Case details

Sciatic nerve injury a known risk of total hip replacement: defense

SUMMARY

$0

Amount

Verdict-Defendant

Result type

Not present

Ruling
KEYWORDS
nerve, neurological
FACTS
On April 23, 2013, plaintiff Angela Belfiore-Braman, 62, a chief financial officer, underwent a total left hip replacement by Dr. D. Daniel Rotenberg, an orthopedic surgeon. Belfiore-Braman had a long history of severe arthritis of the left hip. As a result, surgery was indicated and ultimately performed at Scripps Mercy Hospital, in San Diego. Immediately after the surgery, Belfiore-Braman experienced a drop foot condition in the left leg. Belfiore-Braman sued Rotenberg; Rotenberg’s medical office, Oasis MSO Inc. (which was initially erroneously sued as Oasis MD Inc.); the operator of Scripps Mercy Hospital, Scripps Health; the anesthesiologist who was present during the surgery, Harish Hosalkar, M.D.; and Hosalkar’s medical group, Anesthesia Service Medical Group Inc. Belfiore-Braman alleged that the defendants were negligent in the performance of the surgery and that this negligence constituted medical malpractice that resulted in an injury to her left foot. Several of the defendants were dismissed from the case, and the matter ultimately continued against Rotenberg only. Plaintiff’s counsel asserted that Rotenberg negligently utilized hip implant components — specifically prosthetic components that included a prosthetic femoral neck, femoral head, and femoral stem — that were too long and too tight. Counsel contended that the components stretched the sciatic nerve, which, in turn, caused Belfiore-Braman’s injury. The plaintiff’s orthopedics expert testified that there was no documentation in the medical records of Rotenberg’s efforts to properly position the left leg and protect the sciatic nerve intraoperatively. Thus, the expert testified that he was unable to determine whether positioning also played a role in Belfiore-Braman’s injury. Plaintiff’s counsel noted that during the course of the lawsuit, Belfiore-Braman had contacted Dr. Aaron Filler, a board certified neurosurgeon, to determine the reason why she could not move her leg properly. Filler, who was the lead inventor of the patented magnetic resonance neurography and diffusion tensor imaging, performed an MRI neurography of Belfiore-Braman’s leg. However, Belfiore-Braman was an imaging-only patient, which means Filler never met with Belfiore-Braman. As a result, an Evidence Code § 402 hearing was held regarding Filler’s proposed testimony, which pertained to the question of admissibility of his testimony. During that hearing, Filler was allowed to testify about his findings regarding the condition of the sciatic nerve based on the imaging. He also testified about possible treatment and whether or not he believed significant mechanical force was applied to the nerve during the course of the hip replacement surgery. However, Judge Joan Lewis ultimately found that Filler was neither a treating physician nor a retained expert. Thus, Filler could only testify at trial regarding the study that he performed and the test results, but could not testify as to why Belfiore-Braman’s injury occurred. Rotenberg’s counsel contended that Belfiore-Braman experienced a rare, but recognized, risk of the total hip replacement surgery. Defense counsel noted that both the plaintiff’s and the defense’s orthopedic surgery experts agreed that sciatic nerve injury can occur even if the surgeon does everything, including intraoperative positioning, perfectly. Thus, defense counsel asserted that Rotenberg properly used trial implant components to determine the proper length for the final implant and that when the +0-millimeter femoral head was difficult to reduce during the trial reduction, he appropriately utilized the -3.5-millimeter head, which allowed for full range of motion and was stable in all directions. Thus, counsel contended that even though Belfiore-Braman experienced a serious complication from the surgery, that complication occurred in the absence of negligence and despite Rotenberg’s best efforts to avoid it., Belfiore-Braman sustained a sciatic nerve injury, resulting in a drop foot condition to the left leg. She subsequently underwent nerve conduction studies and physical therapy. She also wears foot/ankle braces. However, Belfiore-Braman claimed her drop foot condition continues. She also claimed she cannot dorsiflex or plantarflex her left foot and that the condition is likely permanent. Thus, Belfiore-Braman sought recovery of past and future medical costs, and damages for her past and future pain and suffering. Her husband, Stephen Braman, sought recovery of damages for his loss of consortium.
COURT
Superior Court of San Diego County, San Diego, CA

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