Medical Opinion Summary
Joseph David, D.O., a board-certified physical medicine and rehabilitation specialist in New Jersey, provides a medical opinion on Michael Stuart, a veteran who served in the US Air Force from 1981 to 1987. Dr. David reviewed extensive medical records, including CT and MRI scans, surgery notes, and statements from Stuart’s family. Stuart has experienced worsening lower back pain following an injury in 2003, leading to multiple surgeries.
- A significant concern is the surgery on August 3, 2021, performed by Dr. Kesterson, which deviated from the pre-surgical plan. Instead of the planned L2-L4 fusion, Stuart underwent an L1-L3 fusion. Subsequent medical imaging revealed issues such as lucencies in the fusion screws and severe degenerative disc disease, which were not adequately addressed. As a result, Stuart’s condition worsened, leading to reliance on a wheelchair for mobility.
- Dr. David asserts that the deviations from standard care, including the surgical level change and inadequate post-surgical follow-up, are likely the cause of Stuart’s flatback syndrome. This condition is characterized by loss of normal lumbar lordosis, leading to a forward tilt of the trunk and significant pain. Dr. David concludes that these medical oversights necessitated further, more extensive surgery for Stuart. He emphasizes that his opinion is based on a thorough review of Stuart’s medical history and is rendered with a reasonable degree of medical probability and certainty.
The letter serves as a professional medical opinion and does not constitute a patient-physician relationship. Dr. David recommends that Stuart continue care and treatment with his regular medical doctors. The opinion is supported by reference to medical literature on flatback syndrome.
Who is negligent ?
Based on the medical summary provided by Joseph David, D.O., the negligence appears to be attributed to two main parties:
- Dr. Oliver Lee Kesterson and the Center for Neurological Disorders: The primary issue of negligence seems to stem from the surgery performed by Dr. Kesterson on August 3, 2021. Despite the pre-operative plan being for an L2-L4 fusion, Dr. Kesterson performed an L1-L3 fusion, which deviated from the agreed-upon surgical plan without prior consent or explanation to Michael Stuart. This deviation is a clear breach of the standard of care. Furthermore, the post-surgical care, including the failure to address issues such as lucencies in the fusion screws evident in the post-surgery CT scans, contributed to the worsening of Stuart’s condition.
- The Veterans Affairs Medical Care (VA): The VA’s role in the negligence appears to be related to the failure to adequately address the complications and progression of Stuart’s condition post-surgery. The VA provided ongoing care, but the deterioration of Stuart’s condition, leading to reliance on a wheelchair and the eventual diagnosis of flatback syndrome, suggests a lack of effective treatment or intervention following the initial surgery. The VA did contract with UT Southwestern to diagnose and treat the failed surgery, but they did not act, most likely because they were also involved in the initial surgery; however, the VA wouldn’t respond after I informed them that both Dr. Kesterson and UT Southwestern were evading post-surgical care.
In summary, Dr. Kesterson and the Center for Neurological Disorders are implicated for the surgical deviations and inadequate postoperative management, while the VA (and UT Southwestern) is indicated for failing to adequately treat and address the complications arising from the surgery.
What standards of care?
Standards of care in medicine refer to the degree of care and skill that the average, reasonably prudent healthcare professional in a given field would provide in similar circumstances. These standards are important for ensuring patient safety and effective treatment, and they serve as a benchmark for evaluating professional conduct in legal and regulatory contexts, such as in cases of alleged medical negligence or malpractice.
In the case of Michael Stuart, as reviewed by Dr. Joseph David, D.O., the standards of care that were potentially breached include:
- Adherence to Surgical Plan: Performing the surgery at the agreed-upon spinal levels (L2-L4, in this case) as consented to by the patient. Deviating from the surgical plan without patient consent or a valid medical reason could be seen as a breach of standard care.
- Postoperative Care and Follow-up: Properly addressing and managing post-surgical complications, such as lucencies in the fusion screws as indicated by CT scans. This includes timely identification, effective communication with the patient, and appropriate intervention to prevent further deterioration of the patient’s condition.
- Communication and Consent: Adequately informing the patient of all pertinent aspects of their medical care, including changes in surgical plans and the nature of postoperative care. Informed consent is a critical component of standard care.
- Management of Complications: Prompt and effective response to any complications arising from surgery. In Stuart’s case, this would involve addressing the factors leading to his progressive back pain, poor posture, limited mobility, and eventual reliance on a wheelchair.
- Documentation and Record Keeping: Accurate and timely documentation of all aspects of patient care, including surgical procedures, postoperative care, and any changes or deviations from planned treatments.
In the context of this case, it appears that these standards may not have been met, leading to allegations of negligence against the surgeon, Dr. Kesterson, and the Center for Neurological Disorders, as well as the Veterans Affairs Medical Care system including UT Southwestern.
The evaluation of whether these standards were met, and to what extent any breaches contributed to the patient’s condition, would typically be assessed in a medical malpractice claim or a professional disciplinary proceeding.