Complex regional pain syndrome (CRPS) is a diagnosis that is frequently involved in medical malpractice lawsuits against podiatrists. It is not uncommon to see plaintiff attorney ads targeting individuals who have been diagnosed with CRPS. Why? Because the plaintiff’s medical expenses and other damages such as pain and suffering, lost wages, family disruption, and loss of quality of life can be quite high. Therefore, settlements or jury verdicts in these claims can exceed a million dollars.
The most common precursors to CRPS are fractures, surgery, sprains/strains, burns, cuts, being in a cast, and nerve injury. CRPS can occur in anyone at any age, but it is more common in women and in middle-aged individuals.
CRPS can be difficult to diagnose as symptoms of CRPS are different for each person, and many of the signs and symptoms of CRPS may be seen in other conditions. It is important that podiatrists consider the possibility of CRPS in patients with pain out of proportion to physical exam findings. For example: changes in skin color, texture and/or temperature; changes in nail and hair growth; hyperalgesia or allodynia; decreased range of motion or motor dysfunction; and/or swelling of the affected limb. Once you determine there is no other likely diagnosis and you suspect CRPS, it is a good idea to initiate early referral for treatment by a CRPS expert because treatment is the most effective when started early.
Common allegations against podiatrists in lawsuits pertaining to CRPS include:
• Performing an unnecessary procedure/surgery
• Perioperative or other nerve injury
• Improper tourniquet use
• Failure to recognize signs and symptoms of CRPS
• Failure to timely refer for treatment
Documentation
Podiatrists can take actions to reduce their risk of a lawsuit being filed or aid in their defense in the event of a lawsuit resulting from CRPS and documentation is the best place to start. Prior to performing surgery, perform and document a neurological evaluation and document the medical indications for surgery. Include documentation of tourniquet placement and length of time, if utilized, in the operative report.
Thoroughly document any patient complaints suggestive of CRPS and the presence or absence of signs and symptoms of CRPS. Document your differential diagnosis and rule out other potential causes of the abnormal signs and symptoms. Document all conversations with the patient regarding his/her symptoms and your treatment rationale and document any referrals to other healthcare providers and the reason for the referral.
Informed Consent
Informed consent discussions and paperwork are also critical in helping to reduce the risk of a potential lawsuit relating to CRPS. Perform and document a thorough informed consent discussion with the patient prior to surgery to include the possible risk of developing CRPS.
Promptly Refer
Another way to help avoid possible lawsuits in relation to CRPS is to promptly refer patients to experts who specialize in this condition. Be cognizant of the need for timely treatment of CRPS. If you determine that there is no other cause for the patient’s signs and symptoms, promptly refer the patient to a healthcare provider who specializes in the treatment of CRPS.
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The information contained on the PICA Blog does not establish a standard of care, nor does it constitute legal advice. The information is for general informational purposes only. We encourage all blog visitors to consult with their personal attorneys for legal advice, as specific legal requirements may vary from state to state. Links or references to organizations, websites, or other information is for reference use only and do not constitute the rendering of legal, financial, or other professional advice or recommendations. All information contained on the blog is subject to change.
