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Delayed diagnosis of cauda equina causing lasting injuries

A multi-million dollars recovery for a Butler County man who suffered a delay in diagnosing cauda equina syndrome. This is a condition in which a ruptured disk presses on the bottom of the spinal cord and, if not detected, can cause paralysis of the legs. Unfortunately, that is what happened to this man in his mid-30s. He had symptoms suggesting that there might be something compressing his spinal cord, but there was a delay in getting a CT scan or MRI in order to discover it.

As with most cauda equina cases, the focus of the debate in this case was on a delay in obtaining a CT scan or an MRI. Cauda equina is usually caused by a bulging disk that compresses the strand of nerves that starts at the bottom of the spinal cord. The best way to diagnose this condition is with an MRI. The problem in this case, as with most cauda equina cases, is that there is a delay in getting the MRI, and the longer the disk compresses on that strand of nerves, the more likely the patient is going to have permanent neurologic harm. In this case, the patient had some of the tell-tale early signs of cauda equina such as back pain, numbness to both legs, and abnormal bladder function.

Part of the reason for the delay in this case was miscommunication between the emergency room physician and the patient's family physician. There was some disagreement among them as to who should have been responsible for getting the MRI. Those sorts of miscommunication, however, should not happen in the hospital. Also, there was some disagreement between the family doctor and the nursing staff as to whether they had informed the doctor that the patient's neurologic condition was deteriorating. By the time they got around to doing the MRI, it was too late. Emergency surgery was performed to relieve the pressure caused by the disk, but the patient by that time had permanent nerve damage and had lost most of the function of his legs.

From a damage standpoint, this young man was pretty much homebound and had to use a wheelchair to get around. He needed a great deal of assistance with dressing and bathing and the like. As in most cases involving spinal cord injury and paraplegia, we hired an expert to prepare a "life care plan," which is a projection of all of the future medical and related needs that the patient is going to have and how much they will cost. Typical things included in the life care plan include the cost of attendant care at home or in a nursing facility; cost to rehabilitate the home to make it handicap accessible; medication costs; future medical visits; wheelchair expenses; and transportation costs such as a specialized vehicle or van with hand controls or wheelchair lift.

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