Case #4019 Violation in the Standards of Care Lead to Paraplegia

Verdict/Settlement

$4,750,000

Summary

The Minor Claimant, age 2, presented to the hospital on April 23, for a C1/C2 fusion.  The child had skeletal dysplasia, and required the C1/C2 fusion to stabilize his cervical spine.  At the time of the operation, the child was moving his arms and legs perfectly normally and, in fact, “was running around” as a normal toddler.

Prior to any incision, the individuals providing the intraoperative neuromonitoring did not have consistent Motor Evoked Potentials (MEP) of the lower extremities.  This was reported to the surgeon, who then ordered that the child be awakened.  When that was accomplished, the child actively moved his arms and legs.

However, without determining why there were inconsistent MEPs of the lower extremities, or making any adjustments, the child was simply placed back in the “over the barrel” position again.  Anesthesia then was induced through the use of an intravenous drip and an inhalant sedation.  The Claimants alleged that the inhalant sedation under these circumstances violated the standards of care, as this type of sedation suppresses MEPs at the outset.  It never should have been utilized, and was not required to perform the operative procedure.  Additionally, the technicians responsible for the intraoperative neuromonitoring utilized the wrong equipment during the surgery.  They used a device designed to measure Sensory Evoked Potentials (SEP) and not MEPs.  This improper equipment selection resulted in further inability to obtain strong MEPs and proper observation of same during the surgical course.

Moreover, the child suffered hypotension and an extended period of decreased mean arterial pressure (and intraoperative monitoring to the low 40’s and 50’s levels) during the procedure, which was not adequately diagnosed and treated.  Finally, during the procedure the upper extremity normal MEPs experienced a dramatic change in amplitude.  The surgeon was not advised of this change in condition.  Following this drastic change, the upper extremity MEPs never returned to normal, but instead remained labile for the remainder of the procedure.

In sum, the wrong inhalant sedation was utilized, the wrong monitoring equipment was utilized, the child should have never been placed back in the “over the barrel” position with inconsistent MEPs with the surgery going forward, the child’s mean arterial pressure dropped significantly which was not corrected appropriately, and during the procedure normal upper extremity MEPs experienced drastic change and the surgeon was not advised.

As the direct and proximate result of these ongoing breaches in the standards of care, the child, when awakening from the anesthesia, was rendered a paraplegic and will permanently be a paraplegic.