Tetraplegia Due to Failure to Perform Appropriate Care
Lawsuit Against University Of Maryland Upper Chesapeake Medical Center | September 18, 2020
The complaint alleges that on April 19, 2018, the patient presented to Brain & Spine Specialists, P.A. for the complaint of a cervical herniated disc that had been causing him pain in the neck that was radiating bilaterally into the shoulders, arms, and hands. The patient was diagnosed with spinal cord compression. The most recent cervical MRI demonstrated, among other things, two very large disc herniations compressing the cervical spinal cord. A four-level anterior cervical discectomy and fusion (“ACDF”) from C3-7 was recommended and scheduled. On April 23, 2018, the patient presented to Upper Chesapeake Hospital to undergo the ACDF procedure and was started on anesthesia at 12:30 p.m. The doctor and a physician’s assistant began the operative procedure at 2:02 p.m. The procedure ended at 4:24 p.m. The patient was transferred directly to the post-anesthesia care unit (“PACU”). At 6:12 p.m., the patient indicated that he had equal sensation up and down with symmetrical smile, equal strength to the bilateral upper extremities, and lower extremity weakness bilaterally. At 6:36 p.m., a nurse called the doctor due to weakness in the patient’s lower extremities. A verbal order for a stat cervical and thoracic MRI was placed. At 6:35 p.m., the anesthesiologist was called to evaluate the complaints of leg weakness and immobility. The patient could move his upper extremities but not his lower extremities. The anesthesiologist ordered a STAT cervical MRI. The MRI showed straightening of the cervical spine with postoperative changes from anterior fusion of C3-C7 with susceptibility artifact from fusion. There was edema within the anterior epidural space which he believed to be related to postoperative changes with evidence of spinal stenosis. At 9:45 a.m., the patient was unable to squeeze the nurse’s hand and he had only “very limited” movement of his arms. The patient could not move his legs or feet and he reported numbness and tingling to both lower and upper bilateral extremities. At 12:12 p.m., the physician’s assistant noted that following the ACDF, the patient had weakness in his lower extremities and could not move his feet and that he had recently been unable to move his legs and complained of weakness in his arms. The patient was unable to sit up on his own. At 1:07 p.m., the patient was seen by the operating doctor for the first time postoperatively. The doctor documented that as of the last nursing note early this morning, the patient had been able to grip and move both lower extremities. However, the doctor noted that the patient was now unable to grip either hand and could not move either lower extremity, which represented a significant decrease in the patient’s ability to move, and that these changes were significant findings that had not been communicated to him or his team members since his last communication with nursing staff at approximately 3:00 a.m. on the morning of April 24. The doctor recommended a STAT MRI to be followed by a multilevel laminectomy of the posterior cervical spine in an effort to expand the central canal, which would possibly increase perfusion and alleviate the sudden change in condition. At approximately 1:20 p.m., the patient underwent an MRI which showed abnormal T2 signal within the spinal cord from C5-C7, which could be caused by edema or ischemia. At approximately 3:35 p.m., the doctor began surgical anterior cervical revision of hardware and exploration. Records show that there was no change in the patient’s neurological monitor baselines during the procedure. At 1:16 p.m. the next day, the patient was still having weakness in his extremities, similar to the day before. The patient was unable to voluntarily move his lower extremities but they would respond when stimulated. On May 1, 2018, the patient was discharged to University of Maryland Orthopedic & Rehabilitation Hospital (“UMD”), an acute, long-term spine and neurological rehabilitation facility. On June 29, 2018, the patient was discharged from UMD with relevant discharge diagnoses of tetraplegia, cervical myelopathy with cervical radiculopathy, neurogenic bowel, and neurogenic bladder.
The lawsuit alleges, among other things, that the doctors’ negligence caused the patient to suffer tetraplegia, among other injuries.
The action is pending in the Circuit Court for Harford County, Maryland.