Spinal canal stenosis and the bounds of medical malpractice

A memorable lecture for most law school tort students is the eggshell skull rule.

Imagine how easy it would be to injure someone who’s skull is like an eggshell rather than hard bone. When a defendant injures a plaintiff through negligence, the defendant is responsible for those injuries, even if the plaintiff has a condition that makes him or her more susceptible to injury—that’s the eggshell skull rule.

This is the situation that we encountered when developing a case where a person fell headfirst onto a concrete surface. Before the accident, the person had no disabilities and was able to walk around and function without any deficits.

After being taken to a Houston-area hospital emergency room (ER), the nursing staff and ER physician noted that the patient had had hand/wrist pain and had lost sensation in both lower extremities.

The ER physician ordered CT scans of the patient’s neck and back. The thoracic CT scan showed “moderate to severe canal stenosis.” That means that the bony spinal canal that holds and protects the spinal column was abnormally narrow. This condition predisposed this patient to spinal cord compression and neurologic injuries in a fall that might not injure someone without this anatomical variant.

 A CT scan won’t show spinal cord compression, an emergency medical condition that would explain the patient’s symptoms. The ER doctor didn’t order an MRI scan, which would have ruled it in or out. Instead, the ER physician discharged the patient and the nurse noted “MD aware of weakness upon discharge.”

After being discharged, the patient’s condition did not improve. Two days later, the patient was evaluated at another hospital ER, where an MRI showed spinal cord compression. Unfortunately, by then, she had permanent neurologic injuries.

This is the eggshell skull rule at work—the ER team had a patient who was born with narrow spinal canals, which made the person particularly vulnerable to traumatic injuries.

In a recent case out of Houston’s First Court of Appeals, the eggshell skull rule took a different twist. The case is styled CHCA Clear Lake, L.P. d/b/a Clear Lake Regional Medical Center et al. v. Jon Stewart, No. 01-19-00874-CV, First Court of Appeals. You can read the opinion here.

In that case, a man was involved in a bicycle accident. He was taken to the emergency room at Clear Lake Regional Medical Center, where radiology scans showed that he had extensive mid and lower cervical degenerative disease. Just like the case we discussed above, this patient had spinal stenosis that was visible on a CT scan of his cervical spine.

About three months after the patient was discharged, he continued to be involved in athletic activities and sustained a broken neck and spinal cord injury during a skiing accident. The new injuries sadly rendered the patient quadriplegic.

The patient filed a medical malpractice lawsuit against the Clear Lake Regional Medical Center physicians who cared for him after his bike accident. The plaintiff’s lawsuit and experts alleged that the Clear Lake radiologist and physicians violated the standard of care by failing to tell him about the seriousness of his degenerative spinal disease.

The plaintiff alleged that if he had been told so, he would’ve had the opportunity to have neurosurgical consultation and care, including neurological testing, cervical spine care, activity limitations, therapy, and surgery.

The First Court of Appeals rejected the plaintiff’s argument and reversed the trial court’s decision, noting that:

• An expert can’t simply offer a conclusory opinion that a breach of the standard of care caused the plaintiff’s injury.

• The plaintiff’s expert offered no more than a bare assertion that the purported breaches of the standard of care by the Clear Lake physicians resulted in later injuries that the plaintiff sustained while skiing.

• The plaintiff’s expert didn’t show how the doctors caused the plaintiff’s ski-related injuries.

• An event that starts a chain of events can be too attenuated from an injury to cause it. An event must be a substantial factor to bring the entry about. It’s not enough for one event to precede the other.

The standards of law and evidence for Texas medical negligence claims are complex. If you’ve been seriously injured because of poor hospital, emergency room, or medical 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.