The theory that has made its way in the Court of First Instance number 70 in Madrid to explain how a cement mass five centimeters long and one wide could reach the doors of the patient's heart is the one offered in the trial the expert of the affected. And it is not easy.
The plaintiff, a 77-year-old woman, underwent a kyphoplasty, which is a cement injection, to treat her spinal fracture after a fall. Two months passed between the intervention and the accident. The injury was diagnosed through an MRI that was taken a few days after falling and was the only imaging test that guided the surgeon in the intervention.
The theory that the expert defends is that when they addressed the back injury, it had already "fused", thus preventing the location of the cement in the vertebra. Then, the injected liquid would have circulated through the body until it solidified in a piece of cement 3 centimeters long and 1 centimeter thick in the right descending lobar artery, at the doors of the heart .
The court has condemned the Zurich company, insurer of the surgeon who carried out the first intervention, to compensate the patient with 73,810 euros for not performing an imaging test of the area to operate shortly before intervening and guided by the resonance that it was taken two months ago. The patient has been defended by the lawyer Ignacio Martínez, collaborator of the Association El Defensor del Paciente. The sentence is final and the convicted party has already deposited the compensation.
The expert's report is forceful in its arguments and insists on " the need to have performed a new resonance prior to the intervention to verify whether the patient's acute fracture was sustained due to the accidental fall caused by crushing of the L5 spinal disc "
In chronological order
The facts that are judged began in July 2015, when the claimant, a 77-year-old woman and resident in Murcia, fell and fractured a vertebra. The magnetic resonance imaging performed in the hospital a few days after the accident confirmed the fracture of a vertebra.
The doctor who treated her indicated a kyphoplasty, which is an injection of cement into the affected area. The surgery was carried out in Murcia on October 1, 2015, as reported in its statement by the Association The Patient Advocate. After being discharged, the patient began to suffer from dyspnea and tiredness , which was not related to surgery until, during a check-up, she underwent an X-ray and chest CT in May 2016.
On May 27, 2016, they confirmed that he had a piece of cement 3 cm long and 1 cm thick in the right descending lobar artery . The situation was "extremely serious" and the patient underwent an "extremely complicated" open surgery to remove the piece of cement, which consisted of a right lateral thoracotomy with muscle preservation through the fourth intercostal space.
This second surgery was carried out on June 23, 2016, at the Quirón de Pozuelo University Hospital (Madrid) at the hands of who, most likely, is one of the few surgeons who could perform it in Spain, Dr. Andrés Varela de Ugarte, head of the Thoracic Surgery Service of the private center. And it is that, according to a source close to the patient, "it was difficult to find a surgeon who dared to extract the cement . " The applicant was informed of the high risk of mortality that this intervention entailed. Finally, everything went well.
To save yourself a test
From the point of view of medical performance in kyphoplasty, the judicial reproach focuses on the fact that an imaging test was not performed shortly before the intervention. "It was necessary to check whether the fracture was consolidated and for this it was necessary and necessary to carry out another MRI before the intervention. If the new MRI had confirmed that the fracture was totally or partially consolidated, the performance of the surgery would have been contraindicated of kyphoplasty by assuming subjecting the patient to excessive risk, "says the ruling.
And it continues, "therefore, the surgical intervention was performed without knowing whether the fracture persisted in the acute phase or in the sub-acute phase. In the second case (sub-acute phase), the technique to be performed should have been changed and should not be having undergone kyphoplasty surgery. "
In short, "they subjected the patient to an excessive risk, without a previous diagnosis of what was happening in the vertebra ... as well as disproportionate resulting damage, as a consequence of the pressure made to inject the cement and for the amount of cement that was injected. "
Delving further into the initial question, which would explain how the piece of cement got where it did, the expert details what, in his opinion, is the "most current and reasonable" answer of what could have happened. This is: " A leak must have occurred at the time of injecting the cement into the vertebra, and this leak was not noticed in the radio-control."
In this way, "the cement particles, not sufficiently solidified, impacted the pulmonary artery and in successive leaks or continuously at the time of injection and subsequently coated with cholesterol, a fact that is consistent with the findings surgical procedures of fibrosis on the pulmonary artery and that no substrates were seen in the cement block, since the cement migrated in a semi-liquid or semi-solid state until the lumen of the vessel and the substitute arteries occluded, causing the symptoms that develop in the patient from March 2016 ".
The total compensation granted by the judge is 73,810 euros, a figure with which it is intended to compensate for the preventive days, hospitalization, operating room and medical expenses of the first and second operations. In addition, of the high risk assumed by the patient when having to undergo the extraction of the piece of cement.
According to the criteria of The Trust Project
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