Virginia Lawyers Weekly//April 18, 2017
Virginia Lawyers Weekly//April 18, 2017//
This was a medical malpractice case against spinal surgeon Thomas J. Raley Jr., M.D., and his practice group, Advanced Spine and Pain PLLC, for injury to a patient during spinal surgery called posterior lumbar interbody fusion (“PLIF”). During surgery, Raley inserted surgical instruments called shavers too deeply into the patient’s body and lacerated two major blood vessels. As a result, the patient bled profusely, required infusion of 20 units of blood, suffered hypovolemic shock, stroke and multi-organ failure. The patient was left with permanent brain injury and functional impairments.
Evidence at trial established that there are three safety steps a surgeon can take during PLIF to prevent the injuries the patient suffered in the case, and it was the standard of care to use all three. Raley contended he utilized all three safety steps during the patient’s procedure, and that her injury was just a risk of the procedure. Plaintiff contended that the medical records and the physical evidence proved that Raley skipped all three safety steps.
One of those safety steps was the use of intraoperative fluoroscopy, a real-time video X-ray, during the placement of the shavers in order to monitor the location, depth and trajectory of the shavers during the procedure. By the end of trial, the jury had heard four stories from Raley about whether and how much fluoroscopy he used during the procedure. Raley’s own operative report did not mention the use of fluoroscopy with the placement of shavers, and there were no fluoroscopic images in the patient’s medical record, strongly suggesting that fluoroscopy had not been utilized as Raley contended.
Plaintiff called neuroradiologist, Mary Jensen, M.D. Jensen showed the jury images from the patient’s post-operative CT scans, which disclosed a tract of bone missing from the patient’s L4 vertebral bone, leading up to the area where the lacerated blood vessels were repaired. Plaintiff’s orthopedic surgeon, Tushar Patel, M.D., explained the importance of that evidence. The shavers were supposed to remove intervertebral disc, not bone. Patel explained, if Raley had utilized fluoroscopy during the placement of these shavers, he would have seen that they were placed on the wrong trajectory, in the wrong anatomy and too deeply into the patient’s body. Further, if Raley had paid attention to his tactile senses, another safety step, he should have realized he was boring through bone, rather than the intervertebral disc. Finally, if Raley had paid attention to safety markings on his instruments, a third safety step, it would have prevented him from inserting the instruments too deeply.
On cross examination, the defendant was confronted with the patient’s post-operative CT scan images and admitted that, until trial, he was unaware of the path that his shavers had taken. The defense called one expert, orthopedic surgeon, Gregory Riebel, M.D. Riebel conceded that the injuries the patient suffered could happen as a result of negligence. But, when he was asked to give an example, he responded, if the doctor “shot a patient or stabbed them with a knife.”
Plaintiff argued that it doesn’t take a physician shooting a patient with a gun or stabbing them with a knife to constitute a deviation from the standard of care in Virginia. Plaintiff presented medical bills totaling $546,000.00, and requested a verdict of $2,000,000.00. After deliberating for approximately four hours, the jury returned a verdict of $2,550,000.00.
Type of action: Medical Malpractice
Injuries alleged: Lacerations of the inferior vena cava and common iliac vein, hypovolemic shock, acute anemia, stroke, multi-organ failure and permanent brain damage and mobility impairments.
Name of case: Erin Locascio v. Thomas Raley Jr. M.D., and Advanced Spine & Pain PLLC
Court: Stafford County Circuit Court
Case no.: CL-13-1356
Name of judge: Michael Levy
Date resolved: Feb. 17, 2017
Special damages: Medical bills of $546,000.00
Verdict or settlement: Verdict
Attorneys for plaintiff: Donna Miller Rostant, Peter C. DePaolis, and Ann LaCroix Jones, Fairfax
Attorneys for defendant: Richard Nagle and Heather Zaug, Fairfax
Plaintiff’s experts: Tushar Patel, M.D., Mary Elizabeth Jensen, M.D., Victor D’Addio, M.D., Peter Sorman, Ph.D., Pedro Macedo, M.D.
Defendant’s experts: Gregory Riebel, M.D.
Insurance carrier: The Doctor’s Company