MLMIC’s most recent Case Review (Winter 2016) contains a perspective on a case with both a catastrophic outcome and serious legal and risk management deficits. The case study – involving paralysis from spinal surgery – highlights not only clear and continuous lack of communication between a variety of providers but also several failures of documentation.
The plaintiff in this case was a 44-year-old construction worker who visited the defendant, a board certified orthopedist, after twisting his neck while on a ladder at work. An MRI revealed a bulging disc at C6-7 impinging on the right neural foramen. After failed physical therapy, steroid injections, pain medications and an acute recurrence, surgical intervention was recommended. The surgical procedure was considered to be uneventful.
However, in the PACU post-surgery, the plaintiff repeatedly complained of severe pain that did not respond to medication. During the initial neurological exams while in the PACU, the patient was able to move his extremities, but within a few hours his condition deteriorated, and he could not move his extremities. The patient was returned to surgery in an attempt to decompress the spinal cord. The size of the hematoma found in this second surgery suggested that the patient had been bleeding for some time. Subsequent procedures did not prevent the accumulation of fluid and compression of the spinal cord, and the patient did not regain strength in his upper extremities and still had no feeling in his lower extremities.
Two years after the initial surgery was performed, the patient commenced a malpractice suit against the hospital and providers who had treated him, including the PACU RN, the orthopedic surgeon, his PC, the initial neurosurgeon, his PC, the anesthesiologist and the CRNA. In addition to paralysis, the plaintiff’s other injuries were also severe and alleged to be permanent in nature. Depositions, which in this case lasted for 18 months, revealed lack of communication between the PACU nurse and the orthopedic surgeon. There was also a serious lack of documentation of, and failure to co-sign, verbal orders and other alleged communication between the PACU nurse and the anesthesiologist. Further, there was some indication that documentation about neurovascular checks was inaccurate or even false.
The plaintiff’s attorney demanded $12 million to settle the case. After several months of negotiations, the litigation was finally settled for $7.6 million. Of this, $600,000 was paid on behalf of the defendant orthopedist, $750,000 on behalf of the defendant anesthesiologist and the remainder on behalf of the hospital and PACU RN. For a detailed accounting of the initial surgery, description of the plaintiff’s time in the PACU, an overview of the depositions and an explanation of why the case was settled instead of taken to trial, visit our Winter 2016 Case Review. Coverage begins on the front page and is followed by a legal and risk management perspective on the case.