Justin Hardin and David Perron secured a defense verdict in St. Louis County in a case in which the plaintiff underwent a below-the-knee amputation. The plaintiff testified she felt a “lightning strike” pain on September 11, 2019, in her groin and continuing down her left leg into her toe. The next day she was directed to the ER where the pain was diagnosed as radiating back pain. Over the next 10 days, the plaintiff testified she experienced worsening pain and additional symptoms of a vascular problem such as purple/blue-colored toes and a cold foot. She claimed she called their client, her primary care physician, to advise him of these changes, but he only directed her take a steroid medication. On September 22, the physician documented a phone conversation including only a discussion of the past ER visit, the diagnosis of radiating back pain, and her plan to see her pain management physician the next day. The primary care physician did not document any reference to earlier calls or the other symptoms described in plaintiff’s testimony. On September 23, the plaintiff saw the pain management physician who identified a possible vascular problem in plaintiff’s foot, but because he could palpate a pulse directed her to contact her PCP for further evaluation. Plaintiff left a message with the PCP’s office at 5:51 p.m. later that evening. At 8:11 a.m. on September 24, her PCP saw the message and directed plaintiff to see him “now.” When plaintiff arrived, her PCP could not feel a pulse in plaintiff’s foot and sent her directly to the ER. Despite attempts to revascularize her leg, plaintiff eventually underwent a BTK amputation. Plaintiff also introduced cellphone records, which she represented were calls to the PCP’s office bolstering her testimony concerning the undocumented (in the medical records) calls she claimed she made between September 12 and September 21. On cross-examination, plaintiff admitted the alleged “undocumented” calls to the PCP’s office came from her mother’s cellphone, who was also a patient of the PCP and who had also had a significant health concern that same week. Plaintiff also admitted the ER delayed her CTA by 24 hours because she had taken a drug, methotrexate, on September 22, which was a contraindication for any contrast study. Last, plaintiff admitted she took a photo of her toes when she began to see the color change, and that photo was time stamped more than an hour after the September 22 call with her PCP. At trial, plaintiff called an emergency medicine expert witness who testified the PCP breached the standard of care on September 22 by failing to direct the plaintiff to the ER. He testified the PCP breached the standard of care on September 23 by failing to review the 5:51 p.m. message before he went to bed, and breached the standard of care on September 24 by having the plaintiff come in for an exam instead of directing her straight to the ER. The plaintiff read the deposition of a pain management expert witness who testified the co-defendant pain management physician breached the standard of care for failing to direct the plaintiff to the ER on September 23. The plaintiff read the deposition of a vascular surgeon expert witness, who testified that “earlier is better” in treating a vascular problem and that plaintiff would have saved her leg if she had arrived at the hospital sooner. However, the witness did not appear to realize plaintiff’s CTA had been delayed because she had taken methotrexate two days earlier. The co-defendant pain management physician testified on his own behalf that plaintiff presented on September 23 with both radiating back and foot pain. He determined plaintiff’s foot complaints were related to a vascular problem, but because she had a pulse in her foot, it was not a vascular emergency. He directed her to call her PCP for further evaluation. The co-defendant called another pain management expert witness, who testified the co-defendant met the standard of care. If a patient has a palpable pedal pulse, it is not an emergent vascular threat mandating direction to the ER. The PCP testified plaintiff made no complaints about worsening foot pain or “blue” toes when plaintiff called on September 22. He had no reason on that date to suspect the ER physician had misdiagnosed a vascular problem. He denied any calls between the September 12 ER visit and the documented September 22 call, and he testified plaintiff’s Walgreens’ records did not show any prescriptions from him for steroids in that period. With regards to the September 23 call, he testified it was his policy to review calls that came in after 4 p.m. the next morning, and further, that if he did see the message, he would still have asked her to come to the office the next day to evaluate her foot. The co-defendant called a vascular surgeon expert witness, who testified he could not say that plaintiff could have avoided amputation even if she arrived at the ER a day early. The PCP called the vascular surgeon who treated plaintiff at the hospital. He testified plaintiff’s CTA, and further treatment, were delayed because of the methotrexate, and that this would have been equally as true on September 23 given plaintiff took methotrexate on September 22. He testified he could not say plaintiff’s outcome would have been better/different if she had arrived a day or even two days earlier. The PCP also called a primary care medicine expert witness who testified our PCP met the standard of care. He had no reason to suspect a vascular problem on September 22, that primary care physicians typically are unable to respond to after-hours phone messages until the next morning, and that if he had known plaintiff had a pulse on September 23 (or 22), it would have been appropriate to take exactly the same action, i.e. have her see the pain management physician on September 23 and call her in for further evaluation the next day. Plaintiff requested $4.2 million in closing. The jury deliberated for just over two hours and returned a defense verdict for both defendants.