Jury Solves Mystery of Retained Foreign Object

While it is not unusual for a retained foreign object to move around a bit, some apparently can travel farther than others.

A gentleman in his mid-60s presented to the hospital for a total knee replacement. Dr. A, the anesthesiologist, had significant difficulty and made several attempts to place a needle for spinal anesthesia before seeking assistance from a colleague. Together, they were able to place a needle using a straight-in approach.

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The surgery was completed without further difficulty and with no apparent anesthetic complications.

Two months later, Dr. A learned that a foreign body had been found in the patient’s lumbar spine after an MRI had been ordered as part of a sciatica workup. Reportedly, the MRI was compared to spine films from three years earlier, which showed no foreign body. The patient was advised of the finding and Dr. A discussed a subsequent CT report with him.

Six weeks later, the patient underwent lumbar surgery.  The surgeon removed a 2.1 cm “needle” from the spinal canal at L2-3, performed a fusion at that location, a posterior osteotomy, partial reduction/decompression of spondylolisthesis, partial laminectomy, bilateral foraminotomy and nerve root decompression, pedicle screw fixation, placement of bilateral rods, and a bone graft.

After the surgery, the patient reported relief of his pre-operative pain symptoms but complained of atrophy and lower extremity weakness. The patient did not return to work and was terminated from employment the next year.

The patient filed suit against Dr. A, alleging that she placed a needle through the spinal canal and through the dura, causing the needle to break and lodge in his spine. The plaintiff further alleged it was negligence to fail to recognize a needle fracture when the needle and introducer were removed.

The litigation was initially worked up on the assumption that the foreign body removed in the lumbar surgery was a needle fragment from the anesthesia administered for the knee surgery. The spinal surgeon testified that he could not state whether the patient’s pain was from the “needle” or from the patient’s pre-existing spinal stenosis but that in any case, the object needed to be removed.

Discovery revealed that the plaintiff had an urgent consult with a neurosurgeon three years earlier for severe leg pain, back pain, and a foot drop after moving pavers during some home landscaping. That neurosurgeon ordered flexion and extension films and had planned, depending on the films, to recommend surgery at L2-3 or L4-5, but the patient never returned.

During the litigation, however, further examination of the foreign object showed that it bore no resemblance to a spinal needle and matched nothing used in the needle drawer at the hospital where Dr. A administered the anesthesia.

During the workup of the case, Dr. A’s defense counsel questioned the plaintiff if he had received medical treatment during a trip that he had made to India three years prior. The plaintiff denied receiving surgical care in India during that time.

Defense counsel then obtained from India samples of cannulas used by physicians in that country. The samples matched the object removed from the patient. Despite the finding, the plaintiff’s counsel refused to dismiss the case, but instead presented an expert who theorized that Dr. A used some blunt needle as an introducer which broke and that the fragment was pushed by a spinal needle through to the ligamentum flavum.

At trial, Dr. A’s defense attorney proposed that the plaintiff traveled to India after suffering from stenosis and underwent either minimally invasive spine surgery or an epidural injection and it was then that the foreign object was introduced and retained. In trial, the plaintiff testified that he had no procedures performed after hurting his back while landscaping his yard three years earlier because his back got better by itself.

When Dr. A testified at trial, her defense attorney asked her if she could think of a theory other than that put forward by plaintiff’s expert. Dr. A responded that she had done some research into the matter and learned that physicians in some Commonwealth countries, like the former British colony of India, use cannulas in their suction procedures.

After 12 days of trial, the jury deliberated for one day to give a defense verdict to Dr. A by a vote of nine to three.    

 

Gordon Ownby is CAP’s General Counsel. Questions or comments related to “Case of the Month” should be directed to gownby@CAPphysicians.com.