An Iowa neurosurgeon beat a $27 million malpractice suit alleging that his misplacement of a surgical screw led a patient to suffer severe leg pain and loss of mobility.
The defense showed that the plaintiff already had multiple degenerative spinal conditions, such as degenerative disc disease, and that her complaints of severe pain predated the surgery by at least five years.
Surgical notes also proved that the surgeon was aware of the screw’s location but elected not to move it, citing a risk to the patient that outweighed any potential benefit.
After a two-week trial, an Iowa jury has ruled in favor of neurosurgeon Dr. David Boarini, MD, clearing him of a $27 million malpractice claim. The plaintiff claimed that a screw placed during a March 2019 surgery was incorrectly positioned by 1 millimeter, leading to severe pain. The surgery was performed to decompress and stabilize the lower spine and to remove a damaged disc. Dr. Boarini’s surgical report notes that there had been a medical breach of a pedicle screw at L4 on the left side.
The plaintiff began reporting extreme pain in her left hip after the surgery. The plaintiff claimed that the pain radiated to her knee and reported it again when she had her surgical staples removed. An MRI showed that the pedicle screw encroached on a nerve root. On April 15, 2019, the plaintiff underwent a CT scan. According to the lawsuit, the scan suggested that there might be changes to the shape and structure of the affected nerve root and post-surgical scarring.
The plaintiff claims that, at this time, Dr. Boarini increased her pain medications but made no efforts to remove the screw. Two weeks later, on April 30, 2019, the plaintiff sought a second opinion at the University of Iowa Hospital in Iowa City, where another neurosurgeon assessed her. Three days later, he performed a revision surgery. The screw was removed and new hardware was placed. However, the plaintiff continued to experience severe leg pain and weakness. According to court documents, the second neurosurgeon told the plaintiff that her symptoms were caused by the misplaced screw, leading to chronic nerve root damage.
The plaintiff’s pain and weakness affected her employment and mobility; she lost her job and now uses a walker. According to the lawsuit, the plaintiff continues to experience “disabling leg pain.”
However, the defense argued that the plaintiff’s pain and disability are unrelated to the surgery and misplaced screw. The plaintiff had experienced severe back pain before her surgery. In fact, according to medical records and arguments made by the defense, she had been experiencing severe back pain for at least 5 years before meeting with Dr. Boarini. Additionally, she had been diagnosed with degenerative disc disease, spondylolisthesis, and spondylosis in 2013 and with scoliosis in 2014. She had also suffered work-related back injuries and had fallen and been in a motor vehicle accident.
In addition to her previous diagnoses and injuries, the plaintiff was a smoker, which reduces the success rate of fusion surgeries. Dr. Boarini’s defense team argued that the plaintiff was aware of these risks before surgery. The defense also argued that Dr. Boarini left the screw in position because it was not touching any nerves and because the potential risks of harm from removing it outweighed any benefit. According to the defense, the screw was positioned in the epidural space of the spine and was not invading the nerve root; it was not causing any harm, they argued, and subsequent revision surgery to remove and replace the screw did not change anything for the plaintiff. The second neurosurgeon was unwilling to testify in the case.
After two weeks of trial and 4 hours of deliberation, the jury ruled in favor of Dr. Boarini.
Beating malpractice charges
The thought of being charged with malpractice is, of course, incredibly stressful. Although statistics show that the majority of malpractice cases never make it to trial, cases that do often result in a favorable ruling for the plaintiff. About 7% of malpractice cases are heard at trial, and in about 87% of these cases, juries rule in favor of the plaintiff.
There’s no guaranteed way to avoid being sued for malpractice or to ensure beating a malpractice claim if you are required to go to trial. However, there are some ways to prepare a defense, should you ever need to. For instance, Dr. Boarini’s team was able to show that the plaintiff had previous diagnoses that would lead to progressive pain. They were also able to show that Dr. Boarini was aware of the screw’s position and had judged the risk of removing it to be greater than any benefit.
Maintaining excellent notes, documentation, and record-keeping is the best way to make sure these patient details are always available. These practices ensure that, whether detailed records are needed for diagnostic purposes, for building a malpractice defense, or for any other reason, they can always be accessed. This is one of the many ways that practices that increase patient safety can also reduce the likelihood of malpractice charges or of a jury ruling in favor of the plaintiff in a malpractice case.
Dr. David L. Feldman, MD, the Senior Vice President and Chief Medical Officer of Healthcare Risk Advisors (a New York City–based group offering professional liability insurance to physicians) and Chief Medical Officer of The Doctors Company, the nation’s largest physician-owned medical malpractice insurer, says that reducing malpractice and improving patient care always go hand-in-hand.
Dr. Feldman adds that, “It’s part of our mission to advance, protect, and reward the practice of good medicine—to help hospitals, doctors, and so forth make care better—because it reduces their malpractice risk, but [also because it] makes care better, which is better for everybody.”