did not set forth a basis for this conclusion, noting only that no other extremity required amputation and that the other larger ulcerations had healed.
The lower court granted the defendant nursing home’s motion dismissing plaintiff’s complaint. The plaintiff appealed the decision. The First Department affirmed the lower court’s decision, holding that the complaint was properly dismissed. The Appellate Division held that the amputation was the unavoidable result of the man’s pre-existing and chronic conditions. Additionally, the plaintiff failed to rebut the defendant’s prima facie showing that it did not depart from accepted medical practice because amputation was recommended and required prior to the man’s admission to the defendant’s nursing home