Hey Doc, Can You Help Out The Team?
On Saturday, November 5, 2016, Will was playing defense for his high school football team. While making a tackle, Will struck the quarterback with his helmet and went down on all fours, experiencing numbness in his arms and legs that lasted for about 10 seconds. Will then got up and stayed in the game for the next several plays. Attorney Howard S. Shafer explains what happened and what it meant for the team doctor.
Posted in Risk Management on Friday, November 15, 2019
By Howard S. Shafer
Before each game, Will’s coach would retain a doctor to tend to any injured players. However, because the team’s regular physician was not available, he asked the opposing team’s coach to recommend someone. The opposing team’s coach suggested Joe Coxton, DC, who frequented the team’s practices, and Dr. Coxton agreed to serve as the doctor in attendance.
In this state, a medical physician was legally required to be present at all football games. If the coaches knew that the doctor in attendance must be a medical physician, they did not share this information with Dr. Coxton.
After the Injury
After Will left the game due to injury, Dr. Coxton examined him. First he palpated the musculature in Will’s neck and upper shoulders. Then, he performed range of motion testing. Lastly, he applied gentle pressure on Will’s head downward, performing a cervical compression test.
Dr. Coxton was evaluating Will for a neck injury, which was well within his training and expertise. He found no increase in the baseline of pain on the cervical range of motion test, and the cervical range of motion was not restricted. He found no increase of the baseline of pain on the cervical compression test.
After careful examination, Dr. Coxton’s working diagnosis was a strain or sprain—perhaps a pinched nerve. In his role as the team doctor, Dr. Coxton was not permitted to treat Will or even see him for follow-up care. Therefore, he simply advised Will to stay out of the game, ice the injury and see his regular doctor if the pain persisted.
Put Me In, Coach
As one of the team’s star players, Will played a variety of positions and usually all 48 minutes of the game. After his injury, Will went in for a few plays before watching the game from the sidelines.
Will grew upset as the game progressed—he wanted to step in to help his team win. After two failed punt attempts, the coach put Will in to punt. Will’s punt was a long one, but unfortunately his team didn’t end up winning the game.
Late Sunday afternoon, Will’s mother became concerned that Will did not seem himself, and she decided to take him to see his chiropractor the next day after school. Will’s pain was exacerbated after a girl jumped on his back at school. Sneezing also made the pain worse.
During the chiropractic appointment on Monday, November 8, Will’s DC suspected something was seriously wrong with his spine, but he didn’t send him immediately to a hospital or another medical facility. Instead, the DC took X-rays during the appointment but didn’t read them until Tuesday. The results revealed a fracture, and the DC recommended Will see see an orthopedist, but he didn’t provide a referral.
After suffering for another three days, Will went to the emergency room at the local hospital where he was diagnosed with a burst fracture at C5. He was admitted to the hospital where he required surgery and a halo brace.
Will’s family filed a lawsuit approximately a year later, in December 2017. This lawsuit was against the school, the city and Dr. Coxton. Unfortunately for Dr. Coxton, the codefendants all settled, and he was left as the sole defendant at trial.
During the trial, Will’s story changed. Transient numbness and pain in the side of the neck became bilateral numbness during Dr. Coxton’s examination. Dr. Coxton’s examination became manipulation. Dr. Coxton’s instructions for Will to stay out for the remainder of the game became stay out for a quarter. Dr. Coxton's advice to see a doctor if the pain persists became "see if the injury clears up overnight." And a sneeze and a girl jumping on his back at school, absent from any medical records, became exacerbating events.
With this testimony, Dr. Coxton was being accused of misrepresenting himself as a medical physician and permitting a student with a potentially serious neck injury to return to the game, delaying his treatment and risking further injury.
The plaintiff experts spoke of worst case scenarios. Conditions like significant neurologic deficits and catastrophic quadriplegia were described.
The Defense Counters
The defense team retained an orthopedic surgeon to evaluate Dr. Coxton’s actions. This expert witness had strong credentials and had treated a high-profile football player with a similar injury. He testified that Dr. Coxton’s care did not worsen Will’s fracture because Will’s neurological function was found to be normal while he was at the hospital. It was his professional opinion that residual damages were caused by Will’s original injury, not by Dr. Coxton’s actions or inactions.
This surgeon further testified that the delay in follow-up care did not change the type of treatment Will needed. Because Will sustained a fracture of the neck, he required stabilization through a spinal fusion.
The trial became a battle of the experts. Will’s experts did not do well at trial; in fact, the chiropractor’s testimony supported Dr. Coxton. The other plaintiff experts testified to what “could have” happened and overreached in their testimony.
Luckily for Dr. Coxton, the injury was one within his expertise, and the jury believed his expert and found for the defense. But the lawsuit and trial made Dr. Coxton fearful not only for a judgment against him but also one in excess of his malpractice policy limits. Consequently, Dr. Coxton suffered many sleepless nights before the jury found in his favor.
All names used in Examiner case studies are fictitious to protect patient and doctor privacy.