Trauma Center Misdiagnosis Of Back Fracture From Accident

[visarunvictim]

I need some advice on how to handle a specific situation with two hospitals that both misdiagnosed and failed to treat a fractured vertebrae caused by a severe vehicle accident caused by reckless driving.

Two months ago I was a passenger in a van accident caused by reckless and dangerous driving by the van driver. Several people were severely injured all with back, neck, or leg injuries. Most of us were transported to the closest government hospital which really wasn't equipped to handle a minor mass casualty situation. Once at the hospital I was left on a gurney for 5 hours while everyone else was treated without any pain killers or preliminary diagnosis or triage. Once they finally got to me, gave me an x-ray, and just bandaged two lacerations on my face, they left me on the gurney again. Eventually I was told I had a lumbar sprain and prescribed pain killers. I still wasn't given anything for the pain I was in which was quite severe. Eventually, I started going into shock from the pain and started to beg for something to help. After 30 min they finally gave me a shot that dulled the pain somewhat but not completely. I was then left to wait again.

Once the van owner arrived and paid the bill they took me and another back injury sufferer from the accident back to Phuket in another van and to a major international hospital in Phuket. Once there it was more waiting, another set of x-rays on only my back, and stitches on the face lacerations. This hospital also diagnosed me with only a lumbar sprain (from Orthopedics) and the lacerations, prescribed pain killers and antibiotics and sent me home with instructions to stay on my back for 3 days then things would slowly get back to normal. I was told that the pain would be gone within 3-4 weeks.

This was all completely wrong. In fact, I had the following injuries:

1. Broken 6th rib on left side

2. Cracked shoulder / collar bone or torn ligiments. I may never know but the pain is constant and unchanging. I can sometime barely use my left, prime, arm.

3. Fractured L3 vertebrae and 2 bulged disks in my back.

4. A rather deep puncture wound on the back of my left leg with moderate to severe hematoma

5. The two lacerations to my nose and face.

1, 2, and 4 were not diagnosed in the either emergency room and were not treated. 3 was misdiagnosed as a Lumbar Sprain. 1, 2, and 4 were never diagnosed or treated even when I went back to the hospital a week later, which was the soonest I could. The key concern is that both hospital emergency rooms, and the orthopedic surgeon I saw a week later for followup failed to diagnose the fractured vertebrae (broken back) and left me completely untreated for this severe, and potentially life threatening condition.

8 weeks after the accident, after 3 weeks of increasing pain, I went back to the second hospital with a complaint of increasingly severe back pain. Another set of x-rays was taken which clearly showed a compression fracture of the L3 vertebrae (which was visibly compressed). I had an MRI done then that clearly shows the broken vertebrae and bulged disks. Thankfully (and I could myself extremely lucky in this case) the broken vertebrae has not yet impacted or compressed my spinal cord. Had it, I would probably be either paralyzed or severely motion and pain impacted from the waist down, and would certainly be facing major surgery and a very long recovery. I got lucky, and I believe the bones will eventually heal. However, I should be nearly healed by now and would have been if I had been properly diagnosed in the beginning and treated accordingly.

I have the original and later x-rays and MRI scan, and to my eyes the L3 fracture is quite apparant on even the original x-ray. If I can see it, why didn't the doctors that initially treated me and why didn't they have me in an MRI then. If I had and had I been properly diagnosed I would have had a much harder initial recovery but would not be in constant pain now, or a 1/2 shorter...

As a result of this accident and subsequent misdiagnosis and late diagnosis I have lost several projects resulting in nearly 500,000 baht in lost revenue and lost the lease on my shop in Pattaya, and possibly all the contents, because the owner believed I had left the country (and she was wrong to do what she did but that's another issue).

As I am now, I am in constant back and right shoulder down my right arm pain and taking prescription pain killers. I have to wear a back brace and spend as much time lying down as possible. All this for the next 6 weeks or more. This means I cannot work that much (mostly on computer but some engineering and fabrication), and cannot travel which is killing my interests in Bangkok and Pattaya.

So, what do you think my options are? I've already filled a complaint with the hospital in Phuket and am looking for new legal advisers (my current lawyer has a conflict of interest). I have also initiated a lawsuit against the vehicle owner and insurance company. But what do I do about the hospital. Their misdiagnosis and failure to treat put my in a potentially life threatening condition and it is only luck that I am not even more severely injured.

Anyone know a good international malpractice lawyer with experience in Thailand? What about personal injury? What would you do?

[jrtmedic]

If you are seeking to commence an American style legal action seeking compensation for your injuries, medical maleficence and loss of earnings here in Thailand, I suspect to are at the beginning of a long and very expensive process with no guarantee or reasonable chance of a successful outcome.

Non of the injuries you describe were or are life threatening.

The vast majority of uncomplicated lumbar spinal compression fractures are treated conservatively with analgesia and a progressive program of physiotherapy. Pain from these injuries can indeed be severe but gradually abates with time.

A few orthopaedic surgeons advocate a more aggressive surgical approach to these injuries but as far as I am aware there is no convincing evidence of an aggressive approach producing a better outcome.

In rare cases so called "red flag" signs and symptoms are evident following a traumatic compression fracture of one of the lumber spinal bodies. These "red flags " are usually associated with loss of bowel/bladder function and other definitive neurological signs/symptoms and In such cases urgent surgery is usually indicated,

It is impossible for me to comment about your shoulder but if you are still suffering pain and disability from the shoulder some 8-9 weeks post trauma maybe you should seek an orthopaedic re-evaluation of the injury. I suspect, however, that the solution will, once again be associated with the provision of physiotherapy and a graduated increase in mobility.

If you are determined to pursue a medical malpractice claim in Thailand I wish you well !

Edited October 13, 2012 by jrtmedic

[visarunvictim]

If you are seeking to commence an American style legal action seeking compensation for your injuries, medical maleficence and loss of earnings here in Thailand, I suspect to are at the beginning of a long and very expensive process with no guarantee or reasonable chance of a successful outcome.

Non of the injuries you describe were or are life threatening.

The vast majority of uncomplicated lumbar spinal compression fractures are treated conservatively with analgesia and a progressive program of physiotherapy. Pain from these injuries can indeed be severe but gradually abates with time.

A few orthopaedic surgeons advocate a more aggressive surgical approach to these injuries but as far as I am aware there is no convincing evidence of an aggressive approach producing a better outcome.

In rare cases so called "red flag" signs and symptoms are evident following a traumatic compression fracture of one of the lumber spinal bodies. These "red flags " are usually associated with loss of bowel/bladder function and other definitive neurological signs/symptoms and In such cases urgent surgery is usually indicated,

It is impossible for me to comment about your shoulder but if you are still suffering pain and disability from the shoulder some 8-9 weeks post trauma maybe you should seek an orthopaedic re-evaluation of the injury. I suspect, however, that the solution will, once again be associated with the provision of physiotherapy and a graduated increase in mobility.

If you are determined to pursue a medical malpractice claim in Thailand I wish you well !

If you are seeking to commence an American style legal action seeking compensation for your injuries, medical maleficence and loss of earnings here in Thailand, I suspect to are at the beginning of a long and very expensive process with no guarantee or reasonable chance of a successful outcome.

Non of the injuries you describe were or are life threatening.

The vast majority of uncomplicated lumbar spinal compression fractures are treated conservatively with analgesia and a progressive program of physiotherapy. Pain from these injuries can indeed be severe but gradually abates with time.

A few orthopaedic surgeons advocate a more aggressive surgical approach to these injuries but as far as I am aware there is no convincing evidence of an aggressive approach producing a better outcome.

In rare cases so called "red flag" signs and symptoms are evident following a traumatic compression fracture of one of the lumber spinal bodies. These "red flags " are usually associated with loss of bowel/bladder function and other definitive neurological signs/symptoms and In such cases urgent surgery is usually indicated,

It is impossible for me to comment about your shoulder but if you are still suffering pain and disability from the shoulder some 8-9 weeks post trauma maybe you should seek an orthopaedic re-evaluation of the injury. I suspect, however, that the solution will, once again be associated with the provision of physiotherapy and a graduated increase in mobility.

If you are determined to pursue a medical malpractice claim in Thailand I wish you well !

The claim here is that since there were 3 people admitted from the same accident with very similar injuries with more or less the same symptoms, two of them were diagnosed with spinal fractures and had MRIs, and the x-ray taken at the time clearly shows a problem with the L3 vertebrae, why was it "assumed" that my injury was only a lumbar sprain? An MRI should have been done as a "just in case" test anyway. Any other major trauma center would have done so, including the others on Phuket (I am getting backup diagnosis from them as well). If an MRI had been done at the time of the accident the diagnosis would have been quite different. From the simple fact that the other two people I came in with had major back injuries it should have been assumed that I did as well until proven, conclusively, otherwise.

I can only think that the trauma center at this particular hospital was overwhelmed by 3 back injury patients at the same time and since I wasn't complaining of the pain (due to a rather high pain tolerance and the morphine I was given at the first hospital) it was assumed that my injuries were not as severe. It was a failure of triage, of diagnosis (possibly assumed from the results from the 1st hospital which did not do a complete or concise examination), and of not taking the time and effort to examine the evidence at hand. I bet the attending orthopedic surgeon only glanced at my x-rays before making his "assumed" diagnosis.

[Sheryl]

In a malpractice suit, be it here or anywhere else, the key issue is to show serious harm as a result. What could have happened doesn't count, even if there was indeed neglogence on the part of the physician. Only what did happen. As you have not suffered paralysis, loss of a limb, or death, you are not in a strong position in terms of winning much in damages, and indeed it might be hard to win more than you would have to pay the lawyers. And, of course, if you lose then you are out the legal fees altogether.

I think as regards the government hospital there is no hope. . With the private hosp[ital, possibly you could get them to settle to avoid the bad press of going to court, but no guarantees.

[visarunvictim]

Just a followup. Went to the hospital today for monthly checkup. X-rays show some healing on the vertebrae and no change in shape or size which I'm told means it's stable. This is good new. Now I need to get my shoulder looked at. I was finally able to convince them that something was very wrong and am now scheduled for an MRI on Friday. Bad news is that even though I have a police mediated agreement that all medical bills will be covered by the insurance company they are refusing to pay for the MRI. I have people working on this so hopefully it will be resolved by Friday.

[Deserted]

Mr OP, listen to me carefully. Scans, x-rays and so on only help identify a problem. Specific problems require care from top specialists. You can choose to try and have the problem fixed -at cost, in Thailand with very little chance of success, or go home. It is quality of life that you have to think about...health must come first.