Levin identified a number of common problems in diabetic management that can lead to litigation. Absence of documentation is considered a failure, so it is important for the provider to be adequately record every finding and intervention.

Common reasons for litigation - education related:

(1) failure to educate the patient about proper foot care

(2) failure to educate the patient about signs and symptoms of worsening infection

(3) failure to prescribe non-weight bearing


Common reasons for litigation - diagnosis related:

(1) failure to perform an appropriate vascular and/or neurologic examination

(2) failure to obtain appropriate radiographs

(3) failure or delay in referral or consultation

(4) failure to take appropriate aerobic and anaerobic cultures of a wound

(5) failure to recognize a worsening infection


Common reasons for litigation - management related:

(1) failure to adequately control the blood glucose level

(2) failure to adequately or appropriately debride a wound

(3) failure to hospitalize or operate when appropriate


Additional reasons to consider:

(1) adverse drug reaction to a hypoglycemic agent

(2) complications of hypoglycemia

(3) failure to examine the patient's feet with each visit

(4) delay in or failure to make a diagnosis

(5) failure to counsel the patient about exercise, especially those to avoid

(6) failure to evaluate renal function

(7) failure to evaluate the patient's eyes

(8) failure to provide dietary or nutritional education

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