A crippling spinal cord injury and a surgeon's conflicting claims regarding his whereabouts when the injury likely occurred were at the center of a malpractice suit underlining the critical importance of proper patient positioning.

In the case of Smith v. Hrynkiw, a confidential settlement was reached in which the facility, not the surgeon, was found responsible for the patient's injuries, according to Charles A. Dauphin, an attorney representing the plaintiffs.

The malpractice claim was brought as a result of a head laceration suffered by Diane Smith, a patient who underwent a cervical fusion operation performed by Zenko J. Hrynkiw, MD, at Baptist Montclair Hospital in Birmingham, Ala. Upon waking from surgery, Ms. Smith had a cut on the upper right side of her head, which had been sutured by another doctor and bandaged with a gauze betadine dressing by a registered nurse, according to court documents. Ms. Smith's entire left arm was numb, and the left side of her body was swollen.

Post-operative studies indicated that Ms. Smith had suffered a spinal cord injury. She is now permanently disfigured and paralyzed on the left side of her body. Post-operative measures to correct these problems have been unsuccessful. Dr. Hrynkiw and the defendants did not dispute these post-operative outcomes.

At issue, however, was how and when the debilitating injury was sustained, and who should bear responsibility. The defendants claimed that the spinal cord injury could have been caused by a strong head lift when Ms. Smith was being extubated in the recovery room. However, Alan D. Rosenthal, MD, a medical expert called to testify in the case, never testified that a strong head lift could have caused Ms. Smith's injuries, in his opinion.

Baptist also argued that, to the extent that Ms. Smith's head injury could have been connected to the use of a Mayfield-Kees headrest, it "was clearly within the operative site and beyond the control or function of any of [Baptist's] employees," according to court records. It was undisputed that Ms. Smith's head was not being operated on when she went in for cervical fusion surgery, and Dr. Rosenthal testified that all of her injuries were "remote" from the surgery that Dr. Hrynkiw performed on her.

Also debated was Dr. Hrynkiw's presence in the operating room and/or the extent of his involvement when Ms. Smith was turned for the second time at the conclusion of her surgery. It is undisputed that Ms. Smith had no evidence of any injuries at the time of the first turn. In his deposition, Dr. Hrynkiw testified that he was involved in turning Ms. Smith, that she would have been turned twice, and that she was turned carefully, according to court records.

Only after giving his deposition did Dr. Hrynkiw submit an affidavit stating he was not in the room for the second turn, and that he did not remove the Mayfield headrest. In his operative report, however, Dr. Hrynkiw indicated that the patient was "closed in the usual fashion," which court documents say "supports a factual inference that Dr. Hrynkiw returned to the room to verify the closure, immediately after which Ms. Smith would be turned back over to the supine position." Another witness for the defendants testified about Dr. Hrynkiw's presence during the second turn, and indicated that Dr. Hrynkiw was the person who actually removed the headrest.

Attorneys for the defendants did not return calls requesting comment.

Mark McGraw