Robert F. Donnelly and Susan L. Kimble obtained a Defense Verdict for their defendant Hospitalist in a medical malpractice case in RIchmond Circuit Court on Sept. 16, 2011. The case involved a 66-year old patient who underwent an anterior cervical diskectomy and fusion (“ACDF”) surgery. The following afternoon, the patient developed slight one-sided facial and eyelid swelling, and the on-call neurosurgeon was contacted by the nursing staff. The neurosurgeon communicated with the operating surgeon and also requested that the hospitalist examine the patient. Following his examination of the patient, the hospitalist conferred with the neurosurgeon with regard to the patient’s symptoms. Medication changes were made to address the possibility of allergy, and frequent monitoring and neurologic checks were ordered. The following morning, 48 hours after her ACDF, the patient exhibited a change in clinical presentation including worsening swelling, and a clinical finding of crepitus, a symptom indicative of an esophageal perforation. A CT scan confirmed that the patient had an esophageal perforation, a rare but known complication of ACDF surgery. After three surgical procedures to repair the injury and a lengthy and complicated hospital course, the patient had a good recovery. The hospitalist and on-call neurosurgeon were named as defendants.
The patient’s otolaryngology (ENT) expert opined that if the complication had been diagnosed and surgically repaired approximately fourteen hours earlier, the patient would have had a ten-day hospital course instead of an 85-day course, and would have avoided the vast majority of the medical treatment she underwent. The defense ENT and infectious disease experts opined that, even if the perforation had been diagnosed sooner, the patient was going to have a lengthy and difficult hospital course, as her condition fell into a category where contamination and infection had set in the neck, but had not yet spread to the chest. The hospitalist and neurosurgeon offered experts in their respective specialties that opined that the standard of care was met in all respects. Specifically, the defendants’ experts opined that the neurosurgeon acted reasonably in relying on the hospitalist’s thorough consultation examination. Furthermore, the defense experts opined that the two defendant physicians appropriately conferred, evaluated the patient’s symptoms and developed differential diagnoses, and planned continued monitoring, assessment and treatment of patient. The defense experts opined that the standard of care did not require that either physician order additional diagnostic tests at the time of the hospitalist’s consultation, because there was no clinical indication for CT or other study.
The jury deliberated for approximately one hour and returned a defense verdict.