This case takes place in Iowa and involves an older male patient. The patient had a morphine pump placed due to chronic back pain; however the morphine pump failed to alleviate the patient’s pain, so the defending neurosurgeon removed it. Following the procedure to remove the device, the patient suffered pain and numbness that radiated to his leg. After many years of physical therapy, MRI scans and X-rays, it was revealed that there was a foreign object in the patient’s lower back that was the most likely source of his symptoms. The patient underwent surgery, performed by a different neurosurgeon, who found that the foreign object was a large piece of catheter left from the morphine pump that had been removed. Following the surgery to remove the foreign object, all the patient’s symptoms were resolved.
Question(s) For Expert Witness
- 1. Do you place and remove morphine pumps? If so, how often?
- 2. What is the standard follow up for patients who have had morphine pumps removed?
- 3. Is it possible that the catheter caused the patient's symptoms?
Expert Witness Response E-000572
I perform pump operations approximately 30 times a year. I have read the synopsis of the case, and, from a causation perspective, the piece of catheter most likely was responsible for the pain. However, it is not a standard of care violation to leave a portion of the catheter behind in the spine. It may have been a violation to not realize what was going on after the pump was removed. A work up in a timelier manner could have offered the patient access to the surgery to remove the catheter earlier and would have provided him pain relief sooner. Therefore, the failure to work it up in a timely manner caused him to have a delay in obtaining relief.