United States District Court, D. Maryland
MARK COULSON UNITED STATES MAGISTRATE JUDGE.
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
FINDINGS OF FACT
MacDonald was an appropriate candidate for the endoscopic
carpel tunnel release surgery recommended and performed by
Dr. Nesti on December 17, 2013.
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.
general, injury to the median nerve (including stretching,
bruising, or laceration) is a known risk of the procedure.
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
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.
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.
MacDonald's right median nerve was partially lacerated
during Dr. Nesti's procedure.
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.
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.
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.
There was no criticism of the order in which Dr. Nesti made
the two cuts for ...