Case# 4008: Failure To Timely Diagnose And Provide Treatment Led To Paralysis
On May 28, the Plaintiff presented to the Defendant Hospital having been previously diagnosed and treated in New Jersey for neuromyelitis optica (NMO) — a neurological disease characterized by inflammation of the optic nerves and spinal cord, eye pain, visual disturbances, weakness, numbness and/or paralysis in the extremities and the possibility of bowel and/or bladder dysfunction.
At the time of presentation, the Plaintiff had decreased lower extremity and bowel and bladder function but no visual disturbance or optic nerve dysfunction, and a negative NMO-IgG titer result which is a specific blood study to confirm a diagnosis of neuromyelitis optica (NMO) as well as negative CSF cultures. The neurologist additionally reviewed an outside magnetic resonance imaging (MRI) scan of the Plaintiff’s thoracic spine and noted a history of a negative spinal angiogram. He diagnosed the Plaintiff with NMO and recommended aggressive immunosuppressant therapy.
Accordingly, the Plaintiff received inpatient plasmapheresis in addition to high dose Cytoxan infusion. The treatment prescribed for the Plaintiff failed to improve his condition. An MRI scan of his thoracic spine on July 3, which the neurologist reviewed, showed no change since the Plaintiff’s last study from May 20. Yet, he simply ordered two additional courses of Cytoxan over the next two months.
On August 25, that same MRI scan was reinterpreted by the Defendant Hospital’s radiologist who agreed that there was no improvement, specifically commented that a vascular malformation should be considered, and recommended a spinal angiogram. The Plaintiff alleged that the spinal angiogram, which was not performed at that time, would have shown the vascular formation (dural arteriovenous fistula) from which the Plaintiff actually suffered.
On August 28, the Plaintiff returned to the Defendant Hospital’s neurologist. By then, he had bilateral leg weakness, back pain, and required a walker to ambulate. Yet, the neurologist simply deemed the disease process to be “treatment resistant,” kept his misdiagnosis, and switched the Plaintiff to a different drug. Although a September 2 MRI confirmed that the Plaintiff’s condition had dramatically worsened, the neurologist also ordered a second administration of Solu-Medrol.
On November 24, the Plaintiff presented to his local medical center in New Jersey for the intravenous Solu-Medrol and within hours of that administration, lost almost all function from the waist down. He went to an acute rehabilitation program until December 24, during which time he regained some function in his legs. A repeat NMO-IgG was again negative for NMO.
On March 25, the Plaintiff returned to the Defendant neurologist who negligently persisted with his diagnosis of NMO and planned another medication change, explaining that the medications sometimes take months to work.
By August 6, the Plaintiff returned to an outside facility in New Jersey with minimal motor function of the lower extremities as well as a temperature. He was diagnosed with bacterial meningitis. On August 22, the Plaintiff was transferred to the Defendant Hospital, lacking all sensation below the level of his waist (approximately T6).
On August 24, the neurologist finally requested the initial spinal angiogram that been performed in New Jersey which he never previously reviewed. It was interpreted by the Defendant’s radiologists as incomplete, and a repeat spinal angiogram was ordered which clearly identified a DAVF at the level of T-10.
Although the Plaintiff had a successful repair of his DAVF, he never regained neurologic function in his legs due to the length of time his true condition went undiagnosed and untreated.
The Plaintiffs alleged that had the Defendant Hospital’s personnel negligently failed to timely review and/or repeat the spinal angiogram and, thereafter, and negligently persisted in the diagnosis and treatment of NMD when the Plaintiff’s laboratory evidence was negative and when treatment failed to show any improvement. The Plaintiffs alleged that timely diagnosis and treatment of his DAVF would have avoided permanent paralysis.