Facts

John Doe was taken to a local hospital by paramedics after suffering stroke-like symptoms at home. In the emergency department, brain imaging revealed a lesion in his brain, suspicious for an arteriovenous malformation or a dural fistula. Such findings are considered complex brain lesions and require treatment by highly skilled physicians at university-level hospital settings. The standard of care required John Doe to be sent to another facility for higher-level care. In the emergency department, hospital personnel did not obtain Mr. Doe's signature on the "conditions of admission," form.

Despite the standard of care requiring he be transferred, Mr. Doe was evaluated by the on-call neurologist, who rushed Mr. Doe to the cath lab to perform a cerebral angiogram, a procedure to study the abnormality in the brain. Thereafter, this neurologist , who should not be treating malformations like Mr. Doe's, started the first stage of a two-stage procedure, done over a period of three days. During the first stage, he introduced catheters into the brain via an arterial approach, and injected Onyx material, a glue like substance, into what he called "feeding arteries." The neurologist completely missed the malformation and did not occlude the arterial supply. At the same time mischaracterized this malformation as an arteriovenous malformation (AVM), when it was in fact a dural fistula. By mischaracterizing this malformation as an AVM he recommended the second stage of the procedure, telling Mr. Doe he was at high risk of rupture and catastrophic brain bleed should he not agree to the second procedure. At this point, it was clear the neurologist did not have the training to treat Mr. Doe, and was required to transfer him to another hospital for higher-level care by specialists who are trained in such malformations of the brain.

During the second stage, the neurologist chose a venous approach, rather than an arterial approach, introducing catheters into the brain via the venous system. The intraoperative angiographic images established that the neurologist's technique was negligent as he was not able to reach the malformation he was attempting to treat, and was in fact several centimeters below the lesion, while at the same time claiming to be on target. The imaging revealed the neurologist clearly missed what he was attempting to treat.

To make matters worse, imaging studies also indicated that because the neurologist missed the vascular malformation, he injected more Onyx material against the flow of blood through the venous system, which then traveled downstream and occluded the major venous drainage from the brain. Imaging performed just before the procedure was completed clearly showed that the Onyx material was blocking the venous drainage of blood. Despite this finding, the neurologist claimed in his operative note that the procedure went perfectly. The neurologist also failed to use blood thinners during the procedure, which was a violation of the standard of care, and compounded the catastrophe.

At this point, the neurologist was required to emergently intervene to re-open the venous system in the brain. However, the neurologist was not aware of this because of his incompetence or because he failed to review the closing imaging at the end of the procedure. Instead, Mr. Doe was sent to the ICU where three hours later he suffered a catastrophic brain bleed. Ultimately, Mr. Doe underwent bilateral craniotomies, removal of portions of his skull on both sides of his brain, in an attempt to reduce severe intracranial pressure and avoid brain damage.

As a result of the neurologist's and hospital's conduct, Mr. Doe suffered severe brain damage, causing multiple physical impairments, but left him cognitively intact. He is unable to walk, largely bed and chair bound, unable to speak, and completely reliant on others for his daily care needs. However, he is mentally and cognitively normal.

PLAINTIFF'S CONTENTIONS: Plaintiff's contentions throughout litigation and at mediation relied heavily on radiologic images of the procedures. The images clearly revealed negligence on the part of the neurologist, and clearly showed how the catheters missed the target multiple times. The imaging also demonstrated the neurologist was several centimeters short of the mass when he injected Onyx, and that the Onyx occluded the venous drainage of the brain, thereby causing catastrophic brain damage. Additionally, the hospital faced exposure under theories of agency and ostensible agency because its staff failed to properly obtain requisite signatures on conditions of admission forms, in which they assert that doctors are independent contractors. According to plaintiffs' experts, this hospital and this neurologist did not have the expertise to treat this condition, with the standard of care requiring he be sent out of the emergency department to a nearby university facility, where one of the foremost experts in this Country was an attending physician. According to the same experts, the lack of expertise in treating such conditions was readily apparent on the intra-operative imaging. In summary, plaintiffs' experts opined that had Mr. Doe been transferred, he would have received curative treatment at another facility, such that his injuries would have been avoided.

Injuries

Permanent brain damage, leaving Mr. Doe completely dependent on others for all of his daily care needs for the remainder of his life. His wife had a corresponding claim for loss of consortium.

Result

Settlement of $8 million.