In this action, the plaintiff contended that the defendant neurosurgeon negligently failed to note progressively increasing intracranial pressure after a rupture of an arteriovenous malformation and negligently failed to conduct emergency surgery. The plaintiff contended that as a result, the patient suffered a fatal uncal herniation involving the uncus, the innermost portion of the temporal lobe.
The evidence disclosed that on the evening of June 7th, the decedent developed severe headaches with vomiting and right-sided weakness while at karate class. The decedent was brought to an initial hospital where a CT scan was properly read as reflecting that the decedent experienced a left frontal intracerebral hemorrhage. The decedent was transferred to the hospital at which the defendant physician had privileges several hours later. The plaintiff did not contend that any care at the first hospital was negligently provided.
The plaintiff maintained that the defendant negligently failed to note progressively increasing intracranial pressure. The plaintiff established that equipment designed to monitor intracranial pressure was available at the hospital and contended that the defendant was negligent in failing to use this tool. The plaintiff further asserted that the patient’s clinical signs on the evening of June 8th were indicative of such an increase. The plaintiff maintained that there was a gradual increase in blood pressure and that the heart rate fell from 106 to 85. The plaintiff contended that such signs were particularly consistent with a so-called Cushing response, signifying progressive, increased intracranial pressure.
The evidence reflected that when suffering a focal right sided seizure on June 8th, the patient was transferred to the intensive care unit. The plaintiff contended that she had two episodes of emesis and another seizure with evident agitation and that a second CT scan was ordered by the defendant and performed at about 9:30 p.m. on June 8th. The plaintiff’s expert neurosurgeon would have testified that the results clearly showed effacement of the basal cisterns. The expert would have maintained that such a finding would have maintained that such a finding was ominous and consistent with an insipient uncal herniation, which the plaintiff maintained occurred three hours later. The plaintiff’s expert maintained that although surgery was risky, the dangers were clearly outweighed by the devastating sequelae of a probable brain herniation.
The defendant interpreted the CT scan as reflecting no significant change from that seen on the CT scan taken the previous day. The defendant did not ask for a radiologist to review the CT scan. The evidence disclosed that when the hospital radiologist conducted a formal review of the scan the following morning, he noted the effacement of the basal cisterns.
The defendant denied that the injury was related to an increase in intracranial pressure. The defendant maintained that the patient was stable neurologically and in fact showed signs of improvement on June 8th, until the time at which she developed supraventricular tachycardia with resultant hypotension. The defense attributed the patient’s death to a sudden decrease in perfusion of the brain due to a drop in blood pressure. The defense argued that cardiac arrhythmia was associated with the initial intracranial hemorrhage and not to an increase in intracranial pressure, and that therefore the patient’s cause of death was the primary cardiac event which could not have been predicted or prevented.
The plaintiff countered that according to the nurse’s flow sheets, the patient herniated at 12:45 am. on June 9th, when she was noted to have lost consciousness with fixed pupils and a decreased respiratory rate. It was not until 1:00 a.m., 15 minutes later, that the nurse noted decreased blood pressure consistent with hypotension. Thus, it was plaintiff’s position that the cardiac arrhythmia was secondary to the uncal herniation.
The actual uncal herniation was not witnessed, the decedent was apparently unconscious when it occurred, and the defendant denied that the decedent experienced any conscious pain and suffering. The plaintiff’s expert maintained that this event would be extremely painful, would be likely to rouse the decedent, and that it was highly probably that should experienced intense pain for a brief period.
The decedent was a student. She left two parents. The plaintiff would have introduced evidence of the replacement cost of guidance and advice under Green/Bitner that approximately $300,000. The case settled prior to trial for $825,000.
REFERENCE
Plaintiff’s neuroradiologist expert: James Abrams, M.D. from New Haven, CT. Plaintiff’s neurosurgeon expert: James Weinstein, M.D. from WV. Plaintiff’s pathologist expert: Donald Jason, M.D. from NC. Defendant’s cardiologist expert: Edward Julie, M.D. from NJ. Defendant’s neurosurgeon expert: David Langer, M.D. from New York, New York. Defendant’s pathologist expert: Gerald Feigen, M.D.
Attorney for plaintiff: Charles A. Cerussi of Cerussi & Gunn, P.C. in Shrewsbury, NJ.
