Spinal Cord Injury Caused by Ignoring the Signs of Spinal Cord Compression due to a Ruptured Disk
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Spinal Cord Injury Caused by Ignoring the Signs of Spinal Cord Compression due to a Ruptured Disk

By Alexander Law Group, LLP

Summary

At midnight on Sunday night March 17, 2013, Dana Vogel, age 43, could walk when she arrived at the Emergency Department of the Saint Louise Regional Hospital in Gilroy, California by ambulance.

On Monday morning March 18, 2013 at 12:20 am Christopher Burke, MD, an emergency medicine specialist saw Dana.

Dr. Burke knew from the report of the EMTs, the triage nurse and from his patient that

  • she had not been in an automobile crash or suffered a severe fall
  • she had been carrying a backpack earlier that week and felt pain in her neck
  • she saw a chiropractor and felt fine until Sunday night when she called 911
  • she walked from her living room to the EMT gurney
  • she arrived by ambulance
  • her legs were numb
  • she had severe neck and back pain
  • neck back spasm
  • needed help to transfer from the EMT gurney to bed
  • there had been a sudden onset of symptoms of neck and back pain
  • tingling
  • her "range of motion was normal," meaning she had full leg muscle control

Dr. Burke violated the chief safety rule in emergency medicine: Always make sure the most critical suspected cause of physical complaints is fully evaluated or "ruled out."

Dr. Burke should have known that these symptoms were and are the red flags of cord compression and that his patient needed an MRI fast, which is mandatory to diagnose compression of the spinal cord.

Dr. Burke knew that the St. Louise Hospital’s MRI scanner was only open 8 am to 4:30 pm M-F. There was no way Dana could get an immediate MRI at St. Louise. He did not consider, or attempt to arrange, a transfer to nearby Trauma Level One hospitals where Dana could be immediately diagnosed for spinal cord compression by an MRI and if necessary treated with neurosurgery on an emergent basis.

Hospitals that had 24/7 MRI and neurosurgeons included Santa Clara Valley Medical Center, San Jose Regional Medical Center and Stanford University Hospital. An MRI was minutes away by open freeways that early morning at 12:20 am. Santa Clara Valley Medical Center Santa Clara Valley Medical Center is one of four adult level one trauma centers in Northern California. The other three are San Francisco General Hospital, Stanford and Sacramento’s UC Davis.

VMC operates the only federally designated spinal cord injury center in Northern California. It was the natural choice because it is the major trauma center in the county, with a trained Emergency Department and neurosurgeons who specialize in brain and spinal trauma surgery.

Not taking action with these red flags fell below the standard of care for emergency room doctors and it allowed the paralytic process to progressively worsen as time passed and a critical MRI was delayed beyond the time when an emergency surgery could have saved Dana’s arms and legs from paralysis.

Progressive Spinal Cord Damage with Cord Compression

Cord compression as a result of a herniated disk is not a single event. A ruptured disk causes a build up of pressure, compounded by a loss of blood supply that creates greater and greater nerve damage the longer it progresses.

Growing pressure in the spinal column involves neurons deep in the spinal cord and continues to permanently destroy more of them until pressure is relieved. That’s why time is life when spinal cord injury is suspected.

Dana Vogel suffered a progressive worsening of her condition while in the care of Drs. Burke and Orvik as her medical records show.

At 1:20 am there was another red flag to add to the multiple symptoms and signs of injury to the spinal cord first seen by Dr. Burke at 12:20 am. Dr. Burke had ordered nurses to help Dana walk. Dana collapsed. Her legs could no longer support her.

At 1:30 pm Dr. Burke ordered CT scans immediately following Dana’s collapse, despite the fact that Dana had not been in a major crash or trauma that had fractured bones. CT scans are totally useless for diagnosing a herniated disk because the spurting soft disk material from the center of a ruptured disc pressing the spinal cord cannot be seen on a CT scan.

At 4:40 am Dr. Burke considered that Dana’s condition was a conversion reaction, i.e. psychosomatic, rather than take immediate action to obtain an MRI, he consulted with a neurologist, Dr. Evan Allen.

At 5:05 Dr. Allen consulted by tele-medicine and found weakness in Dana’s legs. He considered various diagnoses and ordered an MRI, which he expected to be performed "stat" –"as quickly as possible." This patient needed an MRI of the whole spine and cord compression is always an emergency, according to Dr. Allen.

At 6:30 am Dr. Burke finally ordered an MRI, which he should have known was necessary from the moments shortly after midnight when he first saw Dana Vogel. The order only came after Dr. Burke discussed Dana’s condition with Dr. Allen who specifically advised an MRI of the spine was necessary. Dr. Burke then ordered an MRI knowing that service was not available at St. Louise until the department hopefully opened at 8 am. He was betting that there was no cord compression, even though if there was it was exceedingly dangerous to life and limb.

That violated the primary rule of emergency medicine: worst is ruled out first.

At 5:45 am another red flag occurred when Dana could no longer void her bladder. Dr. Burke should have known that this additional symptom indicated damage due to progressing cord compression.

When Dr. Burke left the hospital that morning at 7 am and transferred responsibility to Jeremy Orvik, M.D., there was time for a prompt transfer to a level 1-trauma hospital to save this patient from permanent spinal cord injury.

But there was no urgency in the "hand off" to Dr. Orvik.

At 7:45 am Dr. Orvik saw Dana and had the full record before him. He adopted what Dr. Burke had initiated without exercising his judgment, which is required of an emergency room physician for a patient with these severe symptoms. He should have known that this constellation of symptoms required an immediate cervical MRI to rule out spinal cord injury, which is threatening to life and limb. Dr. Orvik at that time adopted Dr. Burke’s psychosomatic theory and discussed with Dana the "possibility of psychiatric cause," which she said is "very unlikely."

So far, both the emergency room doctors failed to rule out the most serious risk of harm, which was cord compression. They violated the standard of care by jumping to a psychiatric conclusion that can only be made after all tests and evaluations are done and when there is no other explanation, especially with multiple red flags of cord compression and a patient deteriorating before their eyes.

At 2:20 pm Dr. Orvik learned that the MRI of the neck conclusively showed that a ruptured cervical 6-7 disk was invading the spinal column and causing nerve damage. At that time a call was made to begin the transfer of Dana to San Jose Regional Medical Center. That call was put off at 12:20 am, 1:30 am, 5:00 am and again at 5:45 am, when Dana could not void.

Dana finally left St. Louise at 4:55 pm in the middle of the rush hour, was evaluated at St. Louise by a neurosurgeon at 6:30 pm and immediately taken to surgery. Anesthesia began at 7:30 pm and the actual surgery began at 8:03 pm. The pressure in her cervical spine was relieved at approximately 9:00 pm. Surgery was completed at 11:10 pm.

The surgical release of pressure eventually allowed Dana to regain substantial muscle strength.

Had Drs. Burke and Orvik met the standard of care required of emergency room doctors, surgery would have been performed Dana's before cord compression caused permanent spinal cord damage.

Today Dana Vogel is am incomplete permanent quadriplegic without use of her legs, no ability to use of her left arm and limited right hand and arm strength, as a result of her deteriorating in front of her doctor’s eyes, as a ruptured cervical disk at level 6-7 progressively caused increasing damage.

Had Dana been transferred for an immediate MRI and had neurosurgery earlier that day, it was highly probable that she would have functioning legs and arms.

To meet and hear Dana Vogel, please watch this short video.

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