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The Expert: Dr. Michael Freeman, an expert in injury biomechanics, details the likelihood that the fall caused the back injuries that plaintiff complains of.
Dr. Michael Freeman, a forensic epidemiologist with expertise in injury biomechanics, testifies during a 2013 Nevada medical malpractice trial. The plaintiff was injured when she fell off of the operating room table while unconscious and being transferred to a gurney after an appendectomy. As a result of her injuries, she subsequently required a spinal fusion. The expert detailed the likelihood that the traumatic transfer caused the back injuries.
The defense had proposed that the patient sustained her back problems from something other than the mishandling that occurred when she was transferred from the OR table to the gurney. However, the expert concludes that this is highly unlikely. The patient was 21 years old, without any previous history of vertebral disc problems. Back problems like this are exceedingly rare in a person this age without a precipitating traumatic incident. Generally, back problems in this age group result in surgery in only 1 of 3000 cases. Without any history of previous significant vertebral disc degeneration, no risk factors for the development of such a problem, and an obvious precipitating event, the epidemiologist figures that the chances of this happening if the fall had not occurred would be about 1 in 1.1 million.
In discussing the actual fall, there were several explanations by other witnesses and descriptions of an unconscious post-operative patient who was being transferred when those moving her lost control. She fell or slid to the floor in an unusual position while unconscious. Although OR personnel felt that she was gently lowered to the floor, the expert explains that when a person is unconscious, and not properly supported, there are forces placed upon that body that include twisting, shearing, rotation, and compression. A conscious person would tense up or take protective measures to minimize those “loads” and their resulting damage. Without the ability of a patient to protect herself, those torques can become extreme. These forces were put into play by the fulcrum effect of the body bent backwards over the edge of the OR table. The claim that this patient was set down lightly and carefully, the expert maintains, is betrayed by the finding of bruising on the arm and lower back. The low back was therefore either a “pivot point” on the table edge, or she was dropped on her spine.
It is this patient’s age and lack of previous history of back problems that really are significant here. As one ages, the ability of the vertebral discs to maintain their structure by pulling fluid into them decreases. This leads to a disc desiccation process, a decrease in height as we age, and subsequently slowly damages the discs. A person in her early twenties is not yet afflicted by this normal aging process. Being so young and having no previous complaints related to disc pathology, it becomes very unlikely that she suddenly developed the back pain immediately after the appendectomy but for the botched transfer. The epidemiologist concludes that it is far more likely that the patient’s back injury was related to the trauma of the transfer, than to have spontaneously and acutely developed the pathology for totally undetermined reasons.
The jury concurred, handing down a $1.36 million verdict for the plaintiff.
Gary Gansar, MD, is residency-trained in general surgery. He served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Touro Infirmary and Mercy Hospital in New Orleans, LA. Dr. Gansar was Board Certified in general surgery while in active practice. He joined AMFS in 2015 as a Physician Medical Director.
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