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A 46 year old man came to the hospital for a single level lumbar fusion under general anesthesia.

Upon awakening in recovery he had excruciating pain in his left knee.

An MRI showed a partial thickness tear of his left quadriceps tendon.

He would require surgery to repair his quadriceps.

The patient claims he was dropped from the operating room table and nobody told him.

After all, how does one go into back surgery and end up with a torn quad?

The neurosurgeon, anesthesiologist, surgical PA, two OR nurses, and hospital were all individually named in the lawsuit.

The following allegations were laid out against the anesthesiologist.

The patient is a police officer, and his damages were based on lost earnings.

Specifically, he missed out on promotions due to his need for medical leave.

The following is an excerpt from an employment lawyer who specializes in work with police.

The plaintiff underwent a deposition.

This is the evidence that was presented as a scratch on the right cheek.

The deposition continues:

The patient denied any previous injury to his knee here.

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All staff present in the OR including neurosurgeon, anesthesiologist, surgical PA, and OR RNs were deposed.

All denied that any fall had occurred in the OR.

Here was a notable response from the neurosurgeon.

The plaintiff and his attorney continued with the lawsuit.

Here is the plaintiff’s anesthesiology expert

The defense anesthesiology expert opinion is shown here:

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An orthopedic surgeon was also hired who gave the opinion that there was no acute quadriceps tear at all, and his MRI was consistent with a chronic tear.

The orthopedic surgeon’s full expert opinion is at the bottom of this newsletter.

An excerpt is shown here:

The two sides were unable to reach a settlement, and the case proceeded to trial

During the trial, additional information came to light.

Approximately 12 years prior an incident report had been submitted to his department where his left knee was injured while attempting to handcuff a suspect.

He initially denied any previous leg injury, but this injury report was obtained by the defense.

Outcome

The trial concluded and the jury returned a verdict in favor of the defendants.

MedMalReviewer Analysis

1. It takes a real conspiracy theorist to think there could be a grand cover up of an operating room fall. If a patient has a minor skin abrasion it gets addressed and documented immediately. Something as big as a fall and with so many witnesses could never be covered up, even if certain individuals wanted it to be. If a patient fell where I work, the entire OR would know about it within the hour. I know many nurses who would be excited to write up something so juicy.

2. The plaintiff’s expert opinion feels weak to me and I am a bit surprised the case wasn’t dismissed pre trial. Much of his argument feels speculative. Some of his argument for why a fall happened is a cheek scratch which he argues cannot be from endotracheal tube tape. As well know, the tape goes directly on the cheek and the position of this skin finding does not strike me as particularly unusual based on the picture. There was also a random intra op xray of the head, which unfortunately aroused some suspicion.

3. It appears this was a chronic tear that somehow worsened in the perioperative period. He is an active police officer, and had injured that leg on the job before. Of note, the month prior the patient had also been taking levofloxacin. There still must be some precipitating event that would worsen the injury. I don’t see the mechanism how a prone fall would injure the quad. The muscle must be actively firing to be injured, not lax. I am left wondering if the cause could be fasciculations from sux, or from stage 2 emergence with full body clenching and rigidity. It certainly is an odd perioperative injury. What theories can you come up with?

4. The plaintiff’s attorney spent a lot of money on this case. Experts included neurosurgery, orthopedics, anesthesiology, and an employment attorney. This also included testifying in court which is expensive for a lawyer to pay for compared with a written opinion. From case event to verdict took 7 years. The case always seemed a bit weak to me. I suspect they really thought in the depositions somebody was going to admit to a fall. At that point they were invested in the case and saw it through.