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Mercy Clinic in Springfield, Mo., accused of medical negligence

Mercy Clinic in Springfield, Mo., accused of medical negligence

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A businessman has accused Mercy Clinic in Springfield, Mo., and two of its physicians of failing to provide emergency treatment to prevent the spread of flesh-eating bacteria.

In the medical malpractice case, Adam Maier of Springfield, Mo., says that Mercy surgeons began performing a series of operations on him four days after he was seen briefly in Mercy Hospital Springfield’s emergency room yet discharged to go home. By that time, the infection — necrotizing fasciitis — had ravaged his left buttocks and leg down to his knee.

The case, which is pending in Greene County Circuit Court and scheduled for trial in September, comes amid a push in Jefferson City to impose financial caps in future medical malpractice cases.

Medical records show that four operations, including removal of dead and damaged tissue, a colostomy and a skin graft, were needed in 2010 to both contain Maier’s infection and repair its devastating consequences. Charges for the surgeries and related care totaled nearly $400,000.

Maier, 66, says that Mercy Clinic, a physicians group (formerly called St. John’s Clinic Inc.) operated by Chesterfield-based Mercy Health, denied him timely emergency treatment because he was uninsured. Several weeks later, he obtained federal insurance for patients with pre-existing conditions.

Health providers have a legal duty to provide emergency medical care to stabilize the condition of those in need. According to Maier’s two expert witnesses, the hospital made serious errors.

“It’s all about money,” Maier said in an interview. His wife, Nancy Maier, testified in a deposition: “I have lost trust in the medical profession.”

The Maiers have no evidence to prove that Adam’s initial surgery was postponed in June 2010 for financial reasons. But a hospital document bearing the date of his initial emergency room visit indicates that he was unemployed and had no primary insurance coverage; his status was listed as “bad debt.”

Mercy, similar to other health systems, has faced growing amounts of bad debt in recent years. In fiscal year 2011, Mercy Hospital Springfield — formerly known as St. John’s Regional Health Center — listed $41.8 million in patient debts that cannot be collected, according to its IRS 990 tax filing.

The nonprofit health system denies that a patient’s insurance coverage or ability to pay affects the care provided.

“While we cannot comment on pending litigation, Mercy does not determine a patient’s treatment based on their ability to pay,” said Mercy spokeswoman Sonya Kullmann. “Mercy values guide us to treat each person as created in the image of God, providing everyone with compassionate care.”

Maier and his wife have asked the court for a jury trial and damages to compensate them for his continuing pain and mental anguish. Maier’s wife, a co-plaintiff, has asked for damages including loss of consortium and companionship.

Missouri currently has no comprehensive cap on medical malpractice awards because the Missouri Supreme Court last year struck down such limits as unconstitutional. But the court has upheld a cap of $350,000 for noneconomic damages in wrongful death cases.

Noneconomic damages are generally defined as any damages not associated with a person’s lost wages or medical care, such as pain and suffering as well as awards for lost mobility, loss of sight or hearing, loss of enjoyment of life and loss of consortium.

Maier’s lawsuit names Dr. Scott Henke and Dr. Kenneth Larson as defendants. Neither responded to requests for comment.

According to his suit, Maier was seen by the hospital’s emergency room about 8 a.m. on Thursday, June 24, 2010, for complaints of “perirectal abscess and cellulitis.”

Henke, a Mercy emergency medicine physician, noted on Maier’s chart that “the problem is severe.” Maier indicated that he was experiencing pain of “10” on a scale of one to 10, medical records show.

Henke consulted by phone with Larson, a Mercy surgeon, who decided not to evaluate Maier in the emergency room. The patient was given a painkiller as well as oral and intravenous antibiotics, and discharged about 9:30 a.m. He was instructed to rest, take warm sitz baths twice daily and return to the emergency room if his condition worsened.

“At that time, that day, that hour, he did not require surgery, but he was advised that this could potentially turn into a surgical problem,” Henke testified in a deposition.

Maier was also told to schedule an appointment with Larson on the following day. But as it turned out, Larson’s medical practice would not agree to an appointment until four days later on Monday, June 28.

Nancy Maier testified that when Henke examined her husband, the physician pointed to a patch of black skin on the back of his leg and said that it needed to be dealt with by a surgeon — an assertion that Henke denied. “There was no necrotic skin anywhere on the patient when I saw him on June 24,” he said.

In a deposition, Larson agreed that Adam Maier should have been seen by a surgeon prior to June 28. However, he blamed the delay on the patient.

“Dr. Henke and I discussed whether he had an abscess that needed to be drained on his buttock and felt that he did not,” Larson testified. “My opinion is that when Mr. Maier started to see changes from his exam on the 24th that he should have sought treatment.”

‘EGREGIOUS ERRORS’

Dr. Steven Samuel, an expert witness for the plaintiff, testified in a deposition that Henke made “egregious errors” by failing to immediately order lab tests and either an X-ray, a CT scan or ultrasound that would determine the severity and extent of Maier’s infection.

Samuel, a surgeon based in Louisville, Ky., also said that Henke should have required Maier’s admission to the hospital and that Larson should have performed a surgical procedure within 24 hours. “This patient needed immediate attention. I would not have let that patient out of the emergency room or discharged that patient under any circumstances,” he said.

Another plaintiff’s expert, Dr. Mark Cichon of the Loyola University Health System, testified in a deposition that Henke “deviated from the standard of care” by discharging the patient from Mercy’s emergency room, “resulting in a greater amount of potential long term injury and pain and discomfort ...”

“It’s my opinion that this abscess should have been more aggressively addressed in the hospital setting,” Chicon said. “Each subsequent day the window was opening more and more allowing more injury, more damage, more potential for overwhelming sepsis to come through the process. ... His symptoms and disease process worsened.”

After his four surgeries involving 22 specific procedures, Maier recovered in the hospital’s burn unit. But the Maiers say the surgeons had to cut away substantial portions of his buttocks and left leg, leaving him disabled.

According to Nancy Maier, her husband is now unable to lift objects, sit or drive for long periods of time, do yard work and household repairs, or go dancing with her. She said that his physical limitations have lowered his self-esteem.

“I’ve seen my husband change. He’s no longer the man I’ve known for 35 years,” she testified. “I’m fearful for him. The new norm of our daily conversation is what happened to him. The beautiful life that we had is completely upside down.”

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