By Damian D. Capozzola, Esq., and Jamie Terrence, RN
News
The California Court of Appeal for the Second District upheld a trial court’s ruling in favor of a neurosurgeon accused of medical negligence in a case involving a delayed emergency surgery. The court concluded that the neurosurgeon’s decision to leave the hospital before another surgeon physically arrived did not constitute medical negligence and that the jury was properly instructed on the relevant legal standards.
The lawsuit arose after the plaintiff experienced partial paralysis and quadriplegia because of a rare postoperative complication following spinal surgery. The plaintiff alleged that the neurosurgeon’s departure from the hospital caused an undue delay in emergency surgery, which could have mitigated the extent of his injuries.
However, the jury found in favor of the hospital, and the appellate court affirmed that finding. In its ruling, the appellate court emphasized the rarity of the condition, the steps taken to ensure continuity of care, and the lack of evidence that an earlier surgery would have changed the outcome.
Background
In early 2015, the plaintiff, a retired musician and contractor in his 70s, sought treatment for weakness in his left arm. After magnetic resonance imaging (MRI) revealed cervical spine degeneration, a neurosurgeon recommended surgery to address cervical myelopathy. The surgery, performed in March 2015, was uneventful, and the plaintiff was discharged with instructions to wear a cervical collar.
However, within days, the plaintiff reported worsening pain and weakness in his arms. In April 2015, after taking a shower, the plaintiff suddenly became paralyzed from the chest down and was rushed to the emergency room. Initial tests, including computed tomography scans, did not immediately reveal the cause, but the physicians suspected a spinal epidural hematoma, a rare blood clot compressing the spinal cord.
The neurosurgeon, who coincidentally was at the hospital at the time, consulted on the case but informed the plaintiff’s wife that he would not perform the surgery because he was scheduled to leave for a flight. He assured her that another neurosurgeon from his practice, the on-call physician, would handle any necessary procedures.
The MRI required to confirm the diagnosis faced delays because of the need for an infusion pump, which was administering blood pressure medication to the patient, that could be placed in the MRI machine with the patient. The MRI also was delayed because the doctors first had to stabilize the patient’s condition before performing the MRI. By the time the MRI was completed, it revealed the hematoma, and the on-call neurosurgeon began emergency surgery. However, the surgeon had to wait for an operating room that was free. Ultimately, the procedure began six hours after the plaintiff arrived at the hospital.
The plaintiff sued the neurosurgeon, alleging that his decision to leave the hospital constituted medical negligence and delayed surgery, worsening his injuries. After a multi-day trial, the jury found in favor of the neurosurgeon, concluding that his actions complied with the standard of care.
On appeal, the plaintiff challenged the trial court’s refusal to instruct the jury on the doctrine of patient abandonment. The plaintiff argued that the neurosurgeon’s departure from the hospital before another surgeon physically arrived amounted to abandonment and that the jury should have been instructed accordingly. The plaintiff also argued that the trial court improperly instructed the jury on causation and reliance on the conduct of others, which the plaintiff claimed confused the jury and prejudiced the plaintiff’s case.
The California Court of Appeal rejected the plaintiff’s arguments and affirmed the jury’s verdict and the trial court’s instructions. Addressing the abandonment claim, the appellate court concluded that the evidence did not support an abandonment-of-patient jury instruction. The court emphasized that abandonment requires proof that a physician withdrew from care without providing sufficient notice or ensuring continuity of treatment. Here, the neurosurgeon had communicated the patient’s condition to the on-call surgeon, ensured the diagnostic steps were in place, and remained available for consultations after leaving the hospital. The court noted that these actions met the standard of care and precluded a finding of abandonment.
The court also addressed the jury instructions on causation and reliance on the conduct of others. The plaintiff argued that the trial court’s refusal to give certain instructions on causation improperly narrowed what the jury considered. However, the appellate court found that the instructions given sufficiently covered the legal issues and provided the jury with the necessary framework to evaluate the evidence.
The court also addressed the plaintiff’s argument that the jury instructions on causation and reliance on the conduct of others were improper and prejudicial. Specifically, the plaintiff argued that the trial court erred in declining to give instructions on causation that emphasized that the alleged negligence need only be a “substantial factor” in causing the plaintiff’s injury. The plaintiff also objected to the court’s decision to include an instruction that individuals have the right to rely on the reasonable conduct of others. However, the appellate court affirmed the trial court’s decisions.
Regarding the causation instructions, the court noted that the jury did not reach the issue of causation because it found no negligence in the first instance. Therefore, any alleged error in the causation instructions was moot. The court also found that the instruction on reliance on the conduct of others did not prejudice the plaintiff. This instruction, which allowed the jury to consider whether the neurosurgeon reasonably relied on other medical staff to act competently, did not undermine the plaintiff’s theory of the case.
The appellate court found that no evidence was presented at trial to suggest misconduct or negligence by other medical personnel, and the instruction was not inconsistent with the plaintiff’s argument that the neurosurgeon’s decision to leave the hospital caused the delay in treatment.
Ultimately, the appellate court affirmed the jury’s finding of no negligence on behalf of the physician. The plaintiff had failed to prove that the neurosurgeon’s actions fell below the standard of care or caused the plaintiff’s injuries.
What This Means for You
This case underscores the complexities of medical malpractice claims based on allegations of delayed care, particularly in situations involving rare and unforeseen complications. To succeed in such a claim, as in all medical negligence cases, plaintiffs must establish that the physician failed to meet the applicable standard of care and that this failure was the direct cause of the plaintiff’s injuries. This dual burden can be challenging, since courts require clear evidence not only of negligence, but also of causation — a link between the alleged error and the harm experienced by the patient.
In this case, the plaintiff argued that the neurosurgeon abandoned his duty of care by leaving the hospital before another surgeon physically arrived to take over. The plaintiff contended that this departure caused an unnecessary delay in surgery and worsened his injuries. Under the legal doctrine of abandonment, a physician who withdraws from a patient’s care must provide sufficient notice and ensure that another qualified provider is available to assume responsibility. Failing to do so can constitute negligence.
The plaintiff’s experts testified that the neurosurgeon should have stayed at the hospital until the MRI results were available and surgery could begin. They testified that the neurosurgeon’s presence was critical to expediting care, ensuring continuity, and preventing delays. The defense countered that the standard of care did not require the neurosurgeon to remain physically on-site under the circumstances. They pointed to the fact that the diagnosis of a spinal epidural hematoma — a condition described as “extraordinarily rare” — had not yet been confirmed when the neurosurgeon left the hospital. Moreover, they noted that the on-call surgeon was available and ready to perform the procedure once the necessary diagnostic imaging was completed.
The court ultimately sided with the defense and found that the neurosurgeon took reasonable steps to fulfill his professional obligations. He communicated the patient’s condition and the pending diagnostic process to the on-call surgeon, ensured that the next steps in care were clearly outlined, and remained available for consultations by phone. These actions satisfied the physician’s duty under the circumstances.
The court also found persuasive that the plaintiff’s condition was exceptional — a spinal epidural hematoma that developed 11 days after surgery. Expert testimony described this complication as “extremely rare” and difficult to anticipate. The intervening MRI conducted days earlier had shown no abnormalities, making the eventual diagnosis unexpected. Such rarity highlights the challenges physicians face in diagnosing and treating atypical medical conditions.
Additionally, the plaintiff’s condition upon arrival at the emergency room — complete paralysis — was a poor prognostic sign. Defense experts testified that, by the time the MRI confirmed the hematoma, the damage to the spinal cord likely was irreversible. They further testified that earlier surgical intervention, while beneficial in theory, would not have meaningfully altered the plaintiff’s outcome, given the extent of his paralysis and the acute nature of the condition. The plaintiff’s own experts acknowledged that they could not quantify how much earlier surgery might have improved his condition, which undermined the plaintiff’s causation argument.
One key takeaway of this case is the importance of clear protocols for handoffs between providers. Hospitals and physicians can reduce the risk of abandonment claims by documenting communications, outlining responsibilities, and ensuring continuity of care. For example, maintaining a written record of the steps taken to notify on-call physicians and prepare for potential surgical interventions can demonstrate that the standard of care was met. Another takeaway is the value of transparent communication with patients and their families. In situations where care transitions from one provider to another, physicians should clearly explain the process, including who will assume responsibility for the patient’s treatment and when. This clarity can help manage expectations when patients are facing critical medical prognoses.
Physician abandonment rarely is a vague concept. It requires a deliberate action by a physician to walk away from the provision of care without notification of a transfer of care to another provider. A physician can ask a patient who is unhappy about his or her care to contact another physician. Or a physician can ask a colleague to take over the care of a patient the physician no longer wants to treat. In both cases, continuity is preserved by communication between both physicians and the patient. There is no legal requirement that physicians remain in the immediate proximity of the patients they are treating at all times. Being available via phone or getting coverage from another physician is acceptable and reasonable. The issue of operating room availability probably is the most difficult area to manage. With multiple surgeons scheduling multiple procedures in a limited number of surgical suites, there always are issues, especially when emergencies arise. Operating room directors and surgeons need to quickly triage their caseloads and know before the start of shifts which cases can be delayed or postponed.
For plaintiffs, this case illustrates the significant evidentiary burden involved in proving medical malpractice. Allegations of delay must be supported by expert testimony that directly links the delay to the harm experienced. Here, the inability of the plaintiff’s experts to demonstrate how an earlier surgery would have improved the outcome weakened the case. Courts require plaintiffs to go beyond general claims of negligence. Rather, they must present specific evidence showing that the alleged breach of the standard of care was the proximate cause of the injury.
This ruling also highlights that not every adverse outcome constitutes medical negligence. Physicians are held to a standard of reasonable care, not perfection. Courts recognize that some complications, especially those that are rare or unforeseeable, are unavoidable — even with the best medical practices. This understanding is especially relevant in cases involving sudden and serious medical conditions, where decisions often must be made quickly and with incomplete information.
Reference
- Decided on Jan. 31, 2022, in the Court of Appeal, Second District, Division 8, California, Case No. B302404.
The California Court of Appeal for the Second District upheld a trial court’s ruling in favor of a neurosurgeon accused of medical negligence in a case involving a delayed emergency surgery.
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