Legal Review & Commentary

Untreated subdural hematoma leads to brain damage: $1.9 million verdict against hospital

By Jan J. Gorrie, Esq.
Buchanan Ingersoll PC, Tampa, FL

News: An elderly gentleman with a history of fainting presented to a hospital emergency department (ED) was admitted for observation and testing then discharged without a conclusive diagnosis or treatment plan. One month later, he fell, was re-hospitalized, and surgery was performed to relieve a subdural hematoma. He was left brain damaged and unable to live independently. His sister sued the practitioners and hospital on his behalf. The neurosurgeon settled for an undisclosed amount prior to trial. A jury awarded a $1.9 million verdict against the hospital.

Background: The retired and single 75-year-old man with a history of fainting presented to the ED. He was admitted and consultations were made with several specialists, including a neurologist and neurosurgeon. A computed tomography (CT) scan was performed before he was first seen by the neurologist. An MRI was attempted but discontinued when the patient became agitated. During the course of his admission, another MRI was not attempted on the advice of the neurologist and neurosurgeon, who jointly concluded there was no medical basis for one.

Over the next 30 days, the discharged patient was seen by physicians on four separate occasions and by his home health nurse. On the 30th day, the man fell in the bathroom. His sister, with whom he was living, testified at trial that he was lethargic and disoriented following the fall and that she took him to back to the ED the next day. Once readmitted, he was diagnosed as having suffered from a subdural hematoma and evacuation surgeries were performed. Following this hospitalization, he was discharged to long-term care with no hope of independent living.

The plaintiff brought suit against the treating physicians and hospital, claiming that he should not have been discharged in the first instance without an MRI. The plaintiff maintained that the MRI would have conclusively shown he suffered from a subdural hematoma at the time of the first admission and that more timely treatment would have saved him from a debilitating brain injury.

The neurosurgeon settled for a confidential amount prior to trial. The hospital contended the patient had pre-existing dementia and that all his complaints stemmed from it. The hospital and physicians maintained the patient was not suffering from physical signs or symptoms that required a repeat of the MRI during the first admission. This theory was bolstered by the fact that he was seen by several other practitioners between admissions, that none of them believed more testing was necessary, and that none ordered more extensive follow-up testing. The defendants said the sole cause of the subdural hematoma was the fall in the bathroom and that the damage was more extensive due to the delay in getting him to the hospital.

The neurosurgeon settled for a confidential amount. The jury trial moved forward against the hospital only. The jury found the hospital negligent and found it liable for $1.9 million in damages.

What this means to you: "The case history provided indicates that the hospital acted in good faith and that the treatment provided met the standard of care. It appears from the evidence provided that the fall was the cause of the subdural hematoma since the patient was able to continue living independently in the community for a month prior to the accident. The fall also seems to be the participating factor in his neurological decline, even if one factors in the known history of dementia," observes Lynn Rosenblatt, CRRN, LHRM, risk manager, HealthSouth Sea Pines Rehabilitation Hospital in Melbourne, FL. "The only definitive evidence from the first admission that the patient may have had a cerebral bleed was the period of agitation mentioned in connection with the MRI attempt, and that is weak. Many people experience anxiety when faced with the claustrophobic confines of an MRI tube — not simply those with clinically diagnosed dementia. Since the determination of the need for an MRI is certainly within the purview of a neurologist and/or a neurosurgeon, responsibility of not attempting a second MRI scanning should be placed with the physicians.

"Perhaps the only error made was to discharge the patient without having reached a conclusion regarding the nature of the fainting episodes," she notes, "for, in any event, diagnosis and prescribed treatment of the patient’s condition including discharge to community care is the responsibility of the physicians not the hospital. Hospitals are responsible for discharge planning, but it must in accordance to the physician’s instructions.

"Either the jury could not understand that concept or it choose to ignore it and found against the hospital for what is a very large verdict. It appears that in some manner the settlement by the physician influenced the jury to assume that there was in fact a misdiagnosis at the time of the first admission," notes Rosenblatt.

The fact of settlement involving co-defendants is purposely withheld from the jury so that it will not influence its determination of negligence on the party at trial, but testimony frequently provides enough information for the jury to draw conclusions.

"The narrative indicates that the various physicians involved in treating the patient testified that there was no indication of a subdural hematoma at the time of the initial admission, and it did not appear to show up to the time he fell a month later. It is not clear what type of expert witnesses the defense called or how it depicted the hospital’s position. Also the relationship of the physicians to the hospital is not clearly defined as to staff or independent practice," notes Rosenblatt.

"The jury award of near $2 million appears out of line for the amount of liability incurred by the hospital. An appeal to the court to reduce or reverse the verdict is the only possibility as a means to rescue this case, which clearly demonstrates how juries perceive hospitals as dangerous places despite evidence to the contrary," adds Rosenblatt.

"Hindsight is said to be 20/20, but one way to avoid the large judgment may have been for the hospital to follow the physicians’ lead and settle before the case went to the jury. A pre-emptive decision to settle would have allowed the hospital to better control the amount of the award rather than leave that to an unpredictable jury pool. Of course a settlement does not allow for the possibility that the hospital could have prevailed in its on defense and won acquittal," concludes Rosenblatt.

Reference

• Macomb County (MI) Circuit Court, Case No. 01-1350-NH.