Doctor Fails to Heed Caution Signs in Treating Patient
Ryan Borton was a 41-year-old factory machinist weighing 350 pounds. On January 13, 2014, he was walking to his car after work when he slipped on ice and landed on the right side of his back. A rib X-ray was taken that day at the emergency room, which was negative for fracture. Mr. Borton was sent home with instructions to rest and ice his sore back and ribs.
Posted in Risk Management on Tuesday, May 28, 2019
Over the next few days, Mr. Borton’s back pain flared up at work. He went to his primary care physician who recommended Motrin. When his back pain was still not feeling better 10 days later, Mr. Borton went to see John Sidwell, DC, for chiropractic treatment.
After conducting an initial exam at the January 23, 2014, appointment, Dr. Sidwell wanted to rule out thoracic fractures before he adjusted Mr. Borton. The patient was referred to the local hospital and X-rays were taken the next day.
The X-ray was read as negative for fractures, but showed diffuse idiopathic skeletal hyperostosis (DISH) throughout Mr. Borton’s thoracic spine. At a follow-up appointment on January 27, Dr. Sidwell asked about the DISH diagnosis. Mr. Borton recalled being told in the mid-1990s that he had a condition that fused his mid-spine.
Dr. Sidwell saw Mr. Borton three times that week and adjusted Mr. Borton’s thoracic spine with an activator at the first two visits. At the third visit, Dr. Sidwell manually adjusted Mr. Borton while he was face down. He also applied other modalities at all three visits, including heat, massage therapy and electrical muscle stimulation at each visit. During this course of care, Mr. Borton showed slight improvement.
Patient Goes to the ER
The following weekend, on February 1, 2014, Mr. Borton went to the emergency room for constipation. As Mr. Borton attempted to lie flat for an abdominal X-ray, his mid-back went into severe spasm, followed by numbness in his legs. Mr. Borton reported these new symptoms to Dr. Sidwell at his appointment the following Monday, February 3, 2014. Because the patient’s symptoms flared up while laying down for an X-ray at the ER, Dr. Sidwell chose to have Mr. Borton remain standing while he applied activator technique to his thoracic spine.
Mr. Borton returned on February 10, 2014, showing some improvement. However, he said it felt like something was caught in his mid-back, and he asked Dr. Sidwell to perform a firm adjustment.
Because of Mr. Borton’s large size, Dr. Sidwell believed he could apply more force during the adjustment if the patient stood in the doorway while the doctor used the doorjamb for leverage.
In preparation of the adjustment, moist heat was applied to the mid back. He then had the patient stand in the doorway, with his chest and abdomen against the doorjamb with his arms on each side of the wall, parallel to the floor. Dr. Sidwell stood with his back against the opposite doorjamb and performed a standing posterior to anterior thoracic adjustment.
Back Spasm Precedes Fall to the Floor
Immediately following the treatment, the patient’s legs weakened, and Dr. Sidwell had to support the patient as he fell to the floor. Mr. Borton’s back had gone into severe spasm, and he was unable to stand. Mr. Borton remained lying on the floor for approximately one hour during which time Dr. Sidwell checked on him. The front office assistant called Mr. Borton’s wife and asked her to come to the practice.
When Mr. Borton’s wife arrived, Dr. Sidwell solicited the help of three other people to transfer him into a chair. Both Mrs. Borton and Dr. Sidwell reported that they offered to call 911, but Mr. Borton didn’t want to go to the hospital. Rather, he sat for two additional hours in the chair, after which four people helped Mr. Borton move to the passenger seat of his truck. Upon arriving at his home, a dolly was used to get him into the house.
Dr. Sidwell later acknowledged during the deposition that loss of motor function is often an emergency situation. However, he did not examine the patient after the fall. Instead, he monitored him only for loss of bowel or bladder function.
Patient’s Difficulties Continue
Dr. Sidwell called and checked on Mr. Borton the next morning, February 11, 2014. Mr. Borton reported continued spasms in his low back and gluteal region, as well as left leg weakness. He also was still unable to stand.
Dr. Sidwell instructed him to call his primary care physician for pain medication. Later that day, when Mr. Borton couldn’t rise from his chair to use the bathroom, Mrs. Borton called 911, and an emergency team was dispatched. While transferring the patient to the gurney, the EMTs dropped him on the ground.
He was then transferred to a local hospital where Mr. Borton waited more than 24 hours to be seen by a neurologist. Because Mr. Borton was unable to walk, he required an MRI. However, he had to be airlifted to another facility with an MRI machine to accommodate his large size. This MRI revealed an acute T10 fracture with epidural hematoma.
Subsequently, Mr. Borton underwent emergency decompression surgery, but unfortunately he never fully regained the use of his legs and must rely on a scooter or wheelchair to ambulate.
Mr. and Mrs. Borton hired an attorney who filed a lawsuit against Dr. Sidwell and his practice, Sidwell Family Chiropractic. Dr. Sidwell promptly contacted NCMIC, and defense counsel was retained on his behalf. The lawsuit was filed on February 3, 2016, in a state with a 2-year statute of limitations. This was more than two years after the January 24, 2014, thoracic X-ray was taken, but just shy of two years after the doorjamb adjustment of February 10, 2014.
The defense team requested Mr. Borton’s medical records, which revealed a health history including diabetes, hypertension, asthma and sleep apnea prior to the incident. Post-surgery, Mr. Borton required several additional hospitalizations for deep vein thrombosis, pulmonary embolism, sepsis and MRSA at his surgery site.
Dr. Sidwell’s defense team prepared a convincing causation defense.
The NCMIC retained radiology expert performed a “blind” review of the January 24, 2014, thoracic films that had been read as negative by the hospital radiologist. This meant the expert was not given any of the patient’s history before seeing the films. The expert reported that he could see a fracture at T10. Had these films been read correctly by the hospital’s radiologist, Dr. Sidwell would have referred Mr. Borton to a neurosurgeon instead of proceeding with chiropractic care.
NCMIC also retained a neurology expert who opined that the Coumadin given to Mr. Borton when he arrived at the emergency room before he went into surgery was contraindicated. This is what he believed caused the epidural hematoma.
Weaknesses in the Case
Despite several facts working for the benefit of the chiropractor, including the fact that he did not cause the injury, the defense team had to consider whether the contemporaneous relationship of Dr. Sidwell’s doorjamb adjustment and Mr. Borton’s resulting leg weakness would influence a jury.
There was also concern that a significant sum would be awarded to the Bortons. The hospitals and medical providers had billed more than $600,000, and Mr. Borton would require continued medical care for the foreseeable future. Moreover, Mr. Borton wasn’t able to walk or return to his factory job.
Mr. Borton’s potential for future lost earnings equaled nearly $1 million, based on his past wages and potential earning capacity. Additionally, Mr. and Mrs. Borton were very endearing individuals who had hoped to start a family. These hopes ended when Mrs. Borton had to take on a second job and Mr. Borton was left unable to independently perform many activities of daily living. If a jury were inclined to decide in the Bortons’ favor, they would most likely award them with a large sum of money for their pain and suffering.
The Bortons’ attorney sent a letter to Dr. Sidwell’s NCMIC-retained defense attorney demanding that NCMIC pay his policy limits of $1 million. A mediation was scheduled for March 26, 2016. Given some of the weaknesses of this case and the potential it would not be resolved in Dr. Sidwell’s favor, the case was settled with the DC’s consent for $750,000.