Spinal Tap

Sometimes I can only ask in wonderment, what was that doctor thinking? Doctors have been performing lumbar punctures for more than a hundred years.

Naturally, a lot is known about this procedure. A lumbar puncture can yield critical diagnostic information and it is very safe, as long as you take basic precautions.

There are only a handful of reasons that preclude performing a lumbar puncture, most of which are uncommon and every first-year medical student is taught what to look for. So, how do you explain it when a neurologist, i.e., someone who has three post graduate years of specialty training in neurology and who probably has performed hundreds of lumbar punctures, manages to paralyze a patient doing a lumbar puncture?

Sherry Reinhart, married and in her 60’s, was admitted to The Toledo Hospital in May 2008. During this hospitalization, Dr. Purvi Saraiya, a neurologist who is a member of Toledo Clinic, a large multispecialty group, saw Sherry and decided to do a lumbar puncture. But, Sherry had a high level of anticoagulation, which put her at risk of bleeding from the needle that would be placed into her spinal canal as part of the procedure.

No problem. Every doctor knows—or should know—how to handle this situation. Unless the lumbar puncture is an emergency, just stop the anticoagulation and put the procedure off for a few days. Dr. Saraiya went forward anyway. In fact, according to a nurse, Dr. Saraiya stuck Sherry 15 to 20 times and drew back blood every time. Dr. Saraiya ordered some X-rays, but then didn’t come back to see Sherry that day or the next.

Over the next few days, Sherry progressively lost sensation in her legs and then developed weakness. An MRI was not done until 5 days after the procedure, which by that time confirmed a severe bleed that had caused permanent paralysis. Sherry left the hospital in a wheelchair and never got up from it.

A jury just awarded Sherry and her husband nearly $4 million. Her husband said he’d happily give every cent back if Sherry could be restored.

A corollary to my “what was the doctor thinking” question is what was the defense attorney thinking? This case should not have gone to trial. I suspect I know why this case didn’t settle, because cases like this one get tried every day. Jurors have a great bias in favor of doctors and doctors win 90% of medical malpractice trials. Anytime the facts are bad and the verdict is likely to be expensive, it frequently pays for the defense lawyer to try the case and play the odds. But when the facts are bad, the defense lawyer has to invent new ones and hope he can bamboozle the judge and the jury.

Frankly, I’m about fed up with the name calling plaintiff lawyers have to bear. When it comes to acting unprofessionally, no one comes close to the malpractice-defense bar. The most popular defense is a variant of the alibi defense criminals use all the time: Some other dude did it.

The malpractice-defense lawyer varies the ODD defense to: My doctor didn’t do it. Typically, the defense attorney trots out prim-and-proper faculty from Ivy League medical schools to testify that the injury was caused by the victim’s underlying disease. Thrown in for good measure is, “Such a tragedy that the plaintiff had this terrible condition. My doctor did everything he could to save that (ungrateful fill-in-the-blank) from such an awful situation, and nearly did.” It takes a perceptive juror not to fall for that baloney.

Article first published as Spinal Tap on Technorati.

Glenn L. Goodhart, M.D., J.D.