Patient awarded $23M after radiologist missed signs of spinal cord compression
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You have to combine the patient’s history, physical examination, and imaging findings. Looking at any of those in isolation is how diagnoses get missed. If something does not seem right, trust your instincts, your expertise, and your training to guide you.
—Ehsan Jazini, MD
Any of these symptoms would warrant immediate imaging: A bowel or bladder function, saddle anesthesia, dexterity issues, fine motor skills and balance, progressive numbness, loss of sensation or tingling, and a loss of strength.
—Neel P. Shah, MD
Last month, jurors decided that a patient would receive a $23.1 million payout from Northern Light A.R. Gould Hospital and Northern Light Health. The suit alleges that the patient's doctors missed the signs of spinal cord compression, leading to paralysis.[][]
The verdict is the largest non-death medical malpractice award in Maine's history.
A series of failures
In late 2020, Robert-Michael M. Giordano, who was 40 at the time, visited the emergency department at Northern Light after a fall. He developed “10/10” pain in his left thoracic spine overlying his ribs, according to reports.
Related: More than 30 malpractice claims raise questions about this surgeon’s decisionsAt the time, a CT scan was ordered and appeared to show no abnormalities. The radiology report stated that there was no acute fracture or suspicious lesions and no acute abnormality of the chest, concluding: “No significant pathology identified.”
It did not note a calcification protruding into the spinal canal, nor did the radiologist recommend MRI imaging to evaluate for spinal cord compression, according to the official complaint.
The evaluating doctor then sent Giordano home with instructions to take pain medication and try topical treatments to alleviate pain.
By late January 2021, things took a dark turn. Giordano logged into a telehealth appointment with his primary care provider to report sudden and progressive neurological symptoms—he had worsening pain, and he couldn’t stand, or he fell when he tried.
According to the official complaint, Giordano’s PCP believed that Robert was “exaggerating or making up the extent of his pain and his falls.”
The physician documented his concern that Robert was “malingering” to get opioids, despite there being no history of substance use disorder. He was prescribed gabapentin. He was not recommended to visit the emergency department.
Related: Gabapentin’s cognitive-risk signal is reshaping prescribing: What it means for today's clinical practiceThat same day, Giordano had a telehealth appointment with a provider at Northern Light Orthopedics. He reported “bilateral lower extremity numbness with no specific distribution, lower extremity muscle spasms, pain and weakness in his legs, and back pain,” according to the official complaint. This time, he was given a referral for an X-ray to be done the following week.
Two surgeries later…
Just a few days later, Giordano called 911 because he couldn’t move his legs and was unable to urinate. He was taken by ambulance to Cary Medical Center, where the emergency department doctor consulted with a neurosurgeon at Northern Light Eastern Maine Medical Center, who recommended an urgent MRI.
Transferred to Northern Light by LifeFlight, Giordano underwent the MRI, which showed a disc herniation at T6-7 causing severe spinal stenosis and impingement on the spinal cord.
That night, the Northern Light neurosurgeon performed a thoracic laminectomy and decompression. A day later, he performed additional decompression and a T5-9 posterior instrumentation. Despite the surgeries, Giordano was paralyzed from the chest down and now has a neurogenic bowel and bladder.
"Northern Light first missed a dangerous finding on Robert's imaging study and failed to follow its own internal policies on reporting this critical finding, said Giordano’s attorney, Travis M. Brennan, in speaking to the press.[]
“Next,” he continued, “Northern Light providers dismissed Robert when he sought help for new and alarming symptoms. This verdict will allow Robert to secure the vital medical equipment, supplies, and services that he requires to deal with the devastating and permanent injuries he suffered.”
In a statement, Northern Light spokesperson Suzanne Spruce said, “We are deeply sympathetic to Mr. Giordano and his wife and recognize the profound impact that his condition is having on their lives. However, we disagree with the jury’s verdict in this case and in particular the magnitude of this award.”[]
Related: Largest ED malpractice payout in Georgia history slams two doctorsClinicians reflect: When is an MRI warranted?
Neel P. Shah, MD, a spine surgeon at NYU Langone Health, tells MDLinx that an MRI—not a CT scan—is the gold standard for diagnosing spinal cord compression (excluding patients for whom it is contraindicated, like those with certain medical implants).
Related: When back pain and imaging tell two different stories: How to navigate in the clinic“In a trauma setting or if MRI is not available, a CT scan can be used, [but] the spinal cord is better visualized with MRI," Dr. Shah says.
Dr. Shah says that Giordano’s medical providers should have recommended an emergency visit when Giordano reported an inability to stand and notable numbness.
“Any of these symptoms would warrant immediate imaging: A bowel or bladder function, saddle anesthesia, dexterity issues, fine motor skills and balance, progressive numbness, loss of sensation or tingling, and a loss of strength,” Dr. Shah says.
Ehsan Jazini, MD, Virginia Spine Institute spine surgeon, agrees.
“Pain alone rarely tells the full story," Dr. Jazini says. "Back pain and neck pain are common, but when accompanied by other symptoms, especially neurologic issues, physicians should order an MRI sooner rather than later. You have to combine the patient’s history, physical examination, and imaging findings. Looking at any of those in isolation is how diagnoses get missed. If something does not seem right, trust your instincts, your expertise, and your training to guide you.”