bilateral craniotomy for scaphocephaly (Case #398)

• Medical Probability: 6 / 10
• Medical Error Summary: The surgical time is quite long and padding alone may not be sufficient to comply with the standard of care to reduce facial skin ischemia in prone cranial surgery. Adults are placed in skull pins wit...
• Causation Probability: 7 / 10
• Causation Summary: The guidelines from the International Surgery journal emphasize that while supportive padded headrests can minimize inappropriate pressure on the face, the risk of pressure sores and ischemia still ex...
• Expert Summary: I am aboard certified neurosurgeon with 12 years experience. I have reasonable experience as an expert witness on both side. I am however not specifically certified in pediatric neurosurgery.
• Similar Summary: I perform 4-6 prone surgeries per month.

Delay in diagnosis of anterior communicating aneurysm with intracerebral hemorrhage. (Case #442)

• Medical Probability: 9 / 10
• Medical Error Summary: There were multiple errors in this case due to the initial ER’s failure to recognize and document the patient’s reported headache—a red flag for subarachnoid hemorrhage—and the delay in obtain...
• Causation Probability: 10 / 10
• Causation Summary: Two issues: delay in diagnosis and delay in treatment. 1. The delay in diagnosis led to profound coma (GCS 3). The surgery for definitive treatment was done 20 hours post-presentation during which ...
• Expert Summary: I am a board-certified neurosurgeon with fellowship training in cerebrovascular surgery (aneurysm clipping) and current experience taking call in stroke and trauma centers where these cases are common...
• Similar Summary: I encounter roughly 10 cases per year which are ruptured aneurysms with ICH. The incidence of aneurysmal SAH in the general U.S. population is about 6–10 cases per 100,000 people per year. Therefore...

Spinal cord injury, question of delay in care/insufficient care (Case #477)

• Medical Probability: 5 / 10
• Medical Error Summary: A credible argument can be made that surgery should have been performed emergently (same evening) rather than delayed until the next morning, and that the MRI caused avoidable delay. It is hard to ...
• Causation Probability: 4 / 10
• Causation Summary: Repeating the above I don't see causation as the patient arrived with a complete spinal cord injury which is always irreversible. It would be hard to find proof that earlier intervention would have ch...
• Expert Summary: I am an academic neurosurgeon with active and ongoing neurotrauma experience having served as Director of Neurotrauma at two centers certified by the American College of Surgeons. I have experience...
• Similar Summary: I commonly perform similar operations on similar cases. I see a chance fracture (three-column fracture) at least twice a month, most recently last week.

Surgeon performed a C7-T1 fusion that was not consented to by the patient. (Case #550)

• Medical Probability: 8 / 10
• Medical Error Summary: From a patient’s perspective, this case represents a wrong-level cervical spine surgery resulting from a failure to properly localize anatomy before proceeding with irreversible surgical steps. ...
• Causation Probability: 6 / 10
• Causation Summary: There is a reasonable basis to believe that the patient’s worsened pain and fusion constitute an injury (cased by an unindicated fusion l performed at C7–T1) a level not previously identified as s...
• Expert Summary: I am a board-certified neurosurgeon (FAANS) with an active practice in spine surgery, including cervical decompression, arthroplasty, and fusion. I routinely manage degenerative cervical conditions an...
• Similar Summary: I operate over one hundred anterior cervical cases per year, and have done thousands in my career.