Failure to Perform & Interpret MRI Timely Leads to Cauda Equina Syndrome

Situation:

Failure to Perform & Interpret MRI Timely Leads to Cauda Equina Syndrome

Our client, a 31 year old woman was taken by ambulance to a local hospital at 11:00 p.m. after developing severe low back pain radiating down her left leg while pulling a grocery cart. She was admitted into the hospital and assigned an attending physician. The attending first saw the patient the next day at 1:00 p.m. By this time her symptoms had changed and she had pain radiating down her right leg causing numbness in her foot and ankle.

MRI Ordered ASAP

Believing the cause of the patient’s problems to be a nerve injury (i.e. a herniated disc) the attending ordered an MRI to be performed ASAP. Hospital records indicate that the MRI ordered was communicated to the radiology department over its computer system by 2:00 p.m. Records also show that on the day the MRI was ordered, no other patients were scheduled for MRI, and the machine was available for immediate use.

MRI Not Performed. Patient Condition Deteriorates

Tragically, the MRI was not performed for more than 24 hours. During this time, our client’s medical condition deteriorated to the point she required catheterization and developed weakness and numbness in both legs and feet. The MRI showed a massive central herniated disc compressing the nerves in her spinal canal (these nerves are called the cauda equina nerves). Plaintiff suffers today from cauda equina syndrome with permanent impairment of her bowel and bladder function, numbness in her groin area and foot drop, which requires use of braces for her to walk.

Negligence Alleged

We alleged that both the attending physician and hospital were negligent for not having the MRI taken and interpreted on the day it was ordered. Thus, surgery which could have prevented the cauda equina syndrome if performed earlier was delayed for almost two days, and was ineffective. We also alleged that the attending physician failed to recognize the patient’s progressive neurologic deficits between the time of admission and the attending’s first evaluation, and that the attending physician further failed to provide for backup coverage while she was out of the hospital.

Defendant Alleges Immediate Surgery Not Required

The dispute in the case centered on whether surgery was called for on the day the MRI was ordered given our client’s clinical picture, and whether cauda equina syndrome should have been anticipated on that day. Defendants hired two neurosurgeons as expert witnesses. Each stated that our client was admitted to the hospital with the same complaints as a patient in a non-emergency condition – with low back pain and radiating pain down a leg. Since surgery for these complaints is elective rather than mandatory, the defense experts believed our client did not require immediate surgery. Failure to perform surgery the same day the MRI was ordered was therefore not negligence.

Successful Resolution: $2,500,000

We were able to prove that our client was not a typical presentation. The change of symptoms from her left leg to right leg within 12 hours following admission, and her inability to feel the urge to urinate were hallmark features of a developing cauda equina syndrome, a well known, if rare neurologic condition. Further, the lack of explanation as to why the MRI was not immediately taken and that the MRI results indicated compression of multiple nerves in the spinal cord rather than a single nerve that already exited the cord ultimately led to the defendants offering plaintiff $2.5 million in settlement a week before trial was to begin.