Hope your day has been going very well! This week, I thought it would be a great idea to inform you about a Torts case, specifically a medical negligence case. Personally, I love torts and found this to be a very interesting and engaging read. Get ready for a good read!
Plaintiff, who was a sheet metal grader and fabricator, suffered a work-related injury back in 2002 and became a patient of the Defendant Spine Clinic. Since then, he had been treated for his lower back pain. In 2008, an orthopedic surgeon, who was also a named Defendant, performed a discectomy and hemilaminectomy on the Plaintiff’s lumbar spine (lower back). The patient continued to receive narcotics, physical therapy, and spinal injections to treat his lower back condition.
Starting the summer of 2013, the Plaintiff’s condition worsened. He started to trip and fall and his overall ability to navigate himself was greatly restricted. At around this same time, the Plaintiff started to see a physician’s assistant at the Spine Clinic, who was being supervised by a physician, on a monthly basis. On all visits, the Plaintiff alleges he mentioned his worsening condition, specifically his ability to walk, function, and his gait dysfunction. Due to such conditions, the Plaintiff was caused to miss many days of work.
Around Mid-September, the Plaintiff’s condition became so bad, he started using a cane and was unable to exit/enter his car without assistance. On November 7, 2013, the Plaintiff told the physician at the Spine Clinic that he is unable to work due to his condition.
On December 11, 2013, the Plaintiff was seen by the same surgeon who operated on him back in 2008. At this time, the Plaintiff underwent a neurological examination. The findings of the exam were indicative of an, “upper motor neuron pathology and cannot be caused by a spinal condition in the lower back.”
Due to this, the surgeon ordered an MRI; however, the MRI was never taken until February 18, 2014. The MRI revealed a large lesion at the T4-T5 level (around the chest level) of the spinal cord. Thereafter, the surgeon referred the Plaintiff to a neurosurgeon in Boston.
On March 5, 2014, the Plaintiff was admitted in the ER department at the Brigham and Women’s Hospital as his symptoms were advancing. Surgery was performed the very next day and unfortunately, was unsuccessful.
Plaintiff was caused to be paralyzed from the level of T-1 down (right around where the shoulders are) of the spinal cord. Plaintiff was 54 when he became paralyzed.
In the Plaintiff’s case against the Spine Clinic, he alleged that, “The standard of care required the Defendant Spine Clinic and the supervising physician to order appropriate diagnostic testing, including thoracic MRI, in light of the Plaintiff’s clinical presentation beginning in the summer of 2013.” The Plaintiff also alleged that, “An earlier MRI and surgical intervention would have led to a much better outcome.” As well as that, “The standard of care required the Defendant orthopedic surgeon to take measures to further work up the Plaintiff and to expedite an emergency surgery as soon as he exhibited serious neurological symptoms that were inconsistent with his lumbar pathology on Dec. 11, 2013.”
The Defendants claimed that, “The Plaintiff’s clinical presentation in the summer and fall of 2013 was perfectly consistent with his longstanding lower back condition.” The Defendants also claimed that they, “Did order a thoracic MRI right away” and that the delay was due to trying to fix issues with the Plaintiff’s insurance carrier.
The case was settled at mediation, shortly before trial, for $1.5 million.
(Referenced MA Lawyers Weekly, V. 49, No. 27)
Comment Down Below Whether You Believe a Settlement of $1.5 Million Was Enough. What Field of Law Are You Interested In?
(I can find cases related to those fields and post about them.)
Great case. I do no agree with the mediation settlement. There does not appear to be any negligence on the part of the defense team. Between 2008 to 2013, plaintiff had episodes of several worsening, "trips and falls", which were intervening events that could have contributed to his deconditioned state of health. Plaintiff's clinical state was consistent with his state of health. There was nothing to "tip off" that something was serious at that time. It was also noted that plaintiff's “upper motor neuron pathology cannot be caused by a spinal condition in the lower back.” This was the medical evidence which supported the defense, as the origin of the disease was clearly noted to be on a different dermatomal plane, or portion of the thoracic area. The standard radiologic workup for ordering an MRI is not standard in the industry. There must be signs and or symptoms as well as medical insurance authorization, not (according to the fact pattern) warranted at that time.
ReplyDeleteThe plaintiff cannot reasonably predict his future medical state, nor should be able to predict future outcomes. The defendant's reasoning for further work-up with the objective medical data they had gathered determined that they were not practicing defensive medicine, or 'throwing the kitchen sink' at every diagnosis. Further work up can be unnecessary at each visit and in this case was not. I do not believe the defendants were negligent in using reasonable care.
There was a duty which was not breach and lacked a strong causation.
I concur. The defendant is in a position of being guilty until proven innocent by virtue of social bias.It significantly impeded his ability to be represented fairly and be a victim of mental trauma and stress despite doing the right thing while it takes months to decide the case. Hence, historically such cases settle so people can move on but this is not the right basis for establishing a case precedent either.
DeleteThe evidence is not sufficient to prove the patients injuries were a result of proper care. If any timely intervention was delayed, it was negligence of the insurance carrier which is not the doctors duty to discharge but he still tried. The delay caused there of might have been the cause, and to establish this we need more facts of the case.
Wow! Great reply. Your analysis of the case is very thorough and it was great to follow along and see your thought process. In terms of the delayed approval from the insurance company, I agree with you. I was speaking to a couple friends of mine who work in the medical profession and they said they are unable to perform any operations until the insurance is cleared. If that is the standard, it is out of the control of the Defendants in this case to speed up the procedure if the insurance company is the one who is slowing down the process.
DeletePrecisely. The defendants can raise the issue that, according to the American Medical Association (2019), that, “Prior authorization, a health plan cost-control process, restricts access to treatments, drugs and services”, standard within the business of health delivery that could potentially mitigate their case.
ReplyDeleteThank You for reciting the exact wording of the AMA! This give us credible information to support our findings.
Delete