A 28-year-old woman was in labor with a singleton at term.

The nurse asked her if she wanted an epidural for pain relief, and she agreed.

Her husband was also present.

The anesthesiologist came in to do the epidural

The first level attempted at L3-4 resulted in a positive test dose.

The second level attempted at L2-3 was unsuccessful.

The third level attempted at L4-5 was unsuccessful.

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The husband recalls the anesthesiologist asking for help.

The L&D nurse commented on the epidural as well.

The second anesthesiologist was able to successfully place an epidural.

The total procedure time was almost an hour.

Delivery was uneventful.

The following day she felt severe pain in her back and a positional headache. She went on to receive a blood patch which helped somewhat.

Several weeks went by and the back pain and headaches still persisted

She was also intermittently experiencing pain in her extremities and shoulders, plus episodes of dizziness and blacking out.

The symptoms did not resolve and she saw a primary care PA.

She also saw a primary care NP who gave similar advice regarding filing a lawsuit

She was referred to a neurologist for her continued symptoms-

There were no significant findings on MRI

She saw a PM&R physician for further assistance.

She was over a year out from her delivery, and could not return to work as a corrections officer.

At this point the lawsuit against her anesthesiologist was underway.

Here is an affidavit from an expert hired by the plaintiff’s attorney:

Initial settlement discussions were not fruitful and it appeared that the case was headed to trial.

The defense decided to hire a private investigator to follow the plaintiff.

After additional delays in this case, the plaintiff’s attorney sent this letter to the judge:

The judge gave the plaintiff 6 months to find new representation.

Outcome

Six months passed and the plaintiff gave no notice of new representation and did not attend a pre-trial conference.

The case was dismissed.

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MedMalReviewer/Anesthesiologist Analysis:

1. I do have my doubts that the plaintiff’s attorney could not secure an expert for this case. All signs pointed this case would head to trial. An expert had already been found to write the above affidavit. I bet the video evidence of her walking around, talking, and interacting at school was pretty damning for an inability to work claim. “I can’t find an expert” sounds like an excuse to back out of a weak case, and avoid the costs of a trial that is likely to result in a defense verdict.

2. If the patient’s claims about what she was told are true, it seems no one in this case had any sense of professionalism. Patients are smart and they remember what they are told, although the possibility of secondary gain can cloud their recollection. Comments like “I am going to get somebody who does this on a regular basis,” “I’ve never seen one go so poorly,” and “why didn’t you get me sooner?” should be avoided. None of this is good team-building. Encouraging of litigation, by individuals who know nothing about anesthesiology or the legal system, is very frustrating. It is possible to be empathetic while remaining professional.

3. There must have been a wet tap here not documented, or multiple. Three levels and 1 hr of procedure time was a lot of needle passes. I’ll put this under the common theme of didn’t know when to stop. If there is no one to help you, remember, it’s extremely unlikely that you’ll be sued for the lack of an epidural.

4. Chronic pain and functional disability has been described in patients who have suffered an unintended dural puncture. Unfortunately most women in the above study reported persistent rather than resolving symptoms.