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?).

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.

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.

I don’t have any reason to doubt that Olanyk burned himself.

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.

However, to sustain a judgment it needs to be shown that a burn doctor could have saved the foot, which isn’t obvious.

-dk