We just resolved a very bad – and very sad – case. In a case pending in the Eastern District of Virginia, the Navy will pay 1.85 million dollars to resolve a case involving a 48-year-old woman who underwent a dangerous and unnecessary procedure. The performance of the procedure itself was botched, truly adding insult to injury.
The client had a relatively rare condition known as loin pain hematuria. While the condition caused some chronic discomfort it didn’t prevent her from working, nor did it really impair her from a range of activities she enjoyed, such as running. Typically, it was treated with Tylenol or a similar low-level analgesic. The client sought care from the Portsmouth Naval hospital where she was eventually referred to an interventional radiologist. This doctor suggested a procedure known as Celiac Plexus Neurolysis (CPN). CPN is a complicated procedure which involves ethanol being injected into nerve fibers with the intent to destroy nerve tissues to alleviate uncontrolled pain. The injections are made very close to the superior mesenteric artery (SMA) and it is critically important to avoid damaging that artery.
The client underwent the procedure once and got relief. Six months later, the condition recurred and a repeat procedure was suggested. This turned out to be a disaster. Ethanol was injected into the SMA with catastrophic results. The client spent months in the hospital. She has now endured over 20 procedures. Essentially, she has lost a huge portion of her digestive tract, such that she cannot get adequate nutrition despite aggressive efforts. The client continues to lose weight and she is largely debilitated. Almost certainly her condition will get progressively worse and it will almost certainly shorten her life significantly.
CPN never should have even been a consideration for this patient. It is typically used in patients with end-stage pancreatic cancer who are suffering unremitting pain. Their life expectancy is usually measured in weeks. In those circumstances, the risk of the procedure can be easily justified. Indeed, treatment of such terminal patients was the only experience this doctor had doing CPN procedures – and that experience was quite limited. He had never treated loin pain hematuria at all before this patient. While he said that he had done “some research” before recommending CPN, nothing could be pointed out specifically. Indeed, there was no medical literature remotely supporting the use of CPN to treat this condition or similar ones. In essence, this doctor was experimenting on his patient. Of course, this was not disclosed to her. She thought this was something that was safe and commonly done. The patient never should have gotten CPN, but even worse, the procedure itself was not performed appropriately. Before the ethanol was injected, the studies showed the needle was in the wrong place and after the injection it was clear that ethanol was in the SMA. The doctor never realized the danger in which he had placed the patient and didn’t appreciate the damage he had done.
The economic losses were huge, but the case was controlled by the Virginia cap on damages, which was 2.15 million dollars at the time. Fortunately, the case was resolved relatively early in the litigation process and the client was pleased with the expeditious resolution.
The case involved complex medicine relating to an unusual condition. Other malpractice lawyers were not interested in it. We were and we knew what to do and how to do it. We have broad experience in malpractice cases and our nationwide practice handling Federal Tort Claims Act matters gives us a keen sense for the nuances of these matters. I am glad that we were able to use those skills to the benefit of this client. The money will not give her back her life, but we hope it will help her cope better with the tragedy that was inflicted on her.