I spent several hours today taking the deposition of a defendant spine surgeon in a pending medical malpractice case in Houston, Harris County, Texas. It was disturbing to me hear how this surgeon placed essentially disregarded the differential diagnosis process and put his patient, my client, in unnecessary risk.
Let me tell you a little bit about what happened.
In early 2017, my client walked into a Houston-area hospital for a back surgery to address lower back pain that was radiating into his legs. The day after his surgery, physical and occupational therapists showed up in his hospital room. It didn’t take them long to realize that something was wrong. He was having difficulty maintaining balance and was not walking with a normal gait. They didn’t bother to notify the surgeon.
On the same day, the patient started to notice numbness from the waist down. The hospital’s nurses and physical therapists didn’t notify the surgeon that day.
Later that night, the nursing staff recognized that he had urinary retention—he could no longer urinate on his own. Even though the surgeon had made an order to be notified in such cases, the nurses waited around seven hours before calling him. By then, his bladder had filled for the second time. A registered nurse had already used straight catheter to drain the urine once but needed another doctor’s order to address this problem.
The surgeon ordered an indwelling Foley catheter to be inserted through the patient’s penis into his bladder. He also ordered a routine MRI of the lumbar region.
At deposition today, I repeatedly quizzed the surgeon on whether he expected the nurses and therapists to notify him of these finds—particularly the new development of urinary retention. After all, even this surgeon admitted that urinary retention can be an alarming red flag for some serious conditions.
The surgeon initially answered by saying “it depends.” That was surprising to me. Physicians make orders and nurses are supposed to follow them.
Eventually, the surgeon elaborated that even during the surgery he had concluded that the patient might experience a condition called neuropraxia. Neuropraxia is a temporary condition, often lasting two or three months, he explained, that he believes was caused during the back surgeon when some nerves were dislocated or stretched as he was placing some spine hardware.
Thus, he explained, it really didn’t matter what the nurses and therapists would have told him about the patient’s numbness from the waist down, altered gait (pattern of walking), and loss of bladder and bowel control. In his mind, he testified, neuropraxia could explain all these symptoms and findings.
When I asked him if he had already settled on a diagnosis of neuropraxia without doing any exam or testing, he said something like “pretty much.”
This surgeon’s way of practicing post-operative medicine is outright dangerous to patients.
Surgical and medical experts nationwide know that the standard of care requires a physician to consider a patient’s complaints, signs, and symptoms and then form a differential diagnosis list of every potential condition that could explain them.
Then, the doctor must use information from taking a detailed patient history, physical exam, and appropriate diagnostic testing to rule in or rule out every potential diagnosis from the list. They are supposed to start with the most dangerous condition.
I asked the surgeon if there were other potential conditions on his differential diagnosis list. He listed a few, including an epidural hematoma, which could compress the spinal cord or nerves. I asked him if he had completely ruled out those other potential causes and he waffled around a bit. The surgeon eventually admitted that he did nothing to rule them out, other than consider the patient’s history and conduct a physical exam.
All of this makes no sense to me and, frankly, seems to consist of mere after-the-fact rationalizing.
Once the registered nurse finally got around to notifying the surgeon of the patient’s urinary retention and numbness—about seven hours later—the surgeon ordered a lumbar MRI scan. On his order, he stated the clinical indication was urinary retention.
Over seven hours after the surgeon made his order, the hospital still hadn’t gotten around to performing the MRI scan. The surgeon finally made it into the hospital to see the patient. Without doing anything to investigate the urinary retention issue other than examining the patient, he canceled the MRI order.
Unfortunately for my client, he has experienced pain and numbness from the waist down every day since his surgery almost two years go. The last time he had control over his bladder and bowel activity was before the surgery. If the surgeon had used the differential diagnosis method rather than settling on his best guess, our medical expert says that my client would likely have fully recovered.
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Have you been insured because a spine, neuro, bariatric, or weight loss surgeon took short cuts during surgery or post-operative care? The experienced medical malpractice attorneys at Painter Law Firm, in Houston, Texas, are here to help. Click here to send us a confidential email via our “Contact Us” form or call us at 281-580-8800.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2017, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.