The medical malpractice lawyers at Wagners Law Firm recently helped the Nova Scotia victim of medical negligence achieve justice at trial. The facts which led to the patient’s tragic injury are as follows:
On April 2, 1997, Victoria Anderson was admitted to the Victoria General Hospital to be treated for inflammatory bowel disease. Her doctor anticipated that she would require surgery, and prescribed total parenteral nutrition to be administered by a central venous line (“central line”) – a catheter inserted into one of several large veins in the core of the body.
On April 3rd and 4th, residents from the Department of Surgery attempted to insert a central line for Ms. Anderson via the left and right subclavian veins. They were unsuccessful.
On April 5th, the Defendant Dr. Sharma was the medical resident responsible for the floor where Ms. Anderson was located. He was asked to establish the central line for Ms. Anderson because Dr. Love’s prescribed feeding had not yet been initiated. Dr. Sharma sought the assistance of a senior resident, the Defendant Dr. Gee, and they attempted to insert the central line via the internal jugular vein. They, too, were unsuccessful.
In the course of their attempt, the needle used by Dr. Gee entered an artery which she believed was the carotid artery on two occasions. She withdrew the needle and applied pressure. The attempt by Drs. Gee and Sharma took place late on Saturday afternoon. The following morning Ms. Anderson developed neurological symptoms which became progressively more severe, culminating in her present condition of “locked-in syndrome”. Subsequent angiograms showed that this was caused by an occlusion of her right vertebral artery and basilar artery, which supply blood to the brain.
Lawyers for the Plaintiffs alleged that the conduct of the doctors was negligent, and that it caused the stroke. The Plaintiffs further argued that the Defendants did not obtain informed consent before they attempted to insert the TPN. The Defendants denied this, and stated they treated her in a manner which was competent, careful and in accordance with the appropriate standards for physicians in their respective positions. The argued that the stroke which caused her to become “locked in” was the result of her inflammatory bowel disease.
After a month-long trial in early 2012, the trial judge agreed with the Plaintiff’s lawyers. She found that, during the procedure, Dr. Gee did not turn the Plaintiff’s head in accordance with the standard and recognized protocol for TPN insertion. The judge found that the neck was rotated too far towards her shoulder and that this played a role in the inadvertent arterial punctures.
Next the judge had to determine if the inadvertent arterial punctures played a role in the development of the stroke (or if the stroke was purely coincidental). She found that, “In order for blood to be drawn from an artery into a syringe, the inner lining of the vessel must be pierced, and the needle placed within the lumen. Once the needle is withdrawn platelets begin to adhere to the puncture site, and form a clot. This is the body’s natural healing process. In some instances, the clot may become dislodged from the wall of the vessel, and flow through the arterial system.” She ultimately concluded this process to be the cause of the stroke.
After hearing the evidence of numerous doctors from around the world, the trial judge concluded that the Plaintiff’s stroke was not likely caused by a state of inflammatory bowel-related hypercoagulabilty. She wrote in the decision:
I am unable to conclude that Ms. Anderson was probably in a “potently hypercoagulable” state prior to the stroke. There are several aspects of the evidence which are influential in this regard. Ms. Anderson prior to April 6th, showed no indications of being in a hypercoagulable state, let alone a “potent” one. This is despite the fact that she had encountered in the year preceding the stroke, several serious and prolonged flare-ups of her ulcerative colitis, all without venous or arterial difficulties. During the April 1997 hospitalization, Ms. Anderson had daily blood work undertaken in the days preceding her stroke. There were no indications of clotting difficulties arising in that time frame. I accept the evidence of the plaintiff’s experts that the post-stroke clotting incidents are more likely a product of the stroke itself and the resulting immobilization, rather than an indicator of Ms. Anderson’s pre-stroke potent hypercoagulability.
Alternatively, and regardless of the Defendants’ negligence, the trial judge also found that the Defendants had not obtained informed consent, stating:
Stroke is a rare complication of arterial injury. The Sloan article, referenced by experts for both parties, published in 1991 in the authoritative journal, “Neurology”, suggests that notwithstanding its rarity, stroke was viewed as a potential consequence of internal jugular catheterization. Although not common, the serious consequences arising from a stroke make such a risk “material” in my view. It should have been disclosed to Ms. Anderson. In addition, in conjunction with the serious risks which may arise, it is my view, that as part of being properly informed, Ms. Anderson was entitled to be advised of the Defendants’ degree of experience with the procedure to be undertaken.
Notwithstanding a defendant physician’s failure to disclose a material risk, liability will be avoided, if the Court determines that the patient, if fully informed, would have undertaken the procedure. Ms. Anderson was anxious to have the central line placed, and the TPN started. She was, understandably, eager to get home to her young daughter and attend to her wedding preparations. I cannot conclude however, that a reasonable person in such circumstances, if advised of the remote possibility of stroke, would have consented to residents, with the degree of experience possessed by the Defendants, undertaking the internal jugular cannulation.
The medical malpractice lawyers who helped achieve this excellent result for this deserving patient are pleased to be able to help her achieve justice and some future comfort as she ages.