Neurosurgery Expert Witness: Patient Suffered Critical Delay in Cauda Equina Syndrome Treatment

This case involves a patient who presented to the emergency room with back pain, saddle anesthesia, and incontinence, suspicious for cauda equina syndrome. At the hospital, the patient’s diagnosis was confirmed, however there were no neurosurgeons present to consult or treat the patient. It was noted that there was a neurosurgeon on-call at the time, however she did not report to the hospital for over 24 hours after being informed of the patient’s condition. Upon the patient’s arrival, the physician did not order an MRI or any other immediate treatment. The patient ultimately underwent surgery several days later at a different institution, well after the optimal window of treatment for patients with cauda equina syndrome had passed. As a result, the patient suffered permanent injuries including pronounced lower limb dysfunction

Question(s) For Expert Witness

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

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 institutions including Boston College, Yale Medical School, and the University of Pennsylvania, and I am on the faculty at an ivy-league medical school where I instruct residents and medical students. I am widely published in spinal surgery literature. 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.