Facts

Plaintiff Ronald Zannini, 76, developed neck pain radiating down his shoulders and left arm weakness. He was seen by a neurologist who ordered an MRI of the cervical spine, which revealed a 4-millimeter disc osteophyte complex and moderate to severe canal stenosis from C3-7. He was then referred to defendant neurosurgeon Mark Liker, M.D. and his group Neurosurgical Associates of Los Angeles on an urgent basis. After examining plaintiff and reviewing imaging studies, Dr. Liker assessed cervical myelopathy and recommended a C3-6 laminectomy with C3-7 lateral mass instrumentation. Plaintiff agreed.

On March 25, 2015, Dr. Liker performed a C3, C4, C5, and C6 laminectomy, a C3-7 posterior instrumented fusion, a C3-7 posterolateral fusion at Henry Mayo Newhall Memorial Hospital. Surgery was uneventful, and plaintiff was discharged on March 27, 2015. On March 28, 2015, plaintiff called Dr. Liker's office and reported bilateral arm weakness. Arrangements were made for plaintiff to present to the emergency department at Henry Mayo for an MRI. The MRI did not reveal any concerns and showed no evidence of a cervical hematoma. Plaintiff was discharged with instructions to take steroids for suspected neuropraxia.

During the afternoon of April 5, 2015, plaintiff felt a sudden warm wave come over his body and was paralyzed. 911 was called and he was transported to Henry Mayo. CT scans were obtained at 5:45 p.m., which ruled out trauma or hardware failure. Dr. Liker happened to be at the hospital and accompanied plaintiff to the CT scanner, which was adjacent to the emergency department. When the CT scans did not reveal the cause of the paralysis MRIs of the cervical and thoracic spine were ordered at 6:11 p.m.

Dr. Liker dictated a note and called his colleague Martin Mortazavi, M.D., who was the neurosurgeon on-call for the emergency department. Dr. Mortazavi confirmed that he would perform any neurosurgical intervention if warranted based on the MRI findings. The MRI revealed a large cervical epidural hematoma, and at approximately 9:30 p.m. the results were communicated to Dr. Mortazavi, the on-call neurosurgeon. Dr. Mortazavi requested an operating room for an emergent evacuation of the cervical hematoma. Surgery to evacuate the hematoma began at 11:35 p.m. and concluded at 12:25 a.m. on April 6, 2015. Plaintiff was paralyzed from the shoulders down.

PLAINTIFF'S CONTENTIONS: Plaintiffs contended that Dr. Liker should have anticipated an epidural hematoma and accompanied plaintiff to the MRI scanner to view images as they were obtained. Plaintiffs claimed that had this occurred, the diagnosis would have been made sooner. They also alleged that Dr. Liker should not have departed the hospital campus until Dr. Mortazavi the on-call neurosurgeon was physically present. They alleged that the failure to immediately supervise the MRI and take plaintiff caused a two hour and fifty-five-minute delay in commencing surgery. Plaintiffs contended that had surgery commenced then, that plaintiff would have significantly fewer deficits.

DEFENDANT'S CONTENTIONS: Defendant contended that he complied with the standard of care. Cervical epidural hematomas normally developed immediately following surgery, or within 24 hours. Here, there was an MRI on March 28, 2015, which did not reveal a hematoma. While plaintiff did develop a hematoma 11 days following surgery, this is highly unusual and had never been reported in the medical literature. Dr. Liker also contended that the standard of care did not require him to accompany plaintiff to the MRI suite to review imaging studies as they were obtained. Dr. Liker also contended that it was appropriate to have the on-call neurosurgeon perform any neurosurgical intervention, and the standard of care did not require a physical handoff. Furthermore, Dr. Liker contended that the MRI was obtained in a timely manner, and surgery commenced in a timely manner, neither of which was within his control. Finally, Dr. Liker contended that even if surgery commenced within the time frame plaintiffs postulated, that his condition would not have significantly improved given the severity of his symptoms upon presentation to the emergency room.

Settlement Discussions

On July 18, 2017, plaintiffs made a CCP 998 demand on Dr. Liker offering to compromise their claims for $1 million. On July 18, 2017, plaintiffs made a CCP 998 demand on Dr. Liker offering to compromise their claims for $1 million. Neither offer was accepted.

Specials in Evidence

Meds: Medi-Cal asserted a lien for $351,176 and Medicare asserted a lien for $471,166. Future Meds: Plaintiff requested over $2.5 million in future medical needs based on a life care plan.

Damages

Plaintiff sought $500,000 general damages. Bonnie Zannini alleged loss of consortium.

Injuries

Plaintiff underwent a long course of rehabilitation, but ultimately only regained some gross motion in his upper left extremity and was otherwise paralyzed from the shoulders down. Plaintiff suffered tetraplegia.

Result

Defense verdict.

Other Information

At one point there were seven defendants in this matter. Defendants have filed a Memorandum of Costs identifying $46,016 in recoverable costs.

Deliberation

six hours

Poll

11-1 (no negligence)

Length

14 days