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Delay in Hematoma Diagnosis Leads to Paralysis, $1 Million Settlement | Debary Personal Injury Attorney

Delay in Hematoma Diagnosis Leads to Paralysis, $1 Million Settlement

Patients expect that hospital staff will rotate in and out during a stay of any length of time. They expect that their medical records will be properly read and their condition noted.

What they don’t expect is to be denied vital medical care that can have major repercussions due to a mix-up among physicians and the hospital’s lack of a proper hand-off process. Because of such a mixup, this 60-year-old man is now paralyzed from the waist down.

This man underwent a skin graft revision. An epidural spinal catheter was used for anesthesia and maintained one extra day for pain control. After removal of the epidural, the man was kept on Heparin to prevent re-closure of the graft.

Four days later, the man complained of back pain and tenderness in his left groin around the catheterization site. The covering surgical attending and chief surgical resident noted positive graft pulses; no hematoma was detected.

The diagnoses the doctors considered included restenosis, retroperitoneal bleeding, or abdominal aortic aneurysm or dissection. An abdomen and pelvis CT scan noted a full bladder. After placement of a Foley catheter, the man’s severe back pain continued.

Later that day about 4 p.m., the surgical resident was notified when the man started to vomit and complain of low back pain radiating to his left groin. Four hour later, the nurse noted the man was unable to move either leg and notified the resident. The record contains no notes by the resident at this point.

At 11:30 p.m., the man’s blood pressure increased and the surgical resident contacted the intensivist (a first-year cardiology fellow), who was able to control the blood pressure with medication. Based on the man’s pain description, a head CT scan was ordered to rule out an intracranial bleed or stroke. The results were negative.

Two hours later, due to the man’s marked neurological deficits in both legs, the resident contacted the covering neurologist. Accounts differ on what happened next. The neurologist said he instructed the resident to obtain a stat spinal CT scan, call him with the results, and transfer the patient immediately to surgery if the scan revealed an epidural hematoma.

But the resident’s record indicates the neurologist advised him the man’s symptoms may be a result of a number of causes “including psychosomatic illness, Guillain-Barre, or cord compression syndromes.”

According to the resident, their plan rejected a CT scan of the spine in favor of the more optimal MRI, which was available in the morning when the neurologist planned to see the man. The resident checked with the covering surgical attending, who did not voice opposition to the plan.

Almost 10 hours later the next morning, the MRI was performed, revealing an epidural hematoma. The patient was immediately transferred for surgery, but by then suffered significant cord damage, resulting in paralysis below the waist.

The man sued the covering surgeon, the surgical resident, the covering surgeon, the intensivist, and the consulting neurologist for their significant delay in diagnosis and treatment of an epidural hematoma resulting in permanent injuries. Following mediation, this case was settled for more than $1 million against the neurologist, the surgical resident, and the attending surgeons. The intensivist was dismissed from the case.

This lawsuit was successful based on these factors:

Lack of consistent hand-off/sign-out process between doctors. Such a process could prevent complications before significant patient harm sets in, as occurred in this case. The covering surgical attending said she was not concerned about a hematoma because she did not know the patient had an epidural catheter, which would have placed him at increased risk for a neurological problem.

Lack of follow-up. The covering neurologist decided not to come to the hospital in the middle of the night. When a specialist develops a plan with a resident by phone to address a serious development and does not hear back, a follow up conversation or even a personal visit can help prevent a delay that can impact a patient’s outcome. When a patient is threatened with severe consequences, every effort must be expended to reduce risk even if that requires a visit at night from the attending surgeon.

Significant delays in response to the man’s worsening symptoms. Medical decisions must be made with concern about urgency.

Poor communication. A serious disconnect existed between what was documented and the testimony by two physicians who recall different versions of a discussion.

For more on medical safety issues, see the library of articles by Daytona Beach medical malpractice attorney.

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