$________ - MEDICAL MALPRACTICE - FAILURE TO APPRECIATE SIGNS OF IMPENDING SUBARACHNOID HEMORRHAGE AND RUPTURED ANEURYSM - SEVERE BRAIN DAMAGE SUFFERED BY 23-YEAR-OLD MALE - QUADRIPLEGIA.

Kings County

This was a medical malpractice action in which the male plaintiff in his early 20s contended that the defendant hospital’s nurses and physicians negligently failed to consider a rupture of a cerebral aneurysm and subarachnoid hemorrhage as a differential diagnosis when the plaintiff presented with the sudden onset of mid-back pain radiating to the head and vomiting which commenced approximate 45 minutes later. The plaintiff contended that the initial symptoms were probably a "Sentinel bleed" that would not be catastrophic and which provided warnings of an impending "Blow out" bleed. The plaintiff maintained that an immediate CAT scan should have been ordered which would have shown an expanding mass requiring immediate evacuation and that until surgery could be commenced, medication to control the blood pressure and reduce brain swelling, expanding the window of opportunity for surgical intervention, should have been administered. The plaintiff contended that as a results of the defendants’ deviations in this regard, he suffered a catastrophic blow-out bleed approximately 3 1/2 hours after presenting to the hospital, sustaining severe brain damage which has left him quadriplegic and unable to talk.

The plaintiff contended that although the brain damage left him with a severe impairment of his intellectual, emotional and cognitive abilities, he does have a level of awareness which is sufficient to reflect pain and suffering and a loss of enjoyment of life. The plaintiff is unmarried.

The evidence disclosed that the plaintiff had been a mechanic in the employ of an elevator maintenance company and had been assigned to work at the defendant hospital. The plaintiff contended that while he was working near the emergency room at about 11:30 A.M., he experienced sudden, severe back pain which radiated up to his head and that he reported these symptoms to a triage nurse. The plaintiff’s expert neurologist related the cerebral spinal fluid circulates through the entire subarachnoid space from the brain down along spinal cord and contended that the radiating pain from the back to the head was caused by the irritation of the blood in the cerebral fluid.

The plaintiff maintained that the sudden onset of back pain radiating to the head, causing severe headache, is a classic sign of a subarachnoid hemorrhage and that in view of the absence of any prior history of headaches which could account for these symptoms, the triage nurse should have summoned a resident immediately. The plaintiff further contended that once vomiting commenced, it was particularly clear that an ominous event was occurring.

The plaintiff further contended that the resident, whom the plaintiff contended was summoned prior to 1:30 P.M., failed to appreciate the critical nature of the plaintiff’s situation. The plaintiff contended that a CAT scan was not ordered until after the blow-out occurred and that no preparations for surgery had been made or medication given to reduce blood pressure until 4:30 P.M., after the plaintiff had already suffered the catastrophic blow-out and slipped into a coma.

The plaintiff contended through two co-workers, including his bother, who were with him during a portion of this time that during the afternoon, his condition appeared to deteriorate and that he became progressively weaker. The plaintiff’s experts neurologist, emergency room physician and neurosurgeon each maintained that it was clear that the bleed was expanding and that the emergent nature of the condition continued to heighten until the blow-out occurred between 3:00 and 3:30 P.M.

The defendant triage nurse contended that when the plaintiff presented at 11:40 A.M., he advised of "Pressure" on his back only and denied that he complained of severe pain, headache or vomiting until shortly before the nurse went on break at 1:10 P.M. and was relieved by another nurse. There was no evidence as to the identity of this subsequent nurse. The initial nurse contended that she gave the history to the relieving nurse, but conceded that she did not advise her to summon a physician. The plaintiff maintained that the initial triage nurse’s notes reflected a finding of headache at 12:30 and contended that in view of this factor, the triage nurse’s testimony should be rejected. The plaintiff further maintained that the history taken by the resident from the patient reflected that the back pain which radiated to the head had commenced at 11:40. The plaintiff contended that it was clear that the defendant’s personnel failed to recognize the emergent nature of the plaintiff’s symptoms and take appropriate action.

The defendant contended that the standard of care would permit the physicians to wait 24 hours to stabilize a patient before performing surgery, contending that the chances of a blow-out occurring within this period are relatively small and that the benefits of stabilizing the patient are great. The plaintiff countered that if the defendant’s staff had recognized the emergency and conducted appropriate testing including a timely CAT scan, they would have ascertained that the plaintiff was suffering from an expanding mass and that immediate evacuation was necessary. The plaintiff further contended that the defendant’s staff failed to take any steps to expand the window of opportunity, such as giving medication to control blood pressure, and contended that in view of this factor, its contention that it was acceptable to wait 24 hours should be strongly rejected. The plaintiff’s experts related that it is essential to control blood pressure after a sentinel bleed because the weakness in the vessel would render it less able to withstand higher blood pressure. The plaintiff’s experts further contended that had the resident ordered such medication and arranged for surgery when first advised of the situation, it was very likely that a repair could have been performed in sufficient time to avert the catastrophic event.

The plaintiff maintained that the triage nurse’s notes reflected that the resident was summoned at prior to 1:30 P.M. The resident contended that he was not brought into the case until 2:05 P.M., pointing to his records to support this position. The plaintiff contended that the discrepancy in the records regarding the time at which the resident first saw the patient rendered the defendant hospital’s position suspect. The plaintiff also contended that although the resident indicated that he had discussions with the attending physician, the attending physician’s EBT reflected that she had no recollection of this case. The plaintiff maintained that in view of the tragic nature of the case, it was very surprising that the attending physician could not recall the case. The plaintiff argued that either the defendant resident’s contentions that he had such a conversation with the attending was inaccurate, or that the attending’s denial of having a recollection of such a conversation with the attending was untrue, arguing that the defendant’s position was suspect in either case.

The defendant further maintained that an angiogram, which the defendant contended would take several hours to complete, should be conducted prior to surgery in order to provide a surgical "road map" to the aneurysm. The plaintiff contended that the CAT scan report reflected the area of the aneurysm and contended that this "map" was sufficient. The plaintiff further contended that after the blow-out occurred, the defendant immediately performed surgery without the use of an angiogram and maintained that the defendant’s contentions in this regard should be rejected.

The plaintiff contended that when the blow-out occurred, he suffered catastrophic brain damage which has left him quadriplegic and unable to talk. The plaintiff maintained that although the brain damage was severe, the plaintiff has the capacity for some awareness and the plaintiff made a claim for pain and suffering and loss of enjoyment of life. The defendant denied that the plaintiff has the capacity to experience pain and suffering or a loss of enjoyment of life. The plaintiff’s mother testified that when she spoke of the plaintiff’s father’s death, which occurred after the hemorrhage, the plaintiff appeared to cry and that he cries when he experiences pain. The plaintiff also contended that the jury could determine from a day-in-the-life video that the plaintiff did, in fact, have some awareness. In the video, a nurse’s aide initially brushed the plaintiff’s teeth and he gave no resistance. The plaintiff contended that the jury could observe that when the aide returned moments later with a different instrument to do more detailed flossing type work between the teeth, the plaintiff closed his lips tightly in an apparent attempt to prevent the nurse’s aide from continuing.

The plaintiff also contended through the plaintiff’s life care planner that the plaintiff, who is fed through a tube, will require permanent round-the-clock care and the plaintiff’s economist discussed approximately $________ in economic damages, including the cost of care and loss of income and benefits.

The jury found for the plaintiff and awarded $________, including $________ for past pain and suffering and loss of enjoyment of life, $________ for past lost earnings, $________ for future lost earnings, and $________ for future costs of care.