Delayed abscess Dx results in paralysis

Nov 05, 2018

"The factual question presented to the jury was whether the ER doctor breached the standard of care and whether that breach proximately caused the plaintiff’s injury," writes Acacia Brush Perko, Esq.

On May 21, a 28-year-old male presented to the hospital with significant upper back pain, with no history of injury. He reportedly informed the medical staff that he recently had an abdominal methicillin-resistant Staphylococcus aureus (MRSA) infection and that he was taking an antibiotic. He was discharged with a diagnosis of muscle strain.

On the evening of May 22, he returned to the emergency room with worsening thoracic pain, which was wrapping around to his left flank. He claimed he told the triage nurse of his recent MRSA infection and oral antibiotic. An ER doctor suspected a kidney stone, which was then ruled out by a pelvic computed tomography scan. The patient was administered intravenous morphine and an anti-inflammatory. He was discharged with a diagnosis of back pain.

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The following night, on May 23, he again returned to the hospital with continued back pain. While in the ER, he developed leg numbness and weakness that progressed to paralysis. He was diagnosed with a spinal epidural abscess and transferred to another hospital, where he underwent surgery to remove the abscess.

After the patient’s abscess was surgically removed, he remained hospitalized for 2 weeks. He was treated with inpatient rehabilitation for 6 weeks. He suffered incomplete paraplegia with muscle spasms and bowel and bladder dysfunction. Upon discharge, he was treated with physical therapy, which he will do indefinitely, and consulted with a physiatrist, neurologist, urologist, and hematologist.

He was treated with a neurotoxin for muscle spasms and underwent intrathecal baclofen therapy to control them. He further treats with self-catheterization and is on a bowel program. He can only walk a few steps with braces, and is primarily wheelchair-bound.

Next: Medical record noted MRSA infectionMedical record noted MRSA infection

The patient sued the hospital and physicians who treated him, alleging they were negligent in failing to properly diagnose the spinal abscess. The ER doctor who suspected a kidney stone testified that a spinal abscess would have been high on his differential diagnosis if he had known of the recent MRSA infection. The plaintiff’s counsel introduced medical records in which the nurses and other physicians noted the recent MRSA infection, and the ER doctor conceded that he would have had access to those records at the time he treated the patient.

The plaintiff’s expert opined that the ER doctor should have ordered a magnetic resonance imaging scan on May 22, which would have revealed the abscess, allowing for timely and proper treatment, and would have likely avoided subsequent neurologic injury. The plaintiff’s expert criticized the ER doctor for failing to take an adequate history and physical examination of the patient, who had been diagnosed with a MRSA skin infection on his abdomen that had been recently drained. Had the physician known about the patient’s MRSA, the expert opined, it would have raised a red flag to suggest that the patient’s back pain was a potential infection, which would have necessitated an MRI.

The plaintiff’s expert further opined that when the ER doctor did not find any urinary/gallbladder stones on the CT scan, he assumed that the patient’s back pain was soft tissue/muscular in nature, without considering another source. “Abdominal stranding” was found on the scan, which can indicate inflammation moving toward the spine. However, according to the plaintiff’s expert, the ER doctor failed to look at the abdomen more carefully to determine the source of the inflammation.

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The defendants denied liability and contended that standard-of-care treatment was provided. The ER doctor testified that the patient denied taking medications when asked. The defense expert maintained that a spinal abscess is exceedingly rare, and is not clinically diagnosable in the absence of a fever and neurologic deficits, which the patient did not have until his last hospital visit. The defense expert concluded that the MRSA skin infection would not have been an obvious sign of a spinal epidural abscess. The defense expert further testified that since the patient did not have a fever or other symptoms, there was not a high enough suspicion to order an MRI to look for an abscess or another condition in the patient’s spine.

The plaintiff, who is permanently disabled, testified about his daily restrictions and how he leads a sedentary lifestyle. He testified that he rarely sees his two daughters and said he has missed out on teaching them to ride bikes and coach them in sports. He sought damages for past and future medical bills and pain and suffering. His daughters sought damages for loss of services.

After a 2-week trial, a county jury deliberated and awarded the plaintiff $5,200,000 in damages, and $200,000 for each daughter, for a total award of $5,600,000.

LEGAL PERSPECTIVE: This unfortunate outcome left this patient permanently debilitated, and at a young age. The factual question presented to the jury was whether the ER doctor breached the standard of care and whether that breach proximately caused the plaintiff’s injury. The jury heard testimony from the patient’s expert, who indicated that the ER doctor should have known about the MRSA infection, and should have ordered additional testing once he ruled out the kidney stone as a possible source of pain. The ER doctor himself testified that had he known about the MRSA infection, he would have performed additional testing.

 

The evidence that the MRSA infection was contained in the notes likely undercut the ER doctor’s defense, even though he testified that the patient did not exhibit other signs of an abscess, including a fever. The plaintiff presented testimony from a life care expert and economist who presented a life care plan with an approximate present value of $5 million. This testimony ultimately weighed in the patient’s favor.