Did the workers' compensation (workers comp) doctor commit malpractice by failing to initially diagnose a flexor tendon laceration, leading to a delayed referral to a hand specialist?

From the Guidelines

There is likely not a strong case for malpractice against either physician, as the workers' compensation doctor took appropriate corrective action when the issue became apparent, and the patient suffered no permanent harm. The workers' compensation doctor initially missed the flexor tendon laceration, but they referred the patient to a hand specialist and ordered an MRI when symptoms became apparent at the two-week follow-up, which is in line with the standard of care for evaluating tendon injuries, as MRI is ideal for evaluating tendon injuries and helping with surgical planning 1. The hand specialist then performed surgery within a reasonable timeframe (4 days after referral), and the patient achieved full flexion recovery within 2 months post-repair, which represents a good clinical outcome. For malpractice to be established, four elements must be proven: duty of care, breach of that duty, causation, and damages, and in this case, although there was a delayed diagnosis, the workers' compensation doctor took appropriate corrective action when the issue became apparent, and most importantly, the patient suffered no permanent harm as evidenced by the full recovery, which significantly weakens any potential malpractice claim, as the patient would have difficulty demonstrating significant damages resulting from the brief delay in diagnosis. The role of the expert witness in malpractice proceedings is to establish the standard of care applicable to the case at issue and to opine as to whether there has been any deviation from acceptable standards 1, but in this case, the standard of care was ultimately met through timely referral, appropriate imaging, specialist consultation, and successful surgical intervention. The fact that the patient had a full recovery also supports the idea that the delay in diagnosis did not cause significant harm, which is a crucial element in establishing malpractice, as the expert witness may be asked to opine whether that deviation from the standard of care could have been the proximate cause of the patient’s alleged injury 1. In the context of medical malpractice, it is essential to consider the complexities of diagnosis and treatment, as well as the potential consequences of delayed or missed diagnoses, but in this case, the outcome was favorable, and the patient did not suffer any long-term consequences, which suggests that the care provided was ultimately adequate, despite the initial missed diagnosis. The use of MRI in evaluating tendon injuries, as in this case, is supported by the literature, which highlights the importance of timely and appropriate imaging in diagnosing and treating tendon injuries 1. Overall, the good outcome and the lack of permanent harm to the patient make it unlikely that a malpractice claim would be successful, as the patient would have difficulty demonstrating significant damages resulting from the brief delay in diagnosis.

From the Research

Malpractice Case

• The patient's case involves a delay in diagnosis and treatment of a flexor tendon laceration, which may be considered a potential malpractice case.
• The workers' comp doctor initially failed to note the tendon laceration, but later referred the patient to a hand specialist and ordered an MRI after the patient reported difficulty with flexion.
• The hand specialist performed surgery 4 days later, and the patient achieved normal full flexion 2 months post-repair.

Potential Liability

• The workers' comp doctor may be liable for the initial delay in diagnosis and treatment, as they failed to note the tendon laceration and did not refer the patient to a specialist sooner.
• However, the study by 2 suggests that a delay of up to 5 weeks in primary repair of flexor tendon injuries does not necessarily affect the outcome, as long as proper surgical methods and early mobilization are used.
• The fact that the patient achieved normal full flexion 2 months post-repair suggests that the delay may not have had a significant impact on the outcome.

Comparison to Existing Research

• The study by 2 reports excellent and good results in 87% of patients with delayed primary repair of flexor tendons, which suggests that the patient's outcome may not be directly related to the delay in treatment.
• The study by 3 compares early passive and early active range of motion protocols for flexor tendon repair rehabilitation and finds that early active motion protocols may provide better postoperative motion while maintaining low rupture rates.
• The study by 4 finds that surgical delay beyond 2 weeks may increase the risk of wound dehiscence and sural nerve injury, but this may not be directly applicable to the patient's case.

Key Factors

• The key factors in determining potential malpractice liability include the reasonableness of the workers' comp doctor's actions, the timely referral to a specialist, and the outcome of the patient's treatment.
• The studies by 2, 4, and 3 provide context for the potential impact of delay on treatment outcomes, but do not directly address the issue of malpractice liability.