Spinal Tap Pediatric Malpractice Lawsuit

This pediatric medical malpractice claim was filed in Baltimore City against Johns Hopkins after a pediatric neurologist damaged a patient's spinal cord during a diagnostic lumbar puncture procedure. It was filed in Health Claims Arbitration on March 27, 2018, and it is the 145^th medical malpractice case filed in Maryland this year.

A thirteen-year-old boy presented to Johns Hopkins Hospital with a recent medical history of occasional right-sided jerking movements in his face, arm, hand, and leg. Two days later, a pediatric neurologist at the hospital performed a diagnostic lumbar puncture procedure, also known as a spinal tap. The boy was given general anesthesia for the procedure.

Using a twenty-gauge needle, the neurologist made eight attempts to access the boy's spinal canal. Eventually, she obtained sixteen milliliters of blood-tinged spinal fluid, which was sent to the laboratory for analysis. Shortly thereafter, the boy began to complain of lower back pain.

The boy was discharged from the hospital with a diagnosis of Sydenham's chorea. After four days at home, the boy returned to the hospital with complaints of headaches and vomiting. He was re-admitted to the pediatric neurology service for an epidural blood patch - a procedure used to close holes in the membrane surrounding the spinal cord. In the progress notes for the blood patch procedure, the physicians indicate that there were multiple puncture sites from the spinal tap attempts.

After he underwent two additional blood patches in the following months, the boy was diagnosed with complex regional pain syndrome resulting from the traumatic lumbar puncture.

• During a lumbar puncture, or spinal tap, a doctor inserts a needle between two vertebrae to withdraw a cerebrospinal fluid sample. This procedure is used to diagnose certain conditions, measure cerebrospinal fluid pressure, or inject medications.
• Sydenham's chorea (SD) is a pediatric neurological disorder resulting from a bacterial infection. Specifically, SD occurs as a result of immune response cross-reactivity after a streptococcus bacteria infection. (Like SD, rheumatic heart disease is also caused by the immune system's response to streptococcus bacteria.)
• The symptoms of SD, such as involuntary twitching movements, are caused by the body's auto-immune reaction to the bacteria, which impacts the part of the brain that regulates motor function. Most children will make full recoveries from SD after three to six weeks.
• Complex regional pain syndrome is a type of chronic pain that usually develops after an injury, surgery, stroke or heart attack. It most often affects an arm or leg, causing a burning or throbbing pain, sensitivity, swelling, decreased mobility, and/or muscle spasms.

• Baltimore City

• The Johns Hopkins Hospital
• Two pediatric neurologists

• Johns Hopkins Hospital

• Failing to appropriately perform the diagnostic lumbar puncture procedure.
• Failing to protect the claimant from unnecessary injury and harm.
• Failing to obtain timely consultations from specialists.
• Failing to conduct thorough assessments, examinations, evaluations, and diagnostic testing.
• Failing to recognize the claimant's serious medical condition and order the appropriate interventions in a timely manner.
• Failing to take the necessary steps to ensure that the diagnostic lumbar puncture procedure was performed in a secure environment.
• Failing to consider the risk of permanent neurological damage associated with multiple needle insertion attempts at multiple levels of the spine.

• As a direct result of the defendant's medical negligence, the claimant suffered permanent and painful neurological injuries.
• Lack of informed consent.

• Stephen J. Thompson, M.D., pediatrics and neurology

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