I recently reviewed a case involving a middle-aged woman who went to a hospital emergency room (ER) complaining of lower back pain.
The patient told the nurse practitioner who saw her in the ER that she had experienced chronic lower back pain ever since she had a surgery several years earlier to correct scoliosis. She decided to go to the ER because her pain was worse that day.
The nurse practitioner discharged her from the emergency room with a diagnosis of lower back pain and prescriptions for Toradol (a pain killer) and Robaxin (a muscle relaxant).
A week later, a family member found her in the floor of her home. She was unable to get up and barely able to breathe. They took her to the hospital, where she was immediately admitted to the intensive care unit because of concern over sepsis. Sepsis is a dangerous inflammatory response related to infection.
She had multiple surgeries to drain abscesses that formed near her lungs and around her lower spine (spinal epidural abscesses).
The ER provider did an adequate workup
As we always do at Painter Law Firm when investigating a new case, we quickly ordered the hospital medical records. After reviewing them, I have to say that I’m impressed with the thorough workup that the nurse practitioner did in the emergency room.
The emergency provider actually documented a differential diagnosis! I used the exclamation point deliberately because it’s exceptionally rare to see this. The standard of care requires physicians and mid-level providers (like nurse practitioners and physician’s assistants) to form a differential diagnosis list of all potential conditions or diagnoses that would explain the patient’s signs and symptoms.
The nurse practitioner documented in the medical record the following differential diagnosis considerations for this patient: lumbar spine hardware issue, epidural abscess, cauda equina, lumbar spine fracture, lytic lesion of spine, spondylolisthesis, spinal stenosis, spondylolysis, urinary tract infection, pyelonephritis, and aortic aneurysm.
Under the “medical decision-making” heading, the nurse practitioner wrote that, “Pain is suspected to be mechanical in nature as no red flags were noted to suggest an infectious cause or worrisome process requiring further workup or hospitalization.”
Based on my review of the records, I concluded that there was no negligence involved, let alone the willful and wanton negligence required by the Texas hospital emergency room standard. I explained to our client that I believe that this is one of those cases where there was bad result despite appropriate care.
By the way, even when we can’t help a client or potential client in a medical malpractice case, we try to provide answers that will help them understand what happened.
Spinal epidural abscess
A spinal epidural abscess is an accumulation of pus (infected fluid) forming near the spinal cord or cauda equina (nerve roots below the spinal cord). They’re dangerous because they can cause compression of the spinal cord and nerves, which can cause motor and sensory deficits that can progress to paralysis and death.
Sometimes tricky to diagnose. Spinal epidural abscesses can be difficult to diagnose because most patients only complain of lower back pain. Of course, many things can cause lower back pain.
Increased risks. Some patients have a higher risk for spinal epidural abscesses, including patients with:
· Diabetes
· Existing spinal hardware
· Compromised immune system
· Alcoholism or drug abuse
Diagnosis. The standard of care requires providers to consider spinal epidural abscesses in all patients with back pain, particularly in those that have an increased risk. To rule out the condition, the provider can order simple lab tests including C-reactive protein (CSR) and erythrocyte sedimentation rate (ESR), or an MRI scan. The medical literature reflects that the CSR or ESR levels will be elevated in patients with spinal epidural abscesses nearly 100% of the time.
What you can do
As a patient, it’s important to realize that the correct diagnosis of spinal epidural abscess is frequently missed on the first encounter in an emergency room or with a doctor. Thus, to improve your own safety, if you have new lower back pain that’s persistent, keep following up with your provider.
If an abscess is compressing the spinal cord or nerves, emergency surgery to decompress the area will likely be necessary. In addition, if the abscess causes sepsis, that dangerous condition will need to be treated quickly. For both conditions, the faster the treatment, the better the likely outcome.
We are here to help
If you or a loved one has been seriously injured because of poor medical, hospital, or surgical care, click here to send us a confidential email via our “Contact Us” form or call us at 281-580-8800.
All consultations are free, and, because we only represent clients on a contingency fee, you will owe us nothing unless we win your case. We handle cases in the Houston area and all over Texas. We are currently working on medical malpractice lawsuits in Houston, The Woodlands, Sugar Land, Conroe, Dallas, Austin, San Antonio, Corpus Christi, Bryan/College Station, and Waco.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2018, by H Texas as one of Houston’s top lawyers. Also, in 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.
