Jury reaches ‘record’ $60M verdict in case over botched interventional procedure

A jury recently reached a unanimous $60 million verdict over an allegedly botched interventional procedure. Plaintiff attorneys believe the figure is a record for Nassau County, New York.

The case dates to Nov. 18, 2019, when then-64-year-old David Gangaram visited the Pain Institute of Long Island seeking relief for back discomfort. Robert Iadevaio, MD, undertook the “routine,” image-guided lumbar epidural steroid injection, attorneys note. 

However, after awakening from sedation, Gangaram suffered a “massive” spinal cord infarction. This left the Valley Stream, New York, resident permanently paralyzed below the waist, unable to control bodily functions, and suffering from chronic pain. The plaintiffs presented testimony from experts in interventional neuroradiology and other specialties, who charged—based on imaging and “known mechanisms of spinal infarct”—the provider mishandled the injection. 

"This was a routine outpatient procedure that should never have led to catastrophic injury," attorney Marijo C. Adimey, with New York City-based Gair, Gair, Conason, said in a statement May 5. “The jury's verdict recognizes the irreparable harm caused to the victim and his family and holds the physician accountable for the negligent conduct.”

Plaintiff attorneys contend that Iadevaio used “improper, inappropriate and poor image quality” fluoroscopy during the procedure. He also purportedly failed to obtain lateral and oblique imaging to properly ascertain the needle position prior to performing the procedure, according to court documents. Adimey and colleagues also contend the physician failed to use the safer “interlaminar approach” to administering the injection, and they charge that Iadevaio used the drug Kenalog, rather than the correct Dexamethasone. The former can come with rare but serious complications including loss of vision, stroke, paralysis and death, according to FDA warnings. 

Attorneys presented evidence during trial that the findings of a spinal angiogram conducted after the injury were inconsistent with the medication listed in the physician's notes. Instead, Adimey and colleagues contend that a different medication—Kenalog, which is not recommended in this instance—was used. In previous cases, the drug has been shown to cause spinal infarcts, if inadvertently injected into an artery leading to the spinal cord. This, they argued, would represent a “grievous medical error during the procedure.” 

Iadevaio and his legal representatives have disputed the allegations. According to court documents, the defense team charged that using the “transforaminal approach” to injection was “well within the standard of care.” They also noted that the alternative interlaminar approach “does not reduce the risk of a spinal cord infarct during an epidural steroid injection.” Further, they contend Iadevaio used proper imaging during the procedure, with deployment of an extension tube (as plaintiffs contend should have happened) “not mandated by the standard of care.” 

Bruce Brady—an attorney with New York-based Dorf Nelson & Zauderer, which represented the physician—did not immediately respond to a request for comment Tuesday. Iadevaio, who now works for Catholic Health, could not be reached for comment. A spokesman for the Rockville Centre, New York-based hospital system emphasized the 2019 procedure did not take place at a Catholic Health facility, nor was the anesthesiologist employed by the organization at the time. 

The trial lasted around three weeks, with the jury deliberating less than three hours before arriving at the eight-figure verdict. Gair, Gair, Conason said the damages will cover medical expenses, lost income, pain and suffering, and spousal loss of services. Gangaram, a former electrical mechanic at a local airport, was previously the primary provider for his wife, Bibi, and two sons.