Print Friendly and PDF Print or Download

​​Physical Therapist Case Study: Failure to follow the referring practitioner’s orders while treating teenage patient following gymnastics injury

Physical Therapist Medical Malpractice Case Study with Risk Management Strategies
Presented by HPSO and CNA

Medical malpractice claims may be asserted against any healthcare provider, including physical therapists and physical therapy business owners. This case study involves the treating physical therapist working in an outpatient physical therapy office/clinic.


A female patient in her late teens presented for physical therapy after incurring an injury to her dominant right arm during gymnastics.  A subsequent CT scan of the patient’s right upper extremity revealed a displaced and angulated oblique fracture of the distal humeral shaft with anterolateral displacement of the distal fragment, posterior angulation at the fracture apex and approximately 2.5 cm override of the fragments. 

The patient underwent open reduction and internal fixation (ORIF) surgery and began physical therapy three weeks post-operatively. The referring surgeon’s orders for therapy did not include a check in the box on the prescription requesting passive range of motion (PROM). Despite this, two weeks into therapy, the PT performed PROM, during which the patient stated she felt a pop and immediately complained of pain. 

The PT continued with treatment and did not advise the surgeon of the patient’s complaints. The patient’s arm swelled, and her pain intensified during the evening. She scheduled an appointment with her surgeon the following day and it was determined that she had suffered a second fracture that required an additional surgery. 

The post-operative note indicated a “fracture across the junction proximal 2/3 and distal third of the humerus, comminuted with no evidence of infection; posterior humeral plate was fractured obliquely near the central portion at the fracture site.”

Risk Management Comments

The patient/plaintiff filed a lawsuit, naming the PT. Allegations against the insured PT included:
  • Improper management of a surgical patient
  • Failure to respond to patient
  • Failure to cease physical therapy with excessive/unexpected pain
  • Failure to follow the referring practitioner’s orders
  • Failure to report patient’s condition to referring practitioner
During his deposition, the PT testified that, even if the PROM box was not checked, he did not feel that PROM was contraindicated. The surgeon’s deposition indicated that his orders were not open for interpretation and PROM was not indicated for this patient. 


The defense expert was not supportive of the insured’s care.  The expert reported that it was especially concerning that the insured continued treatment after the patient’s sudden complaint of a feeling a pop and pain. Given the defense expert’s negative opinion of the insured’s care, the decision was made to settle the case on behalf of the defendant. The total incurred to manage, defend and settle this case on behalf of the insured physical therapist totaled more than $110,000.

(Note:  Figure represents only the payments made on behalf of our registered physical therapist and do not include any payments that may have been made by the PT’s employer or payments from any co-defendants. Amounts paid on behalf of any co-defendants named in the case are not available.)

Risk Management Recommendations

  • Know and comply with state laws regarding scope of practice. PTs are responsible for knowing and understanding the regulations governing the practice of physical therapy in each state where they practice, as well as the policies and protocols of their employers and the facilities where they provide services.
  • Follow referring practitioner's orders and treatment plans. If orders are ambiguous or unclear, contact practitioner to clarify orders and document any changes and conversations with the practitioner in the PT healthcare record.
  • Before establishing a treatment plan, the PT should be aware of the patient’s pre- and post-surgical diagnoses, including the extent of the injury (e.g., grade and percentage of tear in a should) as this can significantly affect the likelihood of a re-injury.
  • Be vigilant about protecting patients from the most common types of injuries.
  • Respond immediately to any signs or symptoms of a possible fracture by determining the need for additional medical evaluation.
  • Contact the referring practitioner for any consistent patient complaints, such as pain or swelling.
This publication is intended to inform Affinity Insurance Services, Inc., customers of potential liability in their practice. This information is provided for general informational purposes only and is not intended to provide individualized guidance. All descriptions, summaries or highlights of coverage are for general informational purposes only and do not amend, alter or modify the actual terms or conditions of any insurance policy. Coverage is governed only by the terms and conditions of the relevant policy. Any references to non-Aon, AIS, NSO, HPSO websites are provided solely for convenience, and Aon, AIS, NSO and HPSO disclaims any responsibility with respect to such websites. This information is not intended to offer legal advice or to establish appropriate or acceptable standards of professional conduct. Readers should consult with a lawyer if they have specific concerns. Neither Affinity Insurance Services, Inc., HPSO, nor CNA assumes any liability for how this information is applied in practice or for the accuracy of this information.

Healthcare Providers Service Organization is a registered trade name of Affinity Insurance Services, Inc., a licensed producer in all states (TX 13695); (AR 100106022); in CA, MN, AIS Affinity Insurance Agency, Inc. (CA 0795465); in OK, AIS Affinity Insurance Services, Inc.; in CA, Aon Affinity Insurance Services, Inc., (CA 0G94493), Aon Direct Insurance Administrators and Berkely Insurance Agency and in NY, AIS Affinity Insurance Agency.