04/04/2025    Allen M. Jacobs, DPM

Podiatrist's Breach of Standard of Care Proved Fatal (PA) (John Lanthier, DPM)

"Standard of care" is a legal, not medical
concept. The definition of "standard of care" can
and does vary from state to state. Juries are
instructed as to the definition of "standard of
care" in each particular state. For example, in
some states the term average is applied to the
expected care rendered by a podiatrist. However,
in some states fact that a podiatrist provided
less than average care is not assumed to be
negligent care, otherwise 50% of those in practice
would be considered negligent. In other states
terms like "reasonable care" are applied.

Remember however, the interpretation of these
varied definitions will be interpreted by expert
witnesses and lawyers and translated to the jury
as such. This is why the selection of a capable
and experienced lawyer is very important. It is
why the selection of a competent expert witness is
important. It is why the venue and the judge and
many other factors are considered in the
evaluation of each case and its merits for
successful defense.

With specific reference to protocols for post-
operative utilization of anticoagulants, you must
evaluate each patient based on their perceived
individual risk factors and the immobilization or
non-weight bearing status. General recommendations
are available from ACFAS, AOFAS, AAOS, AACP, NICE.
However, when all is said and done each patient
must be evaluated individually. If you wish to
defer this decision making to an alternate health
care provider for whatever reason, than do so.

With reference to the interdiction of
anticoagulants prior to a surgical procedure, it
is generally best to consult or have the patient
consult with the health care provided who
prescribed the anticoagulant. There are some
circumstances, such as uncomplicated atrial
fibrillation without stroke history, no mechanical
valves, no prior history of DVT wherein
anticoagulants can generally be discontinued with
significant increased risk to the patient. There
are other circumstances, such as recent stent
placement or recent acute coronary event in which
anticoagulants should be continued. Under these
circumstances, postpone any non-urgent
discretionary surgery or consult with the
prescribing health care provider.

My mother was on anti-coagulation therapy for
atrial fibrillation. She had no major additional
risk factors. She discontinued her anticoagulants
in preparation for dental work. She died of a
massive pulmonary embolism. You never know, and it
is always best to seek other opinions and protect
the patient as best we can and "share the
liability".

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

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