Facts

Plaintiff Ryan Nguyen was 9 years-old when he was diagnosed with a craniopharyngioma, a benign brain tumor. Ryan’s parents took him to UCLA Medical Center. Because the pediatric neurosurgeon was on medical leave, UCLA had the Nguyens meet with a neurosurgeon who specialized in adult patients.

In June 2013, the neurosurgeon took Ryan to surgery and attempted, endoscopically, a total resection. However, because of the tumor’s size it was very unlikely that there could be a total resection of this tumor. Following the resection, Ryan recovered and in five weeks, was back in school and participating in all of his extracurricular activities. However, because of the size of the tumor, and the unlikelihood of complete removal, the doctors advised Ryan and his family that Ryan would have to undergo serial MRIs to determine whether the tumor had returned.

Ryan returned to UCLA for his serial MRIs. In June 2014, the MRI showed that there was a small 4 mm recurrence of the tumor. Unfortunately, the neuroradiologist who interpreted that MRI missed the recurrence because of the small size. In June 2014, Ryan would have been a candidate for radiation therapy on the recurrence and could have avoided any further surgical procedures. In September 2014, a repeat MRI demonstrated that the recurrent tumor, which was present in June, had doubled in size and was now pressing against the optic chiasm. Ryan, however, was completely asymptomatic at the time. Due to the recurrence of the tumor, the neurosurgeon who operated on Ryan in June 2013, felt that Ryan needed to be taken emergently back for further surgery.

PLAINTIFFS' CONTENTIONS: Plaintiffs contended that at no time during his doctor/patient relationship with Ryan did the neurosurgeon ever disclose to Ryan or his family that he was not a pediatric neurosurgeon. Nor, were they informed that they could refer Ryan to a pediatric neurosurgeon at another facility, despite the fact that several world-renowned pediatric neurosurgeons practice in the Southern California area.

Plaintiffs contended that an adult neurosurgeon should not operate on a pediatric patient due to the significant differences in pediatric anatomy. There was no emergent need to proceed with surgery. Rather, as the radiologist indicated, it was prudent to actually monitor the tumor over the course of several months before having to decide to go forward with surgery. During this time, Ryan’s case could be presented to UCLA’s Tumor Board to determine the best way to proceed with his case.

The neurosurgeon never advised the family of the existence and purpose of the Tumor Board, let alone a recommendation or offer to present the case to the Tumor Board. The standard of care for treating recurrent pediatric craniopharyngiomas was to treat the tumor with radiation (fractionated stereotactic proton radiotherapy being the most effective), not surgery.

Ryan Nguyen was the first 10-year-old pediatric patient that the surgeon was operating on for a recurrent craniopharyngioma. The neurosurgeon admitted he was unable to distinguish between normal tissue and scar tissue. Despite this fact, instead of abandoning the surgery as the standard of care required, the neurosurgeon continued to dissect through areas of brain tissue he could not see. In doing so, the neurosurgeon transected Ryan’s anterior cerebral artery, causing a massive, life-altering cerebral hemorrhage.

As a result of the massive hemorrhage, and damage to the artery, Ryan’s cerebral circulation went into periodic vasospasm. As a result, defendants treated him with Nicardipine, a drug designed to reduce/prevent vasospasm. Nicardipine, per the protocols of the manufacturer, should be given for a minimum of 21 days. The staff neurosurgeons and residents in neurosurgery discontinued the Nicardipine at day 14, even though Ryan continued to have vasospasms. Within 24 hours, Ryan had a subsequent stroke.

DEFENDANTS' CONTENTIONS: Defendants contended that the neurosurgeon’s decisions concerning the need for surgery and the surgical approach were within the neurosurgeon’s discretion and professional judgment. Moreover, the hemorrhage was a known complication of the surgery and therefore, not a breach of the standard of care.

Specials in Evidence

Out of pocket medical expenses to date exceeded $50,000. $8,911,388-$18,319,979 In excess of $19 million.

Damages

Defendants contended that Ryan’s life expectancy is significantly compromised at 34.9 years, due to the craniopharyngioma. Ryan, however, received fractionated radiation, which destroyed the remaining solid tumor. Ryan’s treating physicians and expert witnesses opine that given this new treatment, there is no reason to believe that Ryan would not live to be into his late 50’s to early 60’s and would be able to work.

Injuries

Prior to the surgery, Ryan was a straight-A student, who achieved perfect scores on state testing for math and science. He excelled as an athlete and Cub Scout and was a whiz at computer coding. He played four musical instruments. Ryan suffered catastrophic injuries requiring 24-hour around-the-clock care. He is legally blind. With the exception of a few words here or there, Ryan is unable to speak. He has significantly limited movement of all extremities and cannot walk. Ryan cannot care for himself and requires most of his feedings through a G-tube. Ryan’s intellect is fully intact as are his emotions. He understands all that he has lost. His capacity for suffering remains intact. Because Ryan is cognitively intact, he is still receiving straight A’s at school assisted by a modified schedule and an aide. He also receives extensive occupational therapy, physical therapy and speech therapy. In the future, he will require serial MRI’s, occupational and physical therapy, cognitive therapy and speech therapy. He will continue to require parenteral feeding and a round-the-clock attendant and nursing care. While Ryan may be able to attend college, he will be unable to work. Given his incredible academic aptitude prior to defendants’ alleged negligence and his family members’ academic and occupational prowess, Ryan’s loss of earnings is considerable.

Result

The parties agreed to a $9,000,000 settlement.

Other Information

Mediators Jay C. Horton and Robert N. Dobbins mediated the matter. Jonathan and Mary Nguyen waived their wrongful death claim for $250,000.