03/31/2025    Allen M. Jacobs, DPM

Lessons Learned from DVT/PE Malpractice Cases

I wanted to share some examples from my experience
as an expert witness in DVT/PE cases in which
there was a substantial risk of breach of duty,
and harm caused directly by that breach. In one
case, the patient was scheduled for a tarsal
tunnel surgery. The patient informed the
podiatrist of her history of Factor V Leiden
mutation. The primary physician evaluating the
patient prior to surgery recommended prophylaxis
for 10 days. No prophylaxis was administered. The
result was a massive PE with residual pulmonary
compromise. Tough to defend. The case settled.

In another case, a patient was scheduled for
flatfoot surgery (TAL, calcaneal osteotomy, repair
of PT tendon) with cast immobilization. The
patient record indicated that the podiatrist was
informed that " My brother died of a blood clot.
My father died of a blood clot". There was no
documented specific clotting disorder documented.
Nevertheless, surgery and immobilization followed
with no prophylaxis. The patient died of a
pulmonary embolism. Could this have been a random
event unrelated to the patient history? Possibly.
Would you wish a jury to hear this story and
determine whether this patient death was
preventable?

In another case, a patient underwent a distal
metaphyseal bunion correction. The patient was
over 400 pounds and a bariatric surgical table was
required. The patient died following surgery of a
PE. Random event unrelated to the obesity,
tourniquet, chronic venous insufficiency, relative
immobilization? Possibly. Would prophylaxis been
appropriate and potentially have been lifesaving?
Do you wish to have a jury determine this?

In another case, a patient had a tarsal tunnel
surgery performed. The patient called 3 days
following surgery with leg pain and dyspnea. The
podiatrist directed the patient to go immediately
to the ED. The patient returned to the office 7
days later, and it was noted that he did not go to
the ED as directed. No further consideration for
possible DVT/PE was given. The patient was not
redirected for ED evaluation, d-dimer, venous
doppler. 2 weeks later the patient died of
pulmonary embolic disease. Contributory
negligence? Random event? Do you wish a jury to
determine this?

I could go on and on regarding my years of
experience with DVT/PE litigation. We are
evaluating and treating more and more patients who
are overweight and are increasingly unhealthy. The
problem of DVT/PE and prophylaxis is a serious one
and must be considered in many patients.

Allen M. Jacobs, DPM, St. Louis, MO

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