Woman wins $10M suit over epidural hematoma

[drrosenrosen]

The time course on this sounds very weird. She had an ESI and had numbness in the legs immediately after (don't put local in your epidurals, kids!). She was monitored for about 90 minutes in the pain clinic. This apparently was found as negligent in the case, although if I'd put lidocaine in an epidural (not sure if this one did), I would've done the exact same thing. When no improvement, was sent to ER. Took 1.5 hours to get stat MRI done, surgery was done 5 hours after arriving at the ER.

First of all, immediate hematoma? I guess that's possible if they found an artery. But it's certainly not the first thing I'd be thinking of. I would think that surgery within 8 hours of the injury would not result in permanent paralysis, as I've seen surgeons watch hematomas for even a couple of days with serial neuro exams. But unfortunately this is what happened.

A North Texas hospital waited hours to address a spinal emergency. It led to a woman's paralysis and a $10.1 million court win for her

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[willabeast]

This one thing bothers me. //
"He gave me the shot, but I couldn't feel my legs. They were tingling, but I couldn't feel them," Adams said. "The pain was so bad in my back." //. Now I can see spinal or epidural lidocaine causing tingling, but not severe pain and numbness AT THE SAME TIME. That would definitely get my attention. But according to the article the "malpractice" was questionable hospital delays so it sounds like the hospital got dinged, not the pain person, who transferred the patient in 90 minutes.

 

[Ferrismonk]

Timeframe does seem strange, but obviously there was a hematoma on the MRI or surgery wouldn't have happened. Almost makes you think of a skewered cord, but we don't know what level the ESI was.

 

[Ferrismonk]

This one thing bothers me. //
"He gave me the shot, but I couldn't feel my legs. They were tingling, but I couldn't feel them," Adams said. "The pain was so bad in my back." //. Now I can see spinal or epidural lidocaine causing tingling, but not severe pain and numbness AT THE SAME TIME. That would definitely get my attention. But according to the article the "malpractice" was questionable hospital delays so it sounds like the hospital got dinged, not the pain person, who transferred the patient in 90 minutes.

Pain guy settled out of court. Lawsuit was for the hospital.

 

[SSdoc33]

need more detail. "chest down" sounds like a thoracic ESI. has anyone ever seen a bleed with a thoracic ESI?

hate to say it but much more likely that the pain doc just injected the cord itself.

was there sedation?

this is bad outcome, but to get an MRI 1 hr and 20 minutes after arriving at the ER isnt obscene. and the surgery within a few ohours after that isnt obscene either. if it were the patient i wouldnt be happy, but "wanton negligience" is a bit much.

 

[Agast]

When they settled she must have agreed not to say anything bad about the pain doctor, because they mention the clinic name but not the clinician himself or how he responded to her emergency.

I think he poked the cord first, but with a hematoma forming in the same area it’s probably not a nuance you can really litigate away.

 

[Ducttape]

this sounds more like bad defending attorney and the fact that the hospital probably has been overinundated with HIPAA, so they have all these "mandatory" requirements on the book the hospital is supposed to follow, such as "emergency" surgery is within an hour, etc.

probably doesnt help that the hospital wsa recently fined... im guessing they had to pay this massive sum to the feds, then they had all the inspectors critiquing everything, so they went overboard with their rules about timing of care, etc.

Flower Mound Hospital to Pay $18.2 Million to Settle Federal and State False Claims Act Allegations Arising from Improper Inducements to Referring Physicians

Flower Mound Hospital Partners LLC (Flower Mound Hospital), a partially physician-owned hospital in Flower Mound, Texas, has agreed to pay $18.2 million to resolve allegations that it violated the False Claims Act by knowingly submitting claims to the Medicare, Medicaid and TRICARE programs that...

www.justice.gov

the doctor (whose name i wont mention), is a partial owner of this partially physician owned hospital.
he settled before going to trial.



if anyone wants to watch the trial...

Video of Adams v. Texas Health Presbyterian Hospital - Trial - 11/29/22 to 12/09/22 - Courtroom View Network

Jury trial in medical malpractice lawsuit filed in 2020 alleging a delay in care for an epidural hematoma led to a patient's permanent paralysis.

cvn.com

 

[Laryngospasm]

Lots of strange things here. Immediate pain.. paralysis when operated on that quickly. 5 hours to OR is not that bad at all for anyone who really has experience dealing with ORs and surgery.

 

[drrosenrosen]

Best I can piece it together, about 7-8 hours from procedure to surgery. I have a hard time seeing how you get to complete paralysis from compression from a hematoma for a few hours, which is then completely decompressed. I agree that it sounds like there was another injury involved, perhaps during the epidural

 

[Asclepius186]

Best I can piece it together, about 7-8 hours from procedure to surgery. I have a hard time seeing how you get to complete paralysis from compression from a hematoma for a few hours, which is then completely decompressed. I agree that it sounds like there was another injury involved, perhaps during the epidural

I agree. But also could you even get complete paralysis from a cord stick? I guess maybe if you stuck and injected a bunch of particulate steroid maybe?

 

[au bon pain]

Had to have been a c or t ESI and agree w/the above, cord strike sounds more probable. Also wonder about sedation.

The medical system as we know it is a disaster and getting an MRI completed in an hour and change is spectacularly fast. Same thing with time to incision, very fast.

Aside from the sad/unfortunate outcome, optics that hurt the hospital in this case include the MRI tech delaying the study (still wouldn’t have changed the unfortunate outcome) and probably the hospital’s own policy that somewhere says a “stat” MRI needs to be done in an hour. Easy for a lawyer to show they didn’t follow their own policy and is a nice example of admin saying how things “should” run to make themselves look good while they do pretty much nothing to ensure the policy is actually feasible (ie have enough pt transporters, mri techs, magnets).

 

[lobelsteve]

I agree. But also could you even get complete paralysis from a cord stick? I guess maybe if you stuck and injected a bunch of particulate steroid maybe?

No matter what you inject into the cord, it destroys the tissue. Air, saline, steroid, stem cells. All of it mechanically destroys tissue. Particulates can get arterial and cause infarct.

 

[RoloTomassi]

Does hitting the cord cause hematoma, or two bad complications coincidentally occurring independent of each other?

 

[Greenbayslacker]

No matter what you inject into the cord, it destroys the tissue. Air, saline, steroid, stem cells. All of it mechanically destroys tissue. Particulates can get arterial and cause infarct.

Source? How does saline destroy tissue and not local anesthetic? In fact saline has been injected to prevent PDPH in some situations.

 

[lobelsteve]

Source? How does saline destroy tissue and not local anesthetic? In fact saline has been injected to prevent PDPH in some situations.

Inject it into the cord Einstein. Hydrodissection. Which is postulated as to what is going on here.

 

[Greenbayslacker]

Inject it into the cord Einstein. Hydrodissection. Which is postulated as to what is going on here.

Ahh, cord not intrathecal. Sorry I misread. Thanks for the name calling jackass.

 

[lobelsteve]

Ahh, cord not intrathecal. Sorry I misread. Thanks for the name calling jackass.

Post in: 'Woman wins $10M suit over epidural hematoma'
Woman wins $10M suit over epidural hematoma

 

[SSdoc33]

This was a cord injection. 10:1 sedation was used. Hospital settled bc there was a bad outcome. My guess is that there was some fluid around the site bc the cord is vascular but the "decompression" was relatively minor. Id love to see the MRI.

 

[Kissmyabjj]

Severe pain and complete distal anesthesia immediately following the procedure? Nope. That’s getting sent for STAT MRI. Waiting 90 minutes was ridiculous.

 

[MitchLevi]

Severe pain and complete distal anesthesia immediately following the procedure? Nope. That’s getting sent for STAT MRI. Waiting 90 minutes was ridiculous.

Not really.

If this was a cervical or thoracic and local was injected I can see this happening. Who knows what volume was used...

In the last month I saw a pt who received a T12-L1 ILESI with Depo 80 and 11cc of lido 1% for L5-S1 stenosis with spondy.

It's probably a cord stick witha subsequent injection in a sedated pt.

If he didn't know he was in the cord he prob thought there was spinal anesthesia and opted to wait a bit.

Probably was a hematoma from the cord stick, but that prob wasn't the culprit. I wish I could see the saved images.

Then again, no one saves the real images. They adjust the needle, reshoot and save that.

 

[DrMDAware]

This was a cord injection. 10:1 sedation was used. Hospital settled bc there was a bad outcome. My guess is that there was some fluid around the site bc the cord is vascular but the "decompression" was relatively minor. Id love to see the MRI.

HOW DO YOU KNOW SHE DIDNT HAVE DEGENERATIVE DISC DISEASE?!

/s

 

[Doctodd]

no lateral i bet....i havent read the articles

 

[drrosenrosen]

Severe pain and complete distal anesthesia immediately following the procedure? Nope. That’s getting sent for STAT MRI. Waiting 90 minutes was ridiculous.

Totally depends on the presentation. In my case, where I never put local in my epidural, if pt had distal numbness, I would send to ER. I imagine this pain doc may have used sedation and or local, which clouded the picture. In either event, really seems like the pain doc did the damage (from the information we have available and can infer) and got off easy by settling out of court, while the deep pockets of the hospital took the financial and PR hit, even if they couldn't have improved this catastrophic outcome by doing everything perfectly

 

[nopain1234]

When they settled she must have agreed not to say anything bad about the pain doctor, because they mention the clinic name but not the clinician himself or how he responded to her emergency.

I think he poked the cord first, but with a hematoma forming in the same area it’s probably not a nuance you can really litigate away.

He/she definitely hit the cord. Hematoma was collateral damage