FOCUS

Delay in treatment of large intracranial mass results in patient death while awaiting treatment.  A medical malpractice case requiring review by a Neurosurgery medical expert, Radiology medical expert, and Emergency Medicine medical expert.

 

BACKGROUND

Severe headaches can be a symptom of a significant underlying neurological condition, such as a tumor, aneurysm, or migraine. Treatment can range from the administration of pain relievers to extreme cases such as surgery, depending on the underlying cause.  Appropriate imaging techniques can be used to identify the cause.  The level of care in neurosurgical emergencies is critical, as some complex conditions require highly specialized care.

 

CASE

A 25-year-old woman suffering from severe headaches presents to an emergency department for evaluation, where initial workup identifies a large mass, presumably an aneurysm or tumor. The patient is admitted to the hospital and the treating Neurosurgeon orders a brain MRI and brain MRA, which identifies that the mass is, in fact, an aneurysm.  Neurosurgery felt the patient required a higher level of care, and began to arrange transfer for the patient to a new facility. Despite an extensive effort to reach an accepting neurosurgeon, none could be identified. On the following day, with transfer arrangements still pending, the patient collapsed and died from a rupture of the aneurysm.

 

ELITE’S ROLE

ELITE was contacted by the legal team to assist in case strategy and secure the necessary experts.  The initial assignment for ELITE was to secure a Neurosurgery expert.  However, ELITE’s physician-led internal case strategy team realized that additional medical specialties may be necessary to review the case.  Having had extensive experience with similar cases, ELITE’s case strategy team further recommended a Neuroradiology medical expert and an Emergency Medicine medical expert, as the care given by these specialties can drastically alter the course of treatment for patient’s with neurosurgical emergencies.

 

THE MEDICAL EXPERTS

ELITE rapidly secured  top-tier Professors of NEUROSURGERY, NEURORADIOLOGY and EMERGENCY MEDICINE with extensive experience in the diagnosis and treatment of brain aneurysms to review the medical records and determine the causal links between the alleged delay in treatment, transfer, and subsequent death.

The Neuroradiology expert witness was the Chief of Neuroradiology with further specialization in Endovascular Neuroradiology at a top West Coast academic medical center.  His research focus was the imaging evaluation and minimally invasive treatment of intracranial aneurysms.  The Neurosurgery expert witness similarly was the Chair of her Neurosurgery division, who also focused her research interests on emerging treatments of intracranial aneurysms.  The Emergency Medicine expert was the medical director for his Emergency Department, and had reviewed numerous cases pertaining to the delayed diagnosis and treatment of neurosurgical emergencies and the presentation of headache.

OUTCOME

While the focus of the initial inquiry by the legal team was on a Neurosurgery medical expert, the case strategy outlined by ELITE to include Emergency Medicine and Neuroradiology experts proved critical to the case outcome.  The Emergency Medicine expert witness opined that the triage by the nursing staff was inappropriate, and key red flags such as “worst headache of my life” were not recognized, and thus they did not see a physician promptly and care was delayed.  This led to the legal team naming nursing staff and the hospital in the malpractice lawsuit.

Review by the Neuroradiology expert witness revealed that the “preliminary wet read” by the Radiologist did not appropriately recommend additional imaging, such as CTA and MRA.  If recommended, that would have been obtained emergently by the Emergency Department, rather than being delayed and obtained as an inpatient after being seen by Neurosurgery.  Given these delays, by the time the Neurosurgeon was consulted and involved in the patient’s care, there was no negligence on the part of the Neurosurgeon who quickly recognized this as a neurosurgical emergency and attempted to arrange appropriate care.

The hospital, nursing and Radiology physician settled the case, while the treating Neurosurgeon was dropped from the case.

 

FUTURE ENGAGEMENTS

The legal team recognized the value in the approach by ELITE.  The complimentary case strategy and consultation by ELITE’s internal physician-led case strategy team proved invaluable to the settlement outcome.  The legal team now utilizes ELITE’s “in-house medical team” model, by consulting ELITE at the outset of every new client engagement.  ELITE has lowered the overall costs for the legal team in evaluating new potential cases, and they have seen an increase in efficiency in securing experts and trying complex medical malpractice cases.

 

E-CASE STUDIES are brief clinical vignettes based upon actual cases handled by ELITE. Identifying information has been redacted or altered to protect case confidentiality.

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