Cervical Spine Injury-Occ. Health

Hi. I'm in Boston, MA with a serious problem. I had a c-spine fusion with instrumentation (plates/screws) in 1998 resulting from a work injury. Settled case. I returned to work fulltime for about a year and a half, when I re-injured my neck lifting a stretcher. I stayed off for five months recovering--but realized I needed more "rest time" between work days, so I went per diem. I worked for about 11 months and then was injured again while pulling a patient across to a scan table. I immediately went to Occupational Health. It was well documented when I was hired that I had prior neck surgery but was released to work and why my hours were so few. The Occ Health physician did a thorough exam (he actually did his fellowship in neurology, so I trusted him more than most other "in house" docs) and ordered a plain xray of my neck. He saw the results and proclaimed I was "fine", that the disks were "perfectly normal" and ordered two weeks of PT and some Naprosyn. I was in some serious pain, but it was not debilitating at that point. I actually tried to work a couple of days after that. After two sessions with PT, and these rubber band stretching exercises they give you for strengthening, the pain in my neck and back became so excrutiating, I could barely breathe. I felt like I was having a heart attack when I'd lie down. I slept sitting up. I told the Occ Health doc and he said that there was absolutely nothing wrong with me, that it was a muscle strain and it would "get worse before it got better". I asked for an MRI or a CT (since I work in MRI, i could EASILY have jumped in the scanner for a quick look), but he said absolutely not. I was warned by my supervisor when I got back that I wasn't to do it, or else. I decided to go independent and went to another surgeon. He immediately ordered a CT, MRI, and bone scan. The results are that I not only completely ruptured the disk below my fusion, but the bone scan is consistent with a fracture of the surrounding bone of one of the screws. The pain has never been like this, even before my first surgery. Before I went to PT, I actually had a few "ok" days and thought things might heal---but after those exercises and the manipulation of massage, I haven't had one second's worth of pain free time. My surgeon says that the only way to fix any of this is to re-surgerize me, and the odds of success are less than good the second time around. Not to mention all of the risks, such as paralysis or death. Now all we can do is try to control the pain. I'm zonked 24/7 and my husband's about to leave me because I am sick all the time. Now what. Do I have a case against Occ Health doc for not ordering the proper tests based on my history and complaint and/or PT for administering treatment without knowing how serious the injury was?

[vrzirn]

Before I comment on your post I am going to consult my own "in-house" doctors: son who is interventional radiologist and daughter whose area of expertise is sports rehab and spinal cord injuries. They are very busy so this may take a few days.

[vrzirn]

Any time there is a spinal disc fusion it changes the dynamics of the adjacent vertebrae and makes them more susceptible to injury. Your x-rays were read by both the radiologist and the OH doc, who had a fellowship in neurology. It was perfectfly reasonable to try a course of PT and anti-inflammatories.
The physical therapist follows the prescription written by the doctor. The nerves were no doubt inflamed by the injury and it is certainly possible that the PT irritated them even more. Whether the delay in ordering the MRI and CT scan aggravated your injury is unlikely but a subjective call. At what point does one say," The conservative approach is not working and we should look further or try something else". is also a subjective call.
It is certainly true that if you were to have jumped on the scanner you would have been in big trouble-especially since you were told not to. So, your choice had to be to keep badgering your doctor or seek advice from another one.
Another surgery is your only option and they are fairly common with your injury. Although paralysis is listed as a risk, it is really very small and more of a CYA .
Patients ask for things all the time but that does not mean that at that time it was the right or reasonable thing to do. If you were to ask for an angiogram and were refused and later suffered a heart attack, that is not mal-practice. At that time, your doctor deemed it reasonable to try another and more conservative therapy.
There have been many studies that show that patients on Workman's Comp fare more poorly and are less motivated to recover than those who are not on WC.
I am sure that you can find a doctor and an attorney to take the opposite view because so much of this is subjective. However, I think that you would have a difficult time recovering any compensation. Proving neglicgence and mal-practice is not easy.I do hope this post has answered some of your questions.
I was pleased that my own personal "experts" concurred with me. Good luck.