The PT works in an outpatient clinic. The patient is a 62 year old female and is 4 weeks post bilateral total knee replacement. The patient is seen by the PT for initial physical therapy evaluation and treatment.During the evaluation, the patient was placed on a recumbent bike for 10 minutes and while getting off, she had a problem clearing the right leg over the equipment to dismount and fell. The fall caused a re-tear to her tendon requiring surgical repair. The patient claims that she told the PT that she needed help getting off the bike because her legs felt weak. When the patient exited the bike, the PT was standing on the opposite side of the bike. The PT did not assist the patient off the bike. The patient claims that she lost her balance and struck her left leg against the floor with enough force to rupture the left quadriceps tendon.Patient relates that it took two individuals to assist her into a wheelchair since she was unable to stand. The lawsuit complaint states in part that "assistance was required for plaintiff to safely exit the bike and that she should have been wearing a gait belt.The PT was unable to assist because she was not positioned on the side of the bike that the patient was dismounting and if she had been there, the Plaintiff would not have fallen." The PT denied that the patient ever requested assistance in getting off the bike and had walked into the facility with the assistance of a single point cane. Prior to getting on the bike, the patient walked around the facility with and without use of the cane independently.

7 According to the PT, the patient's right leg did catch on the bike frame causing the left knee to flex but that the patient did not hit the ground. A video of the incident showed the PT quickly hooking her arm under the patient's arm pits and helping the patient stand back up with minimal assistance. The video did show that the patient had looked fatigued (lowered her head to her hands) before trying to get off the bike, that the patient and PT had some sort of dialogue, and that the patient appeared to have difficulty lifting her right leg high enough to clear the bike frame.The video captured the patient fall to the left but it is not clear whether or not the patient hit the ground. As the PT was assisting the patient back down to sitting on the bike, a student PT assisted the patient off the bike. It looked like the student PT helped push the right leg over the bike. The patient was given a walker and she ambulated a few steps without assistance.After about 10 steps, the patient appeared to have trouble taking steps and her balance worsened. The PT student got the patient a chair and as the patient was sitting the patient passed out. After several minutes, the patient was transferred into a wheelchair and her spouse took her home. The following day, the patient called her orthopedic surgeon due to pain in her left leg. An MRI confirmed a full thickness tear of the distal left quadricepstendon of 3.5 cm above the patellar insertion. A repair of the left distal quadriceps was performed, and the patient experienced a good recovery. Complications included arthrofibrosis of the right knee with limitations of range of motion that required manipulation under anesthesia, soft leg cast for left leg x 10 weeks, DVT that required a vein filter inserted to avoid development of scar tissue locking the knee, and eventually a left knee manipulation under anesthesia. The patient's ability to ambulate without discomfort was limited post all procedures and she was unable to resume prior employment that required her to kneel, squat, reach low places, and to work in environments where there exists a danger of tripping. She could only flex the knee to 90 degrees. Lifestyle changes resulted from inability to flex the knee enough to sit on a plane to travel, or sit in a theater or movie seat. The patient used to enjoy long walks but unable to walk very far. The surgeon gave the patient a permanent disability rating and declared the patient unable to resume her former employment as a manager in a large department store. You work for the PT's insurance company and must assess the claim for indemnity (settlement) or trial. The Plaintiff's through her attorney is seeking no less than $2,000,000 in damages. As the insurer, what recommendations will you make to the insurance company and to your client, the PT? Do you want to settle the case? The Plaintiff is looking for damages in excess of $2,000,000.00. If you believe it best to settle the case, at what amount of damages?If not settle, do you want to take this case to trial before a jury? What are the advantages and disadvantages of a jury trial?