Neurology expert witness advises on man’s allegegations that a fall caused brain injury

A neurology expert witness advises on man’s allegations that fall, not long-term health problems caused brain injury. Plaintiff was hospitalized for recurrent seizures. CT scans showed he had a chronic subdural hematoma or hygroma layer along his frontal lobe. He then was ultimately transferred to defendant skilled nursing facility. Four hours after he arrived, nurses discovered him on the floor near his bed. He was examined and returned to bed. His fall was reported to supervisors. Six days later, at his family’s request, plaintiff was transferred to the hospital. A CT scan showed an acute-on-chronic subdural hematoma with septations. The next day plaintiff underwent a craniotomy to drain the blood. He was transferred back to the nursing facility 12 days later.

Plaintiff alleges that he sustained a fall from his bed as a result of a seizure and that the defendant did not timely provide urgently needed medical care after the fall. Plaintiff further alleges he had to undergo a craniotomy to evacuate the hematoma and relieve pressure on his brain, and other procedures including two blood transfusions as a result of the alleged fall. He also alleges that he has permanent injuries, including mental and physical pain and suffering.

Question(s) For Expert Witness

1. Did the plaintiff’s fall cause his injuries?

2. Did delayed treatment cause his injuries?

3. Was his pre-existing medical condition a factor?

Expert Witness Response

I reviewed plaintiffs CT scans, MRIs, plaintiff’s deposition transcript and other documents. Plaintiff's medical records show a history of subdural hematoma and hygromas along with an old ischemic stroke, large ventricles, a shrinking brain, and a large subdural space. Plaintiff also had a severe traumatic brain injury to his frontal lobe when he was much younger, resulting in cognitive developmental delay and mental retardation. Plaintiff has sustained various falls and has received care and treatment from various medical providers for recurrent seizures over the years.

It is my medical opinion that plaintiff cannot demonstrate to a reasonable degree of medical probability a causal connection between his alleged fall, the acute hematoma, subsequent craniotomy or blood transfusions. First, there is no clear evidence that plaintiff in fact sustained a fall at the nursing facility, as the records indicate that he was found on the floor. In addition, there is no evidence that plaintiff sustained head trauma at any point in time while he was a resident there. In fact, all the evidence is to the contrary, as plaintiff had no abrasions, bruises, bleeding, or complaint of pain, upon being discovered on the floor. Furthermore, after plaintiff was found on the floor, he did not display any clinical signs or symptoms that suggested any neurological changes. His vital signs remained stable and he remained alert and responsive. He also denied pain and did not display facial grimacing (which can be a sign of pain). Plaintiff's acute hematoma could have been the result of many other factors. Plaintiff has a history of hematomas/bleeding on the brain evidenced by his pre-existing chronic subdural hematoma and hygromas. It is not uncommon in patients such as plaintiff, who have a chronic hematomas and/or hygromas, coupled with large ventricles, a shrinking brain and a large subdural space, to have spontaneous hematoma bleeding, without any acute trauma (such as a fall). In addition, Plaintiff had a significant seizure disorder and could have sustained acute bleeding on the brain as a result of a seizure(s).

In addition, it cannot be determined, to a reasonable degree of medical probability, that the bleeding from the hematoma occurred during the time he was at the nursing facility. Accordingly, a causal connection between the acute hematoma and bleeding on plaintiff's brain and subsequent craniotomy, and any care and treatment or alleged omissions in care and treatment by the defendant cannot be established to a reasonable degree of medical probability. It is my further opinion, to a reasonable degree of medical probability, that any alleged delay in providing care or transferring plaintiff to the hospital did not cause or contribute to his acute hematoma or bleeds and did not have any effect on his clinical course or outcome in this matter. Further, the bleeding of the hematoma at issue did not cause any further injury or permanent brain injury or damage to plaintiff.

Thus, plaintiff's current neurological state is not the result of the acute hematoma at issue, but rather is the result of a variety of things, including: plaintiff's age, his complex medical history including his recurrent seizure disorder and prior acute care treatment for display of multiple recurrent tonic-clonic seizures lasting for more than 15 minutes in duration, coupled with his pre-existing brain injury, mental retardation, developmental delays, diagnosis of schizophrenia, and other nerve disorders.

The expert is a neurologist with considerable experience treating patients similar to the plaintiff and in treating hematomas, including performing craniotomies.