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Delay in Treating Postop Hematoma

$800,000 – Medical Malpractice/Negligence

Facts

Sustained compression by an undiagnosed and untreated postoperative hematoma results in paraplegia at T6 and incontinence in a 55-year-old.

This 55-year-old plaintiff worked many years as a distributor of newspapers for the Union-Tribune Publishing Company. During his work off-loading and unloading bales of newspapers from trucks, he suffered several back injuries which left him with chronic pain. He had several laminectomies and eventually a fusion in 1993.

According to Dr. Altenau, the Plaintiff did well after these surgeries. However, he would wind up injuring himself again and eventually, additional surgery to the spine was not an option. In November of 1995, he underwent the placement of a dorsal column stimulator (DCS) by Dr. Altenau. The Plaintiff achieved what Dr. Altenau described as “superb” relief of pain with this device, which delivers electrical stimulation to the spinal cord to block pain impulses. It was determined post-operatively that while the Plaintiff was getting good relief of pain in his low back and down his right leg, the lead placed to cover his left leg was not operating correctly.

While Dr. Altenau had considered the placement of the DCS device to be successful and felt that it was probable that the device could continue to be used by the Plaintiff to provide him with pain relief, he referred him to Dr. Finkenberg to see if the device itself could be adjusted. It was intended that the Plaintiff would return to Dr. Altenau for additional surgery if the device could not be adjusted. However, following the consultation with Dr. Finkenberg, Dr. Finkenberg had the Plaintiff admitted to Alvarado Hospital on May 13th, to replace the faulty lead as well as the DCS device itself. Surgery was done without apparent complication, and the Plaintiff was transferred to the medical-surgical floor for further recovery.

As part of his post-operative care, he was to undergo a complete neurologic assessment every three hours by the staffing nurse. A motor and sensory exam was performed at both 9:00 p.m. and 12:00 a.m. These examinations were completely normal. At 3:00 a.m. on the morning of the 14th, the nurse did another complete assessment. At that time, his motor -examination showed zeroes in his lower extremities, and showed that he had lost all sensation.

According to the nurse, she contacted Dr. Finkenberg at 3:10 a.m. and notified him of the situation. Dr. Finkenberg allegedly advised the nurse to have him lie still, and he should be all right in the morning. Dr. Finkenberg testified in his deposition that the nurse called him and told him that the Plaintiff was having difficulty moving his legs but that he asked her three times if he was still moving his legs and she answered yes. Dr. Finkenberg has also testified that he requested that the nurse follow up with the Plaintiff more closely and make neurologic assessments every hour, and to let him know if there was any other change in his condition.

The nurse disputes ever receiving this order. Nothing was done for Plaintiff until after a second phone call was made by the nurse to Dr. Finkenberg at 6:00 a.m. At that time, Dr. Finkenberg carne into the hospital and went in to assist in surgery on another patient.

The CT scan of Plaintiff revealed an epidural hematoma causing significant compression on his thoracic spine. At 9:30 a.m., he was finally taken to the operating room, where the hematoma was evacuated by Dr., Finkenberg. However, because of the sustained compression of the hematoma on his spinal cord, Plaintiff is and will remain a paraplegic at level T-6.

Allegations/Contentions

Plaintiff claimed Dr. Finkenberg admitted that this situation constitutes a medical and surgical emergency and had further admitted that if the nurse had relayed the information contained in the nursing records at 3:00 a.m. to him, the standard of care would have required him to immediately order a CT scan and immediately come in and do a decompressive procedure on an emergency basis. Either Dr. Finkenberg or Alvarado’s nurses, or both, violated the applicable standards of care. Plaintiff’s expert testified that had the standard of care been complied with, i.e. that a decompressive surgery was undertaken by as late as 6:00 a.m., that to a degree of medical probability, the Plaintiff would be walking today and would have full urinary function and continence.

Defendant Finkenberg argued the nurses and Alvarado did not make clear to him the urgency of the situation in either the 3:00 a.m. or 6:00 a.m. telephone call. Defendant Alvarado argued its employees did notify Dr. Finkenberg of the situation promptly. They explained the symptoms to him during the early morning telephone calls. It was Dr. Finkenberg’s decision not to pursue the matter until several hours later.

Injuries/Damages

Paraplegia at T6 and incontinence.

Special Notes

Finkenberg was insured through CAP with a $1,000,000 policy limit. Based on the terms of the policy, its limit was constantly being reduced by any attorney fees and costs incurred by the insured. In September, Plaintiffs demanded the limits of Finkenberg’s policy in full settlement of the matter. The case was subsequently settled as to Alvarado Hospital for a confidential amount one week before trial.


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