Failure to Diagnose Vertebral Fracture of a Trauma Patient

CATEGORIES: Misdiagnosis , Emergency Room CASE LOCATION: Crawford Co., PA. CLASSIFICATION: Multi-Million Recoveries

The Anthony Case

On July 5, 2012, Our client, Anthony, a healthy, very fit 46 year old, was working in the woods as a self-employed lumberjack when a 6” diameter tree branch fell on his back, striking Mr. Anthony in the middle of his shoulder blades. He was knocked to the ground but did not lose consciousness. He was able to walk a short distance but then lay down due to extreme pain. Unknown to Mr. Anthony at the time, he sustained a burst fracture of his thoracic spine and three fractured ribs. Mr. Anthony’s co-worker summoned an ambulance. An EMS crew immobilized Mr. Anthony and took him to the Emergency Department of Titusville Area Hospital (the nearest hospital).

Upon his arrival to Titusville Area Hospital, Mr. Anthony was in dire need of urgent, appropriate medical treatment to avert permanent neurological injury caused by his fractured vertebrae.

Mr. Anthony was evaluated in the ER by Defendant Arthur M. Lewis, M.D. Dr. Lewis mobilized Mr. Anthony and ordered chest and thoracic spine x-rays. Since Mr. Antony could not roll on his side or sit still for the x-rays, the x-rays were of no diagnostic value. Nonetheless, Dr. Lewis noted “no fractures seen” and gave the following diagnosis to Mr. Anthony before turning the care over to Thomas Chesar, MD:

Status post blunt trauma;
Inability to ambulate.

Over six hours later, radiologist Kathleen Etzel, MD interpreted the x-rays from her home in Pittsburgh. Dr. Etzel’s noted in the body of her report that “there is limited visualization of the upper thoracic spine on lateral projection” but only documented “degenerative changes” in the “impression” section of the report. Dr. Etzel also missed one of the rib x-rays, a fracture of the first rib, which did show in the x-rays. Although Dr. Etzel acknowledges in her deposition that the x-rays were of “no diagnostic value” to diagnose a thoracic vertebral fracture, she chose not to request a CT scan or any further image studies. This cursory assessment was grossly negligent and reckless in light of Mr. Anthony’s history of severe spinal trauma and inability to ambulate.

For the next 2½ days, Mr. Anthony laid in bed at Titusville Area Hospital under the direct care of Dr. Chesar who was assigned to be the attending. Mr. Anthony remained in severe pain and was medicated throughout this time with IV morphine. He developed diminished breath sounds with a coarse productive cough. His inability to ambulate was never assessed. Neither Dr. Chesar nor the nurses made any attempt to diagnose the reason for Mr. Anthony’s inability to ambulate. This inaction on the part of Mr. Anthony’s caregivers was grossly negligent and reckless in light of Mr. Anthony’s history of severe spinal trauma and inability to ambulate.

On July 7, 2012, Mr. Anthony was discharged From Defendant Titusville Area Hospital. He was given pain medications and simply instructed to call his family physician, who was known to be out of town on vacation, “as needed. “Mr. Anthony was taken to his vehicle from via a wheelchair. His discharge diagnosis was:

Reason for Admission: “Blunt Trauma, inability to Ambulate”
Discharge Diagnosis: “same”

This discharge, in light of Mr. Anthony’s history of severe spinal trauma, his inability to ambulate, now for 2 ½ days, and still with no explanation for his inability to walk, was grossly negligent and reckless.

Mr. Anthony’s wife, Tina M. Anthony, took Mr. Anthony home, where he laid in pain (he was only able to slowly walk to the bathroom a few times) for 2½ days until, on July 10, 2012, his lower extremities started to become numb and he was unable to void. Mrs. Anthony called an ambulance which transported Mr. Anthony back to Titusville Area Hospital where Mr. Anthony was assessed and then air lifted to UPMC Presbyterian Hospital in Pittsburgh.

At UPMC-Presbyterian Hospital, Mr. Anthony was quickly diagnosed with an unstable T4 burst fracture and 3 fractured ribs and underwent a T2 – T6 laminectomy with fusion performed by Dr. Timothy Ward.

Mr. Anthony experienced a very difficult postoperative course and underwent a VATS, gastroscopy, bronchoscopy, endoscopy, laryngoscopy and exploration of the neck due to suspicion of mediastinitis and esophageal injury. He became hypotensive and septic requiring mechanical ventilation. He remained intubated until August 1, 2012.

On August 3, 2012, Mr. Anthony was transferred to UPMC Mercy Hospital for rehabilitation, where he was noted to have impairment of motor and sensory function, neurogenic bladder/bowel and activities of daily living dysfunction. He was diagnosed with T4 ASIA A paraplegia. Mr. Anthony was discharged from Mercy Hospital on September 8, 2012.

Mr. Anthony’s permanent conditions consisted of complete paralysis from the chest down, incontinence of bowel and bladder and intermittent severe pain throughout his lower body, feeling like uncontrollable muscle spasms.

Suit was brought in the Court of Common Pleas of Crawford, where there had never been a plaintiff’s medical malpractice verdict. Defendants were Mr. Anthony’s Emergency Room Physician, his attending physician and the radiologist. At trial, experts testified how each of these doctors were negligent in failing to diagnose Mr. Anthony’s spinal fractures, each according to the standards of care applicable to their respective specialties. Suit was also brought against the Hospital for its failure to maintain quality assurance standards and also on the basis of nurses who failed to follow protocols that could have led to a diagnosis.

The Defense Expert called on behalf of the Emergency Room Physician testified that the Emergency Room Physician/Defendant did not breach the standard of care because Mr. Anthony complained of pain in an area that proved to have no fractures and also because that Defendant actually admitted Mr. Anthony to the Hospital for observation. The expert further testified that an order for back restraints meant nothing other than the patient should not move further than he felt comfortable moving – essentially that there was never a reason to order back restraints for any patient.

The Defense Expert called on behalf of the radiologist testified that the Defendant radiologist had no duty to call the ordering physician to inform that the x-rays were unreadable, had no duty to suggest a CT scan and no duty to assure that the patient was on back restraints. However, on cross examination, it was brought to this expert’s attention that he had testified in a very similar case, but on behalf of a patient, that a radiologist in a virtual identical position had a professional duty to do all of these things and that the radiologist in the other case was actually “grossly” negligent for not doing those things.

Following the first week of trial, the Hospital, the Emergency Room Physician and the Attending Physician entered into a joint tort feasor’s settlement, meaning that those defendants settled the case against them, but the trial proceeded against the Radiologists, who would not agree to any settlement. Following the second week of trial, the Crawford County Jury returned a verdict of $2.2 Million, finding the Defendant radiologist 20% responsible.