Well, in what seems like another lifetime, I worked at Tulane for four (4) years on a floor that included orthopedics, plastics to pay my way through school...

Then worked for five years in Managed Healthcare (HMO, PPO, TPA) writing dBase tables for everything from benefits, membership, claims adjudication, sales/commissions, and member service documentation and management, etc...

There are days I wished I didn't know all I knew from those nine years, especially when I'm with family or close friends at the Phys office, Urgernt Care, CCU, SICU, etc or realizing a claims processing choice that screws the patient and I recognize the same song or rodeo or dog & pony show bullshinski I learned of then...

Guido is exactly right that most doctors and the business directors of those PHOs (Physican Hospital Organizations) heavily influence the decision making to lean to the idea of do no more harm than good, limiting liability, exposure...

It's easier from a legal defensive point to say we did nothing and only be limited to damages for doing nothing than to risk invasive procedures by doing thus and still no improvement and being second guessed later why a number of other options were not used...

However, in the case of Max Unger, firmly believe in my gut the Ochsner Docs were covering their collective arses rather than processing all factors including my earlier point...

...around that rather simple human arch system he has is a super human amount of flesh and muscle and that that his bearing weight of 300+ lbs alone was more than his arch could bear in its injured state...

I worked with some Docs 25+ years ago who's names have sometimes been in the news these past years with regards to high profile athletes and injuries and I know they'd advised the stabilization of the Lisfranc injury as soon as trauma and inflammation had reduced for Sx...