McClain v. United States

490 F. Supp. 485, 1980 U.S. Dist. LEXIS 11753
CourtDistrict Court, E.D. Wisconsin
DecidedJune 10, 1980
DocketNo. 76-C-718
StatusPublished
Cited by1 cases

This text of 490 F. Supp. 485 (McClain v. United States) is published on Counsel Stack Legal Research, covering District Court, E.D. Wisconsin primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
McClain v. United States, 490 F. Supp. 485, 1980 U.S. Dist. LEXIS 11753 (E.D. Wis. 1980).

Opinion

DECISION and ORDER

MYRON L. GORDON, District Judge.

This is an action for damages brought under the Federal Tort Claims Act, 28 U.S.C. §§ 1346(b) and 2671-2680. A three day bench trial limited to the issue of liability was held in April 1980, and both sides have submitted post-trial briefs. This memorandum constitutes the court’s findings of fact and conclusions of law pursuant to Rule 52(a), Federal Rules of Civil Procedure.

Many of the facts have been stipulated. Complaining of pain in his right hip, the plaintiff entered the Veterans Administration hospital at Wood, Wisconsin, as an outpatient on May 25, 1973; X-rays were taken of Mr. McClain’s pelvis, hips and lumbar (lower) spine. He was then admitted as an inpatient on June 1, 1973, at which time he was tentatively diagnosed as suffering from ankylosing spondylitis and diabetes.

In an effort to diagnose the causes of Mr. McClain’s pain, a lumbar myelogram was attempted at the Veterans Administration hospital by Dr. Van Dyke on June 15, 1973. This procedure was aborted, however, because ossification and calcification caused by the ankylosing spondylitis prevented the passage of the needle into the area of Mr. McClain’s lumbar spine.

Due to the failure of the lumbar myelogram, a different diagnostic procedure, a cisternal puncture, cervical air myelogram was performed on June 21, 1973, by Dr. Kim, a staff neuroradiologist. Sometime during this procedure, Mr. McClain sustained a brain stem injury and was thereafter found by the Veterans Administration to be one hundred percent totally and permanently disabled.

The plaintiff contends that the cisternal puncture procedure was performed negligently, causing his brain stem injury; he also charges that the procedure was performed without his informed consent. The government asserts that the work was performed with due care and that Mr. McClain’s consent had been obtained. The defendant also maintains that the plaintiff’s brain stem injury was caused by a spontaneous stroke, not causally related to the cisternal puncture procedure.

It is undisputed that Mr. McClain sustained a brain stem injury on June 21,1973; the expert witnesses for both sides testified that a lesion in the pons or mid-brain had occurred. Although this procedure involves risk, it is clear that if the procedure had been carefully performed, it should not have caused Mr. McClain’s brain stem injury. Therefore, the basic issue in this case is whether Mr. McClain has proved by a pre[486]*486ponderance of the evidence that it was a negligently performed cisternal puncture procedure which caused his brain stem injury. Since I find that Mr. McClain has met that burden, I need not decide whether he gave his informed consent to the performance of the procedure.

The cisternal puncture, cervical air myelogram is performed in two stages. In stage one, a needle, between three and a half to four and a half inches in length, is inserted from the back of the neck into the cisterna magna subarachnoid space. After the needle is inserted in the cisterna magna, cerebral spinal fluid is withdrawn and air or oxygen is injected incrementally. In stage two, after the needle is withdrawn and the air is caused to move through the spinal canal to the patient’s lumbar spine by elevating the lower half of the body and lowering the upper half, X-rays are then taken of the lumbar spine. The air serves as a “contrast medium,” enabling the radiologist to detect the presence and location of any tumors or other disorders. The diagnostic tools of the procedure include the lumbar X-rays and laboratory analysis of the cerebral spinal fluid.

One of the known risks associated with the cisternal puncture procedure is that the needle may pass through the cisterna magna and penetrate the brain stem, which lies just a few millimeters beyond the cisterna magna. This can occur if the patient moves suddenly while the needle is in place in the cisterna magna, if the needle initially is inserted too far, or if the doctor performing the procedure moves the needle after it is correctly placed in the cisterna magna. If the needle passes through the cisterna magna and becomes lodged in the brain stem, it will not be possible to withdraw cerebral spinal fluid, and certain critical respiratory and cardiac functions controlled by the brain stem may be interrupted.

In the instant case, relevant portions of the hospital record, consisting of doctors’ progress notes and hospital narrative summaries, indicate that the needle was correctly placed in the cisterna magna but that, sometime during the procedure, a lesion occurred in Mr. McClain’s brain stem. Dr. Kim’s progress note states that the first half of the procedure was uncomplicated; cervical spinal fluid was withdrawn and oxygen was insufflated. Based on information obtained from Dr. Kim, Drs. Steinlieb and Van Dyke noted that Mr. McClain had described a bubbling sensation near his ear, which, according to Dr. Kim, meant that the oxygen had been properly injected into the cisterna magna. The hospital records do not include a laboratory analysis of the cerebral spinal fluid which Dr. Kim reported withdrawing, although this analysis was one of the objectives of the procedure. In fact, there is no record that the fluid was kept after the procedure.

The notes and summaries then indicate that, between fifteen minutes and an hour after the needle was removed, Mr. McClain developed a severe headache, nausea and vomitting, high blood pressure, and lowered pulse and respiratory rates. Immediately after demerol was administered for the plaintiff’s headache, Mr. McClain became rigid and unresponsive, or “decerebrate,” and remained in this state over the next twenty-four to forty-eight hours.

Both of the plaintiff’s medical experts testified that these symptoms demonstrated that Mr. McClain sustained a brain stem injury sometime during the procedure. Both testified that the respiratory and cardiac symptomatology indicated an injury to the medulla obligata, the lower portion of the brain stem, and that the decerebrate rigidity showed an injury to the pons, the middle portion of the brain stem, located just above the medulla.

One of the plaintiff’s experts, Dr. Leestma, a board-certified neuropathologist, testified that he was certain that the needle penetrated the medulla and possibly also the pons. He testified that a lesion of the pons could occur even if the needle penetrated the medulla but not the pons, because the medullary injury could be “transferred” upward into the pons by bleeding, edema, progressive necrosis or destruction of tissue.

[487]*487The plaintiff’s other expert, Dr. Gruesen, is a neurosurgeon who is board eligible but not board certified. He was Mr. McClain’s treating physician for a year after Mr. McClain was released from the hospital. He testified that he was certain that it was the cisternal puncture procedure which caused hemorrhaging in Mr. McClain’s brain stem, specifically, in the upper medulla and pons. He declined, however, to state categorically that the needle penetrated either the medulla or the pons. He stated that the specific mechanism of injury could only be revealed by an autopsy.

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Bluebook (online)
490 F. Supp. 485, 1980 U.S. Dist. LEXIS 11753, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mcclain-v-united-states-wied-1980.