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MacDonald v. United States

United States District Court, D. Maryland

March 20, 2019

DELAINE MACDONALD, et al., Plaintiffs,
v.
UNITED STATES OF AMERICA. Defendant.

          MEMORANDUM OPINION

          J. MARK COULSON UNITED STATES MAGISTRATE JUDGE.

         This action for medical negligence was filed by Plaintiffs, Ms. Delaine MacDonald and her husband, Mr. Neal Kringel against Defendant, United States of America based on a carpal tunnel release surgery performed by the Defendant's agent, Dr. Leon Nesti, on December 17, 2013. The Court conducted a bench trial from February 28, 2019 through March 1, 2019. The Court also invited both parties to submit post-trial memoranda (ECF Nos. 80 and 81, respectively) which it has now considered. As set forth more fully below, the Court finds in favor of Defendant.

         I. FINDINGS OF FACT

         1. Ms. MacDonald was an appropriate candidate for the endoscopic carpel tunnel release surgery recommended and performed by Dr. Nesti on December 17, 2013.

         2. The procedure involves surgically gaining access to the carpel tunnel and surgically releasing the carpel tendon so as to create more space for the median nerve.

         3. In general, injury to the median nerve (including stretching, bruising, or laceration) is a known risk of the procedure.

         4. Gaining surgical access to the carpel tunnel involves first dissecting the skin with scissors and then dissecting the next layer of tissue known as the antebrachial fascia with a scalpel, utilizing either a U-shaped incision (consisting of two longitudinal cuts and one transverse cut), or an L-shaped incision (consisting of one longitudinal cut and one transverse cut).

         5. The median nerve is directly beneath the antebrachial fascia. The precise location for an individual can vary, although the median nerve is generally within 1 millimeter under the antebrachial fascia and, in some cases, can be adherent to the antebrachial fascia.

         6. A U-shaped incision may give the surgeon the ability to visualize the median nerve prior to making the transverse (3rd) part of the incision. An L-shaped incision does not provide the same opportunity prior to making the transverse incision. However, both a U-shaped incision and an L-shaped incision are within the standard of care.

         7. Ms. MacDonald's right median nerve was partially lacerated during Dr. Nesti's procedure.

         8. The damage to Ms. MacDonald's right median nerve likely occurred as Dr. Nesti made the transverse portion of his L-shaped incision through the antebrachial fascia so as to gain access to the carpel tunnel.

         9. Injuring the median nerve during the dissection of the antebrachial fascia is uncommon. Neither of the expert witnesses nor the surgeon who performed a second repair surgery in 2015 had experienced the complication, nor had Dr. Nesti experienced the complication before or since Ms. MacDonald's surgery.

         10. Injury is less likely to the median nerve during the longitudinal portions(s) of the incision(s) as such cuts run parallel to the median nerve.

         11. There was no criticism of the order in which Dr. Nesti made the two cuts for ...


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