From the Guidelines
There is a potential malpractice case against the workers' compensation doctor for failing to diagnose the flexor tendon laceration during the initial evaluation, as a reasonably competent physician would have identified it, and the two-week delay in diagnosis and referral may have contributed to a poorer surgical outcome. To establish medical malpractice, four elements must be proven: duty of care, breach of standard of care, causation, and damages. In this case, the workers' comp doctor had a duty to properly evaluate the finger injury, and missing a tendon laceration during the initial examination could represent a breach of the standard of care if a reasonably competent physician would have identified it 1. The two-week delay in diagnosis and referral may have contributed to a poorer surgical outcome, as flexor tendon injuries generally have better outcomes when repaired within 7-10 days of injury.
According to the American College of Radiology, MRI is ideal for evaluating tendon injuries and helping with surgical planning, with a sensitivity of 92% and specificity of 100% for diagnosis of flexor tendon injuries 1. In this case, the hand specialist's use of MRI to evaluate the tendon injury was appropriate, and the difficulty regaining full flexion can occur even with appropriate surgical repair and rehabilitation of flexor tendon injuries.
Key points to consider in this case include:
- The workers' comp doctor's failure to diagnose the flexor tendon laceration during the initial evaluation
- The two-week delay in diagnosis and referral to a hand specialist
- The use of MRI to evaluate the tendon injury and guide surgical planning
- The potential for a poorer surgical outcome due to the delay in diagnosis and treatment
- The need for expert medical testimony to establish whether the standard of care was breached and whether the delay directly caused the patient's current limitations.
The hand specialist would likely not be liable unless there was a surgical error or improper post-operative care, as difficulty regaining full flexion can occur even with appropriate surgical repair and rehabilitation of flexor tendon injuries. The patient should consult with a medical malpractice attorney who specializes in workers' compensation cases to evaluate the specific details and determine if pursuing a claim is warranted.
From the Research
Malpractice Considerations
- The worker's comp doctor initially failed to note the tendon laceration, which could be considered a breach of standard care 2, 3.
- The delay in diagnosis and referral to a hand specialist may have impacted the patient's outcome, as timely intervention is crucial in flexor tendon injuries 4, 5.
- The hand specialist's decision to perform surgery and the subsequent difficulty with full flexion 2 months post-repair may be within the expected outcomes for flexor tendon repairs, as the literature suggests that achieving full range of motion can be challenging 2, 6.
Potential Liability
- The worker's comp doctor may be liable for malpractice due to the initial failure to diagnose the tendon laceration and the delay in referral to a specialist 3, 4.
- The hand specialist's actions may be considered standard care, given the complexity of flexor tendon injuries and the variability in patient outcomes 2, 5, 6.
- However, a thorough review of the medical records and expert testimony would be necessary to determine the extent of any potential malpractice and allocate liability accordingly 2, 3, 4, 5, 6.