discipline summaries the invasive procedures provided has led to significant complications and morbidity .” iii ) Patient C was treated by Dr . James seven times between April and August 2012 for management of lower back pain . Dr . James administered epidural steroid injections to Patient C .
In or around July 2012 , Patient C started to experience increasing pain and decreasing stability on her feet . She reported these concerns to Dr . James , and on two occasions sought treatment at emergency . Patient C continued to see Dr . James throughout that summer . After the epidural injections failed to alleviate Patient C ’ s pain , Dr . James administered bilateral diagnostic lumbar facet blocks in July 2012 . In August 2012 , he performed a left rhizotomy on Patient C . At this appointment he provided Patient C with a note to take to her family doctor recommending a neurosurgery consult and recommending that her family physician request an MRI . He engaged in no further follow up with Patient C .
Patient C was diagnosed with a serious spinal infection . A sensitive strain of Staph aureus was recovered from the surgical specimen and the infection was believed to be the direct result of steroid injections .
Dr . O opined , among other things that , Dr . James failed to appreciate the patient ’ s progressive symptoms , failed to realize that the symptoms could be signs of an infection in a high risk patient . He also failed to adequately document the patients progressive symptoms , failed to correctly diagnosis / work up possible complications of treatments he provided , failed to adequately inquire about the patients ER visits and failed to organize appropriate timely work up of the patient ’ s symptoms .
iv ) Patient D was seen by Dr . James for injections on a regular basis for treatment of chronic back pain commencing in 2010 . In October 2011 , Dr . James administered a lumbar epidural injection . Less than two weeks after receiving the epidural injection , Patient D began to experience symptoms of fever , increasing confusion , neck pain , nausea , vomiting and occipital headaches . She was admitted to hospital . The suspected etiology was an infection secondary to epidural injections received from Dr . James .
Patient D was readmitted to the hospital in November 2011 for a twelve-day period . Her headache , nausea and vomiting continued . An MRI demonstrated an epidural fluid collection with a diagnosis of a likely enlarging epidural abscess . Patient D required extensive surgical laminectomies . v ) Patient E was treated by Dr . James for pain in her right elbow . In January 2012 , Dr . James injected her elbow with cortisone and performed a caudal epidural injection the same day . Soon after the injection , Patient E ’ s right arm became painful and red . She began calling the clinic to get an appointment with Dr . James so that he could look at her arm . Subsequently , Patient E attended at the clinic , and asked that someone look at her red and swollen elbow . After she waited for about an hour and a half , Dr . James saw her , told her it was likely nothing and gave her a prescription for antibiotics and told her to follow up in two weeks . Patient E ’ s arm remained very painful , swollen and red . In March 2012 , Dr . James immediately sent her to the Emergency Department . Patient E was found to have a post-injection abscess and a heavy growth of Staph aureus and was referred for both orthopedic and plastic surgery consults .
Dr . O opined that it is below standard of care to not offer urgent follow up for a potential infection after a procedure , even if there is no fever .
vi ) In May 2012 , Patient F received a lumbar epidural injection for lower back pain from Dr . James . Less than two weeks later , Patient F developed a high fever , delirium and increasing back pain while out of the country . Patient F was admitted to hospital in the United States , critically ill . He was found to have an epidural abscess and sepsis ( Staph aureus bacteremia ), requiring ICU admission , intubation and neurosurgical evacuation together with hemi lami-
Full decisions are available online at www . cpso . on . ca . Select Doctor Search and enter the doctor ’ s name .
Issue 1 , 2017 Dialogue 49