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- MEDICAL MALPRACTICE - FAILURE TO TIMELY DIAGNOSE AND TREAT SUBDURAL HEMATOMA IN ELDERLY MALE - SEVERE COGNITIVE DEFICIT AND SOME MOTOR IMPAIRMENT.

Los Angeles County, California (29355)

This was a medical negligence action brought by the 75-year-old plaintiff, who allegedly suffered brain damage with permanent cognitive and motor impairment as a result of a chronic subdural hematoma which he alleged the defendant physicians failed to timely diagnose and treat. The plaintiff contended that timely diagnosis and treatment would have, in all probability, prevented or minimized the damage caused by the hematoma. The plaintiff presently suffers from severe cognitive deficit and some motor impairment.

The plaintiff was 74 years old on May 19, ________, when he presented to the defendant internist/pulmonologist complaining of a bi- frontal headache which had begun approximately May 4, ________. The plaintiff had no history of trauma nor was he exhibiting any neurological symptoms in conjunction with the headaches, and the defendant internist/pulmonologist diagnosed tension headache, scheduled the plaintiff for dopler cerebral vascular blood flow studies for May 27 to rule out stroke, and discharged the plaintiff with instructions to follow up if his symptoms persisted, or worsened. On May 23, the plaintiff presented to Gallicare, the urgent-care, after-hours clinic of the Gallatin Medical Group, where he was seen by the co-defendant family practitioner. The plaintiff, during that visit, exhibited the same complaints of bi-frontal headache. The co-defendant found no neurologic signs upon examination and prescribed a mild narcotic to be used for relief of pain. The co-defendant advised the plaintiff to present to the Downey Hospital Emergency room if the symptoms persisted or became worse, and further advised that he follow up with his regular physician, the defendant internist/pulmonologist, on Tuesday, May 26, the day after Memorial Day.

On Memorial Day, May 25, the plaintiff presented to the Downey Community Hospital emergency room and was seen by the co- defendant emergentologist/family practitioner. The plaintiff’s complaints at this time were essentially the same with the exception that his headaches had become worse. This co-defendant examined the plaintiff and found no neurologic signs of any kind.

The co-defendant emergentologist maintained that the plaintiff mistakenly informed him that he was to have an MRI on May 27. The co-defendant diagnosed headache of unknown etiology and further stated that he could exclude a possible intracranial lesion, specifically a tumor. The co-defendant contended that the differential diagnosis was made on the basis of information given to him by the plaintiff that an MRI was scheduled. The evidence indicated that the co-defendant emergentologist consulted with the on-call physician for the Gallatin Medical Group who concurred in the co-defendant’s assessment and his plan to have the plaintiff see his regular physician, the defendant, the next morning and to have the MRI as scheduled on May 27.

On May 26, the plaintiff presented to the defendant internist/pulmonologist with continuing complaints of headaches and the additional finding of drowsiness. The defendant then referred the plaintiff to Downey Community Hospital for a CAT Scan which showed the presence of a large chronic subdural hematoma in the left temporal region. The defendant called in the co-defendant neurosurgeon for consultation. The co-defendant neurosurgeon performed a work-up on the plaintiff between May 26 and 11:00 a.m. May 28, at which time he evacuated the subdural hematoma. The plaintiff bled again on May 29 and a second craniotomy was performed by the co-defendant neurosurgeon. The plaintiff bled once again on June second, at which time a third craniotomy was performed by the co-defendant neurosurgeon.

The plaintiff’s medical experts testified that the defendants deviated in failing to timely diagnose the subdural hematoma. The plaintiff’s experts maintained that given the unusual nature of the plaintiff’s complaints, namely, the severity and duration of the headache, a CT scan should have been ordered when the plaintiff first presented to the defendant internist/pulmonologist on May 19, ________ and each time thereafter that he presented exhibiting similar complaints. As against the co-defendant neurosurgeon, the plaintiff contended that he unnecessarily delayed surgery for almost two days. The plaintiff asserted that the defendants’ failure to timely diagnose and treat the plaintiff’s condition permitted brain damage to occur and progress due to increasing pressure continually exerted by the subdural hematoma.

The defendant physicians denied negligence and asserted that the plaintiff did not exhibit any of the classical signs associated with chronic subdural hematoma, which usually presents with unilateral rather than bilateral headache and with a history of trauma, both of which were absent in this situation. In addition, the plaintiff did not exhibit one or more of the other signs commonly associated with subdural hematomas, including drowsiness, dizziness, stupor, coma, hemiparesis and visual disturbance. The defendants maintained that their diagnoses and advisements were well within the standard of care and that no CT scan was indicated nor was consultation with a neurologist warranted given the symptoms exhibited.

The co-defendant neurologist’s defense was predicated on the fact that the two-day delay was warranted for further work-up and an additional brain scan to determine more definitive information.

All the defendants alleged that the delay in diagnosis and surgery was not the proximate cause of the damage suffered by the plaintiff since the subdural hematoma had undoubtedly been present for a period of four to eight weeks prior to his first presenting to a physician. It was further alleged by the defendants that the plaintiff’s present condition is a result of a combination of factors: small vessel cerebral artery disease; four subsequent hospitalizations for fever of unknown origin, pneumonia, and urinary tract infections; the presence of the three subdural hematomas, including the initial chronic bleed and the two acute bleeds suffered in the hospital; the craniotomies to evacuate the hematomas; on-going seizure activity; and the inevitable and inexorable ravages of growing older.

The plaintiff’s initial demand for settlement was $________ reduced to $________ just prior to trial. At trial, the plaintiff asked the jury for $________. No offer was tendered by the defendants. The jury found for the defendants. Plaintiff’s expert neurosurgeon: Theodore Kurze from N.Y.C. Plaintiff’s expert neurologist: Stanley van den Noort from University of California at Irvine. Plaintiff’s expert neuropsychologist: Fred Wise from Kirkland, Wa. Plaintiff’s expert family practitioner/emergentologist: Michael Fox from San Francisco Bay Area. Expert witnesses for defendant internist/pulmonologist, co- defendant family practitioner, and co-defendant Gallatin Medical Group: Ivar Szper, neurosurgeon, from Long Beach, Ca. and Roy Herndon, internist from Orange, Ca. Expert witness for co- defendant neurosurgeon: John Garner, neurosurgeon from Pasadena, Ca. Expert witnesses for defendant Downey Community Hospital and defendant emergentologist/family practitioner: Stanley Kalter, emergentologist from Pasadena, Ca. and H. Ronald Fisk, neurologist from Beverly Hills. Christianson vs. Buchfuhrer, et al. Case no. SOC ________; Judge Betty Jo Sheldon, 11-1-88.

Attorneys for plaintiff: Raymond L. Turchin of Glendale, Ca., William Brody and Jeanne Steffin, both of Los Angeles; Attorney for defendants Gallatin Medical Center, Gallicare, internist/pulmonologist and family practitioner: Marshall Silberberg of Baker, Silberberg & Keener in Santa Monica, Ca.; Attorney for defendant neurosurgeon: George E. Peterson of Bonne, Jones, Bridges, Mueller, O’Keefe & Hunt in Los Angeles; Attorney for defendants Downey Community Hospital and emergentologist/family practitioner: C. Snyder Patin of Veatch, Carlson, Grogan & Nelson in Orange, Ca.