Should physician assistants handle spinal surgery consults

I spent the afternoon deposing a physician assistant (PA) who’s an employee of a large hospital in the Dallas area. The hospital is a trauma center that handles a lot of spine surgery and trauma patients.

I took this PA’s deposition in a medical malpractice case involving a patient, my client, who was rendered quadriplegic after a long delay in getting him to the operating room for emergency spine surgery.

He had been hospitalized after a high-speed motor vehicle collision and treated for abdominal injuries. When his physicians realized that he had lost motor and sensory function in his lower extremities, they ordered a spine consult.

Spine consults are supposed to be handled by spine surgeons.

Spine surgery is a complex area of medicine handled by physicians with significant post-graduate residency and fellowship training. When a spine surgeon is consulted, it often means that the patient has a serious injury that could lead to permanent disability. Any diagnostic mistakes or delays could leave a patient with paraplegia or quadriplegia.

I couldn’t think of any explanation why it would take over a day to take this man to surgery, with known findings including:

• Distraction injury at vertebrae C6-C7 with significant spinal cord edema (swelling).

• Disruption of the anterior and posterior longitudinal ligament at the level of C6-C7, which destabilized the neck/cervical spine.

• Epidural hemorrhaging at vertebral levels C4 to C7.

Instead of the spine surgeon responding to consultation reports, though, it’s a PA who handled the evaluation of the patient. At deposition, I delved into the circumstances leading to this bizarre situation.

The PA explained that when a new surgeon is onboarded to the hospital, the hospital’s business administration office offers to arrange PA services on behalf of the surgeon. For surgeons who opt-in, the hospital provides PAs who will respond to spine surgery consults. Spine surgeons don’t have to rush into the hospital to see patients and can rely on the PA, and the hospital generates more profits by billing for the PA’s services.

The next thing that I learned during this deposition, though, really shocked me.

The typical routine followed in the hospital is that the spine surgeon receives a consultation order and then contacts the PA to ask him or her to see the patient. The PA explained that this particular spine surgeon generally communicates only by text message.

In my client’s case, the spine surgeon sent a text message to the PA’s iPhone to request that she see the patient.

After the PA evaluated the patient, she texted the spine surgeon with her findings. The spine surgeon responded asking her to order some diagnostic imaging, including a CT scan and CT angiogram.

The PAs on the hospital service only work until 5:00 p.m. on weekdays, though, so by the time the additional radiology results came back, the PA was already gone for the day.

The spine surgeon never showed up to see the patient and they waited until the next day to operate. By then, his lower extremity neurological problem had spread to his upper extremity. He was a permanent quadriplegic. The hospital, PA, and spine surgeon had waited too long.

In my view, utilizing physician assistants and nurse practitioners to evaluate spine patients in place of a qualified spine surgeon is simply absurd. Patients should remember that they have a right to be seen by a physician. Remember to be your own advocate.

If you’ve been seriously injured because of poor hospital or surgical 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.