Painter Law Firm recently filed a lawsuit against Houston Methodist Hospital on behalf of a client who had lower back surgery at the hospital. The Harris County District Clerk assigned the matter as cause number 2019-27855, in the 164th District Court, where The Hon. Alexandra Smoots-Thomas is the presiding judge.
Houston Methodist Hospital, located in the Texas Medical Center, is a major academic/teaching hospital with over 2200 licensed beds. Its slogan is “Leading Medicine.” There are certainly some top physicians at this hospital doing some pioneering work. From my past experience with this hospital and many others, though, I know that sometimes even good hospitals miss the mark.
My client hired us to investigate the post-operative care that he received at a Houston Methodist Hospital back in 2017, because he didn’t feel that it was “leading medicine.” Instead, our client believes that the nursing staff ignored him and kept doctors in the dark about his declining neurological status, leading to a delayed diagnosis and treatment of a surgical complication—he had a brain bleed or hemorrhagic stroke that needed urgent attention.
This isn’t the first time I’ve investigated stroke-related care at Houston Methodist Hospital. A few years ago, I represented a client in a misdiagnosed ischemic stroke case. In working up that case, I investigated the hospital’s stroke program. As it turns out, Houston Methodist Hospital was the first hospital ever to obtain Comprehensive Stroke Center status. In September 2008, its stroke center director, Dr. David Chiu, explained that patients should “be aware that some hospitals have comprehensive stroke center capabilities to treat even the sickest stroke patient….”
Back to the current lawsuit. My client suffered from a hemorrhagic stroke, which accounts for only 15% of all strokes. Comprehensive Stroke Center hospitals must have highly-trained nurses capable of identifying post-operative neurological changes for any type of stroke, and notifying the attending physician immediately.
There are at least two factors that put this particular patient at an increased risk for having a hemorrhagic stroke, or bleeding in the brain.
First, he previously had a transient ischemic attack (TIA).
Second, during his lumbar-sacral back surgery at Houston Methodist Hospital, the surgeon lost his grip on a drill and accidentally punctured the protective dura mater layer surrounding the spinal cord. That’s called an incidental durotomy. The surgeon tried to repair it, but there was certainly a leak of cerebrospinal fluid (CSF). A spinal cord leak typically resolves on its own, with a patient placed on bed rest on a totally flat bed.
An incidental durotomy can cause an intense headache and if the leak is ongoing can lead to a bleed in a specific part of the brain, the cerebellum. That condition is called remote cranial or cerebellar hemorrhage.
As part of our thorough review and investigation of this case, we hired neurology and nursing medical experts to provide opinions to satisfy the requirements of Texas law.
Our nursing expert pointed out that the day after the surgery, the nursing documentation wasn’t great, but at least it did make note of the fact that the patient complained of head pain throughout the day.
The next day, though, the nursing expert identified several problems that she felt were serious. First, when the surgeon came to see the patient that morning, the head of the bed was up. The surgeon entered an order again and counseled the nursing staff to make sure and keep the bad entirely flat. Second, our nursing expert felt that the pain assessments by the nursing staff were completely inadequate. Although they recorded a pain score, they didn’t even bother to note the location of the pain. Was it in the back, near the surgery? Was it in the head? Was it both? You certainly can’t tell by the medical records.
According to family members, the patient’s head pain was so severe that he wouldn’t even eat his meals. Breakfast, lunch, dinner—the nurses noted that he wouldn’t eat, but didn’t assess why, didn’t notify the doctor, and didn’t make any note about it in the medical record.
In fact, the nursing expert is critical of the fact that there is about an eight-hour hole in the medical records where there are minimal nursing assessments. By about 8:00 p.m. on the second after the surgery, the patient’s wife begged for help because she felt something was terribly wrong. Someone finally ordered a CT scan. Sure enough, the family was right. The CT scan showed a hemorrhagic stroke.
Once the CT scan results were in, the doctors jumped on it. That’s when the “leading medicine” care that Houston Methodist Hospital advertises about was delivered. Unfortunately, by then, a lot of permanent damage had been done.
According to our neurology expert, the patient should have been imaged and provided with identical treatment eight hours earlier, which would have led to a substantially different outcome for him. Instead, he is left with cognitive, memory, and word-finding difficulties, all classic symptoms of this type of stroke.
As a former hospital administrator, there’s an odd thing about this patient’s medical record. When the physicians were notified and got involved on the evening of the second post-operative day, two of them wrote separate notes about events in the patient’s neurological decline, suggesting that it happened earlier in the day. What’s strange about it is neither of the doctors had seen the patient during that time and there are no nursing notes suggesting that anything was seriously wrong.
Nurses are a critical part of the healthcare team. Doctors are in and out of patient rooms and while they’re gone, nurses are their eyes and ears. Nurses are responsible for assessing and reassessing patients, looking for abnormal signs and symptoms, and promptly notifying physicians to get patients the medical care they need. Under the rules and standards of the Texas Board of Nursing, nurses are required to advocate for their patients.
Our experts believe that the nursing staff at Houston Methodist Hospital let our client down. By keeping the doctors in the dark about our client’s deteriorating clinical status, he didn’t get the timely medical care that he needed to save him from lifelong impairments.