On Aug. 28, 1996, a Floral City woman had a small cut on her right big toe. During the next six weeks, the condition worsened so badly that a surgeon eventually amputated the right leg above the knee.
Now the legal system will decide who, if anyone, is to blame for the tragic turn of events. The woman's primary doctor? Her podiatrist? Workers at the hospital and nursing home where she stayed?
The woman and her husband filed a lawsuit late Monday against her primary care physician, Dr. Herbert I. Cohen, and podiatrist Dr. Gordon Groundwater and Citrus Memorial Hospital. Before long, the Citrus Health and Rehabilitation Center nursing home will become a fourth defendant.
"They will be put on notice shortly," said the woman's lawyer, Michael Smith. "They will be joining the party."
The lawyer argues that all the parties failed to properly monitor his client, Winifred W. Martin. If the care providers had offered reasonable services, the lawyer said, Mrs. Martin would have avoided amputation, or at least endured a less catastrophic operation.
Mrs. Martin and her husband, James, seek more than $15,000 in damages. Their case is filed in circuit court. They declined comment Tuesday afternoon.
The Citrus Times wrote about Mrs. Martin's case April 19. The story did not mention her name because it was not disclosed in various state records.
The records did have plenty to say about the nursing home. The state Agency for Health Care Administration found that the home engaged in "poor care and treatment" of Mrs. Martin, resulting in the amputation.
Citrus Health officials said the problem concerned proper documentation of care provided, not the care itself. Indeed, the home responded to the state complaint so quickly and thoroughly that the state declined to impose fines.
Still, the Martins' said the home's performance was below par. He initially planned to sue only the doctors and the hospitals.
"As we got deeper into it (his investigation), it became more and more apparent that we needed to look into the nursing home," Smith said Tuesday.
The state also is investigating whether the doctors and nurses who treated Mrs. Martin should receive disciplinary action. That review remains pending, Agency for Health Care Administration spokeswoman Nina Bottcher said Tuesday.
A woman who answered the telephone Tuesday at Cohen's office in Inverness said the doctor would not comment on pending litigation. Likewise for Citrus Memorial, said spokeswoman Megan Carella. The Times was unable to reach Groundwater, whose last known telephone number was in New Port Richey. Gary Vandenberg, an official with Citrus Health's parent company, did not return a telephone message left on his voice mail Tuesday afternoon.
According to the suit, Mrs. Martin's trouble began at Citrus Memorial. She entered the hospital Aug. 23 for treatment of a fractured left hip, the suit said. While there, Mrs. Martin "developed an open sore on her right big toe, which was noted initially by CMH's nursing staff, which gave her medication for pain."
The suit alleges that hospital nurses failed to indicate in their charts which toe was injured. Further, they are accused of failing to notify doctors that Mrs. Martin needed treatment, and in fact failed to document the toe wound when discharging her.
She was discharged to Citrus Health Aug. 28, and records showed the wound measured 1 centimeter. Cohen was her doctor, the suit said. According to state records, the nursing home staff ordered a podiatry consult Sept. 3. Four days later, Groundwater examined Mrs. Martin's foot.
On that date, the suit said, Groundwater told Cohen "that there was a serious problem with plaintiff's right big toe and it required immediate attention and peripheral vascular studies."
However, "Cohen saw plaintiff (Mrs. Martin) only twice during the entire time she was at Citrus Health and Rehabilitation . . . and neither time did he examine her right big toe," the suit said. The visits were Sept. 7 and Sept. 28.
The suit alleges that the hospital staff and the doctors should have provided more intensive and timely care of the wound.