Wrong Assumption by Surgeon Leads to Permanent Damage

The following excerpt from a Notice of Intent to File Claim, or more commonly called, “Notice of Intent to Sue,” is a recent case that the litigators at Erlich, Rosen, Bartnick & Cook, P.C., have begun on behalf of one of our clients. If you wish to discuss a medical malpractice claim please contact ERBC at either www.ERBClaw.com or 1-800-595-0506 for a free consultation.

Factual Basis For Claim

Plaintiff age 35 suffered from chronic left hip pain following pelvic surgery in 2001. She presented to a neurosurgeon at a prestigious local hospital for evaluation on September 12, 2007. The neurosurgeon did a physical examination and rendered the following diagnosis and treatment plan:

“Due to the description of her pain and the positive findings of physical exam, it is apparent that the patient has meralgia paresthetica on the left side. She is able to outline rather precisely the associated dermatome within lateral femoral cutaneous nerve through which she experiences most pain. Palpation over the track of the nerve brings this pain about. Additionally, given her past surgical history and allocation, it provides a good explanation for the scar tissue build up around the nerve. Due to these reasons, there is no requirement for MRI, EMG, or diagnostic block of the lateral femoral cutaneous nerve. Upon discussion with the patient, the idea as part of a L1, L2, L3, nerve block as a diagnostic method was raised, and the patient said she will think about it. At this time, the benefits and risks of surgery were discussed with the patient in addition to the approach that would be used.”

Based on the neurosurgeon’s 100% confidence in her diagnosis and recommendation for a surgical fix, Plaintiff agreed to undergo a laparoscopic nerve exploration procedure. This procedure took place on November 6, 2007 and was performed by both the Neurosurgery services and the Urology services. Both physicians partook in the operation with the medical records indicating it was the neurosurgeon’s job to identify the nerve to be dissected and it was the urologist’s job to do the resecting in search of the nerve.

The medical records clearly indicate that neither surgeon was able to identify the lateral femoral cutaneous nerve. Since the neurosurgeon had specifically chosen not to do preoperative imaging studies or nerve conduction testing, the surgery itself, on November 6, 2007, was done blindly by simply looking for the nerve structure while dissecting everything and anything that got in their way. The conclusion of the dictated surgical report says it best regarding this wild goose chase of a surgical procedure:

“At the conclusion of the procedure, we had dissected out the surface of the psoas muscle and the surface of the quadrates lumborum muscle, extending all the way from the diaphragm (cephaled) to the termination of the quadrates lumborum muscle down at the iliac crest (caudad), and medially to the medial edge of the psoas muscle and laterally to the lateral edge of the quadrates lumborum muscle. We identified the ilioinguinal and iliohypogastric common trunk, as well as the genital femoral nerve, but did not clearly identify the lateral femoral cutaneous nerve. Given the extent of the dissection, we presumed that the nerve had been transected during the course of the dissection. As such, we elected to complete the laparoscopy.”

In better words, by the end of the procedure, the consensus between the two surgeons was that since they dissected everything they could find, they presumed that they got the lateral femoral cutaneous nerve. They presumed wrong, and even worse, they ended up dissecting the nerves that provide feeling to Plaintiff’s groin and genitalia. Within two weeks of her procedure, Plaintiff’s medical records clearly indicate that the unremitting pain she had prior to the surgery was still present, and in addition to that, she now had numbness in her legs and region of the lateral cutaneous nerve as well as in her groin and genitalia region.

Following the November 6, 2007, procedure, Plaintiff began treating with a pain specialist in Clinton Township who recommended the placement of a spinal cord stimulator to ease her pain. This surgical procedure took place on June 18, 2008 and has resulted in much relief from Plaintiff’s hip pain. Plaintiff continues to, however, have permanent numbness in her upper leg, groin and genitalia area as a direct and proximate result of the negligence of the two surgeons during the procedure of November 6, 2007 in which her nerves were dissected at random.

As a direct result of the neurosurgeon’s professional assurances to the Plaintiff that she knew which nerve needed to be surgically dissected based upon her cursory physical examination alone, Plaintiff was led to believe that the surgical correction of her pain symptoms would be a very simple procedure involving the cutting of a nerve close to the surface of her skin and would pose no adverse affects and would simply result in the relieving of her pain complaints. Because of the neurosurgeon’s over simplification of the proposed procedure and oral assurances of success, Plaintiff acquiesced to the procedure without being properly informed.

Because of the neurosurgen’s adamant belief that she had properly identified the nerve source of Plaintiff’s pain complaints based upon her physical examination alone, she chose not to perform any pre-operative testing to specifically determine the source of Plaintiff’s pain complaints and also to specifically determine the exact anatomical location of the nerve involved. Furthermore, she failed to take into consideration and/or failed to appreciate the fact that claimant’s prior extensive hip surgeries and pregnancies would have resulted in scar tissue build up in the area of the proposed surgery, making it more difficult to locate the nerve source during a laparoscopic or open procedure, which in and of itself, should have prompted preoperative MRI and EMG testing to properly locate the affected nerve.

The neurosurgeon’s failure to conduct preoperative testing and positively locate the affected nerve, in conjunction with Plaintiff’s pre-existing scar tissue, proximately resulted in both surgeons being unable to locate the affected nerve during the November 6, 2007 surgical procedure. Furthermore, the failure of both surgeons to perform their surgery under local anesthetic eliminated the possibility of utilizing Plaintiff for intraoperative feedback to determine which nerve was a source of her pain complaints and just as importantly which nerves were not involved and should be left alone.

The failure of both surgeons to do a proper preoperative work-up to determine the exact location of the affected nerve resulted in the two of them performing exploratory surgery in the area they “thought” the affected nerve should be and blindly dissecting the nerves found in and around that area in the hope they dissected the correct nerve. This negligent surgical approach by both doctors proximately resulted in both physicians failing to dissect the affected nerve. Furthermore, this negligent surgical approach resulted in the dissection of all of the adjacent nerve structures which during the surgical process either dissected or permanently damaged the nerve structures that supplied feelings to Plaintiff’s genitalia and hip regions. The failure to dissect the correct nerve, and negligent dissection and/or permanently damaging the incorrect nerve structures, has proximately resulted in the need for additional surgery and the implementation of a spinal cord stimulator to address the Plaintiff’s pain complaints. And furthermore as a proximate result of the permanent loss of feeling in Plaintiff’s genital region has resulted in loss of continence, as well as loss of sexual consortium with her husband, in addition to pain, emotional distress and economic damages.