Failure to Monitor | Failure to Treat | Post-Operative Care

MIXED VERDICT $3,500,000 Days after hip replacement, plaintiff became paraplegic

FACTS & ALLEGATIONS
On June 26, 2001, plaintiff Audrey Stresky, 79, entered Forbes Regional Hospital in Monroeville, Pa., for total hip replacement surgery. The surgery was per- formed by orthopedic surgeon David Girdany, and multiple attempts at spinal anesthesia were necessary before the procedure was performed.

The next day, Girdany prescribed non-steroidal anti-inflam- matory drugs as well as the anti-coagulant Lovenox. Stresky also began physical therapy that day, and was able to walk a few steps at a time.

By the early morning of June 28, she complained of pressure and pain in her lower back, and was unable to walk or stand during physical therapy. At about 4:30 in the afternoon, Girdany's partner, orthopedic surgeon David Fowler, evaluat- ed her and ordered an emergency MRI. The scan, which was not performed until approximately four hours later, after Fowler had left the hospital, revealed a subdural bleed in her spine. Fowler was informed, and ordered a neurosurgical consultation. The neurosurgeon recommended an emergency laminectomy to relieve pressure from a hematoma, but no operating rooms were available at Forbes Regional. Stresky was flown approximately 15 miles to Allegheny General Hospital in Pittsburgh, where she underwent the laminectomy at around midnight on June 29. After the procedure, Stresky was unable to walk. She sued Girdany, Fowler and their medical group, East Suburban Orthopedic Associates, Monroeville, as well as Forbes Regional, for negligence.

Stresky claimed that Girdany failed to monitor and respond to her post-operative condition. She also contended that he should have been aware of the likelihood of spinal hematoma when Lovenox is used in conjunction with spinal anesthesia, and of the increased risk of spinal hematoma when non-steroidal anti-inflammatory drugs are used after multiple attempts at spinal anesthesia.

Stresky claimed that Fowler failed to sufficiently monitor her condition after his examination, and had an obligation to see that the MRI was performed in a timely manner. Stresky alleged that Forbes Regional's staff failed to proper- ly monitor her condition and failed to report her steadily declining condition on June 28.

All the defendants contended they met the acceptable standard of care by getting Stresky to an operating room in a timely manner, and that her condition was not a result of any negligence.

Girdany contended that he found no signs of spinal cord compression on the day after the hip replacement surgery. He also claimed that he was not made aware of Stresky's complaints of back pain, or her inability to walk in physical therapy two days after the surgery, and would have investigated her condition if he had been informed.

Forbes Regional contended that elderly patients not being able to walk in post-operative physical therapy is common, and was not worthy of reporting to the doctor two days after surgery. Hospital personnel claimed that Girdany had been informed of Stresky's back pain, which he denied.

INJURIES/DAMAGES paraplegia
Stresky is permanently paraplegic, and will require life-long care, as well as modifications to her home to accommodate a wheelchair. The plaintiff's experts presented evidence that her past and future medical expenses would total approximately $2.4 million.

RESULT
During jury deliberations, Stresky agreed to accept a payment of primary limits of $500,000 for both Girdany and East Suburban, as well as excess coverage of $700,000 for Girdany and $300,000 for East Suburban. Stresky agreed to release the two from any further liability, and also agreed to limit any recovery from Fowler to primary policy limits of $500,000.

The jury attributed 83% of negligence to Forbes Hospital, 17% to Girdany, and 0% to Fowler. It awarded a total of $3.5 million, making Forbes liable for $2,905,000.

EDITOR'S NOTE
Counsel for Girdany was offered an opportunity to contribute to this report, but declined to do so. Counsel for Fowler and Forbes Regional Hospital did not respond to a faxed draft of this report or a phone call.