Medical Expert Witness

Doctor’s Doubts Lead to Missed Diagnosis And Lawsuit

A 30-year-old obese woman visited the emergency department with vaginal bleeding as well as numbness in her legs that was causing her to fall. The patient underwent a lumbar MRI and was admitted. …, WHO Wins Dismissal of Lawsuit in New York Over Pandemic Response, Gordon T. Ownby, 2021


The next day, Dr FP, a family practitioner, evaluated the woman and ordered gynecologic and neurologic consultations. The MRI showed mild degenerative disc disease, but no evidence of significant stenosis. The gynecologist prescribed metronidazole (Flagyl) for vaginitis.


Dr N, the neurologist, charted numbness and tingling in the patient’s hands and feet for the past 5 days. Dr N noted a “stocking and glove” distribution and a decreased deep tendon reflex. Dr N’s initial impression was peripheral neuropathy, and he prescribed lorazepam and gabapentin (Neurontin). He also ordered an ESR (erythrocyte sedimentation rate) and antibody and thyroid tests. When Dr N saw the patient the next day, he noted persistent numbness and tingling in her hands, feet, and chest, extending to the legs. At that time, Dr N’s impression was lumbar spondylosis, and his plan was to continue the gabapentin.


Ten days later, the woman went to the county emergency department with numbness and tingling. A lumbar puncture revealed a protein level of 531 mg/dL (normal, 15-40 mg/dL). After an MRI, the patient was diagnosed with Guillain-Barré syndrome and underwent intravenous treatment and rehabilitation.


The woman later sued Dr N for failing to order proper tests for Guillain-Barré syndrome. The parties resolved the dispute informally.


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