I have had a number of medical malpractice cases in which catastrophic injuries occurred after surgery because of lack of communication between the surgeon and the nurses. The immediate post-operative period is a critical period as the patient’s body attempts to return to normal from the trauma of the surgery and the effects of general anesthesia. Much can go wrong and that is why the patient is closely monitored during this period. However, even the closest and best possible monitoring is worthless, if the doctors in charge of the care are not notified of significant changes in the patient’s condition or don’t respond appropriately when they are.
Each of the cases in which I represented patients who were badly damaged following surgery shared many similarities.
In the first place, each of the cases involved surgery on or near the spine. Because of the presence of the spinal cord, surgery on or near the spine always presents the potential for paralysis, often due to bleeding into the spinal canal which causes compression of the spinal cord.
Each case resulted in paralysis of the patient. The degree of the paralysis depended on the location of the surgery and of the post-operative problem that developed. Some patients became paraplegics, but a few became quadriplegics.
Each of the surgeries was considered to be a success at the time of its completion. The surgeon had done what she or he intended to do and the patient tolerated the procedure well. There was every reason to believe that the patient would make a good recovery by the time the patient was taken to the post-anesthesia care unit (PACU) or the intensive care unit (ICU).
Every hospital or surgery center has its own protocols for monitoring patients following surgery. They involve frequent checks of vital signs until the patient reaches certain benchmarks after which the vitals are checked less often. In addition to vital signs, protocols may require checks of sensation and movement, especially following spinal surgery. The surgeon or anesthesiologist may add elements to these monitoring protocols. In all events, however, it is the responsibility of the nurses in the PACU or ICU to know what is required of them by way of patient monitoring and to be diligent in doing it and in communicating the results.
In each of the cases under discussion here, things started to go wrong in the middle of the night, hours after the patient left the operating room. In each case, a nurse in the PACU or ICU performing regular monitoring recognized that there was a loss of sensation or movement. So far, so good.
In each case, the nurse called the doctor’s answering service, which called the doctor and awakened him or her. In each case, the doctor called the nurse back and they spoke.
Unsurprisingly, in each case, the doctor and the nurse had very different recollections of the conversation. In each case, the nurse testified she told the doctor all about the change in the patient’s condition. She testified the doctor asked questions, which she answered. The doctor gave some orders and that was the end of the call. In each case, the doctor testified that the nurse did not adequately inform him or her of the gravity of the change in the patient’s condition. In none of the cases did the doctor come to the hospital in response to the nurse’s call.
In each of the cases, something was compressing the spinal cord, usually a collection of blood called a hematoma, and causing the changes in movement and sensation. In each of the cases, prompt surgery to relieve the pressure on the spinal cord would have prevented any injury to the patient. In each of the cases, the magnitude of the spinal cord compression and its effects were not realized until the morning when the surgeon returned to the hospital and checked in on the patient. By then it was too late to save the patient from paralysis.
Generally speaking, these communications problems are almost always primarily the fault of the doctor. The doctor is better trained and more educated than the nurse. The doctor should be better able to recognize a developing problem than the nurse. When the nurse calls the doctor, whether in the middle of the night or not, the doctor cannot just sit silently and listen. The conversation must be an interactive one directed by the doctor. The doctor must ask questions to the extent that the information he or she receives is not complete or sufficient. The doctor must ask enough questions to learn the condition of the patient and how to address it. Any questions or problems in communication should be resolved by coming to the hospital immediately or arranging for another surgeon to see the patient immediately. If the doctor did not get enough information to realize there was a significant problem, that is going to be on the doctor.
There is not a lot you as a patient can do in these situations. Sometimes you are still under the effects of the general anesthesia when these problems arise. Even if awake and alert, you may not realize the significance of what is happening. If, however, you have had spinal surgery and begin to lose sensation or movement, scream bloody murder until a doctor comes to see you. The loss of sensation and motion following surgery on or near the spine is never a good thing. Don’t just count on everyone doing their jobs, especially in the middle of the night. Better safe than sorry.
