$10 million dollar verdict for delay of care

[Clean7795]

And how did neurosurgeons perform this surgery prior to the advent of MRI?

I imagine probably the same way trauma surgeons worked before CT. Just cut **** open based on a physical exam and hope it wasn't unnecessary surgery. Interestingly there are a few semi-retired old timers in my hospital who still remember when clinical MRI was invented/introduced in the 80s/90s.

I really doubt any modern neurosurgeon would operate based on H&P alone... the med-mal risk of a delayed diagnosis is probably far lower than unnecessary/unsuccessful surgery from lack of MRI.

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[Janders]

Hypothetically I might have had a stuttering cauda equina (clinically) walk into my ED today where I have… “limited” bankers hours MRI access via how much you can convince the tech, spine operates upstairs 1 day a week but doesn’t do ED consults, and EMS was giving 3-4hr estimates for “first available truck”

This thread and case certainly didnt cause me any heartburn when I tried to decide the best way to take care of said hypothetical patient while not getting my pants sued off… try to get MRI here stat? Try to just punt and transfer immediately based on (stuttering, mild) exam to a tertiary center? Try to pull favors and get local spine to actually see patient in ED (has never happened, but they are in the building…)?

Anyway I had an MRI in about 120min (stroke in the tube) and got a wet read in 5 min and had EMS at bedside 20 min later bc I’d already called them after I looked at the first MR series myself probably 30min earlier. Receiving facility had patient to OR within 1-2hr (still minimal stuttering symptoms).

But this was a LOT of greasing wheels and pulling favors and politician speak to get this timeline accomplished… which largely paralleled the legal case, aside from the transfer time…

Best job in the world!

 

[thegenius]

Hypothetically I might have had a stuttering cauda equina (clinically) walk into my ED today where I have… “limited” bankers hours MRI access via how much you can convince the tech, spine operates upstairs 1 day a week but doesn’t do ED consults, and EMS was giving 3-4hr estimates for “first available truck”

This thread and case certainly didnt cause me any heartburn when I tried to decide the best way to take care of said hypothetical patient while not getting my pants sued off… try to get MRI here stat? Try to just punt and transfer immediately based on (stuttering, mild) exam to a tertiary center? Try to pull favors and get local spine to actually see patient in ED (has never happened, but they are in the building…)?

Anyway I had an MRI in about 120min (stroke in the tube) and got a wet read in 5 min and had EMS at bedside 20 min later bc I’d already called them after I looked at the first MR series myself probably 30min earlier. Receiving facility had patient to OR within 1-2hr (still minimal stuttering symptoms).

But this was a LOT of greasing wheels and pulling favors and politician speak to get this timeline accomplished… which largely paralleled the legal case, aside from the transfer time…

Best job in the world

What is stuttering cauda equina? Like his urinary incontinence would come and go? Or he would have saddle anesthesia one minute, then it would go away the next minute?

 

[Nephro critical care]

Sometimes I feel pain management is such a scam. The typical pain management practice will have a couple of physicians pushing ESI / RFA on everyone and have a two or 3 NP/PAs to distribute candy to keep pts coming in. Pain management claims that the ESIs / RFAs reduce opioids needed when in realty patients just get the injections so that they can keep getting their candies.

 

[Janders]

What is stuttering cause equine? Like his urinary incontinence would come and go? Or he would have saddle anesthesia one minute, then it would go away the next minute?

There was worsening perineal parathesia which had been present chronically but more intense now, with days of intermittent urinary incontinence including a couple hours prior to me seeing them, but normal post void/ control when I saw them.

Seemed real ; got decompressed.

 

[bronx43]

Sometimes I feel pain management is such a scam. The typical pain management practice will have a couple of physicians pushing ESI / RFA on everyone and have a two or 3 NP/PAs to distribute candy to keep pts coming in. Pain management claims that the ESIs / RFAs reduce opioids needed when in realty patients just get the injections so that they can keep getting their candies.

Total scam. Honestly, the majority of outpatient MSK treatment is more or less garbage. The sheer amount of borderline criminal crap I've seen from pain docs and orthos is enough to make your head spin. Us rheumatologists aren't innocent either, but with infusions going down the drain, there really isn't much of an incentive to push questionable therapies for a quick buck.

 

[sloh]

Total scam. Honestly, the majority of outpatient MSK treatment is more or less garbage. The sheer amount of borderline criminal crap I've seen from pain docs and orthos is enough to make your head spin. Us rheumatologists aren't innocent either, but with infusions going down the drain, there really isn't much of an incentive to push questionable therapies for a quick buck.

"On March 21, Adams went to Premier Interventional Pain Management in Flower Mound to receive an epidural steroid injection for pain relief."

Guarantee you the low back pain was axial—not even radicular haha. Shame shame shame

Sometimes I feel pain management is such a scam. The typical pain management practice will have a couple of physicians pushing ESI / RFA on everyone and have a two or 3 NP/PAs to distribute candy to keep pts coming in. Pain management claims that the ESIs / RFAs reduce opioids needed when in realty patients just get the injections so that they can keep getting their candies.

Pills for pokes!

 

[Apollyon]

Also the same. I just don't care what people think about me as I've gotten older.

Today I pulled out in front of a car that was a 1/8 mile away. He was driving about 60 in a 25. I don't speed anymore and he got behind me and started blowing his horn. I got to the red light and got into the left turning lane. He pulled up beside me, rolled down the window, and started cussing at me, flipping me off, etc. I could care less. I started to hit the siren in my car, but I just didn't even give a crap to do that. I just went on my merry way feeling sorry for the guy having a temper like that.

But, honest question - were you in your über- exotic rich guy car? Like, THE last car I'd expect to have a siren and red light is a G Wagon or a Bentley or a R/R.