This case takes place in Illinois and involves a young woman who injured her back while stacking boxes at her workplace. After experiencing an awkward twist in her back after picking up an unexpectedly heavy box, she felt a tingling feeling in her extremities. She reported to the emergency room, where she was given a cervical collar and an MRI was performed, at which point a bulged disk was detected. She was discharged the same day. She followed up the next day at an occupational health facility, where she was given medication and instructed not to twist, bend or climb, or to lift, carry, push, or pull weight over 10 lbs, with additional instructions to follow up later that week with the same physician. However, the patient returned to the facility earlier than expected, complaining of difficulty walking on incline, as well as a mild loss of sensation in her extremities. She was then brought to the hospital, where she was examined and discharged home, with instructions to follow up with a neurologist within the next few days. The doctor who saw the patient in the hospital reviewed his findings with the neurosurgeon shortly after the visit, at which point the neurologist advised that neurosurgical intervention was necessary. Due to scheduling issues caused by worker’s compensation, she was not able to undergo surgery until she sought a second opinion, where the doctor advised that her back injury needed to be managed immediately. The following day, the patient underwent a spinal fusion procedure, however she continues to suffer from a range of complications allegedly caused by the delay in care she experienced.
Question(s) For Expert Witness
- 1. Do you routinely treat patients like the one described above?
- 2. Do you have familiarity with the subject matter described above?
- 3. Have you ever had a patient develop the outcome noted above?
Expert Witness Response E-011918
I routinely treat injured workers, many of which have sustained injuries due to warehouse and inventory-related accidents. Often these injuries involve the cervical and lumbar spine and their surrounding structures. I frequently evaluate and identify such injuries and examine for the presence of medical urgencies involving the neural spaces within the spine. I have periodically identified such emergencies and, once identified, promptly refer to a spine surgeon. I am very familiar with the conditions described above and their clinical implications. I routinely lecture to medical audiences, most often nurse case managers. Many of my talks touch on the differential diagnosis, treatment and potential complications of lumbar disc disease on the injured worker. I have not, to the best of my knowledge, treated an injured worker who developed myelopathy post-injury, as is the case here. At times, such developments are identified after the worker has been urgently referred, and this information may not be relayed back to me. I am board certified in occupational medicine and have served as medical director of occupational medicine programs over 20 years, creating protocols, assessing physician performance, and reviewing care at our centers. In general terms, if I had been presented with an injured worker with known acute, MRI-documented compromise of her cervical spine as described, I would have immediately spoken with and requested referral to a spine surgeon. I would not have advised routine follow-up in my office nor would I have requested a routine referral, with its inherent delays. This has been my practice each time I’ve been presented with similar situations. It is my opinion that, once the occupational physician became aware of the MRI findings, in conjunction with a markedly symptomatic examination, an urgent referral was warranted.