$198,168.36: Man Goes To Doctor For Big Toe Pain And Receives Treatment Causing Nerve Damage

CASE DESCRIPTION:  Plaintiff sees Doctor for pain and swelling in his right big toe.  The Doctor diagnosis the symptoms as a result of gout and injects a drug.  The Doctor’s use of the drug was negligent, which resulted in Plaintiff receiving nerve damage in his arm.  Plaintiffs sue for damages and loss of consortium.  The Defendant disputes whether his actions were negligent.

RESULT:  $198,168.36 total verdict

Plaintiff Darden S. saw Defendant David S., M.D. on August 13, 1993, due to right great toe pain and swelling.  Dr. David S. diagnosed gout and selected to inject the drug, colchicines, intravenous intending to immediately relieve the pain.  The injection was done with a straight syringe needle, as opposed to using an established intravenous line as recommended by the drug manufacturer.

The drug carries with it the risk of severe “tissue irritation” if it is injected so as to permit any of the medication to extravesate (leak) from the vein.  The injection, administered slowly, lasted four to five minutes and was given in the antecubital vein of the left forearm (approximately at the bend of the inner elbow.)  The following day the Plaintiff reported “deep” pain in the “upper arm” in the vicinity of the injection site.  In the following days the upper arm pain lessened, but the left thumb, forefinger and middle finger became severely painful, weak, “clawed”, numb, tingling and burning.  The Plaintiff had suffered median nerve injury due to injection as well as some lesser apparent injury to the ulnar nerve.

Over time, virtually all symptoms resolved, leaving the Plaintiff with mild to moderate intermittent pain, some residual skin atrophy of the forefinger and some numbness and tingling of the thumb, forefinger and middle finger.

At trial Plaintiffs argued Defendant Dr. David S. should not have used the drug I.V. colchicine in the first place as there are many safer drugs that are equally effective.  I.V. colchicine is used for gout, but only in exceptional circumstances where oral medication is inappropriate.  Also, the drug should never be used as a tool to help confirm a “probable” diagnosis of gout, which defendant did in this case.

Next Plaintiff contended if Defendant was going to use the drug, it must be administered with an established intravenous line, with a soft plastic catheter, rather than a straight steel needle/syringe, in order to minimize the risk of extravasation over four to five minutes injection.  Plaintiff alleged that due to the injection technique, Defendant permitted some of the medication to leak into surrounding tissues causing median and ulnar nerve damage.  Plaintiffs also alleged that Defendant failed to provide adequate informed consent.

At trial the Defendant alleged that use of the drug is indicated in cases of gout, and that he has used the drug over twenty times previously in the same manner with great success.  Defendant also stated that he had been trained to use the drug and administer it in the manner that he did.  Defendant also alleged that the injection technique was as safe as using an established I.V. line and that an established I.V., while recommended by the drug manufacturer, is not mandated; but rather is really just one of two accepted modes of administration.  Defendant further alleged that there was no evidence of extravasation at the time of injection and no pain or skin discoloration at the injection site.

Defendant then attempted to develop the theory that Plaintiff’s pain was in his upper arm – suggesting injury due to an idiosyncratic response to the drug as it “diffused” out of the vein at a site more proximal to (above) the injection site.  In the upper arm, the vein and both the median and ulnar nerves are very close together, explaining why both the median and ulnar nerves would be affected.  In contrast, at the injection site the median nerve is close by, but the ulnar nerve is two to three inches away – making it unlikely that the medication, if it extravasated at the injection site, could diffuse all the way to the ulnar nerve.  The Defendant also contended that because the “pronatorteres” muscle was involved in the injury, the injury to the median nerve must have been higher up in the arm than the injection site – making injection site extravasation an improbable cause of the injury.  Defendant also claimed he had told Plaintiff of all material risks related to the injection and Plaintiff chose to proceed in an effort to gain rapid relief.

With regard to damages Plaintiff sought to recover medical expenses, personal injury, loss earnings and loss of consortium.  Defendant disputed those claims by arguing that Plaintiff had made a full and complete recover, that all present symptoms (which were in any event minimal) were entirely subjective and not credible.  Thus Plaintiff had no loss of income or loss of consortium.

TYPE OF CASE:  Medical Malpractice

INJURIES:  Median nerve injury resulting in pain, and abnormal sensation of the left thumb.  Forefinger and middle finger, as well as some weakness.  Some minimal involvement of the ulnar nerve.

DATE & LOCATION OF INCIDENT:  On 8/13/93 at Defendant’s Office.

PLAINTIFF’S AGE:  Darden S. – 47 at time of incident
Linda S. – 47 at time of incident

OCCUPATION:  Darden S. – Computer Data Architect
Linda S. – Customer Relations Director

Richard A. Cohn & Wylie A. Aitken
For Plaintiffs – Darden & Linda S.

Michael “Tony” Brodie
For Defendant – David S., M.D.

DEFENDANT INSURANCE CO.:  Physicians Interindemnity Trust