Security Guard Loses Leg After ER Dismisses Artery Injury as Knee Strain: $5.2 Million Verdict

On December 3, 2009, Kevin Tolson, a 49-year-old security guard, was walking across a collapsible vehicle barrier at a federal building in Baltimore when a colleague accidentally triggered it in emergency mode. The barrier shot upward, entangling his left leg and dislocating his knee. He was taken by ambulance to Saint Agnes Hospital.

In the emergency room, a physician assistant and an ER physician ordered X-rays, found no fracture, and diagnosed a knee strain. Tolson was discharged roughly two hours after arriving, with instructions to follow up with an orthopedic surgeon. At no point did the clinical team evaluate the popliteal artery, the main vessel supplying blood to the lower leg, even though a dislocated knee is a recognized warning sign for arterial injury.

Tolson went home. Over the next two days, his left foot turned cold and lost sensation. A doctor he saw on December 5 found no pulse in the leg and sent him back to Saint Agnes. A vascular surgeon performed a 13-hour emergency operation in an attempt to save the limb, but the tissue was already dead from two days without adequate blood flow. Tolson was transferred to the University of Maryland Medical Center, where surgeons first amputated his foot, then, when that failed to halt the damage, amputated the leg above the knee. He had previously worked two security jobs; after the amputation he could maintain only one.

Laura Zois and Rodney Gaston of Miller and Zois argued that the standard of care requires emergency clinicians to rule out popliteal artery injury whenever a knee dislocation is suspected, even if the joint has spontaneously reduced, because early vascular imaging can prevent exactly this outcome. The defense, represented by Robert Bouse and Gregory VanGeison of Anderson, Coe and King, contested the standard and the causal chain.

After an eight-day trial before Judge Stephen Sfekas, the jury deliberated for about two hours before returning a unanimous verdict of $5.2 million. While the jury was still out, the parties had executed a high-low agreement: Tolson would receive no less than $750,000 and no more than $1.5 million regardless of the verdict, and neither side would appeal. Because the verdict exceeded the cap, Tolson recovered $1.5 million, the high of the agreement.