The eggshell-skull rule, as applied to a self-inflicted injury: Whately, MA selectman Charles Olanyk weighed 460 pounds in 2001 at the age of 51. That sort of obesity leads to health problems, and Olanyk had several: high-blood pressure, obesity, and diabetes. Olanyk stubbed his toe, treated himself with a heating pad, managed to give himself third-degree burns because he didn’t have full sensation in his outer limbs, and went to Doctor John Bookwalter, who had been treating him for leg ulcers; Bookwalter gave him a topical cream and antibiotics. Nevertheless, the burn became gangrenous because of diabetic and lymphedema complications, and Olanyk ended up losing his left leg below the knee. A jury awarded $1.16 million against Bookwalter on grounds that he should have immediately referred Olanyk to a burn doctor. “In the end, everybody’s health care costs go up because this guy couldn’t take care of himself,” said Bookwalter. (Patrick J. Crowley, “Local doctor loses $1.1M malpractice lawsuit”, Brattleboro Reformer, Feb. 14; “After scary bout, months of recovery”, Daily Hampshire Gazette, Mar. 19, 2002).
(Update: eagle-eyed reader F.R. points us to this Telegraph story discussing the UK’s single-payer health service consideration of banning surgery on smokers and the obese to save costs.)
7 Comments
I’m normally sympathetic to the point of view of Overlawyered, but in this particular case I do think the doctor committed malpractice. A third degree burn generally deserves a referral, IMHO, possibly even when the patient has nothing else is going on. The benefit of living in a country which spends a lot of money on health care is that we have our possible problems looked at while they’re still small.
However, to sustain a judgment it needs to be shown that a burn doctor could have saved the foot, which isn’t obvious.
-dk
How does one get third degree burns from a heating pad?
Where was the topical ointment applied? One would suppose on the wounded toe. Then why didn’t the person applying the cream notice that the toe was rotting?
I suspect that the man stubbed his toe and that gangrein had set in. The discolloration was mistaken for a third degee burn.
In his rookie season, Joe Dimaggio missed a few weeks because he was burned by a heating pad: he had no experience with the treatment, and didn’t want to admit pain to the trainer as the pad started to burn.
I don’t have any reason to doubt that Olanyk burned himself.
Ted, 1st degree burns are quite possible with a heating pad, but IIRC, 2nd degree is burning through the skin, and 3rd is burned to the bone. A heating pad that got hot enough to burn through flesh would be on fire itself. And you don’t treat such burns with topical cream. It’s not a judgment call – quite aside from training and knowledge, would you ever smear ointment on a protruding toe-bone and think that would be adequate treatment?
So, the reporting has to be wrong. It was probably a 1st degree burn and/or an infection from stubbing the toe, and the ointment and antibiotics sound like the appropriate first treatment. Where things went wrong is in the followup; the infection got out of control by the next time the doctor saw it, and there isn’t enough information here to say why it wasn’t found sooner. Normally, a busy doctor might expect a patient to change dressings once or twice a day and come back in if it didn’t seem to be healing properly. In this case, the patient probably couldn’t see or feel his toes, so someone else should have been checking at least once a day – but who’d be willing to trek over to the doctor’s office daily for a stubbed toe? I’d like to have a tape of the doctor’s instructions before the guy left the office.
In any case, I’d put the patient’s responsibility at over 50%. I’ve treated worse injuries on myself, no prescription antiobiotics needed. What made this case different was that the guy was so fat his systems were failing before the accident.
While all burns to the bone are third-degree burns, not all third-degree burns are burns to the bone, so the premise behind your comment is not necessarily true. But it could well be the case that the earlier story exaggerated the burn.
Ok Ted,
How does one get a third degree burn from a heating pad to a single toe?
If the burn was exaggerated, then maybe it wouldn’t call for a specialist.
Full blown Diabetes is nasty. That is the nature of the disease.
Any level of heat capable of giving a burn is capable of giving a third dgree burn if left burning long enough.
So, though a person with proper sensation would have removed the pad and suffered a mild first degre burn (if that), this patient did NOT feel it, and left the pad in place. Burning continued… even if the damage was occuring slowly, it would continue until it had burned the entire thickness of the skin (third degree or “full thickness” burn).
Such a slow burn might actually appear much less bad than it actually was, as most third degree burns are caused by very high heat, which has some scondary effects (like charring of the skin – pleasant thought, eh?).