ARTICLE ID 33274
$________ - MEDICAL MALPRACTICE - FAILURE TO RETURN POST-LAMINECTOMY PATIENT TO BED UPON SIGNS OF EXHAUSTION - FAILURE TO REPLACE CERVICAL COLLAR - SEVERE SPINAL CORD INJURY - QUADRIPARESIS.
Kings County
This was an action involving a male plaintiff, age 24 at the time
of the deviation, who had suffered brain damage which had
affected his ability to ambulate four years earlier as a result
of a self induced overdose of Quaaludes, Methadone and alcohol at
a New Years Eve. The plaintiff, who was admitted for a triple
laminectomy and the removal of scar tissue in the cervical cord
which was causing extensive pain, contended that although the
surgery was performed very well, the defendant surgeon
negligently failed to replace the cervical collar after examining
him five days post-surgery. The plaintiff also contended that
despite written orders that the collar be utilized, the nurses
failed to replace it. The plaintiff contended that four days
later, when he was out of bed without the collar, he developed
signs of a drop in blood pressure and that although a nurse noted
it, she did not return him to bed. The plaintiff contended that
he suffered a flexion injury after his head precipitously dropped
forward when he fainted as he was sitting in a chair and that the
combination of the alleged flexion injury and loss of blood
pressure itself culminated in an infarct to the cord which caused
quadriparesis and which will permanently restrict the plaintiff
to a wheelchair, leaving his already limited arm and hand
strength much more restricted and occasioning the need for 24
hour per day care.
The plaintiff maintained that prior to the hospitalization in
question, he was able to ambulate slowly with a cane and required
a wheelchair only upon more rapid or extended walking. The
plaintiff, who had undergone a number of prior surgeries after
the overdose, had an electrical stimulation device implanted into
the cervical area approximately one year earlier in order to
block pain. The plaintiff contended that although properly
performed, the implant was not successful and that he also
developed scar tissue, prompting the subject hospitalization. The
plaintiff had no criticisms of the subject surgery which included
a triple laminectomy and the excision of scar tissue.
The plaintiff contended that over the approximate five day period
following the surgery, he was improving and regaining more
function in the upper and lower extremities. The records of the
operating physician reflected that the family was pleased and
that the physician was hopeful for significant, further
improvement. The plaintiff maintained that during an examination
five days after the surgery, the physician removed the cervical
collar and failed to replace it. The plaintiff contended that the
collar was not replaced over the ensuing four day period. The
plaintiff essentially remained in bed during this four day
period and there was no claim that any injury was sustained
during this time. The plaintiff asserted, however, that he was
out of bed for an extended period on the fifth day without the
collar. The plaintiff maintained that after a long bowel
movement, he felt exhausted, and advised the nurse that he wished
to return to bed. The plaintiffs expert neurologists contended
that such exhaustion was probably a precursor to a drop in blood
pressure. The plaintiff maintained that the nurse advised him to
first finish breakfast while sitting in a chair. The plaintiff
contended that as he was doing so, he felt faint, that his head
slumped forward and that he was found in an unconscious state by
the defendant neurosurgeon.
The plaintiffs expert neurologists maintained that the defendant
physician deviated in failing to replace the collar and that the
nurses deviated in failing to do so over the next several day
period, especially since there were orders in the records for the
plaintiff to wear such a collar. The plaintiff had also named the
neurologist who had obtained the defendant neurosurgeon as a
defendant, contending that she was also monitoring the patient
and should have replaced the collar. This aspect settled prior
to trial for $________.
The plaintiff additionally contended that the nurses should have
replaced the collar. The plaintiff asserted that when he asked
the nurse if he should to return to bed when he became exhausted,
she should have helped him back to bed. The plaintiff contended
that as he was eating breakfast, he became very diaphoretic
(cold, sweaty and clammy) and that the nurse, who was walking by
his room, observed such a condition. The plaintiff maintained
that such diaphoresis was an emergent situation and a precursor
to his fainting. The plaintiff contended that the nurse, who
noted such a diaphoretic condition, should have treated it as an
emergency. The plaintiff asserted that if he had been immediately
returned to bed upon developing such symptoms, the blood
pressure would have returned to normal and that catastrophic
event averted.
The defendant non-settling neurosurgeon questioned if the patient
had been without a collar for this period. The nurses contended
even that if the collar was missing, they had not deviated. The
nurses contended that the doctors were present during each of the
subsequent examinations and that their conduct and deeds in not
replacing it had, in affect, countermanded the written orders.
The nursing records contained no mention of the collar being
present after the time the plaintiff contended it had been
removed.
The defendants denied that any portion of the care resulted in
the spinal cord difficulties. The defendants contended the
plaintiff developed a blood clot which was a normal risk of the
surgery and which caused any spinal cord damage. The defendant
also contended that the chest would prevent the head from flexing
sufficiently to cause such injury. The plaintiff countered that
even if such flexion injury had not occurred, it was clear from
the incident of fainting that the plaintiff suffered a severe
loss of blood pressure which in turn resulted in the loss of
blood supply to the cord and additional neurological insult. The
plaintiff elicited testimony from the nurse who had advised him
to finish breakfast while sitting in a chair that when she saw
the patient approximately 1/2 hour before he was found
unconscious, he was, in fact, diaphoretic. The plaintiff
contended that in view of this concession and the fact that the
plaintiff was found unconscious 1/2 hour later, the plaintiffs
position should be accepted and the defense contention that a
mere normal risk of the surgery had occurred should be rejected.
The plaintiff contended that when the blood pressure was taken
after he was returned to bed, it remained low and argued that it
was clear that before he was placed in bed, it was particularly
low.
The plaintiff contended that before he had entered the hospital
for the subject surgery, he had approximately 70% of his physical
functioning. The plaintiff maintained that his prior limitation
of the upper extremities were only moderate. The plaintiff
contended that he now suffers quadriparesis and is confined to a
wheelchair which must be pushed by another individual. The
plaintiff maintained that it remains to be seen if he will be
able to gather sufficient strength to even use an electric
wheelchair by himself.
The defendants asserted that the plaintiffs condition before he
entered the hospital was much worse than claimed and that he was
only functioning at an approximate 40% level of normal. The
defendant contended that the plaintiff had required a wheelchair
at all times. The prior records contained contradictory entries
regarding this issue and other questions regarding his overall
prior condition. The plaintiff introduced a videotape taken
approximately two years earlier in conjunction with treatment
which depicted him walking with the cane and using his arms. The
defendants contended that the brain damage caused by the earlier
overdose had resulted in a progressive deterioration of the
plaintiffs symptoms and that he was in a much worse condition
when admitted for the subject hospitalization. The plaintiff
denied that this position was accurate and further contended that
the any deficits occurring from the overdose would not continue
to deteriorate, arguing that he was no worse when admitted for
the subject hospitalization than he was on the videotape taken
two years earlier.
The plaintiff maintained that he will require 24 hour a day home
care because of his inability to ambulate and other anticipated
complications. The plaintiff maintained that the costs of such
care will approach $________. The plaintiff made no wage claims.
The jury found the non-settling physician 5% negligent and the
settling physician 5% culpable. They also found the hospital
negligent for failing to follow doctors orders, for failing to
put him back to bed when requested, and for failing to declare
an emergency when the nurse observed that he was diaphoretic
while sitting in the chair. They then awarded $________,
including $________ for past costs of care, $________ for past
pain and suffering, $________ for future costs of care and
$________ over 34 years for future pain and suffering.
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