from the standard of care. (Exh. N-1 at 32.) Based on the testimony given by the other doctors, the court disagrees. Drs. Gordon W. Nuber and Nasim Rana testified that they always cast their patients after the Maquet procedure in order to provide maximum immobilization of the area. (Exh. 8 at 46; Exh. J at 155-156.) Dr. Reider, too, testified that some doctors cast patients after the Maquet procedure. (Tr. at 313.) Although Dr. Reider chooses to immobilize the area using internal fixation, it was his opinion that casting the area was well within the standard of care. (Tr. at 313-314, 341.)
Alternatively, Crowley claims that the standard, at the very least, required that a window be put in his cast. He points to the window cut into the cast on his right knee. However, the purpose behind windowing that cast was different. When changing the cast on Crowley's right knee, the doctors noticed some redness near the wound. The doctors feared that the redness was a sign of infection. (Tr. at 166; Exh. L at 166.) Therefore, they windowed the cast in order that Crowley might be able to observe the wound and perform wound care. (Tr. at 167.) In contrast, there were no signs of infection in the left knee. (Tr. at 320; Exh. J at 113.) Observation of the wound and wound care would not have altered the course of the necrosis that was occurring. (Tr. at 319-320; Exh. J at 114, 117.) It was Dr. Greene's view that the necrosis stemmed from the pressure exerted by the tibia on the skin and/or the incision. (Exh. N-1 at 35-36, 40-41.) Dr. Karzel also identified these elements as being behind Crowley's necrosis. (Tr. at 126.) The existence and scope of this type of necrosis, according to Dr. Reider, is set at the time of incision or elevation. (Tr. at 124, 319.) The only variable which could affect the scope of the necrosis was infection. No doctor found infection here. (Tr. at 126, 320; Exh. J at 110, 113; Exh. N-1 at 42.) Therefore, the court cannot find that a window in the cast was dictated by the applicable standard of care.
E. Failure to Provide Proper Postoperative Care
In addition, Crowley claims that the physicians' postoperative treatment of his wound was lacking. Dr. Greene faulted the doctors for their failure to detect the necrosis earlier. (Exh. N-1 at 39-40.) Dr. Greene suggested that the doctors should have examined the wound multiple times a day over multiple days. (Exh. N-1 at 38.) The doctors did examine the wound two days after surgery. (Tr. at 121.) At that time, they did not see signs of necrosis or infection. Even if they should have followed the wound more closely, the court cannot find that the eleven-day lapse before discovery of the necrosis was the cause of Crowley's injury. Early detection would not have made any difference considering the type of necrosis that Dr. Greene identified as existing in this case. (Exh. N-1 at 35-36, 40-41.) Once the blood supply was disturbed, necrosis was bound to happen. The disturbance itself predetermined the amount of dead skin. (Tr. at 196, 319.) Since infection was not at issue, nothing could be done until the full extent of the disturbance became known. (Tr. at 319, 320; Exh. J at 117.) The doctors just had to wait out the necrosis until it became fully declared. (Tr. at 136, 319; Exh. J at 114, 119-120; Exh. K at 43-44; Exh. 8 at 46-47.) In the case of Crowley's left knee, that demarcation did not occur until several days after his necrosis was discovered by the doctors. (Tr. at 195-196.) Thus, the court cannot find a causal connection between the necrosis and Crowley's postoperative care.
The remaining allegations advanced by Crowley in the complaint were not supported by evidence at trial. There was no sign of infection in the left leg wound. (Exh. AB at 3-117; Tr. at 126, 320; Exh. J at 110, 113; Exh. N-1 at 42.) And, Crowley seems to have abandoned his claims involving use of a tourniquet. Crowley's expert, Dr. Greene, agreed that there was nothing negligent about the application or use of the tourniquet on Crowley's left leg during surgery. (Exh. N-1 at 80-81.) Certainly, then, these allegations could not constitute a deviation from the standard of care.
The plaintiff must bear the burden of proving by a preponderance of the evidence that a defendant deviated from the applicable standard of care. In this case, the court cannot find that Crowley upheld his burden and proved any of the claimed deviations from the applicable standard of care. Therefore, the court finds in favor of the defendant, the United States.
To the extent that any of the foregoing conclusions of law are deemed to be findings of fact, they are hereby adopted as findings of fact.
Judgment is entered in favor of the defendant, the United States.
IT IS SO ORDERED.
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