A 57-year-old Florida man cuts his lower leg while working in his yard.
Two days later, the area around the cut is red and swollen. More concerning, the pain has become excruciating. He tells his wife that his leg hurts far more than he would expect from such a small wound.
He goes to an urgent care center.
The provider examines his leg, diagnoses cellulitis, prescribes oral antibiotics, and sends him home.
Overnight, the pain becomes unbearable. The redness spreads rapidly. He develops a fever, begins vomiting, and becomes confused.
His family takes him to an emergency room the following morning. His blood pressure is dangerously low, and portions of the skin on his leg have begun turning dark.
A surgeon is called immediately.
The diagnosis is necrotizing fasciitis.
Emergency surgery reveals that the infection has already destroyed extensive tissue beneath the skin. Despite aggressive debridement, antibiotics, and intensive care, surgeons ultimately must amputate his leg to control the infection.
This scenario is hypothetical, but it illustrates an important question in medical malpractice:
When should symptoms that appear to be an ordinary skin infection cause a healthcare provider to suspect something much more dangerous?
Contact us today through our free case evaluation form or call 877-644-5122.
What Is Necrotizing Fasciitis?
Necrotizing fasciitis is a rare but extremely serious bacterial infection that attacks tissues beneath the skin.
It is sometimes called a "flesh-eating" infection, although that description is somewhat misleading. The bacteria do not literally consume flesh. Instead, the infection can rapidly destroy soft tissue and interfere with its blood supply.
The Centers for Disease Control and Prevention describes necrotizing fasciitis as a rare but serious infection that can progress very quickly into a life-threatening emergency.
Multiple types of bacteria can cause necrotizing infections.
Once the infection begins spreading through deeper tissue, a patient can deteriorate rapidly.
Potential complications include:
- Sepsis
- Septic shock
- Organ failure
- Extensive tissue destruction
- Permanent nerve or muscle damage
- Amputation
- Severe scarring and disfigurement
- Death
According to the CDC, even with treatment, as many as 1 in 5 people with necrotizing fasciitis die from the infection.
That makes early recognition extremely important.
The Problem: It Can Initially Look Like Cellulitis
One reason necrotizing fasciitis can be difficult to diagnose is that its earliest appearance may resemble a much more common skin infection.
A patient may initially have:
- Redness
- Swelling
- Warmth
- Tenderness
- Fever
Those symptoms can also occur with cellulitis.
The Infectious Diseases Society of America notes that distinguishing cellulitis from a developing necrotizing infection can be difficult early in the disease.
But certain findings can indicate that something more dangerous may be occurring.
Pain Out of Proportion Can Be an Important Warning Sign
One of the classic warning signs is severe pain that appears disproportionate to what can be seen on the skin.
Imagine the hypothetical patient described above.
The cut on his leg is small.
The redness is relatively limited.
Yet he describes the pain as a 9 out of 10 and says it seems to extend well beyond the visibly red area.
That discrepancy can matter.
The IDSA identifies severe pain disproportionate to the apparent clinical findings as one feature suggesting deeper tissue involvement. Other concerning findings can include systemic toxicity, swelling or tenderness extending beyond visible redness, hardening of the tissue, blistering, skin discoloration, crepitus, and tissue necrosis.
The CDC similarly identifies severe pain—including pain extending beyond the visibly affected area—as an early symptom.
A medical malpractice investigation may therefore focus heavily on exactly what the patient reported during the initial examination.
When "It's Just Cellulitis" May Need to Be Reconsidered
Most cases of cellulitis are not necrotizing fasciitis.
A diagnosis of cellulitis therefore does not automatically indicate medical negligence.
The concern arises when the patient's symptoms, progression, vital signs, examination findings, medical history, or response to treatment suggest that the infection may be more serious.
Consider a patient who returns to the hospital after receiving antibiotics for cellulitis.
The redness has spread.
The pain is dramatically worse.
The patient now has a high fever and rapid heart rate.
His blood pressure is falling.
Those changes can alter the clinical picture significantly.
The IDSA identifies failure to respond to initial antibiotics and progression of infection despite treatment among the circumstances that can raise concern for a necrotizing infection.
In a malpractice investigation, the issue may therefore not be whether the first diagnosis of cellulitis was unreasonable.
Instead, the critical question may be:
When did the patient's evolving condition require healthcare providers to reconsider that diagnosis?
Should Doctors Wait for a CT Scan or MRI?
Imaging can sometimes assist in evaluating suspected necrotizing fasciitis.
CT and MRI may reveal abnormalities involving deeper tissues.
But imaging creates another important issue.
Should treatment be delayed while physicians wait for a scan?
Not necessarily.
The CDC states that imaging can assist with diagnosis but emphasizes that treatment should begin as soon as possible and providers may not wait for test results when necrotizing fasciitis is suspected. Its clinical guidance further states that imaging should never delay surgical exploration when suspicion is sufficiently high.
The IDSA similarly notes that CT or MRI may delay definitive diagnosis and treatment and emphasizes the importance of clinical judgment.
That distinction can become extremely important in a malpractice case.
The question may not simply be:
"Did the doctor order the correct test?"
It may instead be:
"Did waiting for additional testing unnecessarily delay the surgical treatment this patient needed?"
Necrotizing Fasciitis Is Primarily a Surgical Emergency
Antibiotics are important.
But antibiotics alone may not be enough.
As tissue dies, blood flow to the infected area can become severely impaired. That can make it difficult for antibiotics to adequately reach all affected tissue.
The CDC explains that treatment typically requires both intravenous antibiotics and surgery to remove dead tissue.
The IDSA recommends prompt surgical consultation when necrotizing fasciitis is suspected and identifies surgical intervention as the primary treatment when the infection is confirmed or suspected.
Patients may require repeated operations as surgeons continue removing infected and dead tissue.
In severe cases, controlling the infection may require amputation.
When Can Delayed Diagnosis Become Florida Medical Malpractice?
A catastrophic outcome does not automatically establish malpractice.
Florida Statute § 766.102 requires a medical malpractice claimant to prove that a healthcare provider breached the prevailing professional standard of care. Florida defines that standard generally as the level of care, skill, and treatment considered acceptable and appropriate by reasonably prudent similar healthcare providers under the surrounding circumstances.
In a delayed necrotizing fasciitis case, experts may therefore examine questions such as:
What symptoms did the patient report?
Was the patient experiencing extreme pain inconsistent with the visible wound?
How rapidly was the condition progressing?
Did redness, swelling, or pain spread during observation?
Were the patient's vital signs concerning?
Fever, rapid heart rate, low blood pressure, or other systemic findings may affect the evaluation.
Was the patient appropriately reassessed?
A patient's condition can change substantially over several hours.
Was the failure to respond to antibiotics recognized?
Continued deterioration despite treatment may require reconsideration of the original diagnosis.
Was surgical consultation obtained when appropriate?
When a necrotizing infection becomes reasonably suspected, the timing of surgical involvement can be critical.
Did diagnostic testing delay treatment?
Experts may evaluate whether physicians continued testing when immediate surgical exploration was warranted.
The Timeline Can Determine the Case
These cases often turn on hours rather than days.
Consider a patient who ultimately undergoes surgery at 3:00 p.m.
The important legal question may be what happened at:
7:00 a.m.
What symptoms existed then?
9:00 a.m.
Had the pain increased?
11:00 a.m.
Was the redness spreading?
12:30 p.m.
Were laboratory results becoming concerning?
1:00 p.m.
Should surgery have been consulted?
3:00 p.m.
How much tissue had become nonviable by the time surgery finally began?
Reconstructing that progression can be essential.
Medical records may reveal when nurses documented increasing pain, when vital signs changed, when physicians were notified, when diagnostic studies were ordered, and when surgical consultation occurred.
Causation: Would Earlier Surgery Have Changed the Outcome?
Identifying a delay is only part of a Florida medical malpractice case.
The next issue is causation.
Suppose experts conclude that a surgeon should have been called four hours earlier.
The investigation must then determine what probably would have happened if that had occurred.
Could the infection have been controlled with less extensive debridement?
Could muscle or nerve tissue have been saved?
Could an amputation have been avoided?
Could septic shock have been prevented?
Would the patient probably have survived?
These questions require careful medical analysis.
Florida law also specifically provides that the existence of a medical injury does not itself create a presumption of negligence. The claimant maintains the burden of establishing that a breach of the prevailing professional standard of care proximately caused the injury.
What Evidence Should Be Examined?
A necrotizing fasciitis malpractice investigation may involve reviewing:
- Urgent care records
- Emergency department records
- Triage documentation
- Nursing notes
- Photographs of the affected area
- Vital-sign records
- Laboratory results
- CT or MRI studies
- Medication administration records
- Antibiotic timing
- Infectious disease consultations
- Surgical consultation records
- Operative reports
- Pathology results
- Microbiology and culture results
- ICU records
- Amputation records
- Rehabilitation records
The patient's prior medical history can also matter.
Certain underlying conditions may increase the risk of severe infection or influence how aggressively a patient should be evaluated.
Nursing Documentation Can Be Particularly Important
Physician notes tell only part of the story.
A patient hospitalized for several hours may have substantially more contact with nurses than physicians.
Nursing documentation may show that:
- Pain continued increasing despite medication.
- Swelling spread beyond previously marked borders.
- The patient's mental status changed.
- Blood pressure began falling.
- The patient's heart rate increased.
- Skin appearance changed.
- A physician was contacted repeatedly.
- New symptoms developed before a physician reassessed the patient.
Those entries can help establish when the patient's condition began changing and when healthcare providers became—or should have become—aware of the deterioration.
The Damages Can Be Life-Changing
Survivors of necrotizing fasciitis can face enormous medical and personal consequences.
A patient may require:
- Multiple surgeries
- Skin grafting
- Reconstructive surgery
- Amputation
- Prosthetic devices
- Physical rehabilitation
- Occupational therapy
- Home modifications
- Psychological treatment
- Long-term wound care
- Future surgical procedures
An individual who loses a leg or arm may also lose the ability to perform the occupation he or she held before the infection.
For younger patients, those losses can affect decades of future employment and medical care.
Florida Requires a Presuit Medical Malpractice Investigation
Florida medical malpractice claims have specific procedural requirements.
Before issuing a notice of intent to initiate medical negligence litigation, Florida Statute § 766.203 requires a claimant to conduct a reasonable investigation to determine whether there are grounds to believe a prospective defendant was negligent and that the negligence caused injury.
The statute also requires corroboration through a verified written medical expert opinion as provided by Florida law.
In a necrotizing fasciitis case, that process may require experts from multiple specialties depending upon where the alleged failures occurred.
Those specialists could potentially include emergency medicine physicians, surgeons, infectious disease physicians, hospitalists, critical-care physicians, and nursing experts.
A Missed Diagnosis Does Not Automatically Mean Malpractice
Necrotizing fasciitis can be difficult to diagnose, particularly during its earliest stages.
The CDC expressly recognizes that early symptoms can be nonspecific, and the IDSA notes that the diagnosis may not be apparent when a patient is first examined.
That matters.
The fact that a patient was initially diagnosed with cellulitis and later developed necrotizing fasciitis does not by itself establish negligence.
The appropriate analysis is much more detailed.
What symptoms were present?
How quickly were they progressing?
What did the physical examination show?
What were the patient's vital signs?
Did the patient deteriorate despite antibiotics?
When should the possibility of a deeper infection reasonably have been considered?
And, critically, would earlier intervention probably have changed the ultimate outcome?
Those are the questions that qualified medical experts must evaluate.
Talk to a Florida Medical Malpractice Attorney
When necrotizing fasciitis results in an amputation, permanent disability, severe disfigurement, or death, determining whether the outcome was preventable requires careful investigation.
At Bounds Law Group, we focus exclusively on medical malpractice cases.
Our attorneys represent patients and families throughout Florida in cases involving delayed diagnosis, emergency room errors, hospital negligence, surgical errors, severe infections, sepsis, and other catastrophic medical injuries.
We can obtain and review the relevant medical records, reconstruct the treatment timeline, and consult qualified medical experts to determine whether earlier recognition and treatment could have prevented or reduced the patient's injuries.
If you or a loved one suffered catastrophic injuries after necrotizing fasciitis was initially missed or treatment was delayed.
Contact us today through our free case evaluation form or call 877-644-5122.