Our Medical Malpractice lawyers recently settled a St Louis county case for a woman who suffered a punctured lung during a trigger point injection procedure. As part fo the settlement of the case, the identity of the parties and the amount of the settlement must remain confidential.
In this case our client, let’s call her Sharon, suffered a lung injury from a negligently performed pain injection. Sharon received several trigger point injections in her upper back area to help relieve some severe back pain she suffers as the result of a spinal defect. Trigger Point Injections are meant to relax the muscles and break knots or “trigger points” using steroid medications injected directly into the muscle knot or the “trigger point”. When doing these injections, it is very important for a nurse or doctor not to push the needle too deep, especially when injecting muscles in the upper back around the chest wall, as pushing the needle too deep can puncture a lung causing a collapsed lung or pneumothorax.
In Sharon’s case the nurse was negligent and did exactly that, she pushed the needle and injected too deep; puncturing Sharon’s lung with the needle, injecting the steroid medication into her lungs, and punching a hole in her lung causing it to collapse. The nurse claimed none of this happened, however, Sharon immediately suffered from a severe cough and pain, was admitted to the emergency room, and immediately diagnosed with a collapsed lung by the emergency room doctors.
The defense raised in every Medical Negligence Case — the “Known Complication” Defense:
Of course, in this case the St Louis nurse, and the orthopedic doctor that supervised the nurse, claimed that punctured lungs are “known complications” of trigger point injections, therefore, the fact that it happened to Sharon was not negligent. For more about the “known complication” defense see Medical Negligence: “Known complication” versus “Preventable Medical Errors”
“As a St Louis medical malpractice lawyer, anytime we handle a medical negligence case for an injured patient, the first things you hear from the doctor’s, hospital’s, or nurse’s lawyer is that the error was a “known complication” and therefore, they will claim, that the fact it happened means no health care provider was negligent because it is a “known complication”. Based on this logic there would be no such thing as medical malpractice and healthcare providers would never be held accountable for sub-standard patient care and preventable medical errors that lead to serious injury or death. Death is a “known complication” of just about every medical procedure, however, death if oftentimes the result of a preventable medical error, about 44% of the time!
The key question to most medical negligence cases is not if a bad result is a known complication, but if the bad result would have been avoided had the healthcare provider acted as they were supposed to.“
Why the “known complication” defense did not work in this punctured lung case:
1. The medical records had no written informed consent and no verbal consent was given disclosing complications.
No written informed consent disclosing the “known compilations” was done, additionally, the nurse that improperly did the pain injections admitted she never gave Sharon informed consent. Moreover, the doctor that trained and supervised the nurse admitted his informed consent does not even mention collapsed lungs as a possibility and states his informed consent is very short and done just seconds before he injects them by saying “I am going to be injecting you with these medicines. There is a risk of bleeding and infection from sticking the needles through your skin. There are other rare potential complications.”
2. This was a preventable error had the injection been done properly the punctured lung would not have occurred:
Sometimes unavoidable errors occur, in a case like this a patient can unexpectedly jerk, cough, or suddenly move during an injection – this would not be negligence by the nurse but an unavoidable error that just happens, or a “known complication”. However, just because an injury is a known complication does not give the doctor or the nurse a pass to do it improperly. All of the defense witnesses in the medical malpractice case admitted that Sharon did nothing wrong. She did not jump, jerk, cough, or unexpectedly move at all during the procedure. But somehow this injury just happened but no defense witness could explain why.
The doctor that trained the nurse to do the injections explained a very different technique than the technique the nurse testified to. Additionally, the doctor and the nurse both admitted they do not aspirate the needle before injecting the steroid into the muscles. Aspiration takes only a few seconds and will tell the nurse with certainty if they are in a dangerous place. The doctor testified that “If needle is in pleural space or lung [a dangerous place to be] and nurse aspirates, they will see air in syringe. That is a tell tale sign you are in pleural space or lung and not in right spot [….] it does not hurt to aspirate and it is not difficult to aspirate[.]”
I believe the defendants’ testimony showed they did not care about what happened and they claimed the collapsed lung must have been from something else, however, they had no idea what that something else could have been. They made no changes to the way they perform the procedure and admitted they have learned nothing from the incident. The doctor testified that “Did not discuss or review the nurse’s TPI [trigger point injection] technique in light of [Sharon’s] situation.”
Juries must see more than just an injury occurring to win a medical malpractice case, you must show the doctor or nurse did not know what they were doing, did not care, or were not qualified. I believe we were able to prove all of these factors in this case and that is why it settled favorably.