Patient Safety and Interventional Spine Procedures

Patient safety is the paramount consideration in any medical treatment.  The universal standard of care is that no physician or other caregiver should ever put a patient at unnecessary risk of harm.  The corollary to this rule is that if a treatment carries certain necessary risks, the caregiver has a duty to disclose those to patients.  That is how the legal side of medicine works in a nutshell.  A recently published set of guidelines puts these rules in action when it comes to interventional spine procedures, such as nerve blocks and epidural anesthesia (the “epidural”), in patients who are on anticoagulant and antiplatelet therapy.

The guidelines were published in the journal called Regional Anesthesia and Pain Medicine in March 2015 in an article entitled “About Bloody Time!: Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications.”  The title reflects that fact that patients on anticoagulant and antiplatelet medicines, such Coumadin, Heparin, Pradaxa (dabigatran), Plavix or aspirin, are at increased risk of bleeding.  Interventional procedures necessarily involve bleeding.  Bleeding can lead to a spinal epidural hematoma, which in turn can cause paralysis and paraplegia if not timely diagnosed and evacuated.

In Ohio, an experienced medical malpractice attorney would investigate whether a doctor performing such an interventional procedure failed to adequately protect patient safety by asking the following questions:

1. Was the procedure necessary?
2. Were all material risks of the procedure and alternatives explained to the patient?
3. Was the caregiver qualified to perform the procedure?
4. Were the guidelines pertaining to management of anticoagulant and antiplatelet therapy followed before, during and after the procedure?
5. In the event that an unavoidable complication occurred, such as an epidural hematoma, were neurologic deficits timely diagnosed and addressed?

These guidelines carry tremendous weight since they reflect a consensus among a variety of medical specialties who perform interventional procedures on the spine, including anesthesiologists and pain management experts.  Nonetheless, as with too many areas of medicine, I would anticipate that the implementation of the guidelines will be unnecessarily delayed by doctors who do not keep current on changing practice standards.