Physicians have often been found negligent for leaving a foreign object in a patient during surgery. In this malpractice case, however, the anesthesiologist claimed no knowledge or ownership of an item found in the patient's spine after surgery — and no one connected with the case knew how it got there.
It is not unusual for a retained foreign object to move around a bit after surgery, but some apparently can travel farther than others.
A man in his mid-60s presented to the hospital for a total knee replacement. Dr A, the anesthesiologist, had significant difficulty and made several attempts to place a needle for spinal anesthesia before seeking assistance from a colleague. Together, they were able to place a needle using a straight-in approach.
The surgery was completed without further difficulty and with no apparent anesthetic complications.
Two months later, Dr A learned that a foreign body had been found in the patient's lumbar spine after an MRI had been ordered as part of a sciatica workup. Reportedly, the MRI was compared with spine films from 3 years earlier which showed no foreign body. The patient was advised of the finding and Dr A discussed a subsequent CT report with him.
Six weeks later, the patient underwent lumbar surgery. The surgeon removed a 2.1-cm needle from the spinal canal at L2-3, performed a fusion at that location, a posterior osteotomy, partial reduction/decompression of spondylolisthesis, partial laminectomy, bilateral foraminotomy and nerve root decompression, pedicle screw fixation, placement of bilateral rods, and a bone graft.
After the surgery, the patient reported relief of his preoperative pain symptoms but complained of atrophy and lower extremity weakness. The patient did not return to work and was terminated from employment the next year.
The patient filed suit against Dr A, alleging that she placed a needle through the spinal canal and through the dura, causing the needle to break and lodge in his spine. The plaintiff further alleged that it was negligence to fail to recognize a needle fracture when the needle and introducer were removed.
The litigation was initially worked up on the assumption that the foreign body removed in the lumbar surgery was a needle fragment from the anesthesia administered for the knee surgery. The spinal surgeon testified that he could not state whether the patient's pain was from the "needle" or from the patient's preexisting spinal stenosis but that in any case, the object needed to be removed.
Discovery revealed that the plaintiff had an urgent consult with a neurosurgeon 3 years earlier for severe leg pain, back pain, and a foot drop after moving pavers during some home landscaping. That neurosurgeon ordered flexion and extension films and had planned, depending on the films, to recommend surgery at L2-3 or L4-5, but the patient never returned.
© 2021 Cooperative of American Physicians, Inc.
This case comes from Medicine on Trial, originally published by Cooperative of American Physicians, Inc., to provide risk management lessons from litigated case histories.