INTRACRANIAL ANEURYSM- How to handle a work up of medical negligence case
After a 59 year old woman presented with headaches, nausea, dizziness and a third nerve palsy (droopy left eyelid e.g. ptosis) at a loc al eastern Washington hospital, certain diagnostic tests were ordered which showed there was no aneurysm or bleed and the woman was discharged. Five (5) days lady she suffered a subarchnoid hemorrhage and nearly died.
The issue was whether or not this persons’ aneurysm should or should not have been diagnosed with a presentation of third nerve palsy and classic signs of third nerve involvement caused by an expanding aneurysm?
Given Mr. Kornfeld’s legal experience in handling similar cases, failures to timely diagnose and treat intracranial aneurysms, another attorney referred this case to Kornfeld, Trudell, Bowen and Lingenbrink. Rob Kornfeld immediately suspected that somewhere in the course of this patient’s care, the diagnosis was missed. The rational is that one cannot present with a third nerve palsy and have a negative scan.
Rob agreed to provisionally accept the case and investigate whether there was evidence of an aneurysm on MRI or MRA scans.
After consulting with an interventional neuroradiologist, the undersigned learned that the patient’s MRA was misread and any general radiologist, even one in the Tri Cities of eastern Washington should have been able to make the diagnose in accordance with the standards of care in that region of the state of Washington.
Mr. Kornfeld then retained opinions of three other radiologists: 1) a general radiologist in Olympia Washington 2) a neuroradiologist from the University of Washington and lastly 3) a known defense radiologist in the greater Seattle area. All doctors confirmed that a general radiologist should have read and diagnosed the posterior communicationg aneurysm on the MRA. All agreed that the failure to diagnose the aneurysm fell beneath the standard of care of a reasonably prudent radiologist acting under the same or similar circumstances as the treating radiologist in eastern Washington.
The next issue to be addressed was whether there was or was not a causation issue, the most challenging and critical issue in any medical negligence case. Would the outcome have been different had the diagnosis been timely met?
The answer was unequivocally, YES. The woman was discharged, after admission from the hospital, and told to return in one week. Within 5 days of discharge, she bled and stroked. Would treatment have likely occurred on a nonemergent basis in the ensuing five (5) days before she hemorrhaged even it was timely diagnosed?
To this extent Plaintiff’s lawyer retained a neurologist and a neurosurgeon both of whom were questioned about the issue of medical causation. Both experts opined that there was plenty of time before the patient bled to take a CT-Angiogram and have a neursurgical or interventional neuroradiologist work up. The neursurgeon would typically clip the aneurysm while the interventional neuroradiologist would coil the aneurysm.
Coiling is the least invasive method of treating an aneurysm. A catheter is place in the patient’s femoral artery in the interior thigh and platinum coil is placed and fed up to the aneurysm, all of which is managed on a computer screen by the inteventional neuro-radiologist. At the point when the platinum coil reaches the aneuyrsm, a charge is sent to it and the coil unwinds into the aneurysm. As this process continues, the blood within the aneurysm ocludes and and obviates the need for invasive surgery. A second electric charge is sent which separates the coil and it is retrieved in reverse in the same way it was inserted.
John Olerud and Sharon Stone are noted public figures who have had aneurysms coiled and continued on in their professional careers.
In emergency situations, clipping of the aneurysm may be the treatment of choice and the treatment most neurosurgeon’s recommend. There is a turf battle between the professions as to which treatment is that of preference between neurosurgeons and interventional neuroradiologists.
In any event, there are complications which can occur regardless if the aneurysm is timely diagnosed and treated such as vasospasms. Most patients do not have complications as vasospasms but they too can be treated and the consequences of vasospasms can be mitigated.
Nerve palsies ,even if timely treated, can leave residual complicationsF,or this reason, lawyers handling cases of this type must consult with a neuro-ophthalmologist. These specialist are few and far between. However, retaining one is imperative in order to analyze the third nerve issues and whether injuries to the third nerve and resulting damages would have happened anyway if the condition was timely diagnosed or treated. This often is a case specific issue. Often the timely diagnosis would have made the resulting disabilities or visual field deficits much less severe or would have resulted in none at all.
Lastly, after you have concluded that there is a case of medical negligence and that you can show causation, what are your damages? Can you client live independently? Does your client need care 24-7?
Most patients die after a subarchnoid hemorrhage. For those who miraculously survive, they are either bed ridden in a nursing home or look normal, without any outward sign of injury after they recover from initial paralysis, hydrocephalus and shunt placement, or speech issues. Mr. Kornfeld has represented several patience who have made miraculous recoveries and appear to be normal until you sit down and try to carry on a normal 5-10 minute conversation. Where after a few minutes, it become readily apparent that the client is missing something and cannot track your conversation or lacks the ability to introspectively see themselves realistically.
It is imperative to work up a life care plan and once a qualified life care planner is retained and concludes their report in conjunction with a rehabilitation therapist to evaluate the patient’s hands on day to day abilities, a physiatrist and neurologist confirm the care your client will need for the rest of their life, including daily care, future care, costs of all current and future care, current speech and cognitive evaluations and rehabilitation, other physical and speech rehabilitation therapy needs, assistance with daily living issues, dressing, sleeping, meal planning, meal executions, cleaning, medication management, exercise, supervision and the like. Once you have a life care plan, make sure you have confirmatory medical reports from the appropriate specialists such as a physiatrist, neuropsychologist and rehabilitation counselors to confirm the abilities and disabilities of your client.
The next step in the work up of an intracranial aneurysm case is to deter any past and futuer economic loss such as earnings, fringe benefits and the like. A CPA or economist can determine the present value of all past and future economic loss.
These are some basis thoughts and models to work up a failure to diagnose an intracranial aneuyrsm case.
Rob Kornfeld, partner, Kornfeld, Trudell, Bowen and Lingenbrink
3724 Lake Washington Blvd. N.E.
Kirkland, Wa. 98004
That was a good read,You discover something new every day.
I just want to let you know I like your post and thanks!
Hello, My name is Mark and I suffered from an aneurysm in late 2005. I was a RE broker in CA (still have my license) and a patient at Kaiser in the SF area. After my aneurysm, Kaiser offered very limited post-op. care, and said they didn’t participate in the disability practice. Furthermore, I was on Valium, pain killers, and tons of medicine for the next several years.behavior, and was eventually dropped by Kaiser as I could not afford the dues and due to agoraphobia I have trouble leaving the house or area at times for weeks. I also now have motor impairment and lost hand use when impaled on a screw driver when painting. I have lost one property and now I may lose another and I am looking for an attorney to pursue disability. Could you help or refer?
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Sure. Feel free to contact me.
Rob
425 893 8989
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what is aneurysm…
Please keep me informed of updates to what is aneurysm. I am considering becoming involved in it….
Hi
Sorry for not timely returning your email.
Feel free to call me next week 800 282 4878
Rob Kornfeld
Rob@Kornfeldlaw.com