Donkey Bite-Failure to Recognize Occlusion-Amputation.

CASE ON POINT: Campbell v. Canty, 969 P.2d 268 - MT (1998)

ISSUE: One of the major defenses that physicians who are negligent have is that their negligence was not the "proximate cause" of injury, harm or death of a patient. That was the situation in this case in which a patient's arm was amputated after a donkey bite. Could the arm have been saved?

CASE FACTS: Kathe and Ken Campbell own and operate a small ranch outside Butte, Montana. On May 30, 1993, Ken had just returned home from the hospital after major surgery. Kathe set out on her own to attend to the ranch chores when a donkey savagely and repeatedly bit her on her right forearm. She was taken to St. James Community Hospital in Butte. The donkey's bites had crushed the bones in her forearm and had caused shearing, crushing and tearing of the skin, muscles, veins and nerves in her arm. Extensive amounts of tissue, muscle and nerves were destroyed by the bites. Dr. C.R. Canty was the orthopedic surgeon on call when the patient was brought to the hospital. After treatment by emergency room personnel to stabilize her vital signs, the patient was transferred to Dr. Canty's care. Dr. Canty, after examining the injury, informed the patient and her family that there was a possibility that amputation would be necessary. In the initial surgery, Dr. Canty inserted a metal rod into the large bone in the patient's forearm. He cleaned the wound removing dead or dying tissue and muscle along with the debris deposited in the wound from the donkey's mouth. Dr. Canty noted that the ulnar artery in the patient's arm was injured and bruised, but the radial artery, although also bruised, was intact. He traced the radial artery to make sure that blood was flowing through the site of the injury and beyond. In a second surgery approximately 68 hours later, Dr. Canty again cleaned the wound and removed more dead and dying tissue and muscle. He noted at that time that the ulnar artery was still bruised and while it was pulsing a little, it was not acting as a major circulatory link to the hand. The patient's family became dissatisfied with Dr. Canty's treatment as they began to realize that the condition of the patient's hand was slowly deteriorating. Hence they took the patient to Billings to be cared for by Dr. Curtis Settergren, a board certified orthopedic surgeon with an additional qualification in hand surgery. He performed a number of surgeries on the patient including a vein graft to bypass the injured artery to allow blood to flow past the injured portion of the arm to the hand. The patient's arm was amputated below the elbow. On June 12, 1995, the Campbells file suit for medical malpractice against Dr. Canty and the ...