The PT works in an outpatient clinic. The patient is a 62
year old female and is 4 weeks post bilateral total knee
replacement. The patient is seen by the PT for initial
physical therapy evaluation and treatment. During the
evaluation, the patient was placed on a recumbent bike for
10 minutes and while getting off, she had a problem
clearing the right leg over the equipment to dismount and
fell. The fall caused a re-tear to her tendon requiring
The patient claims that she told the PT that she needed
help getting off the bike because her legs felt weak. When
the patient exited the bike, the PT was standing on the
opposite side of the bike. The PT did not assist the patient
off the bike. The patient claims that she lost her balance
and struck her left leg against the floor with enough force
to rupture the left quadriceps tendon. Patient relates that
it took two individuals to assist her into a wheelchair since
she was unable to stand.
The lawsuit complaint states in part that “assistance was
required for plaintiff to safely exit the bike and that she
should have been wearing a gait belt. The PT was unable to
assist because she was not positioned on the side of the
bike that the patient was dismounting and if she had been
there, the Plaintiff would not have fallen.”
The PT denied that the patient ever requested assistance in
getting off the bike and had walked into the facility with the
assistance of a single point cane. Prior to getting on the
bike, the patient walked around the facility with and
without use of the cane independently.
According to the PT, the patient’s right leg did catch on the
bike frame causing the left knee to flex but that the patient
did not hit the ground. A video of the incident showed the
PT quickly hooking her arm under the patient’s arm pits and
helping the patient stand back up with minimal assistance.
The video did show that the patient had looked fatigued
(lowered her head to her hands) before trying to get off the
bike, that the patient and PT had some sort of dialogue, and
that the patient appeared to have difficulty lifting her right
leg high enough to clear the bike frame. The video
captured the patient fall to the left but it is not clear
whether or not the patient hit the ground.
As the PT was assisting the patient back down to sitting on
the bike, a student PT assisted the patient off the bike. It
looked like the student PT helped push the right leg over
the bike. The patient was given a walker and she
ambulated a few steps without assistance. After about 10
steps, the patient appeared to have trouble taking steps
and her balance worsened. The PT student got the patient
a chair and as the patient was sitting the patient passed
out. After several minutes, the patient was transferred into
a wheelchair and her spouse took her home.
The following day, the patient called her orthopedic
surgeon due to pain in her left leg. An MRI confirmed a full
thickness tear of the distal left quadriceps tendon of 3.5
cm above the patellar insertion. A repair of the left distal
quadriceps was performed, and the patient experienced a
good recovery. Complications included arthrofibrosis of the
right knee with limitations of range of motion that required
manipulation under anesthesia, soft leg cast for left leg x 10
weeks, DVT that required a vein filter inserted to avoid
development of scar tissue locking the knee, and eventually
a left knee manipulation under anesthesia.
The patient’s ability to ambulate without discomfort was
limited post all procedures and she was unable to resume
prior employment that required her to kneel, squat, reach
low places, and to work in environments where there exists
a danger of tripping. She could only flex the knee to 90
Lifestyle changes resulted from inability to flex the knee
enough to sit on a plane to travel, or sit in a theater or
movie seat. The patient used to enjoy long walks but
unable to walk very far.
The surgeon gave the patient a permanent disability rating
and declared the patient unable to resume her former
employment as a manager in a large department store.
You work for the PT’s insurance company and must assess
the claim for indemnity (settlement) or trial. The Plaintiff’s
through her attorney is seeking no less than $2,000,000 in
1. Frame the legal issues raised by the above facts with
respect to the PT, the student PT and the outpatient clinic.
When you “frame” a legal issue, state/think to the effect:
“is it legal to perform this…….? “is the practice of doing ______
legal or does it form a basis for the legal action of
___________?” Does the legal issue raise questions
involving federal or state law, criminal or civil matter or a
particular cause of action? What ethical principles or
theories are raised by the facts?
2. Consider the facts as given. Who would the plaintiff
sue? Applying the facts to each element of the cause of
action as you think appropriate (e.g., medical malpractice,
breach of contract, etc.).
3. What legal standard of proof will be applied to the
case? (e.g., preponderance, clear and convincing, beyond
any reasonable doubt, or other?)
5. Would an expert be helpful? If so, what credentials
would you look for in the expert? What do you want to
know from the expert?
6. As the insurer, what recommendations will you make
to the insurance company and to your client, the PT? Do
you want to settle the case? The Plaintiff is looking for
damages in excess of $2,000,000.00. If you believe it best
to settle the case, at what amount of damages? If not
settle, do you want to take this case to trial before a jury?
What are the advantages and disadvantages of a jury
7. Discuss ethical issues raised with respect to an insurer
forcing its insured to settle a case based on a purely
business decision that it is more economical to settle than
to secure a verdict that may exonerate the insured. Does
the APTA Code of Ethics provide any guidance to this