Permanent lower body paraplegia

Patient suffered permanent lower body paraplegia after an endoscopic procedure (ERCP) to remove a bile duct stent that had been implanted due to a blockage.

The defendant endoscopist intended to use an instrument called SpyGlass to perform the removal, because it is better than traditional instruments at visualizing the biliary system. However when he began the procedure he discovered that the stent had moved again and was easily removed without the SpyGlass. However, he proceeded to use the SpyGlass anyway to explore the biliary system. A few minutes into the procedure anesthesia records showed that patient’s ET CO2 (end tidal carbon dioxide) had dropped, a sign of insufficient oxygenation. Neither the nurse anesthetist monitoring the patient nor the endoscopist considered stopping the procedure, which was below the standard of care. Patient discovered he could not move his legs in the recovery room. He was transferred to a Boston hospital but despite aggressive efforts (use of a hyperbaric chamber and a spinal tap) he did not regain the use of his legs.

It was determined that there had been a perforation during the procedure, and an air embolism had been introduced into his arterial system, causing a spinal infarct and leaving him a paraplegic.

Review by an expert interventional endoscopist determined that there was no medical indication for continuation of the ERCP with SpyGlass, as the likelihood of cancer (which the endoscopist claimed was the reason for continuing) had been ruled out by the diagnosis of autoimmune pancreatitis by the endoscopist’s partner. A settlement was obtained which compensated the plaintiff for his past and future medical bills and loss of enjoyment of life.