Orthopedic surgeon Milan Moore, MD, of Auburn, Wash., was not clinically negligent in his treatment of a patient who developed an infection following an ACL repair, but a jury decided he's on the hook for $150,000 because he should have been more forthcoming about a positive culture result, no matter how scant the trace of bacteria.

According to court records, Robert Gomez suffered a medial meniscal tear of his ACL while playing basketball at his local YMCA. Soon after an ACL reconstruction with hamstring autograft performed by Dr. Moore, the 28-year-old began to develop symptoms of a post-op infection at the scar where the hamstring tendon was taken, says Dr. Moore's attorney, Steven Fitzer.

About a month after the ligament repair, Mr. Gomez underwent a second procedure to clean the wound and eliminate the potential for infection. Cultures taken during that procedure tested positive for E. coli, say court documents.

During the second of 2 follow-up office visits, Dr. Moore took a culture at the wound site and told Mr. Gomez that he would refer him to an infectious disease specialist if the results came back positive for E. Coli. The culture came back positive, but Dr. Moore did not alert Mr. Gomez. Court documents show Dr. Moore claimed there were no clinical signs of infection and the culture showed only "scant growth" at 30 days - after several intermediate results came back negative - which he says was not clear evidence of an infection.

"In medical terms, 'scant growth' is no big deal," says Mr. Fitzer. "If there had been an intermediate return of bacteria, that would have been something to worry about." He says Mr. Gomez called Dr. Moore's office to tell him he would not be keeping a subsequent follow-up appointment because his knee felt fine.

Mr. Gomez, however, eventually returned when additional drainage appeared around the graft wound. Dr. Moore examined Mr. Gomez's right tibia near the harvest site. He determined that bacteria may have adhered to the tibia screw and decided to remove the hardware he implanted during the initial ligament repair.

Upon removing the hardware, Dr. Moore found what appeared to be infected tissue under the spiked washer that secured the hamstring graft in place. A culture confirmed heavy growth of E.coli on the tissue, according to court documents. After the hardware was removed, Mr. Gomez sought treatment from another orthopedic surgeon, who diagnosed him with osteonecrosis of the knee and suggested he undergo a total knee replacement, which he eventually did.

"In trial we were able to demonstrate that in all probability the knee cartilage died as a result of necrosis unrelated to any infection," says Mr. Fitzer. "There was never an infection in the knee joint."

Mr. Fitzer says the jury felt Dr. Moore treated Mr. Gomez properly, but ruled he should have shared the "scant" positive culture so Mr. Gomez could decide for himself what to do with the information. "We won the big battle, but ended up losing the war on a little claim no one thought had much traction."

Mr. Gomez's attorney did not respond to a request for comment.

Daniel Cook