Immediately after surgery plaintiff awoke with severe pain in his left arm that continues to date. An EMG two weeks post-op confirmed a moderate to severe ulnar neuropathy across his left elbow. Two physicians who consulted in the same hospital attributed this to a stretch injury or from mal-positiong, or excess compression. Four private treating physicians reached the same conclusion. The operating surgeon at deposition stated he has done about 1500 similar surgeries and never had this complication occur. The defense is that pressure against the OR table just from lying there can cause the injury w/o any negligence. My Neurologist says a transient injury can occur, but a moderate to severe permanent injury bespeaks negligence. My Anesthesiologist and Nurse say the entire Surgical Team is responsible for safekeeping of the patient. I need a Surgeon to agree with this principle.
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Do you believe there might have been medical error?
Perioperative ulnar neuropathy of moderate to severe degree indicates prolonged compression or stretch. Proper positioning, padding, and monitoring should prevent such injury. The surgeon and operating team share responsibility for ensuring these measures are implemented and maintained. There should be documentation in the chart that the padding was placed and that the appropriateness of positioning was verified. It is entirely probable that the surgeon was not in the OR until after the patient was prepped and draped, so it is entirely probable that the surgeon never verified positioning and thus assumed. This however does not clear the surgeon from responsibility. We are lacking details as to the conduct of the case and if it lasted longer than usual. We also do not know if unusual equipment was brought in and if there could have been an external compression on the arm. Also don't know how the arm was positioned and if the table was the standard table and appropriate for the case. Regardless of the details, the surgeon is responsible for the conduct of the operation and should have verified.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
It is more likely than not (>50% probability) that the patient’s left ulnar neuropathy resulted from prolonged compression or stretch during the operative procedure. Proper positioning, padding, and monitoring would have prevented this injury. Therefore, the perioperative care was a substantial contributing cause of the neuropathy. The injury was observed immediately after the operation- therefore this was a peri-operative event.
What makes you a good expert for this case?
I have over 20 years of experience as an attending surgeon performing complex cases. These cases include unusual positioning and prolonged operation time.
How often do you encounter cases similar to this one in your practice?
This is not common, fortunately.
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