Hospital must pay $23M jury verdict after radiologist misses spinal cord injury on CT

A Maine hospital must pay what plaintiff attorneys believe is a record figure for the state after a radiologist missed signs of a spinal cord injury on CT images. 

Jurors reached the decision on June 18, ruling in favor of Robert-Michael M. Giordano and his wife and against Northern Light Health. The Madawaska, Maine, man, who was 40 at the time, had visited the emergency room at Northern Light A.R. Gould Hospital on Dec. 14, 2020, after falling, striking his back and developing “10/10” pain in the left thoracic area overlying the ribs. 

Jeffrey D. Georgia, MD, reviewed the CT scan ordered by an ER provider and reported no abnormalities, according to the complaint. However, the radiologist purportedly had overlooked a calcification protruding into the spinal canal, failing to recommend an MRI to evaluate for spinal cord compression. 

These alleged failures led to Giordano’s permanent paralysis. Jurors deliberated for three hours before recommending a $23.1 million payout, which attorneys believe is the largest non-death medical practice award in Maine’s history. The eight-figure sum will cover “extraordinary” past and future medical expenses, pain and suffering, emotional distress, permanent impairment, and loss of both enjoyment of life and consortium. 

"The jury's verdict provided validation for our client that this tragic situation never should have happened," Attorney Travis M. Brennan, with Lewiston, Maine-based Berman & Simmons, said in a statement Monday. “Northern Light first missed a dangerous finding on Robert's imaging study and failed to follow its own internal policies on reporting this critical finding.”

The health system, which operates 10 hospitals across Maine, shared a statement with local media after the two-week trial’s conclusion. 

“We are deeply sympathetic to Mr. Giordano and his wife and recognize the profound impact that his condition is having on their lives,” Northern Light Health spokeswoman Suzanne Spruce told the Bangor Daily News. “However, we disagree with jury’s verdict in this case and in particular the magnitude of this award.”

The radiologist reportedly relayed his findings verbally to the ordering physician, Edwin Layng, MD, never mentioning the bony calcifications nor the possibility of a spinal cord compression. Layng sent the patient home from the Presque Isle, Maine, ER with instructions to take pain medications, try topical treatments such as ice or a heating pad, and follow-up with his primary care provider. 

On Jan. 29, 2021, Giordano had a telehealth appointment with his PCP, nurse practitioner Brandon W. Howlett. At the time, he reported the sudden onset of progressive symptoms including an inability to stand, worsening pain, and falling every time he stood up. Howlett reviewed medical records from two previous follow-up visits in January, and likely understood that the patient had remained neurologically intact up until this last appointment, with these representing new symptoms, attorneys charged. 

They claim that the nurse practitioner believed Giordano was “exaggerating or making up the extent of his pain and his falls,” according to the complaint. Howlett documented concerns that the patient was “malingering” to get opioids, despite no documented history of substance use disorder. The PCP diagnosed Giordano with chronic pain, prescribed an increased dosage of an anticonvulsant, and did not denote the need for an urgent evaluation. 

Also on Jan. 29, Giordano had another appointment with a nurse practitioner, Amanda Tracy, with Northern Light Orthopedics. At the time, the patient reported bilateral lower extremity numbness with no specific distribution, lower extremity muscle spasms, pain and weakness in his legs, and back pain. Tracy reportedly diagnosed the man with leg weakness and lumbar radicular pain, ordering X-rays and labs for the following week. 

The next day, on Jan. 30, Giordano called 911 after his legs became completely paralyzed and he was unable to urinate. He was transported by ambulance to Cary Medical Center in Caribou, Maine, for further evaluation. There, an emergency physician confirmed Giordano had no sensation below the bottom of his spine (T12). After consulting with a neurosurgeon, physicians recommended an urgent MRI. 

He was transported by air to the Northern Light Eastern Maine Medical Center, Bangor, where an emergency MRI indicated a disc herniation at the mid-spine (T6-7). This was causing severe spinal stenosis and impingement on the spinal cord, according to the lawsuit. Neurosurgeon Michael Cohen, MD, concluded that this had been a chronic injury progressively caused by spinal cord compression. 

On Jan. 31, Cohen performed a thoracic laminectomy and decompression surgery to alleviate the pressure on the spinal cord. A second surgery the following day sought to provide additional decompression. However, despite these efforts, Giordano remains paralyzed from the chest down. He has a neurogenic bowel and bladder and has required additional surgeries to address complications relating to his loss of bathroom functions.

"As the patient developed progressive neurologic deficits over the next six weeks, people were unaware that he had this ticking time bomb in his spine. It then detonated on Jan. 30, with him becoming fully and permanently paralyzed," Attorney Brennan said.

“This verdict will allow Robert to secure the vital medical equipment, supplies, and services that he requires to deal with the devastating and permanent injuries he suffered,” he added, noting that this also represents the largest malpractice verdict “of any kind” north of Portland, Maine.