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A Massachusetts hospital must pay $20 million to a man who lost his left leg after a blood clot was misdiagnosed as sciatica, according to a story posted on boston.com, the news site of The Boston Globe.

On March 7, 2015, Steven Luppold, at the time a construction worker, went to the emergency department (ED) at Lowell General Hospital, medicine for incontinence in Lowell, Massachusetts. He had a long history of sciatica. The pain often radiated down his left leg. This time, though, his discomfort in his left foot felt different.

At the ED, Luppold was initially examined by two nurses, who wrote in the patient’s chart that his foot was turning purple and felt cool to the touch. He was next examined by a physician assistant (PA), Charles Loucraft, who made a diagnosis of worsening sciatica and sent the patient home. Court records suggest Loucraft made this diagnosis without having read the patient’s chart.

Six days later, Luppold returned to the ED with severe pain — a 9 on a scale of 10, as he reported at the time. Again, he was seen by two nurses, one of whom had examined him the previous week. He was then examined by Carlos Flores, a nurse practitioner (NP), who reiterated the PA’s initial diagnosis of sciatica. Once more, Luppold was sent home.

Four days later, on March 17, Luppold placed a call to his primary care physician (PCP), who worked at Lahey Hospital and Medical Center, in Burlington, Massachusetts, about 18 miles south of Lowell.

The PCP administered an ultrasound and diagnosed the patient as having a deep-vein thrombosis and an arterial thrombosis in his left leg. Luppold was taken immediately to the Lahey Hospital ED. A vascular surgeon ordered a CT scan, which indicated that the tissue in the patient’s left leg was necrotic. The following day, with few options open to them, surgeons amputated the patient’s left leg above the knee.

At some point after the surgery, Luppold filed a medical malpractice suit that named the PA, NP, and their physician-group employer, Merrimack Valley Emergency Associates, in Lowell. Also named in the suit were the three ED nurses who had examined him.

“Honestly, the reason this happened was because the communication…in the emergency department between the nurses and providers was nonexistent,” says Robert M. Higgins, a partner at Lubin & Meyer, in Boston, who represented the plaintiff. Had providers ordered “a simple ultrasound” during either of Luppold’s visits to the ED, Higgins added, his leg could have been saved.

The jury agreed. It awarded Luppold $10 million for pain and suffering and another $10 million in compensatory damages.

At press time, there was no word on whether the defendants planned to appeal.

Doctors at Risk for Providing Trans Care to Minors

Arkansas doctors who “perform a gender transition procedure” for persons younger than 18 years could be in legal jeopardy for well beyond the date of treatment, reports a story in the Arkansas Advocate, among other news sites.

That prospect is the result of a bill signed into law last month by Arkansas Gov. Sarah Huckabee Sanders. Under the law, slated to take effect this summer, a doctor who provides gender-affirming care to a minor can be sued for a period of up to 15 years after that patient turns 18. (Under current state law, plaintiffs must file a med-mal claim within 2 years of an injury.)

A federal judge is considering whether to strike down a similar measure that was signed into law by Sanders’s predecessor, Asa Hutchinson, in 2021. That statute prohibits doctors from providing or from referring a minor to someone who would provide gender-affirming hormone or puberty blockers. (Minors in the state do not qualify for gender-related surgery.)

Opponents of such care are hopeful that the 2021 statute will survive judicial review. Even if it doesn’t, though, they believe the new med-mal law will have a similar effect: to dissuade Arkansas doctors from treating minors seeking gender-related treatment.

It’s possible that the new law could itself be subject to a court review. But at least one of the bill’s sponsors, Sen. Gary Stubblefield, a Republican member of the Arkansas senate, is cautiously optimistic: “I know what we did was what we thought was best for our children.”

Opponents argue, though, that the new law will end up harming children who identify as transgender.

“You might not understand what it means to be gay or trans or a member of the LGBTQ community,” explained House Minority Leader Tippi McCullough during debate over the bill in the GOP-led chamber. “I get that, but I’m standing here as the only member of that community in the entire General Assembly, a caucus of one, telling you…[the bill] denies trans kids the most affirming care they may ever receive in their lives, and that’s cruel.”

Appeals Court Slashes Jury Award

A Pennsylvania doctor who faced paying a $2.7 million award has had it cut in nearly half by a three-judge Superior Court panel, as a story in the Claims Journal reports.

The underlying case stems from a suit brought by the estate of a man who died in 2018. At the time of his death, he had been diagnosed with advanced prostate cancer and liver cancer. The suit by the family estate was initially centered on the doctor’s alleged negligence in treating the man’s prostate cancer. At some point during the 2021 trial, though, the suit was amended to include a second claim — an allegation that the doctor had also been negligent in treating the patient’s liver cancer, which had been belatedly diagnosed. The doctor’s medical practice was also a named defendant in the suit.

On March 2, 2022, a jury sided with the plaintiffs, awarding them compensatory damages of $1.5 million for the prostate cancer claim and $1.2 million for the liver cancer claim.

The doctor and other defendants appealed, arguing two essential points: first, the liver cancer claim amounted to a new cause of action, one for which they had not been given adequate notice.

Second, and more significantly, plaintiff action relating to this second claim had only begun in earnest on July 6, 2021, when an expert report was first filled with the court. But this filing was nearly a full year beyond the state’s 2-year statute of limitations, which, given the patient’s death in 2018, was at the very limit, said defendants. For these reasons, they argued, the appeals court should forthwith order a new trial.

That court, however, ended up walking a middle road. Although the court found that the liver claim was “time-barred,” since it had exceeded the 2-year statute of limitations, the court denied the defendants’ motion for a new trial.

Instead, the court cut $1.2 million from the portion of the jury award that applied to the liver cancer claim but left intact the $1.5 million that related to the cause of action regarding prostate cancer.

It was a Solomonic decision that undoubtedly displeased both sides equally.

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