Neurosugeon Opines on Delayed Treatment of Cauda Equina Syndrome

This case involves a patient who presented to the emergency room with cauda equina syndrome. There was one neurosurgeon on-call, but the physician did not report to the hospital for over 24 hours after being informed of the patient’s condition. Upon his arrival, the physician did not order an MRI or any other immediate treatment. The ER did not have MRI facilities on site on weekends, and no arrangements were made for the patient to undergo imaging elsewhere. The patient ultimately underwent surgery four days later at a different institution, well after the optimal window of treatment for patients with cauda equina syndrome had passed. An expert in neurosurgery is required to help determine whether there was a deviation from the standard of care.

Question(s) For Expert Witness

1. Do you routinely treat patients similar to the one described in the case?

2. Have you ever had a patient develop the outcome described in the case?

3. Do you believe there may have been a deviation in the standard of care that contributed to this patient's poor outcome?

Expert Witness Response E-013763

I have 20 years of experience practicing neurosurgery in academic and veterans hospitals. I have top level training with excellent name recognition (Boston College, Yale Medical School, University of Pennsylvania residency), and I am on the faculty at an ivy-league medical school where I instruct residents and medical students. I am also widely published in spine surgery. I have been in practice since 1995, when I completed my neurosurgery residency and during my 20 years of practice I have evaluated and operated on numerous patients with cauda equina syndrome. It appears that the patient failed to receive timely neurosurgical intervention that might have prevented or reduced any subsequent permanent neurologic deficit. I have consulted on cases before that involved delayed treatment of pressure on spinal nerves or the spinal cord that resulted in permanent deficits, and I would be happy to review this case.