Legal Net, Huge Settlement

Repurposed from The Scope, Third Quarter, 2026

Examination and Treatment

A 33-year-old patient was transported by EMS to the Emergency Department (ED) of a facility not insured by MLMIC Insurance Company complaining of body numbness with burning pain rated 10/10 in the arms and an inability to walk. The triage complaint was “numbness to the body, bilateral arms burning.” A triage acuity level 2 was assigned. The nurses recorded a pain level of 10 and noted that the patient’s gait was “not compromised.” Under the Past Medical History, it was documented that the patient stated, “herniated disc at C5 to C6.” The triage exam noted a Glasgow Coma Scale score of 15, but no other neurologic exam was completed by the nursing staff. It was documented that the patient had taken ibuprofen, Percocet, and Darvon prior to arrival.

After the MLMIC-insured Emergency Medicine (EM) physician’s first assessment, the NPO restriction was removed and a CT scan of the cervical spine, a 2-view CXR, and a CT scan of the head were ordered. It was noted that after a recent long-distance run, the patient developed arm neuralgia that the patient felt was related to the neck symptoms. The patient had sought and obtained chiropractic care, which was not effective. The most recent treatment was the day prior, and by that evening the patient noted a progression of symptoms to the bilateral upper extremities, with similar burning neuralgias in the lower extremities, to the point that the patient “cannot move legs or ambulate” or get comfortable.

In the Review of Systems, the EM physician noted no myalgia, muscle weakness, joint pain, or back pain, but noted under genitourinary that the patient stated, “No feeling down there.” No physical exam was recorded at that time. However, a “Late Entry Documentation” was made six days later stating that mentation was anxious, the patient was in pain and distress with “neck-tense and guarding ROM,” no masses anterior, normal skin, clear heart with regular rate and rhythm and no murmur, lungs clear, abdomen benign, and low back normal. The nurses further documented that a nurse practitioner advised the rectal tone was “intact.” Blood work was ordered, and the patient was prescribed IV fluids and Dilaudid and was catheterized. A neurology consult was requested, but no neurology consult note was made, nor was there any documentation by a provider of a discussion with the neurologist.

The cervical spine CT showed degenerative disc disease that was most severe at C5-C6 and C6-C7, with “no osseous cervical canal stenosis.” The CT of the head showed no acute intracranial abnormalities.

An MRI was ordered, but the EM physician’s shift had ended, so this physician provided no further care or treatment. The patient’s care was assumed by another MLMIC-insured EM physician, who, based on the MRI results, diagnosed spinal cord compression that resulted in paraplegia with no movement from the chest down and limited bilateral grip strength, despite spinal cord decompression and neurologic rehabilitation.

Lawsuit Filed

The patient originally commenced a lawsuit against a MLMIC-insured family practice physician and family practice entity, a non-MLMIC-insured chiropractor and chiropractic entity, a non-MLMIC insured facility and a MLMIC-insured neurosurgeon. Then, the MLMIC-insured EM physicians, the non-MLMIC-insured EM employers, and a non-MLMIC insured nurse practitioner were vouched into the action by the non-MLMIC facility. Allegations included a failure to timely diagnose and treat spinal cord compression, depriving the patient of earlier treatment and the lessening of residual damages. The chiropractor (not the chiropractic entity) sought and was granted a stay of the action, allowing the plaintiff and the chiropractor to pursue arbitration with the chiropractic defendant’s carrier regarding denial of coverage and the entire scope of the allegations in the original complaint. The plaintiff was awarded $10,745,074 in arbitration.

MLMIC’s subsequent efforts to prevent the plaintiff from seeking further damages and to obtain a setoff failed. Eventually, all the non-chiropractic defendants were dismissed from the action, except for the first EM physician (the first ED provider), that physician’s non-MLMIC employer, and the non-MLMIC facility.

MLMIC’s expert reviewers opined that the EM physician failed to perform or document a thorough neurologic exam, insist upon an emergent MRI, and call a neurosurgeon when the MRI was delayed, as the physician did not recognize the extent of the patient’s symptoms, specifically the paralysis. The expert reviewers further opined that the chiropractor and the facility were negligent for failing to document a neurological exam other than the Glasgow Coma Scale, for allowing the long delay in obtaining the MRI, and for having the neurosurgical call handled by an orthopedic surgeon who was not a spine surgeon.

The case was ultimately settled for very high dollar amounts paid by MLMIC, the EM physician’s primary insurance carrier, and the EM physician’s excess insurance carrier. An additional large amount was paid on behalf of the insurance carrier for the EM physician’s employer.

A Legal and Risk Management Analysis

Delayed diagnosis of spinal cord compression is a common allegation in malpractice cases, especially since it can result in permanent neurological injuries, as was the case here. However, this case proved to be more than a typical delayed diagnosis case and provides pertinent legal and risk management lessons for healthcare professionals. The lawsuit that followed is a valuable case study not only on medical issues but also on complications that often surround medical malpractice cases.

Unique Challenges

Inadequate documentation was a prominent issue in this case. Experts retained by the defense took note of the fact that the EM physician failed to perform or document a thorough neurologic exam. Adequate documentation is indispensable when defending a medical malpractice action. If critical information or neurological findings are omitted, it would be extremely difficult to prove to a jury that adequate care was provided. No savvy plaintiff’s attorney will forego the opportunity to discredit treatment based on inadequate documentation.

Expert reviewers also noted that there was unnecessary delay by the EM physician in ordering an emergency MRI and consulting with a neurosurgeon. Such a delay in ordering diagnostic imaging and consulting with the appropriate specialist can, as here, result in life altering neurological injuries. The expert reviewers also criticized the neurosurgical decisions being handled by an orthopedic surgeon rather than a spine surgeon. Taken together, these factors would indicate to a jury that the plaintiff’s neurological symptoms were not taken as seriously as they should have been.

While this case involved multiple medical and documentation issues, what makes it unique are the complex litigation issues that arose during the lawsuit. As additional healthcare providers and entities were brought into the lawsuit, the defendants argued that another party was responsible for the plaintiff’s injuries. Further, each defendant is typically represented by their own counsel, who will offer different explanations of what occurred and who is at fault. The case also involved an insurance coverage dispute, adding to the complications and making it more complex than a typical malpractice action. Such cases become complicated for a jury, especially when it comes to allocating fault.

In addition, the more parties there are in a case, the slower it will proceed. The fact that the case was stayed to resolve an insurance coverage issue delayed its final resolution. The plaintiff’s attorneys, who work on a contingency fee basis, would also accrue more expenses as the case drags on and would have to wait longer to receive compensation. Insurance companies that are financing the defense attorneys would also incur high litigation costs.

The unpredictability of how a jury will rule also played a role in the parties' strategy. While certain venues and jurisdictions are known to have proplaintiff or pro-defendant juries, no attorney can accurately predict which way a jury will lean, and this is often an impetus for both parties to settle.

Lessons Learned

This case is a powerful reminder of how clinical judgment, timely diagnostic evaluation, and adequate documentation not only affect patient outcomes but also can change the direction of a lawsuit. Beyond medical issues, however, defending medical malpractice cases can be a complicated ordeal. Accordingly, cases such as this one illustrate the importance of having a competent and experienced legal and risk management team by your side. Our team here at MLMIC is well-versed in all aspects of medical malpractice litigation. Whether you are facing a lawsuit or need advice on another issue, our team of experts is available to help you with any challenges that may arise.

MLMIC policyholders can reach out to our healthcare attorneys for questions about documentation, or any other healthcare law inquiries by calling (877) 426-9555 Monday-Friday, 8 a.m.-6 p.m. or by email here.

Our 24/7 hotline is also available for urgent matters after hours at (877) 426-9555 or by emailing hotline@tmglawny.com.

Follow us on Facebook, LinkedIn, Instagram or Twitter to stay in the loop about the medical professional liability industry.

If you are not already a MLMIC insured, learn more about us here.

This document is for general purposes only and should not be construed as medical, dental or legal advice. This document is not comprehensive and does not cover all possible factual circumstances. Because the facts applicable to your situation may vary, or the laws applicable in your jurisdiction may differ, please contact your attorney or other professional advisors for any questions related to legal, medical, dental or professional obligations, the applicable state or federal laws or other professional questions.