Physician met standard of care in woman’s spinal fusion case — Defense verdict

Injuries alleged: Permanent injury to the nerves of the lumbar plexus, resulting in weakness and altered sensation in the left leg

Name of case: Pando v. Subach

Court: Arlington County Circuit Court

Case no.: CL23-2836

Tried before: Jury

Name of judge: Judge Louise M. DiMateo

Date resolved: March 31, 2025

Special damages: $58,155.21 in past medical expenses; $787,318.59 life care plan

Demand: $2.45 million

Attorneys for defendant: Carlyle R. “Randy” Wimbish III and Bradley D. Reeser, Richmond

Description of case: The plaintiff, a 68-year-old woman, underwent three level spinal fusion surgery that included extreme lateral interbody fusion procedures at L3-L4 and L4-L5. The XLIF procedures included the use of surgeon directed neuromonitoring designed to identify the proximity of surgical instruments to the nerves of the lumbar plexus and thereby avoid injury to those nerves.

After the surgery, the plaintiff was unable to move her left leg, which was also numb from the hip to the knee. She eventually regained some strength and sensation in that leg but was left with permanent weakness in her quadriceps and associated numbness which limited her mobility and required her to walk with a cane or walking stick. She claimed that her injury prevented her from biking and engaging in a variety of other recreational activities that she enjoyed before the surgery.

The plaintiff received multiple doses of two non-depolarizing muscle relaxants as part of the anesthesia for the lengthy procedure. The plaintiff claimed that the use of these medications was contraindicated because of their potential to prevent the neuromonitoring equipment from detecting the proximity of the instruments to the nerves. Her experts testified that the defendant should have instructed the anesthesia team not to use non-depolarizing muscle relaxants, and once he became aware that they had done so, should have ordered reversal medications and/or refused to proceed with surgery until the medications wore off.
They testified that the volume of medication that the plaintiff received would have rendered the neuromonitoring equipment useless and that the surgeon’s failure to recognize that fact was another breach of the standard of care. In addition, the plaintiff alleged that the defendant breached the standard of care by failing to read the contraindications section of the user manual for the neuromonitoring equipment.

The defendant’s standard of care experts, who included the head of neurosurgical spine surgery at Johns Hopkins and a community based orthopedic spine surgeon who had performed more than 3,000 XLIF procedures, testified that the standard of care did not require the defendant to read the user manual, did not require him to dictate to the anesthesia team what medications to administer, and did not require him to conclude that the neuromonitoring equipment was not working properly.

They testified that the anesthesia records confirmed that despite the large amount of muscle relaxants the plaintiff received, she still had sufficient neuromuscular activity for the neuromonitoring equipment to work as intended. They further testified that the post-operative imaging demonstrated textbook placement of the surgical hardware, which could not have happened if the neuromonitoring equipment had not worked or if the defendant had otherwise breached the standard of care.

The jury deliberated for just under two hours before returning a defense verdict.

Defense counsel Carlyle R. Wimbish III provided case information.

[025-T-081]