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Medical Justice

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Healthcare Reform

Simple Procedures: An Occasional Multi-Million Dollar Lawsuit

05/13/16 3:43 PM

We often worry about complications from difficult procedures. What might happen if a patient has anesthesia for 12 hours. Or, operating on a redo-redo cervical spine. And we’re right to be cautious.

But, even simple things can be fraught with hazards; hazards that are easily prevented.

Such an argument is being propelled in Nelson v. Emory Healthcare. The 55 year old patient, Chris Nelson, had blood drawn as part of a wellness exam. He was seated upright on an exam table. Nelson lost consciousness, fell off the table, and was found on the floor, prone, bleeding from his head. It’s not clear from the report whether he fell during the blood draw, or after the venipuncture (when he might have been left alone).

The doctor entered the room, performed a neurological exam, and implemented cervical spine immobilization (given the high index of suspicion for a cervical spine injury).

Once the patient regained consciousness, he complained of tingling in his arms and legs. He was transported to Atlanta Medical Center where he was diagnosed with a broken neck and spinal cord injury.

It’s unclear from the reporting whether his cord injury is complete or partial. It’s also unclear what level his quadriplegia/quadriparesis starts.

What is clear is his plaintiff’s attorney is arguing Nelson will require nearly $5M in economic damages alone – including medical bills and lost wages. That’s before any calculation on pain and suffering.

His lawyer is arguing that it was foreseeable venipuncture could trigger syncope and he should not have been on an exam table. He should have been in a padded chair that would prevent or cushion a fall.

Syncope after blood draw is not unusual.  Losing consciousness after any needle stick happens – this includes Botox, trigger point injections, etc.

We’re right to think about complications after complex procedures. We also need to prevent complications after simple procedures.


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Posted by Medical Justice | in Healthcare Reform | 6 Comments »
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Dr. Calvin Day
Guest

For 28 years I had a private practice with emphasis on dermatologic surgery including Mohs surgery. I performed over 26,000 Mohs surgeries under local anesthesia and I performed tens of thousands of biopsies using local anesthesia. For 17 years I taught dermatologic surgery to dermatology residents at UT medical school here in San Antonio and I emphasized and reemphasized and reemphasized again to the residents that every time you put a needle in a patient, that patient should be lying down unless of course they are unable to do so or have a contraindication. Padded chairs are not necessary. All… Read more »

Byron W Rovine, MD
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Byron W Rovine, MD

I agree with Dr. Day. However, regardless of any and all other circumstances, I believe that keeping the patients attended and under observation until they are able to tolerate the erect position without symptoms is the sine qua non.

Michael M. Rosenblatt, DPM
Guest
Michael M. Rosenblatt, DPM

There are a number of circumstances that can result in unexpected syncope in an office or clinic. Another common one occurs when an operative pin, sutures/staples remove, catheter extracted or installed, etc. Sometimes syncope occurs outside a clinic. When I was a teenager applying for a job at a day camp, I was asked by the owner’s wife for a blood sample for an academic project she was doing. I submitted to the venipuncture and immediately fainted. I realized the problem: the woman who withdrew my sample was drop-dead gorgeous. But the patient above fell directly on the floor. His… Read more »

Anon
Guest
Anon

We have seen more cases of vaso-vagal syncope during or after a needle-assault, than you can imagine. This is why God invented Trendelenburg which is immediately curative. You can often see patients’ respiratory rate increase, followed by pallor and lightheadedness before vaso-vagal syncope occurs. After administering a needle assault, I always observe the patient and ask the patient if they feel like they may pass out before making the examination chair vertical and leaving the room. That said, vaso-vagal syncope can come on quickly. I had a young lady pass out when I raised the exam chair – she slipped… Read more »

Raymond Reich, M.D.
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Raymond Reich, M.D.

Anybody notice it’s not the women who faint, but the strong young men?
No surprise, of course.
Men weak!
Women strong!

Raymond Reich, M.D.
Guest
Raymond Reich, M.D.

Anybody notice it’s not the women who faint, but the strong young men?
No surprise, of course.
Men weak!
Women strong!