$6.4 Million Plaintiff Verdict for Delayed Diagnosis and Treatment of Congenital Brain Defect

Case Overview

Case Name: Elizabeth Brubaker and Greg Brubaker v. Venkatachalam Mangeshkumar, M.D. and Neurology & Stroke Associates, P.C.

Case Type: Medical Malpractice – failure to diagnose; failure to treat; failure to test; and delayed treatment.

Injury:

• Quadriparesis
• Radicular pain/Radiculitis
• Decreased range of motion
• Cervical fusion
• Numbness
• Incontinence

Plaintiff Attorneys:

• April Strang-Kutay; Law Office of April Strang-Kutay

Defense Attorneys:

• Chilton (Chad) G. Goebel III; Saxton & Stump, LLC

Case Outcome: Verdict – Plaintiffs

Award Amount: $6,413,412.64

What Happened?

On September 30, 2011, Elizabeth Brubaker, a hair stylist, began seeing Venkatachalam Mangeshkumar, M.D. at Neurology & Stroke Associates, P.C., because she was experiencing sensory loss and muscle spasms in her arms and thighs. The physician diagnosed her with a repetitive stress injury and/or a brachial plexus injury (an injury to the network of nerves in the shoulder that carry signals from the spinal cord to the arms and hands). The doctor ordered a right shoulder MRI and prescribed nerve-pain medication. The MRI results were normal.

In the following months, after undergoing physical therapy and continuing the prescribed medication, Brubaker’s right arm did improve. However, the spasms in her arms and thighs continued. In 2012, Brubaker visited Mangeshkumar’s office twice and informed the doctor of her symptoms. Around the same time, she also informed him that she had stopped taking the medication because she was trying to become pregnant.

Brubaker subsequently became pregnant in 2013 and did not see the doctor during her pregnancy. She still suffered from spasms throughout her pregnancy and in March 2014, she gave birth via vaginal delivery. After approximately four hours of pushing, Brubaker developed a headache and weakness in both arms (the right arm being weaker than the left) immediately after giving birth. Within the following few months after her delivery, Brubaker’s symptoms worsened. She experienced weakness and sensory loss in both legs, resulting in clumsiness, tripping, and urinary incontinence.

The Diagnosis

In October 2014, Brubaker, who was now in her late 20s, was diagnosed with a condition referred to as a Chiari malformation, which is a structural defect in the base of the skull and cerebellum that causes brain tissue to extend outside the skull into the spinal canal. The condition can cause headaches, neck pain, weakness, numbness, dizziness, and problems with balance, among other things. A Chiari malformation is most often a congenital condition. However, it can also be the result of traumatic injury, disease, or infection. Mangeshkumar discovered Brubaker’s condition after conducting an MRI. The physician advised her that the malformation was incidental and of no significance.

Six months after her diagnosis, Brubaker underwent suboccipital decompression surgery. The procedure removed bone from the back of the skull to create more space for the brain. Then in 2016, she underwent additional surgery to release a tethered spinal cord in which the musculatures in her lumbar spine were adhering too tightly to her vertebrae, a condition that sometimes accompanies a Chiari malformation. She now suffers from quadriparesis (muscle weakness in both arms and legs). Brubaker was unable to walk independently until she was fitted with motorized braces in 2020. Prior to that, Brubaker had suffered a fall and dislodged hardware in her neck, requiring a cervical fusion. She continues with physical therapy in order to treat her condition and maintain muscle mass.

The Lawsuit’s Allegations and Trial Testimony

Brubaker and her husband, Greg Brubaker, filed a lawsuit against Mangeshkumar and his practice, Neurology & Stroke Associates, P.C. They alleged that the doctor was negligent in failing to timely diagnose Brubaker’s Chiari malformation and this constituted medical malpractice. Specifically, the plaintiff’s counsel argued that Mangeshkumar failed to detect it earlier and that once he did detect it, he failed to treat her accordingly.

At trial, the plaintiff’s counsel presented a number of medical experts. A neurology expert testified that when Brubaker first presented to Mangeshkumar in 2011, he should have ordered an MRI of her brain or cervical spine, which would have shown the Chiari malformation. If the doctor had discovered the Chiari malformation in 2011, then he could have referred Brubaker to a neurosurgeon in order to determine whether she was a suitable candidate for surgery. Most importantly, had the Chiari formation been discovered in 2011, Brubaker would have been instructed to abstain from natural childbirth, which caused exertion on her brain. The expert also opined that Mangeshkumar further breached the requisite standard of care when he eventually conducted the MRI in October 2014 and advised Brubaker that the condition was incidental and insignificant.

The plaintiff’s counsel also presented the testimony of a neurosurgeon who corroborated the neurologist’s testimony that had Brubaker been diagnosed with a Chiari malformation prior to pregnancy, the proper medical advice would be to refrain from vaginal delivery. Notably, Brubaker’s symptoms worsened after delivery. The expert further testified that if surgery was performed earlier, Brubaker’s neurological disability would be substantially less severe than her current condition. An expert in neurosurgery corroborated this finding, stating that a proper diagnosis prior to giving birth could have prevented Brubaker’s neurological deficits.

Conversion Disorder Theory

The defense counsel presented their own experts who countered that Mangeshkumar’s treatment of Brubaker met the requisite standard of care. The neurology expert testified that Brubaker’s neurological deficits were caused by a psychological condition known as conversion disorder. This disorder is a mental condition where the patient experiences neurological symptoms without any underlying medical cause. The expert further testified that Mangeshkumar’s treatment plan was proper and resulted in the improvement of Brubaker’s right arm. The neurology expert also stated that Mangeshkumar should not have ordered a brain or neck MRI. The expert opined that Brubaker did not need brain surgery.

The defense counsel’s neurosurgery expert did not completely corroborate the neurologist. The neurosurgeon noted that earlier surgery would not have affected Brubaker’s outcome due to the complexity of Chiari malformation. However, the expert denied that Brubaker had conversion disorder and went on to describe such a diagnosis as tragic.

The plaintiff’s neuropsychology expert, who performed a battery of tests, presented strong evidence against the conversion disorder theory. The expert found that Brubaker didn’t have conversion disorder and that her physical condition was solely due to Chiari malformation. The plaintiff’s counsel, through the experts, also presented an MRI which clearly shows the Chiari malformation.

Who Won the Case?

After an 8-day trial, the 6-person jury unanimously found in favor of the plaintiffs. The jury found that the defendant was negligent and that his negligence caused Brubaker’s injuries.

The jury awarded damages totaling $6,413,412.64 in total, including $413,412.64 for past medical costs and $4.9 million for future medical costs and past and future pain and suffering.

Expert Specialties

The plaintiffs retained expert witnesses in:

• Neurosurgery
• Life Care Planning
• Neurology
• Neuropsychology

The defendants retained expert witnesses in:

• Neurology
• Neurosurgery
• Neuropsychology
• Life Care Planning

Key Takeaways

Both parties presented a number of medical experts to advance their respective theories. However, it is notable that the defendant’s experts did not all agree on one critical piece of the defense counsel’s theory—the cause of the plaintiff’s symptoms. The conversion disorder diagnosis advanced by the neurologist lost its strength when the defense’s neurosurgery expert didn’t corroborate it. It is hard to imagine that this did not affect the jury’s decision. Likewise, it is a reminder to attorneys to fully discuss their case theories with their experts to ensure that they are setting forth arguments that can be backed up by the evidence.