By Michael A. Sonkin and Samantha E. Shaw
Tuesday, June 19, 2018
Parkinson’s disease is a progressive disorder of the nervous system that affects movements. There are well-recognized signs and symptoms of Parkinson’s disease, including both motor and nonmotor symptoms. Some of the most common symptoms include tremors, slowed movement, rigidity, postural instability, cognitive impairment, mood disorders, sleeping issues, low blood pressure, constipation, and difficulties with speech, swallowing and writing. The symptoms vary from patient to patient as does the overall progression and severity of the disease. As discussed in more detail below, treating patients with Parkinson’s disease is often complex, and can give rise to situations that increase the likelihood of a lawsuit. Specifically, patients with Parkinson’s disease are both inherently more susceptible to injury and can experience hindered recoveries as a result of the disease.
The Eggshell Plaintiff Doctrine is well known. In brief, this doctrine holds that a tortfeasor takes the victim as he finds him. The Eggshell Plaintiff Doctrine is applicable in the context of medical malpractice actions. By nature of the condition, a patient with Parkinson’s disease frequently requires more medical care and treatment, and the impact of the disease certainly impacts overall fragility. In this same respect, medically treating fragile patients can result in a greater susceptibility of injury, exacerbation of prior injury and result in a complicated and/or hindered treatment course — all of which increase the likelihood of poor outcomes and potentially lead to the initiation of a medical malpractice lawsuit. The Eggshell Plaintiff Doctrine indicates that a physician can be legally responsible for more severe damages due to a plaintiff’s pre-existing condition than otherwise would have resulted. Thus, even though a patient with Parkinson’s disease might be more prone to injury or exacerbation, a physician can still be held liable for the entirety of the injury. Likewise, a physician may also be liable for any complications or inability to repair and/or mitigate said injuries.
This precise issue recently arose in one of our cases. In this litigation, the plaintiff, who had a prior diagnosis of Parkinson’s disease, was admitted to a hospital to receive treatment for severe depression. While it would seem unlikely that inpatient mental health treatment would result in an orthopedic injury, the plaintiff ultimately suffered a shoulder injury, which was generally treatable with surgery, in the course of his treatment. Whether that shoulder injury was the result of negligence is yet to be determined, but the issue further faced by the defendant hospital is that this plaintiff is limited in his ability to receive treatment for his injured shoulder due to his Parkinson’s diagnosis. A simple surgery to correct this orthopedic injury, which is often performed arthroscopically, is not recommended for this patient due to the unpredictability of the patient’s tremors, secondary to his Parkinson’s disease, which could complicate the surgery. Even if the tremors could be controlled during surgery, there was additional hesitance to perform this common procedure due to the near impossibility of ensuring that the plaintiff will not have any tremors in the recovery period following surgery. As such, the shoulder injury was determined to be surgically irreparable. While other treatment methods, such as physical therapy, have helped to reduce potential damages, there remain claims of continued pain and shoulder limitation that could prove problematic in limiting damages that would otherwise have been largely mitigated by surgery in a patient who did not have Parkinson’s.
The purpose of this article is certainly not to discourage medical providers from treating patients with Parkinson’s disease or similar neurological disorders; as such patients need and deserve good medical care and treatment. Rather, the purpose of this article is to create awareness of the potential complications that can arise from rendering treatment to patients so that every medical provider can better prepare a plan to protect patients from harm and protect physicians from malpractice claims. Such patients may require additional consideration when creating treatment plans in light of their comorbidity, which would not otherwise be. Another suggested strategy is to have more in-depth conversations about risks, benefits and alternative treatment options, including discussions regarding potential limitations of repairs to injuries. Further documentation of such discussions, aside from general consent forms, is also recommended and could ultimately prove very useful in the event that a malpractice action is commenced.