Missed Vascular Injury After Ladder Fall Leads to Above-Knee Amputation and $1.25 Million Judgment

On the afternoon of June 11, 2011, Warren, then 60, was standing on a wooden stepladder outside his home in Wayne County, Indiana, fixing a gutter when a step broke. He fell, landed hard on his right knee, and heard something pop. His wife drove him to the emergency department at Reid Hospital in Richmond, where he was wheeled in unable to bear weight on the leg.

An ER nurse charted that Warren's right foot was purple in color and that she could find no manual or Doppler pulse in his right leg. Dr. Jennifer Behrens, the treating physician, gave him IV pain medication and, according to the nurse's later notes, was able to obtain a Doppler pulse herself. Over the next several hours, Warren's daughter arrived and found her father's leg swollen and his foot 'purplish' and splotchy, a condition that had not changed by the time he was discharged. Behrens ordered X-rays, consulted an orthopedist, diagnosed right calf pain from a likely muscle tear, splinted the leg from the knee down, and sent Warren home around 11:30 p.m. with instructions to follow up with the orthopedist two days later.

When the orthopedist removed the splint that Monday, he found Warren's foot cyanotic and immediately referred him to a vascular surgeon, who described the prognosis for saving the limb as guarded. Warren's family sought a second opinion at a hospital in Indianapolis, where another vascular surgeon determined the leg could not be salvaged. On June 16, 2011, five days after the fall, surgeons amputated Warren's right leg above the knee.

Warren filed a malpractice claim against Behrens and her employer, Emergency Medicine of Eastern Indiana, P.C., with the Indiana Department of Insurance in June 2013, along with a parallel lawsuit in Wayne Circuit Court. A medical review panel split in February 2019, with one physician member concluding the treatment fell below the standard of care. The case did not reach trial until September 2024, delayed in part by a dispute over a photo of Warren's discolored foot that his late wife had taken in the ED and texted to their other daughter; Warren's wife had died of breast cancer in 2013, before the photo surfaced in the litigation.

The ten-day jury trial opened September 3, 2024, before Wayne Circuit Judge April Drake. Warren and his daughter testified that his foot remained purple throughout his hours in the ED, and three medical experts told the jury that Behrens' diagnosis and treatment fell below the standard of care and contributed to the amputation. The jury returned a verdict of $3.5 million for Warren. Because Indiana law caps total malpractice recovery for care rendered in 2011 at $1.25 million, the trial court entered judgment at that capped amount.

Behrens and the medical group appealed, arguing the foot photo should never have reached the jury and that the trial court should have declared a mistrial after a juror disclosed a phone call from a friend who mentioned the case. The Indiana Court of Appeals affirmed the judgment in full on August 28, 2026, finding the photo properly authenticated through eyewitness testimony and the juror contact harmless, since the juror was immediately excused and had not shared any details with the rest of the panel.