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The plaintiff, age 64, presented to the emergency department with complaints of back pain that had been present for the preceding week. He was evaluated and diagnosed (not by the defendant) with an acute muscular lumbar strain. He was discharged, prescribed Ultram and directed to continue taking Ibuprofen.
Three days later, the plaintiff again presented to the same ER with continued complaints of back pain, which had increased since his initial visit. The plaintiff reported the back pain increased with movement and also increased at night while lying flat. He was evaluated and diagnosed by the defendant ER physician with sciatica. Plaintiff testified during his deposition that no physical examination was performed by the defendant. There were no orders given for blood, urine or radiographic studies. Plaintiff was given Solu-Medrol 125mg IM and Norco for pain. He was prescribed Prednisone for inflammation and advised to continue the Ultram and Ibuprofen. He was also advised to add Tylenol to his regimen. Defendant ER physician was also plaintiff’s primary care doctor and plaintiff was directed to follow up with him at his office if he experienced worsening symptoms.
The next day, the plaintiff returned via ambulance to the same ER after suffering symptoms of hallucinations, incoherent/rapid speech, disorientation and delirium. The defendant was again assigned to his care. Laboratory studies revealed significantly elevated white blood count, BUN, Creatinine, CK and CK-MB levels. Plaintiff’s platelet count was decreased and his urinalysis was positive with bilirubin, protein and blood. He was diagnosed with atypical steroid-induced psychosis and Rhabdomyolysis (a serious syndrome due to muscle injury), and promptly transferred to a regional trauma center for further evaluation and care.
During the plaintiff’s hospitalization, he was treated for multiple infections including L3 – 4 discitis, osteomyelitis, epidural abscess, meningitis, encephalopathy, staph sepsis and thrombocytopenia. He suffered from acute kidney injury, which required dialysis and respiratory failure that required ventilation. Over the next 30 days of hospitalization, plaintiff continued to experience medical problems and complications and his family decided to transfer him to Johns Hopkins Medical Center in Baltimore.
Upon arrival at Johns Hopkins, plaintiff was ventilator dependent, febrile and minimally responsive. He was diagnosed and treated for a number of medical problems including MSSA bacteremia with encephalitis, as well hematogenous seeding of the psoas muscle, right middle lobe, posterior mediastinum, left anterior tibia and parietal lobe, as well as suspected discitis at the L3 – L4 level. He was again treated for an acute kidney injury, which required dialysis. Ultimately, the plaintiff’s condition improved and he was discharged from the facility six weeks after admission.
Plaintiff’s experts on standard of care opined that defendant was negligent in failing to conduct a thorough examination of the plaintiff at the time of his second visit to the ER. Specifically, that the defendant failed to appreciate the plaintiff’s complaints were not consistent with sciatica; failed to order blood work which would have revealed an elevated WBC indicating an infectious process; and failing to include aortic dissection as a possible explanation for the plaintiff’s worsening symptoms which diagnosis would have required an immediate CT scan with contrast.
Dr. Max Wintermark, chief of neuroradiology at Stanford University, would have provided testimony at trial that had a CT scan been performed at the time of the plaintiff’s second visit to the ER (when examined by the defendant) the scan would have revealed the plaintiff’s complaints were caused by an infectious process in his lumbar spine and psoas muscle. Further, plaintiff’s infectious disease expert opined that such a finding would have resulted in intravenous antibiotic treatment on an outpatient basis and plaintiff’s extensive hospitalization would have been avoided.
The defense experts on standard of care opined the defendant met the standard of care and the defense causation expert held the opinion that earlier diagnosis and treatment of the plaintiff’s epidural abscess and psoas muscle infection would not have materially changed the course of treatment.
Suit was filed and extensive discovery undertaken. The claim settled the day before trial.
[15-T-005]
Type of action: Medical malpractice
Injuries alleged: Complications resulting from delay in diagnosis of spinal abscess
Date resolved: Oct. 30, 2014
Special damages: $600,000 in related medical treatment
Verdict or settlement: Settlement
Amount: Confidential
Attorneys for plaintiff: T. Daniel Frith III and Lauren E. Davis, Roanoke; Paul J. Weber, Annapolis, Maryland
Attorney for defendant: L. Thompson Hanes, Richmond
Plaintiff’s experts: Bruce D. Janiak, MD, emergency medicine, Augusta, Georgia; Terrance L. Baker, MD, emergency medicine, Kingsville, Maryland; Max Wintermark, MD, neuroradiologist, Stanford, California; John C. Schaefer, MD, infectious disease, Norfolk; David Hager, MD, critical care, Baltimore; Brad Weaver, MD, internal medicine/hospitalist, Roanoke
Defendant’s experts: Kevin Fox, MD, emergency medicine, Wytheville; Chris M. Thomson, MD, emergency medicine, Lynchburg; Robert O. Brennan, MD, infectious disease, Lynchburg
