Alleged Negligent Neuroma Surgery - District of
Columbia
Plaintiff, a 48 year-old government attorney,
presented to the defendant podiatrist in July,
2000, complaining of disabling bilateral
forefoot pain of one year's duration. After
examination, the defendant podiatrist diagnosed
bilateral Morton's neuromas, which were
confirmed by ultrasound examination. A brief
course of conservative care using orthotics and
cortisone injections provided no long term
relief. The defendant podiatrist then
recommended surgical excision. In December 2000,
the defendant podiatrist removed a .76 cm
Morton's neuroma and a 1.08 cm neurofibroma from
the plaintiff's right foot. In February, 2001,
the defendant podiatrist removed a 1.02 cm
neuroma from plaintiff's left foot. Plaintiff
complained that the surgery provided no relief
from his foot pain which he claimed actually got
worse. Subsequent excision of a presumed stump
neuroma from plaintiff's left foot by a
different doctor provided no relief. Three 7-
injection courses of alcohol sclerosing
injections by a third doctor provided some
relief, but did not completely resolve
plaintiff's pain. At the time of the trial
plaintiff was being treated for complex regional
pain syndrome by a pain management specialist
and had undergone emplacement of a spinal cord
stimulator which provided only slight relief of
his pain.
Plaintiff claimed the defendant podiatrist was
negligent because he did not exhaust
conservative treatment options before performing
surgery and did not obtain a proper informed
consent. The principal thrust of plaintiff's
case was that the defendant podiatrist was
negligent in not offering and then performing a
course of alcohol sclerosing therapy injections
prior to performing surgery. Plaintiff's
standard of care expert, the Associate Dean for
Clinical Affairs at a podiatric medical school,
relied upon an article published in late 1999
which described alcohol sclerosing injections as
an alternative treatment for neuromas. He
testified that the article provided such
compelling data that it had, all by itself,
established a new national standard of care for
treatment of neuromas which the defendant
podiatrist was obligated to follow before
performing the surgery.
Experts for the defendant podiatrist vigorously
disputed plaintiff's contention that alcohol
sclerosing injection therapy was the standard of
care either in December, 2000, when the first
surgery was performed, or at the present time.
Indeed, defendant's experts took the position
that such injections would have been ineffective
to treat neuromas of the size of the lesions
present in the plaintiff's feet. In addition,
the diagnosis of complex regional pain syndrome
was vigorously disputed as well. It was
defendant's experts position that plaintiff's
pain was attributable to a pre-existing
peripheral neuropathy.
Plaintiff claimed over $102,000 in past medical
expenses and $1,414,000 in projected future care
costs.
Result: The jury deliberated for one hour and 5
minutes before returning a verdict in favor of
the defendants.
Plaintiff's Experts Witnesses: Kevin M. Smith,
D.P.M. (Standard of Care) , Des Moines, IA,
Robert Gerwin, M.D. (Pain Management),
Washington, D.C.
Defendants' Experts Witnesses: Allen M. Jacobs,
D.P.M. (Standard of Care), St. Louis, MO,
Ilene S. H. Terrell, D.P.M. (Standard of Care
and IME), Locust Grove, VA.
