Hospitalist Attending Successfully Defended Against Claims of Medical Malpractice
On April 15, 2012, Clifford Rizzo returned to New York from a Caribbean vacation in severe back pain. Mr. Rizzo was a large man, over 300 pounds, and suffered from multiple ailments including diabetes, high cholesterol, high blood pressure, and narrowing of the carotid arteries, among others.
It turned out that he had an epidural abscess. The abscess was in his lumbar spine, extending upward as high as an MRI showed. Mr. Rizzo had intermittent weakness in his left leg. Getting a complete lumbar spine MRI was complicated by Mr. Rizzo’s difficulty fitting in to the MRI scanner, and his anxiety in attempting it. Imaging the thoracic and cervical spine was also problematic. Mr. Rizzo refused tests. His doctors planned an MRI under anesthesia.
Before the MRI under anesthesia was done, Mr. Rizzo woke up at 4:00 a.m. with sudden left arm weakness. All concerned attributed the weakness to an ascending epidural abscess. The MRI under anesthesia was planned to locate the abscess, with decompression surgery likely once that was done.
Mr. Rizzo’s second MRI showed that the abscess had been successfully treated with antibiotics, and investigation turned to identify other sources of his symptoms. Two CT scans of his brain were normal, but on the next day, an MRI (again under anesthesia) revealed a watershed stroke.
Mr. Rizzo died of unrelated causes three years after his stroke. His widow continued his medical malpractice lawsuit. She claimed that his medical attending doctor should have anticoagulated Mr. Rizzo due to his history of atrial fibrillation, that he should have been on two hour neuro checks due to his threatening neurologic deficits, and that he should have called a neurologist, or a stroke code, as soon as he learned of Mr. Rizzo’s left arm weakness. She also claimed that the orthopedics team, including his orthopedic attending surgeon, should have called a neurologist, or a stroke code.
Both defendants claimed that Mr. Rizzo’s stroke was not amenable to treatment because it was a watershed (low-flow) stroke, not an embolic stroke, with no clot to bust, because he had symptoms upon awakening, and was therefore outside the temporal window for treatment with clot busters, and because he had an epidural aspiration two days before, and with possible spinal decompression planned, was too high-risk of hemorrhage to be given clot busters.
The orthopedic surgeon claimed that diagnosing strokes was outside his area of expertise. The medical attending doctor claimed that he was not notified of the events in question until he rounded on the patient in the morning, much too late to order clot busters. Mr. Rizzo’s stroke was eventually diagnosed approximately 36 hours after the onset of symptoms.
The jury determined that the medical attending doctor was not negligent for allegedly failing to prevent the stroke. It found that neither the medical attending doctor nor the orthopedic surgeon were negligent for failing to immediately call a stroke code or a neurologist.
The case was settled after verdict pursuant to a high-low agreement. James M. Furey, Jr. represented the medical attending doctor.