Man ends up with anoxic brain injury after facet injections to relief lumbar back pain

According to a lawsuit pending in a Harris County, Texas District Court, a patient suffered a severe anoxic brain injury while receiving facet nerve blocks for severe lumbar spine pain. The lawsuit named Vista Community Medical Center, LLP d/b/a Surgery Specialty Hospitals of America and three physicians as defendants in the medical malpractice case.

Lumbar, or lower back, pain can be intense and disabling. One surgical treatment option is a facet or selective nerve root block. Facets are the joints that serve as connections between the bones of the spinal column. Nerve roots branch off the spinal cord and pass through facet joints to innervate (supply nerve function) to the extremities and different body parts.

An anesthesiologist or interventional pain physician performs a facet nerve block under radiologic guidance to ensure the correct location. A needle is inserted into the facet joint that’s causing the pain, and then an anesthetic medication and/or steroid medication is injected. The injection can be on the left side, right side, or both sides (bilateral).

In this case, the patient had bilateral facet blocks at three different facet joints, L3-L4, L4-L5, and L5-S1. An anesthesiology expert for the plaintiff wrote a supportive report detailing that the patient suffered severe complications during the blocks.

The expert shared his opinion that the patient had a complicated medical condition that was relevant to his care. The patient had high blood pressure (hypertension), diabetes, and high cholesterol (hypercholesterolemia). He’d also undergone multiple previous procedures  to help with his severe lumbar pain, including three rounds of epidural injections (ESIs), lumbar radiofrequency thermocoagulation (RFTC) procedure, ultrasound lumbar trigger point injections, lumbar facet blocks, and lumbar rhizotomies.

None of these procedures would be expected to provide permanent relief. When some are successful, they last for a period of months. For example, the beneficial effects of a rhizotomy typically last 6–12 month. In this procedure, troublesome nerve fibers are deliberately destroyed to prevent pain sensations.

Less than three months after having rhizotomies at three different levels of his lumbar spine, a nurse practitioner reordered  facet blocks on the same three levels. The interventional pain management physician, Jerry Keepers, MD, reviewed the nurse practitioner’s order and scheduled the patient for lumbar facet blocks a week later.

The medical expert explained that this was not an urgent or emergency procedure, so the patient’s medical condition should have been optimized before the elective procedure occurred. The expert further detailed his criticisms that:

• There was no cardiovascular assessment or clearance for the procedure.

• No one consulted the patient’s cardiologist, despite multiple risk factors including age, high cholesterol, high blood pressure, diabetes, obesity, a past medical history of cardiac arrhythmias, and abnormal EKG (electrocardiogram).

• The anesthesia plan was vague and no appropriate evaluation results were noted in the medical records.

Although we’re thankful for anesthesia and the pain relief it offers, it’s still a risky business, whether it’s provided by an anesthesiologist physician or certified registered nurse anesthetist (CRNA). The American Society of Anesthesiologists and the standard of care mandate documentation of a pre-anesthesia evaluation that identifies an individual patient’s risks for tolerating the procedure and anesthetic care. Additionally, the anesthetic plan must take into account these risks.

The expert was critical of both Dr. Keepers and the anesthesiologist for the procedure, Eric Kay-Fung Chong, MD, for allegedly failing to perform and document these assessments and plans.

The medical expert believes that this case involved a high-risk patient, yet anesthesia expert chose to administer three powerful agents, Versed, fentanyl, and propofol. According to the expert, it’s controversial uses reagents together because it can cause hypoventilation (inadequate exchange of air), obstruct upper airway, and apnea (collapse of the airway). The cocktail can also alter the cardiovascular system, so careful monitoring is necessary.

After the facet injection procedure is complete, the vital monitors were removed before the patient was awake and alert. There was a 15-minute gap in the medical records where there are no vital signs after the procedure.

A Code Blue was eventually called. The hospital and physicians who subsequently treated the patient documented that the patient suffered respiratory arrest that caused hypoxia (reduced oxygen in the blood) and bradycardia (an abnormally slow heart rate).

The plaintiff’s medical expert contends it is likely that the heavy sedation administered to the patient produced an unrecognized pulmonary aspiration, which is a prolonged airway obstruction that caused his respiratory arrest and other complications. This led to inadequate oxygen levels for a long period of time before it was recognized and emergency cardiopulmonary resuscitation (CPR) could be started. Despite emergency efforts, he developed a permanent brain injury.

In this catastrophic medical malpractice case, the defendants responded by seeking to have the trial court throw the case out by a motion to dismiss. They claimed that the medical expert opinions were not sufficient to satisfy stringent tort reform requirements. The trial court denied the motion to dismiss and, on appeal, Houston’s First Court of Appeals agreed with the decision. The case is styled Jerry M. Keepers, MD, Eric Kay-Fund Chan, MD, and Vista Community Medical Center, LP d/b/a Surgery Specially Hospitals of America v. Michael Smith and Valery Smith; No. 01-20-00463-CV, In the First Court of Appeals of Texas. You can read the opinion here.

If you’ve been seriously injured because of poor anesthesia care in Texas, then contact a top-rated, experienced Texas medical malpractice lawyer for a free consultation about your potential case.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.