Howard Smith, MD, writes about what he calls a “hypothetical” example of medical malpractice that begins in a hospital’s emergency room. An adult male, over 40 years old, presents at the ER with ulcers on both heels. He is not diabetic, but he is a smoker suffering from hypertension. A diagnosis of peripheral artery disease results in admission to “Dr. X’s” service. Dr. X is a vascular surgeon with a special interest in endovascular devices for PAD, but he happens to be out of the country. Another surgeon, “Dr. Y,” is covering. A week later, Dr. Y performs a conventional femoral popliteal bypass on the right leg, presumably, to prevent amputation. After another week, Dr. X returns to work and ends up operating on the left leg, implanting a state-of-the-art endovascular device to replace a portion of the femoral artery he determined to be blocked. Sometime later, the care team that included a vascular surgery resident, podiatrist, and a hospitalist (but neither surgeon) determined that the right leg was in jeopardy and recommended below-theknee amputation. The patient and his family requested transfer to another in-system hospital with a reputation for saving limbs. For six days, the patient is moved from ICU and then to several rooms with different care teams (hospitalists and nurses). Wound care is inconsistent, and finally the left-foot ulcers advance to the point of introducing life-threatening sepsis. The left leg is amputated, and with stump revision, becomes an above-the-knee removal. While in the rehab unit, the wound-care team discovered a possible infection in the right heel bone. The patient is finally transferred to the hospital with the limb-salvage reputation where debridement and excision successfully salvaged the right leg. This begs the question: Could the left leg have been saved if the patient were transferred sooner? Smith asks whether the amputation was an example of malpractice or just part of the background risk. Several medical plaintiff attorneys declined to represent the patient, so Smith concluded that since they work on a contingency basis, “it simply means this case is just not worth their time or effort to litigate.” [ABSTRACT FROM AUTHOR]