Diabetic Foot Patient Wins Compensation Due To Medical Negligence Resulting In Amputation

Diabetes, with local injury and arterial insufficiency

• A man with a 20-year history of insulin-dependent diabetes presented to his general practitioner having trodden on a nail.
• The general practitioner observed the puncture site, and made no examination of the patient but prescribed antibiotics and advised him to clean it.
• One week later, the patient returned to the general practitioner with a small discharging area on the sole of his foot.
• The general practitioner arranged for the district nurse to visit, to continue the dressings and continue antibiotics.
• Three weeks after the original injury, the patient complained of redness and swelling on the upper aspect of the foot.
• His GP referred him to the local hospital, where he was examined and noted to have absent femoral, dorsalis pedis and posterior tibial pulses in that leg. His blood sugar was high and he had evidence of extensive infection within the foot.
• He received treatment for his diabetes and underwent arteriography. Arteriography revealed iliac artery stenosis amenable to angioplasty (which was carried out) and evidence of arterial disease throughout the limb.
• Despite intravenous antibiotics, the infection spread and the patient underwent a below-knee amputation. 

When the patient saw his general practitioner, the general practitioner did not examine the circulation. Had the general practitioner appreciated that the patient had a reduced circulation, and had he referred him to the hospital, he would have undergone arteriography at that stage. A combination of restoring circulation to the limb and effective antibiotics given by an intravenous route would have prevented the extensive infection in the foot and probably have prevented the amputation.

Liability was not an issue, but the defendants argued that the patient would probably have lost his leg at some point. Diabetic patients are at risk of developing foot problems and local amputation of the toes or part of the foot is quite common. The patient lost his foot and lower leg partly because of the infection and partly because of unrecognised arterial disease, which, at that stage was amenable to treatment. It is probable that this man’s disease would have progressed and therefore, at some point, he would almost certainly have required either further surgery or amputation. An agreement was reached between both parties and the plaintiff received some compensation, but the compensation was reduced in view of the long term prognosis.