Legal Review & Commentary - Neck fracture not detected: $31.1 million verdict in Texas
Neck fracture not detected: $31.1 million verdict in Texas
By Jan. J. Gorrie, Esq.
Buchanan Ingersoll PC,
Tampa, FL
News: A professional truck driver was involved in a serious motor vehicle accident. EMS personnel placed him on a backboard, supported his neck with a cervical collar, and transported him to the nearest trauma center. While being triaged and evaluated in the ED, the patient’s protective neck collar was removed and he was assisted in walking to a wheelchair. On the way to the wheelchair, he collapsed and has been unable to walk since. The patient and his family brought suit against the trauma center and emergency physicians; they were collectively awarded $31.1 million, which included almost $8 million in punitive damages against the hospital.
Background: The patient, a 41-year-old truck driver, was injured in a brutal rollover motor vehicle accident on a highway near Dallas. EMS placed the driver, who had visible swelling on his head due to a hematoma, on a stabilizing backboard and placed a cervical collar on his neck prior to transporting him to the nearest Level I trauma center.
At the trauma center, his examination included several neck X-rays, which were interpreted by a radiology resident. After receiving the X-ray results, the emergency nurse removed the protective neck collar and had walked the patient about 10 feet toward a wheelchair when he collapsed. He was left without sensation from the chest down and with minimal movement and strength in his arms and hands. The patient ultimately suffered a severe subluxation of the spinal cord, which left him paralyzed.
The patient and his two children — a daughter age 18 and an 11-year-old son — sued the hospital and the two physicians involved. The patient alleged that had his condition been treated conservatively and appropriately, he would have experienced 100% recovery. The plaintiffs claimed that when the patient arrived at the trauma center, he complained of a burning sensation within his fingers and that consideration of his complaints combined with a cor- rect interpretation of his X-rays should have lead the staff and physicians to a more conclusive diagnosis. In addition, the plaintiffs maintained that the nursing staff and physicians ignored the signs and symptoms that the EMS personnel had observed in the field, and that they should have followed EMS’ lead in paying more attention to the potential severity of the injury. Specifically, the plaintiffs averred that the medical personnel should have realized that his neck needed to be surgically fused prior to his attempting to walk. Instead, the plain- tiffs claimed the staff and physicians failed clinically and radiologically to find the two small fractures along with the torn ligaments in the patient’s neck, which made his cervical spine unstable for any movement.
At trial, the emergency physician testified that he had not completed his examination of the patient at the time of the further aggravation. The ED doctor contended that he did not order the nurse, and had not intended for her, to walk the patient, much less remove the neck collar. The nurse testified to the contrary. She claimed that the physician had explicitly instructed her to remove the stabilizing collar and to discharge him. The plaintiffs successfully maintained that the hospital was negligent, that its policies and procedures were insufficient to address the injuries sustained by the patient and that the nursing staff was not properly trained to work in a Level I trauma center. They further contended the ED was understaffed at the time of the incident, operating with a 9-1 patient-staff ratio instead of the 4-1 ratio standard for a trauma center. The plaintiffs also argued the hospital’s malfeasance constituted malice.
The patient claimed damages for past and future medical expenses, pain and suffering, impairment, disfigurement, and mental anguish. His children claimed damages for loss of society and support. The jury found the hospital 65% liable, the radiology resident 27% at fault, and the emergency physician 8% liable. The plaintiffs were collectively awarded $31.1 million. The patient was awarded $30.4 million, including: $190,000 for past medical expenses, $7.5 million for future medical costs, $200,000 for past lost earnings, $800,000 for future lost wages, $1.75 million for past pain and suffering, $3.5 million for future pain and suffering, $300,000 for past disfigurement, $700,000 for future disfigurement, and $7.75 million in punitive damages against the hospital. His daughter will receive $246,500 for loss of consortium, and his son shall receive $492,000 for the same.
What this means to you: “This emergency room was a scary place. The narrative provided reflects a group of medical professionals who lacked leadership, team cooperation, and communication. Trauma patient policies appear to be lacking or at a minimum not adhered to. The nurse in question either was unfamiliar with ER policy, was inadequately trained or merely disregarded the ramifications of what she was about to do. The physician was not exercising proper oversight over the patients or his subordinate staff. The unit appeared to be understaffed, a huge liability particularly in such a critical care area where every minute counts and every decision must be made in light of all if known facts,” says Lynn Rosenblatt, CRRN, LHRM, risk manager at HealthSouth Sea Pines Rehabilitation Hospital in Melbourne, FL. “The ER is not the place for the faint of heart. Quick action is the order of moment. The environment is supercharged and the staff runs on continuous adrenaline high. Given the pace and severity of the patients seen, it is certainly a place where the potential for serious life threatening and life endangering mistakes is magnified a hundredfold.
“The nature of care expected to be provided in a trauma center requires the quick mind of not one but many highly trained professionals each contributing to the whole. Staffing in this setting is an enormous challenge as the volume of patients and the level care required is unpredictable. The ability to accurately triage patients and assign care to appropriate staff requires specialty training in itself, and advanced practice across all participating care givers. Competency of the trauma team should be assessed and reassessed. Hospital personnel who have not been trained in an ER environment and specifically in trauma care should not be assigned there,” notes Rosenblatt.
“Trauma patients arrive as total strangers, many are unable to assist in providing essential details as to the nature of the illness or injury. Some are mildly sick and barely injured, while others are near death. Treatment success depends on a coordinated assessment by all members of the trauma team under the direct leadership of the physician. Each member collects independent data related to a specific clinical specialty and collaborates with the other team members on a plan of care,” says Rosenblatt.
“In this case the information gathered at the scene of the accident did not trigger the cautious responses that it should have,” says Rosenblatt, “a patient arriving via ambulance following a roll-over trucking accident on a backboard and in a neck collar should have sent a signal that this patient would require very careful handling. The situation spoke loudly to an assumption of potential spinal cord injury — had the staff and physicians been listening. This assumption was even more reasonable given the patient’s complaint of burning in his distal extremities, a common diagnostic sign in spinal cord trauma.
“The X-ray department should have received the patient in the same state that he arrived, backboard and collar. This would have provided not only stabilization, but also would have served as an alert to the radiology staff as to the patient’s potential for a serious spinal injury. While the narrative failed to identify the actual training level of the radiology resident, anyone less than at a senior level probably should have sought confirmation of the initial impression given the serious nature of the suspected injury and the results of a misdiagnosis,” notes Rosenblatt.
“Protocols should be designed that trigger additional diagnostic procedures, should the patient’s symptoms merit greater investigation. The same is true in dealing with cardiac patients or strokes. The patient’s symptoms should speak to medical professionals in a manner that demands a correct diagnosis. In this case the films appeared negative but the nature of the injury and the patient’s burning sensation should have defied the radiology evidence. There appeared to be sufficient rational to look further prior to letting the patient walk,” says Rosenblatt.
“In this modern age of medical response, success with many catastrophic emergency situations depends on protocols that are implemented in a time-sensitive and highly coordinated manner. The timing and accuracy of the diagnosis and treatment are essential to the patient’s recovery, and the policies and procedures are the dictates by which the response team operates. Just as specific procedures are the cornerstone of the operating room suite and dictate in every respect the outcome of the procedure, the same holds true for specific responses in the ER — particularly one that purports to be a trauma center,” adds Rosenblatt.
“The contradictory testimony of the physician and the nurse certainly speaks to a failure of some sort of established leadership and communication channels. It certainly raises several questions. Was the physician too busy with other cases to realize what the nurse was speaking to him about? Alternatively, was this patient confused with another whose injury may not have been so serious? Did the nurse assume that the treating physician had reviewed the radiology findings, completed his assessment of the patient, and signed off on the case? Were there policies to cover all of these potential risk situations and the countless other possibilities that emergency care can generate?” asks Rosenblatt.
“During trial, it is relatively easy and certainly common for both sides to proffer expert testimony as to what should have and should not have been done. The jury will believe the testimony that supports the injury that the patient can prove was sustained, or testimony that allows a reasonable deduction that there was no injury or no blame. In this situation it was impossible for the hospital to dispute the plaintiffs’ contention that the hospital was understaffed, as staff records would be readily available and testimony as to general practice damning,” says Rosenblatt.
“The dispute between the nurse and the physician was also a critical factor. The physician claims that he never ordered that the patient was to be discharged. Certainly there was no written order to that effect, so the nurse relied on a verbal order, or so she claimed. It also appears that medical evaluation was not complete. A cursory look at the treatment record should have indicated that to the nurse, which raises the question of whether she reviewed the patient’s treatment record before removing the collar in preparation for discharge. In fact there is no way to determine what she verified, but it is easy for a jury to assume that she acted on her own as there is no proof otherwise, even though the physician’s statement is self-serving,” notes Rosenblatt.
“A case like this is big anytime a jury has to decide how much will it cost to make it right. What was likely described to that jury was the hospital’s incompetence. What they saw was a severely injured individual with multiple life-altering situations. They also saw lifelong dependency, two children whose lives were impacted, and major medical expense over his lifetime. Is there any doubt that the award would be huge? And don’t for a minute think only in Texas!” concludes Rosenblatt.
Reference
• Dallas District Court, Case No. 01-1793-E.
A professional truck driver was involved in a serious motor vehicle accident. EMS personnel placed him on a backboard, supported his neck with a cervical collar, and transported him to the nearest trauma center. While being triaged and evaluated in the ED, the patient's protective neck collar was removed and he was assisted in walking to a wheelchair. On the way to the wheelchair, he collapsed and has been unable to walk since. The patient and his family brought suit against the trauma center and emergency physicians; they were collectively awarded $31.1 million, which included almost $8 million in punitive damages against the hospital.
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