A recent $48 million verdict serves as a sobering reminder of the devastating consequences when medical providers deviate from established standards of care. The case involved a patient and his wife. They sued a dermatologist and the practice group. The medical malpractice claim was for the negligent misdiagnosis and delay to treat recurrent skin cancer.

The jury’s decision highlights a critical failure in the continuum of care—one that transformed a treatable condition into a life-altering catastrophe.

What is Peri-Neural Invasion (PNI)?

To understand why this case resulted in such a substantial award, one must first understand the clinical significance of the pathology findings. The doctor had previously removed a skin cancer near the patient’s right ear. The pathology report identified peri-neural invasion (PNI).

Peri-neural invasion occurs when cancer cells wrap around or invade the space surrounding a nerve. It is not merely a localized growth; it is a specialized method of cancer spread. Think of nerves as “highways” for malignant cells. Once a tumor gains access to the nerve sheath, it can travel far beyond the visible margins of the original lesion, moving deep into the head, neck, or even toward the brain.

Why is PNI Important?

PNI is a “high-risk feature” because it is strongly associates with aggressive recurrence. When a pathologist notes PNI, it signals that the cancer is no longer a simple skin-deep issue. It indicates a high probability that microscopic “seeds” of the cancer remain along the nerve path, even if the primary tumor appears to have been removed.

The Appropriate Response to PNI

The discovery of PNI necessitates an immediate escalation in the treatment plan. Standards of care typically require:

• Clear Margins: Ensuring the surgical site is completely free of malignant cells.
• Multidisciplinary Consultation: Consulting with doctors that are specialists outside of dermatology.
• Adjuvant Therapy: Because of the high risk of recurrence, doctors often should refer patients with PNI for radiation therapy to “mop up” any microscopic cells traveling along the nerves.

The Compounding Risk of Skin Cancer Delay: Leukemia and Immunocompromise

The doctor’s failure to act on the PNI further exacerbated the patient’s underlying health status. The patient had a history of cancer and was immunocompromised due to chronic leukemia.

In medical malpractice litigation, the patient’s baseline health is a critical factor in determining the “standard of care.” An immunocompromised system is less capable of fighting off microscopic cancer cells or controlling a recurrence. For a patient like this one, the “wait and see” approach is inherently more dangerous. The lack of a robust immune response means that any delay in diagnosis allows the cancer to progress at an accelerated rate.

The Critical Omission: Referral to a Radiation Oncologist

Despite the PNI and the patient’s immunocompromised state, no referral to a radiation oncologist was made. This omission is a central pillar of the negligence claim.

A radiation oncologist specializes in using high-energy beams to destroy cancer cells. In cases of recurrent or high-risk skin cancer, radiation is often used as a “secondary shield.” While a surgeon removes what they can see, the radiation oncologist treats the surrounding tissue to ensure the “highway” (the nerves) is cleared of remaining disease. By failing to make this referral, the defendants deprived the patient of a vital line of defense.

The Domino Effect of Misdiagnosis

The tragedy deepened months later when a painful lesion appeared in the same area where the doctor had removed the initial cancer. This is a classic “red flag” for recurrence. However, the doctor misdiagnosed the lesion as benign, removed it, and—critically—discarded it without a biopsy.

Discarding tissue without a biopsy when there is a history of high-risk malignancy is a significant breach of protocol. It effectively “blinded” the medical team, allowing the cancer to advance unchecked until it required radical intervention.

The Human Toll: Surgery and Permanent Injury from Skin Cancer Delay

The delayed diagnosis allowed the cancer to invade deep structures of the head and neck. To save the patient’s life, surgeons had to perform extensive, radical surgery. The results were devastating:

1. Facial Paralysis: Because the cancer follows the nerves (PNI), surgeons often have to sacrifice the facial nerve to ensure they have removed all malignant tissue. This results in the “dropping” of one side of the face, making it impossible to smile, close an eye, or speak clearly.
2. Loss of Hearing: If the cancer invades the ear canal or the auditory nerves, the surgical removal of the tumor often necessitates the removal of the hearing apparatus.
3. Disfigurement: Radical head and neck surgery involves the removal of skin, muscle, and sometimes bone, leading to significant changes in physical appearance.
4. Chronic Pain: Nerve damage from both the cancer and the surgery can lead to permanent, neuropathic pain that is notoriously difficult to treat.

Breaking Down the $48 Million Damages for Skin Cancer Delay

The jury’s award split into two distinct categories reflecting the different types of harm suffered by the family:

$32 Million for Pain and Suffering

The jury awarded this portion for the physical and emotional agony the patient endured over more than eight years. This covers the physical pain of the cancer, the trauma of the surgeries, the loss of bodily function, and the mental anguish of living with disfigurement and a terminal outlook.

$16 Million for Loss of Consortium

The jury awarded this amount to the patient’s widow. Loss of consortium is a legal claim for the spouse of an injured or deceased person. It compensates for the loss of the “benefits” of a married relationship, including:

• Affection and companionship.
• Comfort and solace.
• Sexual relations.
• The ability of the spouse to provide the same level of emotional and household support they did prior to the injury.

In this case, the jury recognized that the negligence didn’t just hurt the patient; it effectively ended the marriage as the couple had known it, long before his actual passing.

A Final Lesson for Providers and Patients on Skin Cancer Delay

The $48 million verdict underscores the massive exposure healthcare providers face when they ignore high-risk pathology markers and fail to follow established standards of care for vulnerable patients.

For patients, this serves as a reminder to always ask: “Was a biopsy performed, and what were the high-risk features?” For the legal and medical communities, it is a landmark example of how a single ignored pathology note can lead to a lifetime of suffering.

You can read Blog posts on other Verdicts.

Have you or a loved one suffered due to a delayed cancer diagnosis? Contact the Kopec Law Firm now.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

In the high-stakes environment of an Emergency Room, time is of the essence. However, a recent verdict serves as a sobering reminder that when speed replaces diligence, the consequences can be fatal. A jury awarded $15.5 million to the family of a 74-year-old man. His life irrevocably altered—and eventually ended—due to a misread spinal CT scan.

The case specifically highlights a growing concern in modern medicine. The reliance on international teleradiology and the potential for medical malpractice when doctors review complex diagnostic images in mere minutes.

The Case: A Five-Minute Oversight

The patient entered the hospital with a suspected spine injury, requiring urgent diagnostic imaging of his spine. A teleradiologist (a radiologist working remotely) in Thailand did the preliminary interpretation of his CT scans. The doctor misread the CT scans and subsequently reported the scans as “completely normal for a 74-year-old”.

Afterward, based on this “clear” report, ER physicians removed the patient’s protective neck brace. Shortly after, his condition spiraled, leading to permanent paralysis (quadriplegia) and his death two and a half years later. The jury’s decision hinged on a startling audit. The doctor had spent only five minutes reviewing two separate CT scans. This is a duration far below the standard of care required for such complex images.

What is a CT Scan?

A Computed Tomography (CT) scan is a powerful diagnostic tool that uses a series of X-ray images taken from different angles around your body. A computer then processes these “slices” to create cross-sectional images of the bones, blood vessels, and soft tissues.

In emergency trauma cases, the CT scan is the “gold standard” for identifying fractures or displacements in the spinal column. It allows radiologists to see details that a standard 2D X-ray might miss, such as small bone fragments or subtle misalignments of the vertebrae.

Spinal Damage: What the Scan Should Have Shown

In a case involving spinal trauma, a radiologist is looking for several critical indicators:

• Vertebral Fractures: Breaks in the bony structure of the spine.
• Subluxation: Partial dislocation of the spinal joints.
• Spinal Canal Narrowing (Stenosis): Evidence that bone or disc material is pressing against the spinal cord.
• Hematomas: Internal bleeding that can put pressure on the nerves.

In this patient’s case, while the preliminary read claimed the spine was “normal,” a later final report noted significant abnormalities that went unaddressed during the most critical window of his care.

The Danger of Premature Neck Brace Removal

When a patient presents with a potential neck or back injury, medical providers place them in a cervical collar (neck brace) to maintain “spinal precautions.” This immobilizes the spine to prevent any movement that could damage the spinal cord.

If a CT scan is misread as “normal” and the brace is removed prematurely, the results can be catastrophic. Without the brace, a fractured or unstable spine can shift. Even a small movement—tilting the head or being repositioned in bed—can cause a bone fragment to sever or crush the spinal cord. This is precisely the “deterioration” that led to the plaintiff’s paralysis.

Understanding Quadriplegia

The verdict focused heavily on the fact that the malpractice resulted in quadriplegia (also known as tetraplegia).

Quadriplegia is a form of paralysis that results in the partial or total loss of use of all four limbs and the torso. This typically occurs when there is an injury to the cervical (neck) section of the spinal cord. Because the spinal cord acts as the main “data cable” for the brain, an injury high up in the neck blocks signals to everything below it, including the arms, legs, and even the muscles required for breathing.

For a 74-year-old, the onset of quadriplegia is not just a loss of mobility; it is a total loss of independence that places immense strain on the respiratory and cardiovascular systems, often leading to a shortened life expectancy.

The Standard Time to Read a CT Scan: How Fast is Too Fast?

One of the most damning pieces of evidence in this trial was the five-minute review time for two CT scans.

While there is no “hard” universal timer, medical literature and expert testimony generally suggest that a thorough review of complex spinal CTs—which involve hundreds of individual image “slices”—requires significantly more time than 150 seconds per scan. Radiologists must compare different views (axial, sagittal, and coronal), check for subtle bone density changes, and ensure no soft tissue swelling is present.

The jury viewed the five-minute “speed-read” as a lack of diligence that rose to the level of negligence.

The Dangers of International Telemedicine – Misread CT Scans

Telemedicine allows hospitals to have 24/7 radiology coverage by sending images to doctors in different time zones (like Thailand) where it is currently daylight. However, this “follow-the-sun” model introduces unique malpractice risks:

1. Volume Over Value: Teleradiologists are often paid per “read,” which can create an implicit incentive to move through images as quickly as possible to increase compensation.
2. Lack of Context: A remote doctor does not see the patient. They lack the “clinical correlation”—the ability to see that the patient is in extreme pain or showing neurological deficits—which might prompt a more careful look at the scan.

A Precedent for Patient Safety

The $15.5 million verdict is a victory for patient advocacy. Consequently, it sends a clear message to teleradiology firms and hospitals: the convenience of remote medicine does not excuse a departure from the standard of care. Whether a doctor is in the next room or halfway across the globe, they owe the patient their full, focused attention.

You can read Blog posts on other Verdicts.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

A jury awarded a $16 million verdict in a medical malpractice case involving the tragic wrongful death of an infant due to a delayed C-section. The case centered on the devastating consequences of hospital staff and doctors failing to respond to clear warning signs during a prolonged labor. The family alleged that despite visible indications of fetal distress—including oxygen deprivation and the presence of meconium—the doctor did not perform an emergency C-section until the window for a safe delivery had closed.

This verdict is more than just a financial figure. It reflects the severe harm caused by medical inaction and the profound emotional toll on a family. The decision sends a powerful message that negligence causing devastating injury has serious consequences.

To understand why this case resulted in such a significant verdict, it is essential to explore the medical red flags that the legal team argued were ignored that resulted in infant death and birth injury medical malpractice.

Understanding Signs of Fetal Distress

Fetal distress is a broad term used to describe a situation where a baby is not receiving adequate oxygen or is otherwise struggling during labor and delivery. Monitoring these signs is the primary responsibility of the labor and delivery team.

Common signs of fetal distress include:

• Abnormal Heart Rate: This is often the first indicator. A heart rate that is too fast (tachycardia) or, more alarmingly, too slow (bradycardia) can signal trouble.
• Decreased Fetal Movement: If a mother notices a significant drop in the baby’s activity, it may indicate the baby is trying to conserve energy due to stress.
• Abnormal Results on a Non-Stress Test: These tests measure the baby’s heart rate in response to their own movements.

If medical providers do not respond to fetal distress, it can lead to infant death and medical malpractice.

What is Prolonged Labor?

In this case, the family alleged that the distress occurred during a prolonged labor. Labor is generally considered “prolonged” (or “failure to progress”) when it lasts longer than 20 hours for a first-time mother or 14 hours for someone who has given birth before.

Prolonged labor is dangerous because it puts physical stress on both the mother and the infant. As labor stretches on, the risk of infection increases, and the baby may become exhausted or experience restricted blood flow during contractions. When labor stalls, medical professionals must decide whether to intervene with medication or move toward an emergency C-section to prevent injury. Inaction here resulted in infant death and medical malpractice.

Indications of Oxygen Deprivation (Hypoxia)

The core of the plaintiff’s argument was that the medical team ignored indications of oxygen deprivation. When circumstances compomise a baby’s oxygen supply, it can lead to Birth Asphyxia. This often results in permanent brain damage or, as in this case, infant death and medical malpractice.

Indications of oxygen deprivation include:

• Late Decelerations: On a fetal monitor, if the baby’s heart rate drops after the peak of a mother’s contraction and takes a long time to recover, it is a classic sign that the placenta is not delivering enough oxygen.
• Low Apgar Scores: Immediately after birth, doctors assess babies on a scale of 1–10. Very low scores often point to oxygen deprivation during delivery.
• Acidosis: Blood tests taken from the umbilical cord can reveal high acid levels, confirming the baby was struggling to breathe.

The Presence of Meconium and Its Significance

The trial highlighted the presence of meconium as a critical warning sign that the medical providers appeared to overlook. Meconium is the baby’s first stool. It is thick, sticky, and dark green.

Why is meconium significant during labor? Under normal circumstances, a baby does not pass meconium until after birth. If meconium is in the amniotic fluid while the baby is still in the womb, it is often a sign of physiological stress. The baby’s digestive system may contract due to a lack of oxygen, causing the stool to be expelled.

The greatest danger is Meconium Aspiration Syndrome (MAS). If a distressed baby gasps for air while still in the womb or during birth, they can inhale the meconium-stained fluid into their lungs. This can cause severe inflammation, block the airways, and lead to fatal lung or brain injuries. When meconium is present, the medical team must act with heightened urgency. Inaction here led to infant death and medical malpractice.

The Consequences of Inaction: Infant Death & Medical Malpractice

In this case, the doctor delayed in performing a C-section despite these clear markers. This delay led to a fatal brain injury shortly after birth. The $16 million award covers medical expenses. More importantly, it also addresses the “emotional damages” and the loss of a life that timely intervention could have saved.

Medical malpractice cases involving infant deaths are incredibly complex. They require a deep understanding of both the law and the strict protocols that govern obstetric care. This verdict serves as a reminder to healthcare providers that “inaction” can be just as negligent as an active mistake.

You can read Blog posts on other Verdicts.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

Medical procedures are inherently stressful. Consequently, patients place an immense amount of trust in the hands of their surgeons and hospital systems. We expect that even in complex cases, doctors and nurses will follow the basic safety protocols designed to protect us. However, a recent verdict serves as a sobering reminder of what can happen when those systems fail. The result was a retained surgical instrument.

A jury recently awarded $16.75 million in a medical malpractice lawsuit against a hospital and medical group. The case specifically centered on a “retained surgical instrument”—a preventable medical error that left a patient suffering for nearly two months.

The Case: A 13-Inch Oversight

The patient underwent a significant surgery to remove a massive, 75-pound benign tumor. While the removal of the tumor was successful, the aftermath was a nightmare. The surgical team left a 13-inch metal retractor inside her abdomen following the procedure.

For 58 days, the metal object remained undetected inside her body. During this time, the patient experienced:

• Severe physical pain.
• Persistent nausea.
• Heightened anxiety and sleep disturbances.

A CT scan nearly two months later identified the source of her agony. To fix the error, the patient had to undergo a second surgery to remove the instrument, subjecting her to further medical risks and a prolonged recovery period.

What is a Metal Retractor?

In the context of this case, the object left behind was a surgical retractor. These are essential tools surgical teams use in almost every operating room. A retractor is a manual or handheld medical instrument used by surgeons to separate the edges of a surgical incision or to hold back underlying organs and tissues.

By keeping the “surgical field” open and clear, retractors allow the surgeon to see and access the specific area they are operating on without having to hold the tissue back with their own hands. In major abdominal surgeries, these instruments can be quite large—as seen in the 13-inch tool involved in this verdict—to provide enough leverage to move muscle and organs.

How is it Used in Abdominal Tumor Removal?

Removing a 75-pound tumor is a significant surgery. During such a procedure, the surgeon must navigate around organs, blood vessels, and nerves.

1. Exposure: Retractors are placed strategically to pull back the abdominal wall.
2. Stability: Once the incision is open, larger, often heavier metal retractors are used to keep the intestines or other organs away from the tumor site.
3. Precision: By “retracting” the surrounding tissue, the surgeon has the visibility needed to detach the tumor from the body safely.

In a procedure involving a tumor of that size, surgeons typically use multiple retractors of various shapes and sizes simultaneously to maintain a clear view of the operating site.

What is a Retained Surgical Instrument (RSI) Case?

A Retained Surgical Instrument (RSI) case is a specific type of medical malpractice claim. The surgical team accidently left a foreign object—such as a sponge, needle, or tool—inside a patient’s body after closing the incision.

In the legal and medical world, these are often “Never Events.” These are errors that are so egregious and preventable that they should never occur if the surgical team follows standard safety protocols.

In this case, the defense argued that the error was an “inadvertent mistake” occurring during a “complex procedure”. However, the jury disagreed, siding with the plaintiff’s argument that the incident represented gross negligence and a failure to adhere to basic surgical protocols.

Protocols to Prevent Retained Instruments

To prevent RSIs, hospitals must follow strict “count” protocols. These protocols are the primary line of defense against leaving foreign objects in a patient. They usually include:

• The Initial Count: The surgical team counts every instrument, sponge, and needle and records them before the surgery begins.
• The Intermediate Count: Counts are performed whenever instruments are added or when there is a shift change in the surgical staff.
• The Final Count: Before the surgeon begins to close the primary incision, the scrub nurse and the circulating nurse must perform a final count of every item to ensure it matches the initial tally.
• Post-Closure Count: The surgical team often does a final verification after the surgeon closes the skin.

If a count does not match, the surgeon is notified immediately, and an X-ray is typically taken while the patient is still on the operating table to locate the missing item.

Accountability and the Verdict: Retained Surgical Instrument

The jury’s decision was a clear statement on hospital accountability. The $16.75 million total broke down into two parts:

• $1.75 million in compensatory damages (to cover the plaintiff’s pain, suffering, and medical bills).
• $15 million in punitive damages against the hospital.

The jury held the hospital 99% responsible for the error. Some courts allow punitive damages to punish the defendant and deter similar behavior in the future. The plaintiff’s legal team emphasized that this large award was necessary to push the hospital system toward improved safety measures and also to ensure that no other patient has to endure a 58-day ordeal with a 13-inch metal object inside them.

This case serves as a powerful reminder. While surgeries are complex, the safety of the patient must always remain the highest priority.

A Note on Damages in Maryland

In Maryland, it is unlikely that punitive damages would be available in a case like this because Maryland requires actual malice for punitive damages. Moreover, there is no reference to any permanent injury in this case. In the absence of a permanent injury, it can generally be difficult to obtain significant damages in a medical malpractice case. However, the liability in this case was so sloppy that it likely drove the damage award.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

The lawsuit alleged medical negligence in the timing of a C-section for a high-risk pregnancy. This then led to a uterine rupture and subsequent oxygen deprivation for the newborn. While the defense maintained their approach met medical standards, the settlement underscores the critical nature of managing complex placental conditions.

Anatomy of the Placenta: The Life Support System

The placenta is a vital, temporary organ that forms in the uterus during pregnancy. It acts as the primary communication link between the mother and the developing fetus, responsible for providing oxygen and nutrients while removing waste products via the umbilical cord.

Structurally, the placenta consists of both fetal and maternal components. The fetal side, known as the chorion, develops branching structures called chorionic villi. These villi are essential for nutrient exchange as they dip into the mother’s blood supply within the uterine wall. Normally, these villi attach to the endometrium (the inner lining of the uterus) and detach easily after birth.

Understanding Placenta Percreta Birth Injury: When Invasion Becomes Dangerous

Placenta percreta is specifically the most severe form of “placenta accreta spectrum” (PAS), a range of conditions where the placenta attaches too deeply to the uterine wall.

• Placenta Accreta: The villi attach to the superficial muscle of the uterus.
• Placenta Increta: The villi grow deeper into the uterine muscle (myometrium).
• Placenta Percreta: The most catastrophic type, where the placenta grows entirely through the uterine wall and may invade nearby organs like the bladder or intestines.

In this case, her diagnosis of placenta percreta meant that the placental tissue breached the outer uterine layer and severely compromised the structural integrity of her uterus.

Causes and Risk Factors of Placenta Percreta Birth Injury

The leading theory is that a “defective” decidua (uterine lining) allows for uncontrolled placental invasion. This often occurs at the site of previous surgical scars.

The primary risk factors include:

• Previous Cesarean Sections: This is the single most important risk factor; the more C-sections a woman has had, the higher the risk.
• Placenta Previa: A condition where the placenta covers the cervix.
• Uterine Surgery: History of fibroid removal (myomectomy) or dilation and curettage (D&C).
• Advanced Maternal Age: Typically defined as age 35 or older.

Diagnosis: Who and How?

Suspected cases of PAS are typically managed and diagnosed by Maternal-Fetal Medicine (MFM) specialists—doctors who specialize in high-risk pregnancies.

The primary diagnostic tools are:

• Prenatal Ultrasound: Often performed during the second-trimester anatomy scan, it has a sensitivity of over 90% for detecting placental abnormalities.
• MRI: Used as an adjunct to ultrasound, MRI provides better detail of the depth of invasion and whether the placenta has reached the bladder or other pelvic organs.

Baltimore birth injury lawyer Mark Kopec can assess the diagnosis of your placenta percreta and advise you on a potential birth injury case.

The Treatment Plan: Management of a High-Risk Delivery

Because of the extreme risk of life-threatening hemorrhage, a “C-hysterectomy” (delivering the baby via C-section followed immediately by the removal of the uterus) is the standard of care.

The delivery is typically scheduled prematurely, often between 34 and 37 weeks, to avoid the mother going into spontaneous labor, which could trigger a rupture. In this case, she was scheduled for 37 weeks, but the lawsuit argued this delay was negligent as her uterus ruptured before the procedure could take place.

Uterine Rupture: A Catastrophic Event

A uterine rupture is a full-thickness tear of the uterine wall. In placenta percreta, the invading placental villi weaken the uterine muscle to the point of failure. As the pregnancy progresses and the uterus stretches, the thinned, invaded section can then spontaneously burst.

Placenta Percreta Birth Injuries: HIE and Cerebral Palsy

When a uterus ruptures, it is a medical emergency for both mother and child. For the baby, the rupture often disrupts the blood and oxygen supply from the placenta.

• HIE: Hypoxic Ischemic Encephalopathy: This is a brain injury caused by a lack of oxygen (hypoxia) and a lack of blood flow (ischemia). If the brain is deprived of oxygen for even a few minutes, brain cells begin to die.
• Cerebral Palsy (CP): HIE is a leading cause of cerebral palsy, a permanent neurological disorder that affects motor skills, muscle tone, and also movement.

In this case, the uterine rupture led to baby to suffer from HIE. This ultimately resulted in her developing cerebral palsy. This $17 million settlement will provide for the baby’s lifetime medical needs, including specialized therapies and accommodations required for her condition.

You can read Blog posts on other delayed c-section cases:

• Pitocin Misuse $951M
• Prolonged Labor $48 Million
• Fetal Decelerations $29M
• Preeclampsia Stillbirth $25M
• Delayed C-Section $18M

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

A recent medical malpractice case has resulted in a $40.3 million verdict, highlighting the devastating consequences of failing to follow established medical protocols in stroke mismanagement. The case involved a 45-year-old patient who was left permanently disabled after two hospitals failed to provide timely and accurate medical interventions.

The jury’s decision specifically includes over $7 million in life-care costs. This case serves as a somber reminder of how critical every second is when the brain’s blood supply is compromised.

What is a Stroke?

A stroke, often called a “brain attack,” occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Within minutes, brain cells begin to die.

There are two primary types of strokes:

1. Ischemic Stroke: The most common type (about 87% of cases), caused by a blockage (blood clot) in an artery leading to the brain.
2. Hemorrhagic Stroke: Caused by a ruptured blood vessel that bleeds into the brain.

In this case, the focus was on the mismanagement of an ischemic event where the window for treatment was missed due to procedural errors and there was stroke mismanagement.

Brain Anatomy and Stroke Impact

To understand why this verdict was so high, one must understand the anatomy involved. The brain has specific regions, each responsible for different functions:

• The Cerebrum: Controls higher functions like speech, emotion, and fine motor skills.
• The Brainstem: Controls vital life functions like breathing and heart rate.
• The Cerebellum: Manages balance and coordination.

When a stroke occurs in the Middle Cerebral Artery (MCA), for example, it can lead to paralysis on one side of the body and loss of speech. Because the 45-year-old plaintiff in this case was left “permanently disabled,” it suggests that a significant portion of functional brain tissue was lost due to the lack of intervention, and stroke mismanagement.

Causes and Risk Factors

Strokes don’t usually happen in a vacuum. They are often the result of years of cardiovascular “wear and tear.”

Common Causes:

• Thrombosis: A clot forms inside an artery in the brain.
• Embolism: A clot forms elsewhere in the body (often the heart) and travels to the brain.

Key Risk Factors:

• Hypertension (High Blood Pressure): The leading cause of stroke.
• Atrial Fibrillation (AFib): An irregular heart rhythm that allows clots to form.
• Diabetes: Damages blood vessels over time.
• Lifestyle Factors: Smoking, high cholesterol, and physical inactivity.

The Role of tPA: The “Clot Buster”

One of the central issues in this legal battle was the administration of tPA (tissue plasminogen activator).

What is tPA and How Does it Work? Why is Stroke Mismanagement Medical Malpractice Potentially Tragic?

tPA is an intravenous medication that treats acute ischemic stroke. It works by dissolving the blood clot that is blocking blood flow to the brain. By “busting” the clot, it restores blood flow and can significantly reduce the long-term disability associated with a stroke.

However, doctors must give tPA within a strict time window—traditionally 3 to 4.5 hours from the onset of symptoms. If given too late, the risk of brain bleeding (hemorrhage) outweighs the benefits.

The Importance of “Time of Onset” & Stroke Mismanagement Medical Malpractice

This case hinged on a dispute over the “last known normal” time. The plaintiffs argued that one hospital ignored precise EMS documentation regarding when the patient’s symptoms began. Instead, the hospital relied on a “last known normal” time provided by the patient’s wife, who had been away for hours.

By prioritizing a third-party report over the patient’s own reported onset time and EMS data, the hospital incorrectly deemed the patient ineligible for tPA and there was stroke mismanagement. This underscores a vital medical truth: Time is brain. Every minute a stroke goes untreated, the brain loses approximately 1.9 million neurons.

CT Perfusion Imaging: Assessing the Damage

When a patient is outside the standard tPA window or has a large vessel blockage, doctors use advanced imaging like CT Perfusion (CTP).

What is CT Perfusion Imaging?

CT Perfusion is a specialized scan that shows how much blood is reaching various parts of the brain. it helps doctors distinguish between:

1. The Core: Brain tissue that is already dead (irreversibly damaged).
2. The Penumbra: Brain tissue that is currently “starving” for blood but restoring blood flow quickly can still save it.

Misinterpreting the Data and Stroke Mismanagement Medical Malpractice

In this case, clinicians at the second hospital allegedly misread the CT perfusion imaging. They overestimated the “core” (dead tissue), concluding the patient wouldn’t benefit from a mechanical thrombectomy (the surgical removal of a clot).

However, expert testimony from an interventional neuroradiologist revealed that the patient’s true “core” damage was only 20–25%. This was well within the threshold where a thrombectomy could have saved significant brain function.

Conclusion on Stroke Mismanagement: A Lesson in Medical Malpractice

The $40.3 million verdict reflects the jury’s finding that the hospitals failed to adhere to national stroke guidelines. By ignoring accurate onset data and misinterpreting advanced imaging, the medical teams accordingly missed multiple opportunities to prevent permanent disability.

For the patient, the award provides the necessary funds for lifelong care, but it also serves as a landmark warning to healthcare facilities regarding the necessity of rigorous protocol adherence in emergency stroke care.

To read Blog posts on other stroke verdicts, see:

• Stroke Misdiagnosis $70.8 Million
• Stroke Mismanagement $40M

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

A jury recently delivered a potent message regarding the critical need for meticulous post-operative care. It awarded a $17 million verdict to the family of a 57-year-old woman. She tragically died five days after an elective hernia procedure. The core of the medical malpractice lawsuit was the allegation that medical malpractice by a surgeon led to a fatal bowel perforation. This bowel injury went dangerously undiagnosed until the patient was in crisis.

The case shows the severe risks associated with bowel perforation, an emergency that demands immediate recognition and treatment. The surgeon claimed that the operation was “without incident.” However, expert witness testimony revealed that the perforation likely occurred during the surgery itself. Key evidence of negligence included the surgeon’s failure to follow up on the patient’s worsening post-operative complaints. Also, the doctor delegated critical medical advice to an unqualified assistant. The patient was suffering from severe pain and an inability to eat. The doctor merely reassured her instead of professionally evaluating her. By the time she was taken to the emergency room, she had deteriorated into septic shock. This verdict compensates the family for their devastating loss. It also highlights the systemic dangers of misdiagnosis or delayed diagnosis and inadequate care for this life-threatening surgical complication.

What is a Bowel Perforation?

A bowel perforation is also a gastrointestinal perforation or perforated viscus. It is a medical emergency and is a hole or a complete loss of continuity in the wall of the small intestine or the colon. This breach in the intestinal wall allows the contents of the bowel—including food, digestive juices, waste (stool), and a massive load of highly virulent bacteria—to leak out into the peritoneal cavity. The peritoneal cavity is the space between the membranes that line the walls of the abdomen and pelvis and the organs themselves.

This leakage rapidly causes severe inflammation and infection of the abdominal lining, a condition called peritonitis. Peritonitis is extremely dangerous. The infection can spread throughout the abdomen. This can lead to a local collection of pus known as an abscess, or, worse, entering the blood. Once in the blood, the infection can rapidly spiral into a widespread, life-threatening systemic infection known as sepsis, which can quickly progress to septic shock and multiple organ failure. Because of the severe, rapid onset of system wide infection, a bowel perforation requires immediate surgery intervention to contain the contamination and prevent death.

How Bowel Perforation Can Occur During a Hernia Procedure – Medical Malpractice

A hernia occurs when an organ, such as a loop of the intestine, protrudes through a weak spot or tear in the muscle wall that normally contains it. Hernia repair surgery is a common procedure, yet it carries the possibility of an iatrogenic (medically caused) bowel injury. The mechanisms by which a perforation can occur during or immediately following a hernia repair include:

• Iatrogenic Trauma and Viscerolysis: The most direct cause is surgical error: physical trauma from surgical instruments. During the repair, the surgeon must identify and carefully free any intestinal loops that have become trapped inside the hernia sac or adhered to the abdominal wall, a process called viscerolysis. The intestine can be fragile, especially if it has been incarcerated (trapped) or inflamed, making it susceptible to accidental tears or punctures from sharp instruments or even rough handling.
• Laparoscopic Injury: Many doctors perform hernia repairs laparoscopically (minimally invasively). This technique introduces additional risks, including direct injury during the insertion of the laparoscopic ports (access injury), trauma from instruments used inside the abdomen, and thermal injuries. Thermal injury, caused by using energy devices (like electrocautery or ultrasonic forceps) too close to the bowel wall, can cause a full-thickness burn that may lead to a delayed perforation several days after the procedure.

Pre-existing

• Pre-existing Injury/Ischemia: In some cases, the perforation may not be a direct injury from the surgeon but a consequence of the underlying hernia. An incarcerated hernia can lead to strangulation, where the blood supply to the trapped intestinal segment is cut off. This results in ischemia (tissue death), which can cause the bowel wall to become gangrenous and spontaneously rupture, potentially even before the surgical repair is completed or recognized during the operation.

The patient in this reported case, who presented with symptoms five days after her surgery, highlights the critical danger of an injury that might not be immediately apparent, such as a small iatrogenic tear or a delayed thermal injury.

Recognizing the Symptoms – Bowel Perforation Medical Malpractice

The clinical presentation of a bowel perforation is often sudden, severe, and catastrophic, though it can sometimes be delayed, particularly if the perforation is small or walled off by surrounding tissue (like the omentum). When contamination occurs, the body reacts with a massive inflammatory response.

Classic Symptoms of Bowel Perforation:

• Severe Abdominal Pain: This is the hallmark symptom and is typically sudden, acute, and intense. It often starts localized and then spreads to become generalized across the entire abdomen as peritonitis develops. The pain is often sharp and worsens with any movement or pressure. The patient in this case suffered from “severe pain” post-operatively.
• Peritoneal Signs: On physical examination, the abdomen may be rigid, distended, and also extremely tender to the touch (tenderness and guarding).
• Systemic Signs of Infection:
  • Fever and Chills: A rise in body temperature is a common indicator of the rapidly developing infection.
  • Nausea and Vomiting: Caused by the inflammation and potential functional obstruction of the gut. The patient in the featured case also experienced an “inability to eat”.
• Vascular/Shock Signs: As the infection progresses to sepsis and shock, signs of hemodynamic instability emerge, including an increased heart rate (tachycardia) and low blood pressure (hypotension). These are critical indicators of a deteriorating patient, which in the featured case led to septic shock.
• Absent Bowel Sounds: The infection and inflammation often cause the intestines to cease normal peristaltic motion, resulting in absent or significantly quiet bowel sounds upon auscultation.

Diagnosis and Diagnosing Medical Providers – Bowel Perforation Medical Malpractice

A bowel perforation requires a rapid, definitive diagnosis by medical providers capable of initiating immediate, life-saving management.

Diagnosing Medical Providers

The primary medical providers involved in the diagnosis and initial management are those in Emergency Care (Emergency Physicians) and General Surgeons. Given that the definitive treatment is almost always emergency surgery, an emergent surgical consultation is essential as soon as perforation is suspected.

Diagnostic Process

The diagnosis relies on a thorough patient history, physical examination, and key imaging and laboratory tests.

1. History and Physical Examination: A history of sudden, severe abdominal pain. This is especially after a recent gastrointestinal or abdominal procedure like hernia repair, and is a major red flag. The physical exam focuses on locating abdominal tenderness, distension, and signs of peritonitis.
2. Laboratory Tests: Blood work is crucial and typically reveals signs of a massive inflammatory response, most notably a high white blood cell count (leukocytosis).
3. Imaging Tests:
   • Abdominal and Chest X-Rays: These are often the first, quickest, and cheapest screening tools. The key finding is the presence of “free air” (pneumoperitoneum)—gas that has leaked out of the perforated bowel and collected in the abdominal cavity, often seen as a crescent shape under the diaphragm.
   • Computed Tomography (CT) Scan: The gold standard for diagnosis. A CT scan with contrast provides detailed images that can:
     • Confirm the presence of free air and extraluminal fluid.
     • Pinpoint the precise location of the perforation.
     • Assess the extent of contamination, such as localized abscess formation.

The failure to properly evaluate the patient’s complaints in this case, delaying the crucial diagnostic work-up, illustrates the catastrophic consequences of diagnostic error or delay.

Comprehensive Treatment Protocol – Bowel Perforation Medical Malpractice

The management of a bowel perforation is a time-sensitive emergency protocol focused on three critical phases: resuscitation, infection control, and definitive surgical repair.

1. Resuscitation and Stabilization

Before or simultaneously with surgery planning, the patient must be rapidly stabilized to counter the effects of shock and sepsis. This involves:

• Fluid Resuscitation: Administering large volumes of intravenous (IV) isotonic crystalloids (fluids) to restore blood pressure and tissue perfusion, especially in cases of septic shock.
• Airway and Breathing: Maintaining oxygenation and correcting any acidosis.
• NPO and Gastric Decompression: The patient is kept nil per os (NPO—nothing by mouth) to prevent further leakage, and a nasogastric tube may be inserted to decompress the stomach and prevent vomiting.

2. Infection Control (Antibiotics)

Doctors must give broad-spectrum intravenous antibiotics immediately, ideally within the first hour of suspicion. These medications target the likely intestinal bacteria that have leaked out and are crucial for fighting the severe infection and preventing the progression to sepsis.

3. Definitive Surgical Intervention

The most definitive step is emergency surgery, which is required for the vast majority of perforations. The goals of surgery are to:

1. Control Contamination: This is achieved through a thorough intra-operative washout of the abdominal cavity to remove leaked stool, food, and pus.
2. Identify and Manage the Defect: The surgeon must locate the hole and perform the appropriate repair.
   • Small Perforations: A surgeon may close directly a small, clean defect by primary repair (oversewing the hole).
   • Large or Contaminated Perforations: If the area of bowel is heavily contaminated or damaged by ischemia, the surgeon must perform a bowel resection—removing the damaged segment.
3. Restore Continuity (or Create a Stoma): After resection, the doctor can sometimes immediately reconnect (anastomosis) two healthy ends of the bowel. However, in cases of severe contamination, diffuse peritonitis, or if the patient is very unstable, the safer option is to create a stoma. This is an opening in the abdominal wall (a temporary or permanent colostomy or ileostomy). It diverts waste while the body recovers.

Potential Outcomes and Prognosis – Bowel Perforation Medical Malpractice

Bowel perforation is one of the most serious gastrointestinal emergencies. It carries high rates of morbidity (bad outcomes) and mortality (death), even with swift treatment. The ultimate outcome is highly dependent on the quick diagnosis and intervention.

Adverse Outcomes of Delayed Diagnosis

The most severe consequences link to a delayed diagnosis. This is shown by the case where the patient was found to be in septic shock. These outcomes include:

• Septic Shock and Multi-Organ Failure: The leading cause of death. Uncontrolled sepsis causes dangerous low blood pressure and widespread organ shutdown (kidneys, lungs, etc.).
• Persistent Abdominal Abscesses: Localized pockets of infection that may require further draining procedures or surgery.
• Fistula Formation: Abnormal connections between the intestine and other organs, or the skin, requiring complex surgery correction.
• Prolonged Hospitalization and Intensive Care: Patients often require extended stays and critical care support.
• The Need for a Permanent Stoma: While often temporary, a stoma (colostomy/ileostomy) for fecal diversion can be permanent. This can significantly impact a patient’s quality of life.

Prognostic Factors

Survival rates vary widely (mortality rates reported between 11% and 81%), with specific factors significantly worsening the outlook. Prognostic factors associated with a higher risk of death include:

• Advanced Age.
• Organ Failure at the time of presentation.
• Diffuse Peritonitis (widespread contamination).
• Hemodynamic Instability (e.g., low blood pressure and high heart rate).
• Delay in Diagnosis and Surgery.

The verdict serves as a stark reminder to all medical providers. Recognizing the subtle, yet severe, post-operative symptoms of bowel perforation and acting immediately—rather than delegating or dismissing patient complaints—is critical to a positive outcome. The failure to perform a timely evaluation can escalate a surgical bad outcome into a fatal tragedy.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

The Baltimore Medical Malpractice Lawyer Blog features reported verdicts and settlement in medical malpractice cases. A recent, significant legal victory underscores the devastating consequences of medical malpractice during childbirth and the critical importance of timely intervention. A hospital agreed to a $18 million settlement in a highly complex birth injury case. This financial resolution serves as a measure of accountability for the hospital. It is also a necessary lifeline for the young victim and her family following birth injury after a delayed c-section.

The core of the claim was the hospital’s failure to timely perform a cesarean section (C-section). This was after the mother, who was 40 weeks pregnant, presented for care. The delay in surgical delivery resulted in the newborn having two life-altering conditions: Hypoxic Ischemic Encephalopathy (HIE) and also Cerebral Palsy.

The settlement will ensure lifelong access to critical services. These specifically include specialized education, home care, and therapy. These services will offer the family a much-needed measure of relief and stability. This case is a stark reminder of the immense financial and emotional burden placed on families due to avoidable birth trauma.

👶 Understanding Birth Injuries: When Joy Turns to Tragedy

A birth injury refers to any damage or trauma sustained by a newborn just before, during, or shortly after the process of labor and delivery. While some birth injuries are minor and heal quickly, others are severe and permanent, often resulting from a lack of oxygen, excessive force, or medical staff failing to monitor the mother and baby properly.

Unlike birth defects, which are pre-existing conditions, birth injuries are caused by an external force or event during the delivery process. In cases like this settlement, the injury is often linked to medical malpractice—a situation where a doctor or hospital deviates from the accepted standard of care, causing harm. The most severe injuries are often those related to a deprivation of oxygen, leading to brain damage, as seen in the HIE diagnosis of this child.

🤰 Why Going Beyond 40 Weeks is Dangerous – Delayed C-Section

A pregnancy is generally full-term at 40 weeks. While some healthy pregnancies safely progress beyond this point (post-term), the risk of complications rises significantly as the pregnancy continues past the due date.

Increased Risks After 40 Weeks

• Placental Insufficiency: The placenta, which supplies the fetus with oxygen and nutrients, naturally begins to degrade after 40 weeks. This can lead to a decrease in its efficiency, causing the fetus to receive less oxygen and essential nutrients.
• Oligohydramnios: The volume of amniotic fluid can decrease substantially. Low fluid levels increase the risk of umbilical cord compression, which can severely restrict the flow of blood and, critically, oxygen to the baby.
• Macrosomia: The baby continues to grow, increasing the risk of difficult vaginal delivery, including shoulder dystocia (where the shoulder gets stuck), which can cause nerve damage or head trauma.
• Fetal Distress: As the pregnancy advances, the risk of the baby experiencing distress—signaled by a non-reassuring heart rate—increases. When signs of distress appear, particularly in a post-term pregnancy, an immediate delivery, often via C-section, is the required standard of care to prevent permanent injury. The delay in C-section cited in the $18 million settlement case is a classic example of this lapse in timely care.

🧠 Hypoxic Ischemic Encephalopathy (HIE) After Delayed C-Section

HIE: Hypoxic Ischemic Encephalopathy is a type of brain damage that occurs when the baby’s brain doesn’t receive enough oxygen (hypoxia) and/or blood flow (ischemia) for a period of time. It is a critical, medical emergency.

The Mechanism of Injury

The lack of oxygenated blood causes brain cells to die, which can then cascade into further damage. In the context of childbirth, HIE is often caused by:

• Severe cord compression.
• Placental abruption (the placenta detaches early).
• Maternal hypotension or uterine rupture.
• Crucially, a delay in delivery after fetal distress is identified, such as the delayed C-section in this case.

HIE is categorized as mild, moderate, or severe. Even with prompt intervention like therapeutic hypothermia (cooling the baby), moderate to severe HIE often leads to lifelong neurological disabilities, including the most common motor disorder: Cerebral Palsy.

♿ Cerebral Palsy (CP)

Cerebral Palsy (CP) is a permanent disorder that affects a person’s ability to move and maintain posture and balance. It is the most common motor disability in childhood. CP is not a single disease but an umbrella term for a group of disorders. They occur after abnormal brain development or damage to the developing brain.

Key Characteristics of CP

The effects of CP vary widely, but they typically involve:

• Movement Difficulties: Spasticity (stiff muscles), involuntary movements, and poor coordination.
• Balance and Posture: Difficulty maintaining an upright posture or controlling one’s body.

In the case of the newborn in the $18 million settlement, the HIE caused by the lack of oxygen during the delayed delivery led to the brain damage that resulted in her Cerebral Palsy diagnosis.

👨‍👩‍👧‍👦 Lifelong Needs: The Care Required by Children with HIE and CP After Delayed C-Section

The $18 million settlement reflects the high, lifelong cost of caring for a child with severe HIE and Cerebral Palsy. These conditions often necessitate intensive, multidisciplinary care that continues well into adulthood.

Future Care Requirements After Delayed C-Section

The settlement funds cover these crucial services:

• Therapies:
  • Physical Therapy (PT): To improve movement, strength, flexibility, and prevent contractures.
  • Occupational Therapy (OT): To develop fine motor skills for daily living tasks like dressing, eating, and writing.
  • Speech-Language Therapy (SLT): To address difficulties with speaking, communication, and sometimes feeding/swallowing.
• Specialized Education: Many children with HIE/CP require individualized education programs (IEPs), specialized classrooms, and assistive technology to learn effectively.
• Adaptive Equipment: This includes essential, expensive equipment such as custom wheelchairs, braces, mobility aids, and communication devices.
• Home Care/Respite Care: Depending on the severity of the CP, the child may require full-time, skilled nursing or home health aides. Respite care is also essential to provide the parents with temporary relief from the demanding 24/7 care schedule.
• Medical Procedures and Surgeries: This can include orthopedic surgeries to correct muscle stiffness or joint deformities. This can also include regular medical consultations with neurologists and other specialists.

In conclusion, the settlement sends an unequivocal message: timely medical care during labor is non-negotiable. For families navigating the tragedy of a birth injury from a delayed c-section, securing a fair settlement is not a windfall. It is a critical necessity to ensure their child has the resources, care, and dignity they deserve for the rest of their lives.

Additional Reported Birth Injury Verdicts

You can read Blog posts in on Verdicts in other medical areas and the following birth injury verdict reports:

• Pitocin Misuse $951M
• Prolonged Labor $48 Million
• Fetal Decelerations $29M
• Preeclampsia Stillbirth $25M

If your child has a birth injury, see below to contact the Kopec Law Firm.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

A patient seeking treatment for chronic pain trusts their surgeon to uphold the highest standard of care. This expectation is especially in an elective procedure. That trust broke when a surgery shortcut and a critical lapse in sterilization protocol led to a severe infection. A professional athletic career ended and led to an infection medical malpractice lawsuit.

In a medical malpractice verdict, a jury awarded the patient $20 million against an orthopedic surgeon. The case serves as a stark warning. It is a profound reminder of the consequences when a doctor violates fundamental guidelines designed to protect patient safety.

The story centers on a surgery intended to correct chronic leg pain caused by stress fractures in both shins. This should have been a routine procedure to extend the career. Instead, it became a series of operations after the doctor placed improperly sterilized surgical plates into his legs. This medical malpractice led to subsequent deep-tissue infection. It ended his professional career. It also forced him to undergo 13 to 14 additional surgeries. These left him unable to walk without pain.

The core issue of medical malpractice, according to the lawsuit, was twofold. A failure to adhere to strict sterilization protocols and the failure to obtain informed consent. Mid-procedure, the proper, fully sterilized steel shin implants were reportedly not available. The doctor chose to rush replacement hardware through a non-recommended sterilization process known as “flash steam sterilization” before placement. An infection followed, leading to years of physical and emotional suffering.

What Are Shin Implants and How Do Doctors Use Them for Chronic Leg Pain?

In the context of elite athletes, chronic leg pain is often the result of tibial stress fractures—tiny, hairline cracks in the shin bone that occur from repetitive stress and overuse. When rest and physical therapy fail to heal these fractures, they can become a source of debilitating, career-threatening pain.

The implants to treat this condition—what are “shin implants” in regular terms—are typically metal plates and screws. This hardware is surgically affixed to the bone to provide internal fixation, stabilizing the fracture site and offloading stress so the bone can properly fuse and heal. It is considered a permanent piece of hardware intended to remain in the body for the patient’s lifetime.

This case involved plates for fractures. For other types of chronic nerve-related leg pain, doctors use a very different kind of implant: the spinal cord stimulator (SCS). An SCS is a device with electrodes near the spinal cord, and a generator under the skin, that sends electrical impulses to interrupt or block pain signals before they reach the brain. Both types of implants, whether plates or stimulators, must be surgically placed and are considered foreign bodies, making their preparation a matter of paramount safety.

The Peril of “Flash Steam Sterilization” for Permanent Hardware

The sterilization method at the heart of the case—flash steam sterilization—is a term now largely replaced by the professional guideline term Immediate-Use Steam Sterilization (IUSS). It is important to understand how medical malpractice led to the infection in this case.

IUSS is a rapid process where unwrapped medical instruments are subjected to an abbreviated steam exposure time for immediate use. It is distinct from standard or “terminal sterilization.” That uses a validated container or wrapper designed to maintain the instrument’s sterility indefinitely. IUSS should be the rare exception, reserved only for genuine emergencies, such as when an instrument is contaminated or inadvertently dropped during a procedure and is non-replaceable.

Why is IUSS not recommended for permanent orthopedic hardware?

1. Risk of Contamination During Transfer: Unlike terminal sterilization where items are wrapped and protected, IUSS items are typically unwrapped or loosely contained. This creates a high risk of contamination during the time the hot, wet item transfers from the sterilizer to the sterile field.
2. Conflict with Manufacturer Instructions (IFUs): Complex devices and orthopedic implants often have specific Instructions for Use (IFUs) that require precise, lengthy exposure and dry times only achieved in a terminal sterilization cycle. Using a short IUSS cycle can violate these instructions and compromise sterility.
3. Abuse as Convenience: National standards, including those from the Joint Commission, advise that a doctor must not use IUSS for mere convenience or as a substitute for insufficient instrument inventory. In this case, the doctor did the sterilization in a “rushed attempt” to avoid rescheduling an elective surgery—a clear case of using IUSS for convenience, not a true emergency. For permanent implants, this abbreviated process introduces an unacceptable level of risk.

A Vicious Cycle: How Hardware Infection Results in Multiple Surgeries Following Medical Malpractice

An infection involving foreign orthopedic hardware, such as a metal plate, is one of the most feared complications in surgery. It often triggers a devastating cycle of one surgery after another, as the plaintiff experienced.

The root of the problem lies in biofilm formation. When bacteria contaminate the implant, they quickly adhere to its metallic surface and encase themselves in a protective, slimy matrix known as a biofilm. This biofilm acts as a shield, making the bacteria highly resistant to the patient’s immune response and rendering systemic antibiotics largely ineffective.

For the infection to fully heal, the doctor often has to remove the source of the biofilm—the foreign hardware. The typical multi-stage surgical protocol to address a deep hardware infection includes:

1. Initial Debridement and Hardware Removal: The first surgery involves aggressively cleaning out the infected tissue (debridement), removing the infected plates and screws, and sending tissue cultures to identify the exact bacteria.
2. Placement of an Antibiotic Spacer: With the hardware gone and stability potentially compromised, the surgeon may insert a temporary antibiotic spacer (or cement) impregnated with high doses of antibiotics into the surgery site. The patient must then complete a lengthy course of intravenous (IV) antibiotics, sometimes for six weeks or more.
3. Re-Implantation of New Hardware: Blood tests confirm that the infection is completely clear. Only then will the patient return to the operating room. That is for a third or even fourth surgery to remove the temporary spacer and implant new, definitive, sterile hardware.

The necessity of removing the infected hardware and performing these serial cleanings and re-implantations is precisely why a single surgical complication can quickly become a series of debilitating, life-altering operations.

Upholding the Standard of Care and Preventing Infection Medical Malpractice

This case is a powerful example of a medical professional violating the standard of care. He chose a path of convenience over patient safety. When the doctor could not meet the standard sterilization protocol for the permanent hardware, he should have canceled the elective surgery and rescheduled.

Ultimately, the jury agreed that the doctor committed malpractice. He used the “flashed implants” and screws and concealed the intraoperative chaos. These were the direct cause of the plaintiff’s resulting infection, physical pain, emotional suffering. They also ended his professional career. The $20 million verdict included significant non-economic damages for his lifetime of pain and suffering. It highlights the law’s mandate. Patient safety protocols, especially sterilization, are not optional. The failure to follow them carries immense liability.

Cautionary Note

Many medical malpractice inquiries in infection situations do not become cases because the source of the infection cannot be proven.

You can read Blog Posts on other Verdicts.

If you have a potential medical malpractice lawsuit, see below to contact the Kopec Law Firm.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

The birth of a child should be a moment of pure joy, but for too many families, it turns into a tragedy. One of the most devastating outcomes is stillbirth, a loss often complicated and compounded when medical negligence is involved. The recent $25 million medical malpractice verdict in a preeclampsia stillbirth case shines a harsh light on this issue. It underscores the critical importance of timely diagnosis and aggressive management of a pregnancy complication known as preeclampsia.

A jury delivered this massive verdict in the wrongful death of an unborn child. The case against two OB/GYNs was based on their alleged negligent failure to diagnose and manage the mother’s severe preeclampsia. According to the complaint, the doctors discharged the mother without proper monitoring. She returned days later with severe complications that resulted in the loss of her baby. The verdict had $4 million for economic value and $15 million for the intangible value of the fetus’s life. It serves as a grave warning about the human cost of medical oversights and miscommunications.

For expecting parents, understanding preeclampsia is not just a matter of health awareness—it’s a critical component of advocating for their own care.

What is Preeclampsia?

Preeclampsia is a serious, sudden-onset hypertensive disorder unique to pregnancy. It occurs with new-onset high blood pressure (hypertension) and signs of end-organ dysfunction. This is most commonly detected after 20 weeks of gestation.

The core issue involves the placenta: in preeclampsia, the blood vessels in the placenta fail to develop normally, leading to poor blood flow to the organ (placental ischemia). This compromised blood flow causes the placenta to release various substances into the mother’s bloodstream, triggering widespread dysfunction of the blood vessel lining (endothelial dysfunction) throughout the mother’s body. This systemic reaction results in the defining symptoms and complications:

• Hypertension: Blood pressure readings of 140/90 mm Hg or higher on two occasions at least four hours apart.
• Proteinuria: High levels of protein in the urine, indicating kidney damage.
• Other Organ Damage: This can include elevated liver enzymes, low platelet count, fluid in the lungs (pulmonary edema), severe headaches, and vision changes.

If preeclampsia progresses and causes seizures, the condition is then classified as eclampsia, a life-threatening medical emergency. A severe form affecting the blood and liver is known as HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets).

What Type of Monitoring is Needed for Preeclampsia and What Does it Show to Avoid a Stillbirth?

Managing preeclampsia involves close, aggressive monitoring and the medical providers must do it once they suspect or diagnose the condition. The goal of monitoring is to assess the severity of the mother’s condition, check for deterioration, and evaluate the baby’s health.

Maternal Monitoring: To Track Progression and Organ Function

• Blood Pressure Checks: Frequent (sometimes daily) checks are necessary to identify any abnormal increases. A blood pressure of 160/110 mm Hg or higher is classified as severe hypertension and requires urgent treatment.
• Urine Samples (Proteinuria): Regular samples (often a 24-hour collection) measure protein levels, which indicate the extent of kidney impairment.
• Blood Tests: These tests are crucial for assessing end-organ function, specifically checking:
  • Platelet Count: To detect a drop, which can indicate HELLP syndrome or clotting issues.
  • Liver Enzymes (e.g., AST and ALT): To check for liver damage.
  • Kidney Function (e.g., Creatinine): To assess how well the kidneys are clearing waste.

Fetal Monitoring: To Assess the Baby’s Well-being

The high blood pressure in the mother can decrease the blood and oxygen flow to the placenta and the baby. This may restrict the baby’s growth. Monitoring includes:

• Fetal Ultrasound: Used to measure the baby’s growth (to detect Intrauterine Growth Restriction (IUGR)) and to check the amount of amniotic fluid. Low amniotic fluid (oligohydramnios) can be a sign of placental problems.
• Nonstress Test (NST): A simple procedure that electronically monitors the baby’s heart rate in response to movement, which can detect stress or distress.
• Biophysical Profile (BPP): This uses ultrasound to measure the baby’s breathing, muscle tone, movement, and the volume of amniotic fluid, providing a more comprehensive view of fetal health.

When Does a Mother Have to Be Admitted and Monitored or Treated?

While mild preeclampsia may sometimes be managed at home with frequent follow-up appointments, a mother with preeclampsia is typically admitted to the hospital for closer observation and/or treatment under several key scenarios:

• Severe Hypertension: If the mother’s blood pressure is consistently 160 mm Hg systolic or 110 mm Hg diastolic or higher. This is a hypertensive emergency that requires immediate in-patient care and parenteral (IV) medication.
• Severe Preeclampsia/Adverse Maternal Conditions: The doctors must hospitalize the patient if she presents with any severe features or adverse maternal conditions. These include:
  • Severe, persistent headaches, visual disturbances, or altered mental state.
  • Persistent epigastric or right upper quadrant pain.
  • Signs of worsening organ failure (e.g., worsening kidney or liver function on blood tests, pulmonary edema).
  • Diagnosis of HELLP syndrome or eclampsia.
• Early Onset Preeclampsia: If preeclampsia is diagnosed before 34 weeks of gestation, a hospital stay is often necessary for continuous monitoring and to administer steroids to help the baby’s lungs mature if early delivery becomes necessary.

In this case, the negligence involved discharging the patient without proper monitoring, highlighting a potential catastrophic failure to recognize the severity of the mother’s condition or to follow admission and surveillance protocols.

What Kind of Treatment is Needed to Avoid a Preeclampsia Stillbirth?

The only curative treatment for preeclampsia is the delivery of the baby and the placenta. However, until delivery is safe or necessary, treatment focuses on managing the mother’s symptoms and preventing life-threatening complications.

Key Treatment Modalities:

1. Antihypertensive Medications: Doctors use medicine to manage high blood pressure and reduce the risk of serious maternal complications like stroke. Common medications include labetalol, nifedipine, or methyldopa. The goal is to bring the blood pressure down to a safer target (e.g., a diastolic blood pressure of around 85 mm Hg).
2. Magnesium Sulfate: This is the first-line medication used to prevent or treat eclamptic seizures (fits) in women with severe preeclampsia. Magnesium sulfate is an anticonvulsant that reduces the risk of eclampsia by more than half.
3. Corticosteroids: If the doctor anticipates a preterm delivery (before 34 weeks of gestation), they give corticosteroids like betamethasone to the mother to speed up the maturation of the baby’s lungs.
4. Delivery: The timing of delivery is a critical decision based on the severity of the preeclampsia and the gestational age of the baby.
   • For preeclampsia that is not severe, the doctor should deliver at or around 37 weeks of pregnancy.
   • For severe preeclampsia, doctors must deliver before 37 weeks to protect the health of the mother and baby.

What is Stillbirth and How Can Preeclampsia Cause It?

A stillbirth is the death of a fetus at or after 20 weeks of pregnancy. This devastating event affects thousands of families annually and can have numerous underlying causes, with placental complications being a major factor.

Preeclampsia is a significant risk factor and contributor to stillbirth, linked to approximately 9.2% of all stillbirths. The connection is rooted in the underlying pathology of the condition: placental insufficiency.

Here is how preeclampsia can lead to stillbirth:

• Compromised Blood Flow: The failure of the mother’s arteries to remodel properly causes preeclampsia, resulting in poor blood flow to the placenta. This damages the placenta, which is the baby’s lifeline for oxygen and nutrients, and essentially starves the baby.
• Fetal Growth Restriction: The impaired blood and oxygen supply often leads to Intrauterine Growth Restriction (IUGR), meaning the baby cannot grow at a healthy rate. A baby with compromised growth is at a much higher risk of distress and death in utero.
• Placental Abruption: Preeclampsia also significantly increases the risk of placental abruption, where the placenta prematurely separates from the uterine wall. This causes severe bleeding and immediately cuts off the baby’s oxygen supply, leading to stillbirth.

The stillbirth of the baby here, resulting from the doctors’ missed diagnosis and failure to manage severe preeclampsia, perfectly illustrates the fatal course of this disease when doctors do not uphold medical standards.

The Legal Imperative: Adherence to Medical Guidelines

The verdict underscores a critical point: while preeclampsia is a complication of pregnancy, its severe consequences, including stillbirth, are often preventable with appropriate and timely medical intervention.

Medical malpractice occurs when a medical provider fails to follow the accepted “standard of care.” Further, that failure causes injury or death. In preeclampsia cases, this often involves:

• Misdiagnosis or Failure to Diagnose: Missing the signs of hypertension and/or proteinuria during routine prenatal visits.
• Failure to Monitor: Discharging a high-risk patient without a clear follow-up plan or failing to admit a patient with severe features for continuous monitoring. In this case, one doctor discharged the patient without proper monitoring, and a second failed to follow up with necessary records.
• Failure to Timely Treat/Deliver: Delaying the administration of necessary medications like magnesium sulfate or delaying the decision to deliver the baby when maternal or fetal conditions indicate imminent danger.

The $25 million award serves as a powerful reminder to medical professionals. Violating medical guidelines can lead to irreversible tragedy. The award holds them responsible for the failure to meet the standard of care in a stillbirth case. For families, it highlights the importance of asking questions, knowing the signs of preeclampsia, and making sure their medical providers are following the protocols for monitoring and managing this dangerous, but often controllable, condition.

You can read Blog Posts on other Verdicts.

If your pregnancy ended in a stillbirth, see below to contact the Kopec Law Firm.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

A jury recently delivered a powerful message about accountability in the delivery room. It awarded a $29 million verdict to a family whose child developed cerebral palsy birth injury due to medical malpractice during birth. The case involved fetal heart rate monitor decelerations. The case serves as a solemn reminder of how quickly negligence can turn a moment of joy into a lifetime of specialized care.

The lawsuit centered on the actions of a Certified Nurse Midwife (CNM). According to the jury’s finding, she failed to recognize and act upon significant fetal heart rate decelerations. This delay in calling the on-call OB/GYN resulted in the infant suffering prolonged oxygen deprivation. This lead to severe and permanent neurological damage.

The massive $29 million verdict secures the child’s future. It covers past and future medical expenses, loss of earning capacity, and compensation for pain and suffering. It underscores the high financial and emotional toll of preventable birth injuries, emphasizing that holding healthcare providers accountable is crucial for securing the essential resources a child with severe disabilities will require throughout their life.

What is a Certified Nurse Midwife (CNM)?

A Certified Nurse Midwife (CNM) is an advanced practice registered nurse (APRN) who specializes in women’s health and childbirth. CNMs provide a broad spectrum of care, focusing on a holistic approach that includes gynecologic and family planning services, preconception care, and comprehensive care during pregnancy, labor, delivery, and the postpartum period.

CNMs are highly educated, typically holding a master’s or higher-level degree and passing a national certification exam. They function as primary healthcare providers for low-risk patients. Crucially, they train to independently provide care during labor, which includes monitoring the mother and fetus for fetal heart rate decelerations, assessing the progress of labor, managing common complications, and delivering the newborn. Their scope of practice requires them to possess the critical skill of recognizing signs of fetal distress and knowing when consultation, collaboration, or referral to an obstetrician or other specialist is immediately necessary. In the case of the $29 million verdict, the central issue was the CNM’s failure to perform this core duty—recognizing a crisis and escalating care.

Understanding Fetal Heart Rate Decelerations

Fetal Heart Rate (FHR) decelerations are temporary decreases in the baby’s heart rate recorded during labor monitoring. They are one of the most important tools healthcare providers use to assess fetal well-being. These drops categorize based on their shape and timing relative to the mother’s uterine contractions:

1. Early Decelerations: These are symmetrical drops where the heart rate nadir (slowest point) occurs at the same time as the peak of the contraction. They are generally considered benign and are caused by compression of the baby’s head, which triggers a vagal nerve response.
2. Variable Decelerations: These are abrupt, quick drops that vary in their onset, duration, and severity. They are usually caused by umbilical cord compression. While they can often be resolved by simply changing the mother’s position, recurrent or severe variable decelerations can be concerning signs of fetal distress.
3. Late Decelerations: These are the most alarming pattern. They involve a gradual decrease in FHR that begins after the contraction onset, with the nadir occurring after the contraction has peaked. Late decelerations indicate uteroplacental insufficiency, meaning the placenta is not delivering sufficient oxygen to the fetus (fetal hypoxemia). Recurrent late decelerations, especially when coupled with absent FHR variability, are a Category III (abnormal) tracing and require immediate and urgent intervention, often expedited delivery, to prevent permanent brain injury.

How Does Oxygen Deprivation Occur During Birth?

Oxygen deprivation, medically termed birth asphyxia or neonatal asphyxia, happens when a baby does not receive enough oxygen or blood flow before, during, or immediately after birth. This can happen following fetal heart rate decelerations. A number of complications can cause this severe oxygen shortage:

• Umbilical Cord Issues: The most common mechanical cause is the compression or prolapse of the umbilical cord, which cuts off the baby’s blood and oxygen supply.
• Placental Problems: Conditions like placental abruption (early separation of the placenta from the uterus) or poor placental function (due to conditions like high maternal blood pressure) can drastically reduce oxygen circulation to the baby.
• Uterine or Maternal Issues: An inadequate relaxation of the uterus during labor, maternal low blood pressure, or maternal respiratory problems can also lead to insufficient oxygen in the mother’s blood, which then passes to the fetus.
• Prolonged or Difficult Labor: If labor is too long or complications arise, the chances of the newborn experiencing asphyxia increase.

In malpractice cases like the $29 million verdict, the lack of oxygen is often not an unavoidable complication, but a result of healthcare providers failing to properly monitor the FHR and missing or mismanaging the signs of distress (like recurrent late decelerations) that require immediate intervention.

The Critical Link: Oxygen Deprivation Leading to Cerebral Palsy

Following fetal heart rate decelerations, when a fetus or newborn is deprived of sufficient oxygen and blood flow, the brain is one of the first and most sensitive organs to be affected. This severe lack of oxygen quickly leads to a type of brain injury called HIE: Hypoxic Ischemic Encephalopathy.

Brain cells require a constant, abundant supply of oxygen and glucose (sugar) carried by the blood to function. If the oxygen loss is severe or prolonged—damage can begin in as little as four minutes—brain cells in critical areas begin to die. This damage often targets areas of the brain that control movement, posture, and muscle tone.

This permanent injury results in Cerebral Palsy (CP). CP is a non-progressive neurological disorder that affects a person’s ability to move and maintain posture and balance. The specific symptoms depend on which part of the brain was injured, but often include:

• Spasticity: Stiff or tight muscles and exaggerated reflexes.
• Ataxia: Lack of muscle coordination.
• Developmental Delays: Delays in reaching milestones like sitting, crawling, or walking.

The severity of the resulting cerebral palsy directly ties to the duration and intensity of the oxygen deprivation. This highlights why prompt recognition and delivery are essential when fetal distress is evident.

Lifelong Care Needs for a Child with Cerebral Palsy After Fetal Heart Rate Decelerations

The $29 million verdict reflects the extraordinary, lifelong care required for a child who has suffered severe neurological injury following fetal heart rate decelerations. Managing cerebral palsy is a complex, continuous process that requires a dedicated support team and specialized resources.

The core needs typically fall into three major categories:

1. Physical and Developmental Therapies

These therapies are essential for maximizing the child’s motor function and independence:

• Physical Therapy (PT): Focuses on developing stronger muscles for skills like walking, sitting, and balance.
• Occupational Therapy (OT): Helps the child develop fine motor skills and daily living tasks, such as feeding, dressing, and writing.
• Speech-Language Pathology (S/L): Addresses communication skills, as well as feeding and swallowing difficulties, which are common in children with CP.

2. Specialized Equipment and Assistive Technology

Children with CP often require a range of devices to improve mobility and communication:

• Mobility: Wheelchairs, walkers, canes, and ankle-foot orthoses (braces or AFOs) to stabilize the foot.
• Communication (AAC): For children who are non-verbal, devices like communication boards, tablets, or specialized computer programs allow them to express themselves.
• Home Adaptation: Installing handrails, ramps, and lifts to make the home environment fully accessible.

3. Education and Medical Oversight

From an early age, children with CP following fetal heart rate decelerations integrate into a system of specialized support:

• Early Intervention (IFSP) and Special Education (IEP): The public school system provides individualized education programs (IEP) that include specialized instruction and related services like PT, OT, and S/L.
• Medical Management: This includes ongoing appointments with neurologists and specialists, medications to manage muscle stiffness (spasticity), and sometimes surgical procedures.

The combined expenses for these lifelong needs—medical, therapeutic, and technological—often exceed $1 million over a child’s lifetime. This emphasizes why large medical malpractice verdicts are often necessary to ensure the child receives the care they desperately need.

You can read Blog Posts on other Verdicts.

If your child has a birth injury, see below to contact the Kopec Law Firm.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

In medical malpractice cases, few outcomes are as devastating and illustrative of catastrophic negligence as a missed or misdiagnosed stroke. This is the case of a plaintiff, who suffered a brain stem stroke. He developed locked-in syndrome after a chiropractic neck adjustment. It serves as a profound and tragic example of how a failure of communication and critical assessment in the Emergency Room can alter a life forever.

This blog post examines the medical and legal complexities of this specific type of injury. It highlights the critical signs of a brain stem stroke. The post also discusses the mechanism by which seemingly minor procedures can cause catastrophic damage. It also discusses the life-saving steps an attentive neurologist must take to prevent a permanent disability.

The Catastrophe of Misdiagnosis: A $40M Warning to Emergency Medicine

An appellate court upheld a $40 million medical malpractice verdict against emergency physician. The patient, a 32-year-old, presented to an Emergency Department with urgent symptoms following a chiropractic neck adjustment. Despite presenting with classic warning signs, the patient did not receive the critical care he required. He suffered a massive brain stem stroke that resulted in permanent and catastrophic injuries.

The jury found the doctor guilty of gross negligence. It cited egregious lapses in communication and, critically, his failure to seek a neurological consultation. This verdict reinforces a crucial legal principle. Emergency room physicians are held accountable when their inaction leads to catastrophic, permanent harm.

Recognizing the Warning Signs: Symptoms of a Brain Stem Stroke

A brain stem stroke is particularly dangerous because the brain stem—a half-inch diameter bundle of nerves—controls all basic activities of the central nervous system, including consciousness, blood pressure, and breathing.

A brain stem stroke often presents with a unique and varied set of signs:

• Vertigo and Severe Dizziness: Patients may experience intense dizziness, vertigo (the feeling of spinning). Also, a severe loss of balance (ataxia) or sense of where their body is in space. This feeling of imbalance or unsteadiness often leads to severe nausea and vomiting.
• Vision Changes (The “Eyes” in BE FAST): This can include double vision (diplopia) and involuntary eye movements (nystagmus). Also, an inability for the eyes to move together (dysconjugate gaze).
• Speech and Swallowing Difficulties: Slurred or difficult speech (dysarthria) and trouble swallowing (dysphagia) are common, as the brain stem controls the muscles of the mouth and throat.
• “Crossed Signs”: A hallmark of brain stem lesions is having motor or sensory loss on the same side of the face as the injury, but motor or sensory loss on the opposite side of the body.

For an ER physician, failing to connect these acute, sudden-onset symptoms to the possibility of stroke, particularly in a younger patient following a neck trauma like a chiropractic adjustment, constitutes a severe diagnosis failure.

The Chiropractic Connection: How Neck Adjustment Can Cause Brain Stem Stroke

While a common procedure, cervical spinal manipulation (a chiropractic neck adjustment) carries a small, well-documented risk of causing a stroke, which is what happened in this case. The most likely mechanism for this is not the stroke itself, but an underlying injury to the artery supplying the brain stem.

This process involves:

1. Arterial Injury: The force, rotation, or extension applied during the neck adjustment can cause a tear or dissection in the wall of the vertebral artery (VA). The vertebral artery is particularly susceptible because it passes through the small, bony canals of the upper cervical vertebrae on its way to the base of the skull.
2. Clot Formation: As the artery wall tears, the body attempts to heal itself, which leads to the formation of a blood clot at the site of the injury.
3. Ischemic Stroke: A piece of this clot, called an embolus, can break free and travel up into the brain’s blood supply (the basilar artery), where it lodges in a smaller blood vessel and blocks blood flow to the brain stem. This is an ischemic stroke, and the resulting lack of oxygen causes tissue death and neurological deficits.

It is also important to note that the neck pain and headache that result from the initial artery dissection can occur days or weeks before the actual stroke takes place. Patients often seek chiropractic or medical care for this pain, which means a physician may be presented with a patient whose symptoms are actually the first stage of a catastrophic vascular event.

The Critical Window: A Neurologist’s Response to Prevent Permanent Damage from Brain Stem Stroke

When a patient presents to the ER with symptoms suggestive of a posterior circulation stroke (brain stem or cerebellar), the need for an immediate neurological consult cannot be overstated. A neurologist’s response is governed by the mantra: Time is Brain .

The neurologist’s immediate goal is to restore blood flow and save brain tissue. For an ischemic stroke (the type caused by a clot), the key treatments are highly time-sensitive:

1. Emergency Imaging: A CT scan or MRI is required immediately to confirm the stroke type (ischemic vs. hemorrhagic) and location.
2. Thrombolytic Therapy (Clot-Busting Drugs): If the stroke is ischemic and the patient is within a critical time window (typically 4.5 hours from symptom onset), they may be eligible for an intravenous injection of Tissue Plasminogen Activator (TPA). TPA works to dissolve the blood clot and restore circulation. This significantly improves the chances for a full recovery and reducing long-term disability.
3. Mechanical Thrombectomy (Endovascular Procedure): For large clots, especially those in the major vessels of the brain stem, a neurologist or neurosurgeon may perform a thrombectomy. The doctor inserts a long, thin catheter, typically through an artery in the groin, and guides it to the clot, where they use a specialized device (a stent retriever) to physically remove the clot. This procedure is vital for improving outcomes and must be performed as soon as possible.

Failure to call a neurologist means failing to activate this time-sensitive protocol. This forfeits the patient’s only real chance at preventing permanent, catastrophic damage following a brain stem stroke.

Life Trapped: Understanding Locked-in Syndrome and Patient Care Needs

The ultimate tragic outcome of the misdiagnosis in this case was Locked-in Syndrome (LIS). LIS is a devastating, yet rare, neurological disorder caused by severe damage to the brain stem, most commonly the pons.

• The Condition: LIS results in total paralysis (quadriplegia) of all voluntary muscles. This includes the ability to speak (anarthria), chew, or swallow. Crucially, the individual remains fully conscious, awake, and cognitively intact. They can hear, think, and reason normally, but are trapped within a non-responsive body.
• Communication: The condition typically preserves vertical eye movement and blinking, which becomes the patient’s sole means of communication. They can communicate a “yes” or “no” by blinking or moving the eyes up and down. This system that requires immense patience and skill from both the patient and their care team.

Lifelong Care

A patient with LIS following a brain stem stroke requires comprehensive, lifelong care:

• Medical and Supportive Care: Due to the inability to breathe voluntarily or protect the airway, most LIS patients require an artificial aid for breathing and will have a tracheotomy. Since they cannot safely swallow (dysphagia), they must receive nutrition via a gastrostomy tube (G-tube) inserted directly into the stomach.
• Rehabilitation: They need extensive physical, occupational, and speech therapy. This is vital for preventing secondary complications of immobilization, such as muscle contractures, pneumonia, and pressure injuries (bedsores).
• Assistive Technology: The core of their daily life depends on assistive technology and adaptive equipment. This includes eye-tracking technology that allows them to access computers, communicate by spelling words, and operate other devices.

Recovery of motor function is extremely rare. However, establishing effective communication and providing aggressive supportive care and rehabilitation are essential to maintaining the quality of life and dignity of a patient with Locked-in Syndrome after a brain stem stroke. This verdict stands as a clear signal that the law will hold medical professionals accountable when malpractice strips a patient of their ability to move, speak, and live independently.

You can also read Blog posts about other Verdicts.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

A family has secured a $951 million judgment against a hospital. This birth injury case highlights the devastating consequences of alleged misuse of the labor-inducing drug Pitocin. It also involves a dangerous delay in performing a necessary Cesarean section, which resulted in a catastrophic birth injury.

The court found that newly oriented nurses administered dangerously high levels of Pitocin for hours despite clear signs that the baby was in fetal distress, and that the on-call physician was unresponsive. After more than 30 hours in labor without proper medical intervention, the baby was born with a severe hypoxic ischemic brain injury, a condition that requires round-the-clock care and extensive lifelong support.

The case concluded with a default judgment after the hospital’s legal team withdrew and failed to engage in the proceedings.

Understanding Pitocin: A Powerful Tool in Childbirth

What is Pitocin and When Do Medical Providers Give It?

Pitocin is the brand name for a synthetic version of oxytocin, a hormone naturally produced and stored in the brain. Often called the “love hormone,” natural oxytocin stimulates the uterus. It causes the uterus to contract during labor and helps the body expel the placenta and control bleeding after delivery.

Medical providers administer Pitocin intravenously (via an IV) and primarily use it to induce labor (start contractions) or augment labor (strengthen contractions that have slowed down or are ineffective). It may be used when it is medically riskier to wait for labor to start on its own, such as when a mother is past her due date or her water has broken without contractions starting.

How Does Pitocin Work?

When medical providers give Pitocin, it binds to oxytocin receptors in the uterus, triggering rhythmic muscle contractions. The dosage is carefully controlled and slowly increased until contractions occur a few minutes apart. Unlike natural oxytocin, which can ebb and flow based on the body’s needs, Pitocin is a continuous administration.

The Danger of Too Much and For Too Long: Pitocin Misuse & Birth Injury

While Pitocin is generally safe when used correctly and monitored closely, improper use—such as excessive dosage or prolonged administration—carries significant risks for both mother and baby.

The main danger is uterine hyperstimulation (or hypertonicity). That occurs when contractions become too strong, too frequent (more than five every ten minutes), or too long. Excessive contractions decrease the blood and oxygen flow to the fetus, which can result in:

• Fetal distress.
• Birth asphyxia (oxygen deprivation).
• Uterine rupture, a life-threatening emergency for both mother and baby, especially in mothers with a previous C-section.
• Infant brain damage, including HIE: Hypoxic Ischemic Encephalopathy.

The Warning Signs: Recognizing Fetal Distress – Pitocin Misuse & Birth Injury

Fetal distress is a historical term describing when a fetus is not receiving adequate amounts of oxygen during pregnancy or labor. Medical staff monitor for a non-reassuring fetal status, which may include:

• Abnormal Fetal Heart Rate: The most common sign, which includes a heart rate that is too slow (bradycardia) or has concerning patterns, such as late decelerations (the heart rate dropping after a contraction and taking too long to recover) or a lack of heart rate variability.
• Decreased Fetal Movement.
• Meconium in the Amniotic Fluid (the baby’s first stool passing before birth).

Treatment Response to Fetal Distress

When signs of fetal distress are detected, the immediate treatment is a series of steps known as intrauterine resuscitation to restore oxygen to the baby. These steps include:

1. Stop Pitocin immediately to prevent further uterine overstimulation.
2. Change the mother’s position (often turning her onto her side) to correct potential maternal hypotension (low blood pressure) and improve blood flow.
3. Ensure the mother is well-hydrated and has adequate oxygen.
4. If these measures do not resolve the distress and the abnormal fetal heart rate persists, the doctor must deliver the baby as soon as possible, which in most cases requires an emergency Caesarean section.

The Devastating Result from Pitocin Misuse: Hypoxic Ischemic Encephalopathy (HIE) Birth Injury

What is Hypoxic Ischemic Brain Injury?

Hypoxic Ischemic Encephalopathy (HIE) is a type of brain injury that occurs when the brain is deprived of adequate oxygen (hypoxia) or blood flow (ischemia). This injury can happen before, during, or shortly after birth, and is often a result of prolonged fetal distress. Because brain tissue has a very high need for oxygen, even a short period of deprivation can lead to permanent damage.

The severity of the resulting disabilities depends on the duration of oxygen deprivation and how much of the brain is affected.

What Kind of Care Does Someone With HIE Need?

Children with HIE often have long-term challenges, including:

• Cerebral palsy.
• Intellectual disabilities and developmental delays.
• Epilepsy (seizure disorders).

Immediate treatment for HIE in a newborn involves therapeutic hypothermia (or cooling therapy). This cools the infant’s body and brain for 72 hours to slow cell function and prevent further brain damage that occurs when blood flow restores (reperfusion injury). The medical providers must initiate this treatment within six hours of birth to be effective.

Long-term care for HIE is often extensive and tailored to the child’s specific symptoms and disabilities, including:

• Physical, occupational, and speech therapy.
• Medications to control seizures (anticonvulsants).
• Specialized feeding/swallowing therapy and vision or hearing supports.

The Legal Backdrop: Default Judgment and Bankruptcy – Pitocin Misuse & Birth Injury

What is a Default Judgment?

A default judgment is a final ruling issued by a court in favor of one party (the plaintiff). It is because the opposing party (the defendant) failed to answer a legal complaint, appear in court, or otherwise participate in the proceedings. In this case, the court entered judgment against the hospital after its legal team withdrew. The company then failed to engage.

What Happens to a Medical Malpractice Judgment When the Hospital Files for Bankruptcy?

When a hospital or corporate entity like the hospital files for bankruptcy (which it has since done), it creates significant hurdles for collecting on a judgment.

1. The Automatic Stay: The bankruptcy filing immediately triggers an automatic stay. That is a “stop work” order that halts most civil actions. These include collection efforts on judgments, against the debtor.
2. Dischargeable Debt: In general, if an individual (like a doctor) files for bankruptcy, a medical malpractice debt arising from negligence or recklessness is typically considered dischargeable (can be wiped clean) in a Chapter 7 liquidation bankruptcy. The exception to discharge is generally limited to debts arising from willful and malicious (intentional) injury.
3. Corporate Reorganization: Since the hospital is a corporation, it likely filed for Chapter 11 reorganization. The court does not immediately erase the judgment itself. The $951 million claim becomes one of many claims against the company’s assets. The family must now pursue payment through the complex bankruptcy process. The ultimate recovery amount will depend on the value of the hospital’s assets and the priority of their claim compared to other creditors.

Despite the challenges posed by the bankruptcy, the lawyers for the family have stated they remain committed to pursuing recovery for the family.

You can read Blog posts about other issues involving Verdicts.

If your child has a birth injury, see below and call The Kopec Law Firm to discuss your options.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

The emergency room is the ultimate safety net. It is a place where rapid, high-stakes decisions mean the difference between life and death. When a patient presents with a classic, high-alert symptom, the standard of care requires that medical providers operate with an immediate, diagnostic urgency. For conditions like stroke, every second counts. Consequently, misdiagnosis of a stroke can have permanent life-altering effects.

Yet, in a recent case, a jury delivered a monumental $70.8 million medical malpractice verdict that serves as a tragic, resounding condemnation of an Emergency Department’s failure to act on a ticking clock. The case centered on a 42-year-old woman whose life was irrevocably shattered after she was discharged from the hospital despite presenting with the “worst headache of her life” and critical stroke risk factors.

The hospital gave the patient a “headache cocktail” and sent her home. However, the hospital did not perform a CT scan, and did not consult a neurologist. Less than 30 hours later, she suffered a devastating, preventable stroke. The catastrophic outcome—resulting in blindness, paralysis, and a lifelong need for care—was deemed by the jury to be the direct result of egregious negligence.

What is a Stroke? A Brain Attack Defined

A stroke is a medical emergency that occurs when blood flow to the brain is interrupted, starving cells of oxygen and nutrients. Often called a “brain attack,” this interruption causes brain cells to begin dying within minutes.

Strokes fall into two main categories:

1. Ischemic Stroke: The most common type (about 87% of cases), caused by a blood clot that blocks an artery leading to the brain.
2. Hemorrhagic Stroke: Caused by a weakened blood vessel that ruptures and bleeds into the surrounding brain tissue.

The specific, and often misdiagnosed, event in the patient’s case here was a Cerebral Venous Sinus Thrombosis (CVST). CVST is a rare type of stroke where a clot forms in the brain’s venous sinuses—the large channels designed to drain blood out of the brain. When these sinuses are blocked, blood is trapped, causing immense pressure to build up. This condition is dangerous because the increased pressure can lead to swelling and, critically, cause a subsequent bleed (hemorrhage) into the brain tissue, which is the mechanism that results in permanent injury.

The Critical Clock & Cost of Misdiagnosis: Symptoms and Risk Factors of Stroke

Recognizing a stroke begins with two crucial elements: the symptoms the patient reports and the risk factors that heighten the possibility of a cerebrovascular event.

General Symptoms and the F.A.S.T. Acronym

For ischemic and hemorrhagic strokes, recognizing the signs immediately is paramount:

• Face Drooping.
• Arm Weakness.
• Speech Difficulty or slurred speech.
• Time to call 911.

CVST-Specific Warning Signs

While traditional stroke symptoms can be present, CVST often presents with less specific, but equally alarming, signs, which demand a high index of suspicion. These must be considered to avoid stroke misdiagnosis.

• Severe Headache: This is the most common symptom, present in the majority of CVST cases, often described as sudden, severe, and persistent, such as the “worst headache of her life” reported by the patient.
• Vision Problems: Blurred or double vision, or even sudden loss of vision, due to the pressure buildup in the head.
• Seizures.

General and CVST-Specific Risk Factors

When a patient presents with a severe headache, physicians must immediately screen for known risk factors that make CVST more likely. This is necessary to avoid stroke misdiagnosis.

In the patient’s case, the presence of diabetes and recent birth control use alongside the “worst headache of her life” were the twin red flags that should have mandated a full stroke workup.

The Medical Team: Who Assesses a Stroke & is Responsible for Misdiagnosis

The clock starts in the Emergency Department (ED). The ED physician’s duty is to rapidly stabilize the patient and initiate imaging to determine the stroke type.

However, once stroke is a possibility, the standard of care requires immediate involvement of other doctors in other specialties. This includes:

• The Vascular Neurologist (Stroke Specialist): This physician is critical for complex or ambiguous cases, such as CVST, and is responsible for confirming the diagnosis and guiding the specific, time-sensitive anticoagulant therapy.
• The Neuro-Radiologist: This specialist interprets the complex imaging, such as venograms, to definitively locate the clot and assess the extent of brain damage.

The failure to consult a neurologist was a central element of the negligence that led to the $70.8 million verdict.

Diagnostic Tests: What Imaging Reveals

A stroke diagnosis cannot be made by physical exam alone; it relies entirely on rapid and accurate neuroimaging.

By failing to perform even the basic CT scan, the ED physician bypassed the foundational step required to diagnose a brain emergency.

The Life-Saving Intervention: Acute Treatment for Suspected CVST

Once the clot (thrombosis) has formed, the primary medical goal shifts to preventing the clot from growing and causing catastrophic brain damage (venous infarction or hemorrhage), which constitutes the actual stroke event.

Immediate Anticoagulation (Blood Thinners)

The cornerstone of acute CVST treatment is the immediate administration of anticoagulation (blood thinners), usually through parenteral Heparin (either Intravenous Unfractionated Heparin or Low Molecular Weight Heparin, LMWH). This is why stroke misdiagnosis delay is so dangerous.

• Mechanism: Anticoagulants do not immediately dissolve the existing clot. Instead, they work by preventing the existing clot from propagating (growing larger) and stopping the formation of new clots. By halting the clot’s growth, anticoagulation prevents further blockage of the sinuses and gives the body’s natural processes time to gradually reabsorb the clot.
• Timing: Treatment must begin immediately upon diagnosis or even high clinical suspicion, as every hour delayed increases the risk of stroke progression. This treatment is given even when a patient has a hemorrhage (bleeding) associated with the CVST, because the danger of the clot extending is judged to be greater than the risk of the existing bleed worsening under close monitoring.
• Post-Acute Care: After stabilization, doctors transition patients to an oral anticoagulant (like Warfarin) for 3 to 12 months or longer to prevent recurrence.

The 30-hour delay in the patient’s treatment, caused by the negligent discharge, allowed the CVST clot to progress to a severe, hemorrhagic stroke, making her catastrophic injuries entirely preventable.

The Catastrophic Cost of Misdiagnosis: Permanent Stroke Injuries

When the blood supply to the brain is disrupted for a prolonged period, the resulting cell death can lead to profound, permanent neurological deficits.

The $70.8 million verdict reflects the devastating, lifelong consequences of a severe stroke, which include:

• Paralysis or Hemiparesis: Significant weakness or complete paralysis, typically affecting one side of the body. The patient now suffers from left-sided paralysis.
• Vision Loss: Damage to the visual processing centers or the optic nerve due to dangerously high intracranial pressure. The patient was left with blindness.
• Aphasia or Dysarthria: Impairment of language, ranging from difficulty finding words (aphasia) to physical difficulty articulating speech due to muscle weakness. The patient suffers from a neurogenic stutter.
• Cognitive Impairments: Difficulty with memory, attention, executive functions (planning, problem-solving), and also reasoning. The patient has lasting cognitive impairments.
• Neuropsychiatric Issues: Common long-term complications include chronic fatigue, depression, anxiety, and behavioral changes.
• Seizures (Epilepsy): Occurring in a minority of survivors, seizures can be a chronic long-term complication requiring medication.

Conclusion on Stroke Misdiagnosis

The verdict for the plaintiff is a stark reminder to medical facilities across the country. The failure to follow basic diagnostic protocols for a suspected stroke is not just an error in judgment. It is a catastrophic breach of the standard of care.

The $70.8 million verdict specifically provides the necessary resources for the patient’s lifelong care and rehabilitation. However, its greater purpose is to enforce accountability in the emergency room. When a patient’s life hangs in the balance, a severe headache paired with known risk factors must trigger an aggressive, time-sensitive diagnostic response. Any less is medical negligence.

If you or a family member had stroke symptoms, did not receive a stroke work-up, and subsequently had a stroke leaving permanent injury, see below and contact the Kopec Law Firm.

You can read Blog posts about other Verdicts.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

Time is Heart Muscle: When Delayed Cardiac Cath Becomes Medical Malpractice

The difference between life and death during a massive heart attack is often minutes. In the world of cardiology, a widely understood and critical concept is that “time is heart muscle.” Minutes can waste due to hospital negligence, miscommunication, or—shockingly—internal policy. The results of a delayed cardiac cath can be catastrophic. It can lead directly to multi-million-dollar medical malpractice verdicts.

A recent jury verdict serves as a grim and powerful example. It highlights high-stakes legal ramifications. The healthcare system prioritized internal patient retention over a patient’s most urgent need for life-saving care.

The Crisis: Understanding the Causes of a Heart Attack

A heart attack is also medically a myocardial infarction (MI). It occurs when a portion of the heart muscle doesn’t receive enough oxygenated blood. A blockage in one of the coronary arteries typically caused the lack of blood flow.

The vast majority of heart attacks are caused by Coronary Artery Disease (CAD), a condition where a waxy substance called plaque—made of fat, cholesterol, and other materials—builds up inside the arteries, a process known as atherosclerosis.

The critical event that triggers a heart attack is the rupture of this plaque. When a plaque deposit breaks open, a blood clot rapidly forms on its surface. If this clot completely blocks the artery, it will cut off blood flow to the heart muscle. This causes the muscle to begin dying within 30 minutes of the blockage. This complete blockage, often identified on an electrocardiogram (ECG) as an ST-Elevation Myocardial Infarction (STEMI), is a true medical emergency that requires immediate intervention.

While less common, other causes of a heart attack include:

• Coronary Artery Spasm: A sudden, severe tightening of the artery that temporarily stops blood flow, which can occur even without significant plaque buildup.
• Spontaneous Coronary Artery Dissection (SCAD): A life-threatening, non-traumatic tear that forms inside the artery wall.
• Coronary Artery Embolism: A blood clot that travels from another part of the body and lodges in a coronary artery.

We will see below that the patient must get to a cardiac cath lab without delay.

The Life-Saving Solution: The Cardiac Catheterization Lab

For a patient suffering a STEMI, the definitive, gold-standard treatment is a procedure doctors perform in a specialized area of the hospital – the Cardiac Catheterization Laboratory (Cath Lab).

A cath lab is a high-tech examination room with advanced imaging technology. It is used to both diagnose and treat a variety of heart conditions. The primary emergency procedure performed is:

1. Coronary Angiogram: The doctor, often an interventional radiologist or interventional cardiologist, inserts a catheter—a long, thin, flexible tube— through an artery, usually in the wrist or groin, and threads it up to the heart. A special dye is injected, and X-rays are taken to visualize the arteries and pinpoint the exact location and severity of any blockage.
2. Percutaneous Coronary Intervention (PCI) / Angioplasty and Stenting: Once the doctor finds the blockage, they inflate a tiny balloon at the tip of the catheter to compress the plaque and open the artery. In most cases, a metal mesh tube called a stent is then permanently implanted to prop the artery open and restore blood flow.

This procedure is a race against the clock. The current standard of care for a patient who must be transferred from one facility to another for this procedure—known as the “first medical contact-to-device” time—is recommended to be no more than 120 minutes. Every minute lost means more heart muscle dies, leading to permanent damage and a significantly lower chance of survival.

Not All Hospitals Are Equipped: Understanding Cardiac Care Levels

The critical nature of a heart attack requires a high level of specialized care, and not every hospital can provide it. In many states, cardiac catheterization services are categorized into different levels based on their capabilities, particularly whether they can provide interventional procedures and surgical backup:

• Level I: Typically offers low-risk or diagnostic-only catheterization services.
• Level II: Offers some high-risk and interventional procedures (like PCI), but does not have on-site open-heart surgical back-up.
• Level III: Provides the highest level of care, offering all risk and all interventional procedures, with mandatory on-site open-heart surgical back-up. These hospitals are often comprehensive cardiovascular centers and are the ideal, non-negotiable destination for a STEMI patient.

Hospitals that are not Level III or a PCI-capable facility must adhere to strict transfer protocols. This is to ensure the rapid moving patients suffering a STEMI to a center that can provide definitive cardiac cath care without delay.

The EMS Protocol: The Prehospital Deciding Factor

The race to the cath lab begins the moment the Emergency Medical Services (EMS) team arrives on the scene. First responders are the first crucial link in this chain of survival:

1. Diagnosis: First responders use a prehospital 12-lead ECG to rapidly diagnose a STEMI. The presence of ST Elevation of ≥2 mm in two or more adjacent leads is often the trigger for immediate action.
2. Activation: Once EMTs confirm a STEMI, EMS protocols dictate immediately activating the receiving hospital’s cath lab team while the patient is still en route. This pre-alerting ensures that the team, including an interventional cardiologist, is ready upon the patient’s arrival.
3. Destination Decision: Critically, first responders are to bypass community hospitals that lack PCI capabilities and transport the patient directly to the closest Level III or PCI-capable facility. In ideal scenarios, the EMTs take the patient straight to the cath lab, bypassing the Emergency Department (ED), to minimize the crucial “door-to-balloon” time.

This system is designed to overcome initial obstacles and eliminate unnecessary delays at facilities that cannot provide the necessary care.

A Fatal Cardiac Cath Delay: The $45 Million Malpractice Verdict

The recent verdict is a devastating illustration of what happens when this critical system breaks down.

The decedent suffered a fatal heart attack after EMTS first took him to a local hospital. This was a facility that was, by all accounts, unequipped to perform the urgent catheterization and stenting he desperately needed. The emergency responders alerted the hospital staff to the severity of his STEMI condition. They also conveyed his need for a PCI-capable center. However, the staff at the local hospital made the fatal decision to admit him to their facility.

The staff did not immediately direct the ambulance to the nearby, fully equipped facility. Instead, they admitted the patient. They then transferred him by helicopter to a different hospital within the same network. This internal transfer, which allegedly prioritized keeping the patient within the hospital system rather than providing immediate care, resulted in a delay of nearly 90 minutes.

The decedent died shortly after arriving at the receiving hospital, without ever getting the life-saving intervention he required.

The family filed a medical malpractice lawsuit against the health network. It argued that the system acted with negligence. It further prioritized its own internal financial or patient retention goals over the patient’s established, time-sensitive medical needs. A jury agreed with the family. It found the hospital acted with reckless disregard. The jury delivered a staggering $45 million verdict to the widow and minor children.

The Legal Ramifications of Delayed Cardiac Cath

The $45 million verdict sends an unambiguous message. Healthcare systems have a duty to adhere to established, life-saving protocols. This is especially true for time-critical conditions like a heart attack. When a hospital is aware of a patient’s need for an immediate procedure—such as a PCI in a cath lab—and they fail to transfer the patient to an appropriate facility in a timely manner, it constitutes a clear deviation from the standard of care.

The standard of care demands efficiency, coordination, and a singular focus on the patient’s well-being. A transfer delay, whether driven by administrative inertia or prioritizing internal network revenue, is a form of medical negligence that can—and in this tragic case, did—cost a life. For victims and their families, a medical malpractice lawsuit is often the only path to accountability and justice when a system fails at the moment it was most needed.

If you have been injured by delay in getting to a cardiac cath lab, or were injured in the lab, see below to contact the Kopec Law Firm.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

The Baltimore Medical Malpractice Lawyer Blog features verdicts in medical malpractice cases. In this post, I discuss a verdict in a birth injury case based on injury after prolonged labor.

A jury awarded $48.1 million in a medical malpractice case to the parents of a child who sustained life-altering brain injuries during birth at a hospital. The lawsuit alleged that despite evidence of fetal distress, the doctor and the hospital staff allowed the mother to push for over twelve hours instead of performing an earlier C-section. Following the difficult delivery, the infant suffered seizures within 24 hours, spent over six weeks in the NICU, and was ultimately diagnosed with a cerebral palsy birth injury. The total verdict included $28.1 million in compensatory damages and an additional $20 million in punitive damages.

What is Prolonged Labor and What are its Dangers, Including Birth Injury?

Prolonged labor, also known as failure to progress, occurs when the process of labor takes significantly longer than expected.

• Definition 🕰️: Labor is generally considered prolonged if it lasts 20 hours or more for a first-time mother, or 14–20 hours or more for a woman who has given birth before. This stalled progression can happen in one of two stages:
  • First Stage: The cervix starts to dilate (open) but stops before reaching full dilation at 10 centimeters.
  • Second Stage: The cervix has fully dilated, but the baby stops moving down the birth canal.

Dangers to the Baby Prolonged labor, particularly in the second stage, can lead to serious complications for the infant. These risks are primarily due to the duration and stress of the labor:

• Oxygen Deprivation (Perinatal Asphyxia): The baby may not receive enough oxygen and blood flow, a condition called perinatal asphyxia.
• Fetal Distress: The sustained stress can lead to fetal distress (see below for more detail).
• HIE: Hypoxic Ischemic Encephalopathy: Oxygen deprivation and decreased blood flow can cause brain damage, known as HIE. This is a major cause of lifelong disabilities, including cerebral palsy and seizure disorders.
• Instrumental Delivery Injuries: Prolonged labor often necessitates the use of instruments like a vacuum extractor or forceps to complete the delivery, which can, in some cases, cause physical injury to the baby’s skull and brain.

Dangers to the Mother Prolonged labor also increases the mother’s risk of infection, extreme exhaustion, postpartum hemorrhage (severe bleeding after delivery), and the need for an assisted vaginal delivery or an emergency C-section.

What is Fetal Distress and What is the Response to It?

Fetal distress is a term used to describe when a fetus shows signs of being compromised. This is most often due to inadequate oxygenation during late pregnancy or labor. Medical professionals now commonly use the less ambiguous term non-reassuring fetal status (NRFS).

Signs of Fetal Distress The condition is typically detected by monitoring the baby’s fetal heart rate (FHR) using an electronic fetal monitor (EFM). Abnormal heart rate patterns that signal distress include:

• Tachycardia (abnormally fast) or Bradycardia (abnormally slow) heart rate.
• Late Decelerations: A drop in the heart rate that occurs after the peak of a uterine contraction.
• Decreased Fetal Movement: A change in the baby’s usual movement pattern is a critical sign.
• Meconium-Stained Amniotic Fluid: The presence of meconium (the baby’s first stool) in the fluid is another potential indicator of distress.

Medical Response to Fetal Distress When non-reassuring fetal status is detected, the immediate medical response is aimed at improving the baby’s oxygen supply. This process is intrauterine resuscitation.

• Initial Resuscitation Steps: Changing the mother’s position, administering oxygen through a mask, or giving fluids through an IV line may alleviate the distress. The medical provides also may give medication to slow or stop contractions if they are too frequent.
• Expedited Delivery: If the baby’s status does not improve, or if the heart rate pattern is dangerously abnormal (Category III tracing), the doctor must immediately deliver to prevent serious complications, such as permanent brain damage. The doctor achieves this either through an assisted vaginal delivery (using forceps or a vacuum extractor) or an emergency C-section.

Birth Injury Seizures, the NICU, and Cerebral Palsy

Birth Injury Seizures

Neonatal seizures are involuntary movements or behaviors caused by abnormal electrical activity in the newborn’s brain. They can occur within the first hours or days of life and are often the first visible clinical sign of a significant birth injury.

• Cause: The most common cause is Hypoxic-Ischemic Encephalopathy (HIE), which is brain damage resulting from a lack of oxygen and blood flow that occurred before or during delivery, often as a result of prolonged labor or untreated fetal distress.
• Treatment: Seizures in newborns are a neurological emergency. Medical providers must treat them immediately, as continuous seizure activity can worsen existing brain damage. The medical staff must quickly identify and address the underlying cause.

The NICU

The Neonatal Intensive Care Unit (NICU) is the hospital ward that treats newborns requiring intensive medical care, such as those with severe birth injuries.

• HIE Treatment: Infants suspected of having HIE are often candidates for therapeutic hypothermia (brain cooling). This specialized treatment involves carefully lowering the baby’s body temperature for a period. This is to slow down metabolic activity. Then limit the cascade of cell death, thereby minimizing the extent of permanent brain damage.

Cerebral Palsy (CP)

Cerebral Palsy (CP) is a permanent neurological disorder that affects muscle movement, posture, and balance.

• Cause: Damage to the developing brain that occurs before, during, or shortly after birth causes CP. A severe lack of oxygen to the brain (HIE) is one of the leading causes of CP linked to complications at birth, such as those that arise from unmanaged prolonged labor.
• Nature of CP: The disorder is static, meaning the original brain injury does not worsen over time. However, the resulting physical impairments may become more obvious as a child grows and fails to meet typical developmental milestones.
• Associated Conditions: Children with CP have a significantly increased risk of developing other neurological conditions. This includes epilepsy (a chronic seizure disorder), which can be another manifestation of the underlying brain damage.

Next Step: Call Baltimore Prolonged Labor Lawyer Mark Kopec for Your Child’s Birth Injury

If your child has a birth injury from prolonged labor, call Baltimore prolonged labor lawyer Mark Kopec now.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

Understanding the Risks of Epidural Steroid Injections: A Case Study in Spinal Cord Infarction

A jury awarded over $60 million to a man after a routine epidural steroid injection (ESI) permanently paralyzed him. The procedure allegedly resulted in a spinal cord infarction. This case highlights the extremely bad outcomes that can arise from this common medical procedure. It also stresses the importance of proper technique and steroid selection.

What is an Epidural Steroid Injection?

An epidural steroid injection is a procedure in which anti-inflammatory medicine, such as a steroid or corticosteroid, is injected into the epidural space of the spine. The epidural space is the area surrounding your spinal nerves. This treatment commonly manages pain caused by irritation and inflammation of the spinal nerve roots, often associated with conditions like spinal stenosis or a herniated disc. The medication is a combination of a corticosteroid and a local anesthetic.

A Brief History of Epidural Steroid Injections

The concept of epidural injections for pain management dates back to the early 1900s. The first record of use was around 1901 by French physicians Jean-Athanase Sicard and Fernand Cathelin, who injected cocaine through the sacral hiatus to treat conditions like sciatica. Over time, the technique also began to use local anesthetics. In the early 1950s, corticosteroids started in epidural use. Since the 1970s, numerous clinical trials have shown that ESIs can have a significant, though small, short-term effect on leg pain. Despite ongoing debate about their effectiveness and safety, ESIs are now one of the most widely utilized pain management procedures in the world.

Technique and the Critical Role of Imaging

Proper administration of an ESI is crucial to minimizing risk and avoiding medical malpractice. The doctor can perform the procedure using an interlaminar approach, where he places the needle between the vertebral lamina, or a transforaminal approach, where the doctor places the needle into the neural foramen next to the exiting nerve root.

Image guidance is essential for the accurate placement of the needle and the safe delivery of the medication. Doctors use imaging techniques like computed tomography (CT) or X-ray fluoroscopy to guide in real-time. A contrast medium or air is often injected to confirm the needle’s position in the epidural space before the steroid is administered. This step helps to ensure that doctor does not accidentally inject the medication into a blood vessel or the intrathecal space (the fluid-filled area surrounding the spinal cord), which can lead to serious complications.

The Steroid Choice: Particulate vs. Non-Particulate

The type of corticosteroid used in an ESI is a key factor in the safety of the procedure, as highlighted in the Gangaram case. Steroids are classified as either particulate or non-particulate. Particulate preparations, such as methylprednisolone acetate (Depo-Medrol), triamcinolone acetonide (Kenalog), and betamethasone acetate, contain undissolved crystals. These crystals are often large enough to occlude the small arteries that supply the spinal cord. Non-particulate preparations, like dexamethasone, dissolve completely and do not contain these crystals.

The use of particulate corticosteroids, particularly in the cervical spine, can have catastrophic complications, including paralysis and even death. The theoretical benefit of particulate steroids is that their anti-inflammatory effect is delayed but sustained because the crystals are released gradually. However, non-particulate preparations are safer due to the lack of risk of embolic events. This case specifically noted the use of Kenalog, a particulate steroid, which plaintiffs argued was a contributing factor to his injury.

What Can Go Wrong? ESI Medical Malpractice

While generally considered a safe procedure, ESIs carry potential risks and bad outcomes. Minor side effects can include a “steroid flush,” increased blood sugar, and pain at the injection site. More serious, though rare, bad outcomes can include:

• Infection: Infections can range from meningitis to epidural abscesses and are often due to poor sterile technique.
• Bleeding/Hematoma: A collection of blood at the injection site can occur.
• Nerve Damage: Direct trauma to a nerve or the spinal cord itself is a possibility.
• Intravascular Injection: This is one of the most serious risks, where the doctor accidentally injects medication into a blood vessel. The FDA has issued a warning that this can lead to serious events like loss of vision, stroke, paralysis, and death.
• Spinal Headache: A severe headache can result if cerebrospinal fluid leaks out of the epidural region.
• Spinal Cord Infarction: This is the most severe and rare bad outcome, as seen in the this case.

Spinal Cord Infarction: The Ultimate Risk of ESI Medical Malpractice

A spinal cord infarction is a stroke that occurs within the spinal cord. It is caused by a blockage of the blood supply to the spinal cord, leading to the death of nerve tissue. Symptoms often appear suddenly and can include sharp back pain, weakness, and paralysis in the legs or arms.

The mechanism by which an ESI can cause a spinal cord infarction is most often inadvertent intra-arterial injection, particularly with particulate steroids. A needle, especially during a transforaminal injection, can accidentally enter a radicular artery that supplies the spinal cord. If a doctor injects a particulate steroid into this artery, the tiny crystals can travel. They can cause a blockage (embolism) in the smaller, more distal arteries of the spinal cord. This can cut off the blood supply to a section of the spinal cord, resulting in an infarction. This case of illustrates this risk, with experts stating that the use of a particulate steroid and wrong technique led to his permanent paraplegia. This tragic outcome is a powerful reminder of the potential for severe, life-altering complications, even in what is a routine medical procedure.

Next Step: Call Baltimore ESI Medical Malpractice Lawyer Mark Kopec

If you have been injured by ESI medical malpractice, call Baltimore ESI Lawyer Mark Kopec now.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

A jury delivered a $70 million verdict to the plaintiff, who tragically suffered bilateral above-the-knee amputations. The verdict found the defendant physicians and their medical practices equally liable for the plaintiff’s devastating injuries. The plaintiff’s legal team successfully argued that the injuries were a direct result of medical malpractice. Specifically, the medical malpractice was the administration of an excessive dose of Vasopressin. In addition, the doctors‘ subsequent mismanagement of her care while she was in the hospital for sepsis and shock. The hospital where the events occurred had previously settled with the plaintiff prior to the start of the trial. Defense attorneys maintained that the plaintiff’s condition was a tragic and highly complex medical emergency. They also claimed that the doctors’ actions were lifesaving and within the accepted standard of care. This report also provides background on the key medical concepts involved and explains medical mechanisms.

The Role of Vasopressin in Medical Treatment

Vasopressin, also known as antidiuretic hormone (ADH), is a naturally occurring hormone produced in the hypothalamus and stored in the pituitary gland. Its primary function is to regulate the body’s water balance by controlling the reabsorption of water by the kidneys. It also acts as a powerful vasoconstrictor, meaning it causes blood vessels to narrow. In a medical context, doctors use synthetic vasopressin as a potent medication, primarily in critical care settings. Doctors often administer it as a vasopressor to increase blood pressure in patients who are in a state of shock, particularly septic shock. The rationale behind its use in these situations is to constrict blood vessels and redirect blood flow to vital organs, such as the brain and heart, to prevent organ failure. If the doctor is not careful, vasopressin misuse can result in medical malpractice.

In addition to shock, doctors also use vasopressin to treat diabetes insipidus, a rare condition that causes the body to produce excessive amounts of urine. In this context, it helps the kidneys retain water. The doctor administers the drug intravenously, and the titrates the dosage based on the patient’s blood pressure and other physiological responses. Its powerful effects necessitate close monitoring, as both under-dosing and over-dosing can have severe consequences.

Understanding Above-the-Knee Amputation

An above-the-knee amputation, medically termed a transfemoral amputation, is a major surgical procedure involving the complete removal of the leg at a point above the knee joint. The surgeon performs this procedure when the lower limb is no longer viable and poses a risk to the patient’s life. Common reasons for this surgery include severe trauma that has crushed the limb, uncontrolled infection, or advanced peripheral vascular disease, which has led to a critical lack of blood flow and subsequent tissue death (gangrene). Excessive vasopressin resulting in medical malpractice can also cause the need for this surgery.

The surgical procedure involves several critical steps. The surgeon first makes an incision through the skin and muscle of the thigh. The major blood vessels, including the femoral artery and vein, are identified and ligated (tied off) to prevent excessive bleeding. The surgeon also severs the nerves and carefully manages to prevent the formation of painful nerve endings, known as neuromas. The thigh bone (femur) is then cut with a surgical saw, and the end of the bone is smoothed to create a clean surface. The remaining muscles are shaped and sutured to form a soft, padded stump. Finally, the skin is closed over the stump. The surgery creates a functional residual limb to fit with a prosthesis, allowing for mobility and a good quality of life for the patient.

Vasopressin, Sepsis, and Amputation

With vasopressin medical malpractice, one must first consider the nature of sepsis and septic shock. Sepsis is the body’s extreme response to an infection, which can lead to widespread inflammation and blood clots. Septic shock is a life-threatening stage of sepsis where a patient’s blood pressure drops dangerously low, and their organs begin to fail.

The body’s blood vessels are dilating and leaking. Septic shock can cause blood pressure to plummet. Doctors use medications like Vasopressin to counter this by causing vasoconstriction. However, this action can be a double-edged sword and can lead to medical malpractice. If the dose is too high or the patient’s body is particularly sensitive, the vasoconstriction can become so severe that it cuts off blood flow not only to non-essential areas but also to the extremities.

An excessive dose of vasopressin, combined with already compromised circulation due to sepsis and shock, can lead to a medical malpractice situation of severe and prolonged ischemia (lack of blood flow) to the legs. This lack of oxygen and nutrients to the tissue can cause widespread tissue death, or necrosis. Once the tissue in the legs dies, it can become gangrenous and a source of life-threatening infection. In such a scenario, the only way to save the patient’s life is to remove the necrotic tissue. This may require bilateral above-the-knee amputations.

Conclusion on Vasopressin Medical Malpractice

This report underscores the critical importance of careful medication dosage and patient monitoring in complex medical emergencies. Method and dosage of the vasopressin treatment can constitute medical malpractice that may lead led to devastating injuries. High stakes are involved in critical care medicine and medical error can cause serious consequences. If you have a potential medical malpractice case, contact us now.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.