June 22, 2006
Lancaster County, Pennsylvania

Peter J. Curry, Esquire (Bethlehem) obtained a defense verdict in Lancaster County in a case involving an 84 year old woman who sustained a spinal cord injury resulting in the loss of function of her lower extremities.  The case was tried before the Honorable Paul K. Allison.

Thomas, Thomas & Hafer LLP represented an anesthesiologist with a subspecialty in pain management. The Plaintiff had chronic back pain for which she sought out the services of a pain management specialist. In order to provide the Plaintiff with some relief, the pain management specialist performed a fluoroscopically guided thoracic epidural steroid injection.

Following the procedure the Plaintiff experienced an increase in her pain, which is known to occur. This type of pain can persist for hours. In this instance the Plaintiff was given pain medication which afforded her some relief and she was discharged from the pain management center.

After the Plaintiff arrived home the pain returned and persisted. The family attempted to call the defendant pain management specialist but were unable to contact him.  He returned their call, but by that time the family had taken the Plaintiff to a nearby emergency room. The emergency room physician examined the Plaintiff and concluded that she had no neurological deficits and that the pain she was experiencing was related to the epidural injection.  He gave her pain medication which relieved the pain and after approximately three hours in the emergency room, the Plaintiff was discharged. 

Once again the family took the Plaintiff back to her home and once again the pain returned. The family attempted to contact the pain management specialist who was providing anesthesia services at a local medical center.  He advised the family that he was not in a position to see the patient and he recommended that they take the Plaintiff back to the emergency room that she had visited earlier in the evening because the emergency room physician would be familiar with her case.

The family brought the Plaintiff back to the emergency room where she was once again examined by the emergency room physician who concluded that she had no neurological deficits and that her pain was related to the epidural injection.  Nevertheless, he admitted the Plaintiff to the hospital for observation. 

At approximately 9:30 a.m. on the following day, the nurses determined that the Plaintiff had lost the use of the her lower extremities. The Plaintiff was transferred to the local medical center where it was determined that she had suffered an epidural hematoma as a result of the epidural injection. It was further determined that the epidural hematoma compressed the spinal cord causing Plaintiff’s paralysis.

The Plaintiffs did not contend that the pain management specialist was negligent in the performance of the epidural injection. An epidural hematoma is a known risk and complication of an epidural injection. They were contending that his management fell below the applicable standard of care because he prematurely discharged the Plaintiff from the pain management center and he referred the Plaintiff back to the emergency room of the local hospital as opposed to the emergency room of the local medical center.

The Plaintiff further contended that the pain management specialist’s conduct resulted in the delay in diagnosis of the epidural hematoma which in turn led to the paralysis of her lower extremities.

The defendant pain management specialist asserted that an increase in pain following an epidural injection is not uncommon and that it was appropriate to discharge the Plaintiff after her pain responded to the medication. It should be noted that the Plaintiff dropped this theory of liability immediately prior to the start of the trial.

The pain management specialist further maintained that it was entirely reasonable for him to refer the patient back to the emergency room of the local hospital because the emergency room physician and staff were completely familiar with her situation and in a better position to assess her status. Furthermore, in the event the emergency room physician determined that the Plaintiff required a higher level of care, he was fully capable of transferring the patient to the local medical center.

The emergency room physician was a co-defendant in the case. The Plaintiff contended that he should have had a higher index of suspicion for a spinal cord injury and admitted the Plaintiff to the hospital with specific instructions to the nurses to check her neurologic status more frequently. The Plaintiff maintained that his failure to do so also led to a delay in diagnosis of the hematoma and resulted in the Plaintiff’s lower extremity paralysis.

The jury concluded that it was reasonable for the pain management specialist to refer the Plaintiff to the emergency room of the local hospital. They further concluded that in light of the fact that the emergency room physician’s neurological examinations were within normal limits, it was reasonable for him to admit the Plaintiff to the hospital for observation including routine neurologic checks.