Paralysis Due To Brain Herniation - Delayed Treatment

Summary: Medical malpractice - Female plaintiff waited more than two hours in the emergency room before a CT-scan of her head was performed - Plaintiff was left paralyzed due to a brain herniation which she contended was due to delayed treatment - Defendant contended that the plaintiff would have been paralyzed regardless of when the CT-scan was performed.

- Queens County, NY

This medical malpractice case was brought after the female plaintiff fell down a flight of stairs at work and suffered a brain herniation that compressed the brain stem, which she contended was due to delayed treatment at the hospital emergency room. She was taken to the emergency room at New York Hospital Medical Center of Queens and waited two hours before a CT-scan of her head was performed. Surgery to evacuate her hematoma was not performed until more than four hours after her arrival in the emergency room, after she had already lapsed in to a coma and required resuscitation. The plaintiff was left paralyzed on her left side and wheel chair bound. The plaintiff contended that the CT-scan should have been performed immediately to preserve her neurological function and that the hospital was therefore liable for her permanent neurological damage. The defendant alleged that because of the size of the bleed, the plaintiff would have had neurological damage regardless of when both the CT-scan and the surgery were performed. The jury found the hospital liable and awarded $10.7 million. The defendant also sued the landlord of the building in which she fell and a settlement during the trial was reached for $3 million with that defendant.

The plaintiff, in her 60s at the time, fell down a flight of stairs that she and her husband, the male plaintiff, contended were defective. They claimed the risers were not of the proper height, which caused her to lose her balance, and they further claimed that the hand rails were too high, resulting in her inability to grasp the rail as she lost her balance.

Immediately after the fall, the plaintiff was rushed by ambulance to New York Hospital, and at that time she was awake and alert. Although she did not suffer major trauma, she was also exhibiting slurred speech, disorientation, confusion and amnesia of the accident, all signs consistent with a major head injury, the plaintiff contended. Upon arrival at the hospital around 1:00 p.m., the plaintiff was triaged within five minutes and was also very quickly seen by a physician assistant. The physician assistant ordered at CT-scan of the plaintiff's head and at trial he testified that all CT-scans in the emergency room are done stat, yet the CT-scan was not performed until 3:30 p.m.

At 3:15 p.m. a physical was performed by an emergency room physician, and at that time the plaintiff was still moving her extremities and was awake and alert and oriented times 1 as opposed to alert and oriented times 3, as she had been earlier when she arrived at the hospital. The CT-scan revealed an uncal herniation in the brain stem, and at 4:15 p.m. when the plaintiff came back from the CT-scan, she lapsed into a coma. Hospital staff spent roughly 45 minutes resuscitating and stabilizing her. A neurosurgeon then performed emergency surgery. A large hematoma was found in the parietal section of her brain and she was left paralyzed on her left side and wheelchair bound. She suffered no cognitive damage.

At trial, the plaintiff contended that the CT-scan should have been done within a half-hour to an hour of the initial order. The plaintiff's expert neurosurgeon further opined that had the plaintiff been in the operating room by 3:30 p.m., before she deteriorated and while she was still moving all her extremities, she would have been spared neurological damage. The defendant produced testimony that the plaintiff did not require an immediate CT-scan and that the bleed in the brain was so large that neurological damage was unavoidable regardless of the timing of the surgery.

The plaintiff argued that she was already in a high risk category for a bleed in brain when she arrived at the hospital since she was over 60 years old, had an injury above her clavicle, a hematoma on the back of her head and also because she had displayed some confusion and had vomited, even though she was awake, alert, talking and walking, and therefore she required an immediate CT-scan.

Major factors in the jury's determination included the physician assistant's testimony that in fact the CT-scan should have been performed within the half-hour and that he should have made sure that it was done. Also a factor was the defendant's expert neurologist's testimony upon cross examination that he was not in fact an expert in neurological outcomes of uncal hernations. The jury found the hospital liable for $10.7 million which included damages for past pain and suffering, future pain and suffering, past loss of service and future loss of services.

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