discipline summaries the invasive procedures provided has led to significant complications and morbidity.” iii) Patient C was treated by Dr. James seven times between April and August 2012 for management of lower back pain. Dr. James administered epidural steroid injections to Patient C.
In or around July 2012, Patient C started to experience increasing pain and decreasing stability on her feet. She reported these concerns to Dr. James, and on two occasions sought treatment at emergency. Patient C continued to see Dr. James throughout that summer. After the epidural injections failed to alleviate Patient C’ s pain, Dr. James administered bilateral diagnostic lumbar facet blocks in July 2012. In August 2012, he performed a left rhizotomy on Patient C. At this appointment he provided Patient C with a note to take to her family doctor recommending a neurosurgery consult and recommending that her family physician request an MRI. He engaged in no further follow up with Patient C.
Patient C was diagnosed with a serious spinal infection. A sensitive strain of Staph aureus was recovered from the surgical specimen and the infection was believed to be the direct result of steroid injections.
Dr. O opined, among other things that, Dr. James failed to appreciate the patient’ s progressive symptoms, failed to realize that the symptoms could be signs of an infection in a high risk patient. He also failed to adequately document the patients progressive symptoms, failed to correctly diagnosis / work up possible complications of treatments he provided, failed to adequately inquire about the patients ER visits and failed to organize appropriate timely work up of the patient’ s symptoms.
iv) Patient D was seen by Dr. James for injections on a regular basis for treatment of chronic back pain commencing in 2010. In October 2011, Dr. James administered a lumbar epidural injection. Less than two weeks after receiving the epidural injection, Patient D began to experience symptoms of fever, increasing confusion, neck pain, nausea, vomiting and occipital headaches. She was admitted to hospital. The suspected etiology was an infection secondary to epidural injections received from Dr. James.
Patient D was readmitted to the hospital in November 2011 for a twelve-day period. Her headache, nausea and vomiting continued. An MRI demonstrated an epidural fluid collection with a diagnosis of a likely enlarging epidural abscess. Patient D required extensive surgical laminectomies. v) Patient E was treated by Dr. James for pain in her right elbow. In January 2012, Dr. James injected her elbow with cortisone and performed a caudal epidural injection the same day. Soon after the injection, Patient E’ s right arm became painful and red. She began calling the clinic to get an appointment with Dr. James so that he could look at her arm. Subsequently, Patient E attended at the clinic, and asked that someone look at her red and swollen elbow. After she waited for about an hour and a half, Dr. James saw her, told her it was likely nothing and gave her a prescription for antibiotics and told her to follow up in two weeks. Patient E’ s arm remained very painful, swollen and red. In March 2012, Dr. James immediately sent her to the Emergency Department. Patient E was found to have a post-injection abscess and a heavy growth of Staph aureus and was referred for both orthopedic and plastic surgery consults.
Dr. O opined that it is below standard of care to not offer urgent follow up for a potential infection after a procedure, even if there is no fever.
vi) In May 2012, Patient F received a lumbar epidural injection for lower back pain from Dr. James. Less than two weeks later, Patient F developed a high fever, delirium and increasing back pain while out of the country. Patient F was admitted to hospital in the United States, critically ill. He was found to have an epidural abscess and sepsis( Staph aureus bacteremia), requiring ICU admission, intubation and neurosurgical evacuation together with hemi lami-
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Issue 1, 2017 Dialogue 49