Gash & Associates, P.C. in the Courtroom

For more than a year prior to December 26, 2003, the plaintiff was a patient of the defendant, LAM Medical Associates, P.C., d/b/a Servicios Medicos Hispano. The Medical Director of this facility was also a defendant. The doctor also was his primary care physician who directed most if not all of his medical care prior to his ganglion cyst surgery. As a patient of this medical facility, the plaintiff relied upon the facility and its Medical Director to prescribe and order the proper and necessary medical procedures to be performed by proper medial practitioners.

One year prior to the surgery complained of in this lawsuit, the plaintiff was previously diagnosed with an identical ganglion cyst, for which there was no surgery, nor was there any medical intervention of any kind. A year later, without any medical work-up, the defendant’s “rushed to surgery,” and removed what they claim was this cyst.

The medical records suggest that the person who performed this surgery was the defendant, (“Dr. X”), a doctor who admitted he was not licensed to practice medicine at the time of the surgery. These records include an operative note signed by Dr. X, a surgical consent form indicating that Dr. X was to perform the surgery, follow-up visits authored by the defendant Medical Director, suggesting that the plaintiff was to follow-up with Dr. X, but could not because the physician was not in that day.

During discovery, the defendants suggested that Dr. X impersonated another doctor who was associated with the medical facility and/or, that Dr. X did the surgery without anyone else knowing about it and, apparently alone and without assistance. The defendants further urged that “Dr. X” was only acting in the capacity as a “physicians assistant,” at defendant LAM’s facility, and that defendants had no clue that this surgery was performed, until after the event.

Suffice it to say, the surgery and its results were a complete disaster. It was alleged that the removal of a ganglion cyst was medically unnecessary; that the procedure was negligently performed, and that it was followed up and managed improperly. This unwarranted and botched procedure has required subsequent surgical repair, and that it has left the plaintiff with profound and severe nerve and sensory abnormalities, and chronic pain. The matter was settled before trial, for the sum of $600,000.00.

Plaintiff suffered 3rd degree burns to his elbow due to a defective operating room light while undergoing orthopedic elbow surgery. He required skin grafts and suffers from residual pain in both the area that was burned, the donor site, as well as scaring of his right arm. The skin graft of his arm, because he suffered third degree burns (the most serious burn one can sustain) lacks hair follicles, pigmentation and pores, and therefore it does not perspire and, as such, is susceptible to the development of cancer. The defendant’s took a no-pay position. Jury Verdict – $325,000. Plaintiff appealed and the Appellate Division of the Supreme Court raised the recovery to $450,000.

In this medical malpractice case, the defendant, a Board Certified neurosurgeon, diagnosed the plaintiff with Chiari I malformation. This is a genetic malformation of the bones in the back of the brain, which results in increased intra-cranial pressure and related symptoms. It can be treated in a variety of ways, the most dramatic of which is surgery in which part of the bone in the back of the brain is removed, along with and some of the vertebral bodies in the upper part of the neck are removed and fused.

As a result of this diagnosis, he persuaded the plaintiff to undergo neurosurgery of the brain, consisting of a suboccipital craniectomy with a C1 laminectomy and decompression with duraplasty. This surgery later failed (see below), which resulted in a more dramatic and involved salvage surgery, by a world famous brain surgeon who specializes in Chiari malformation surgery.

In connection with the initial surgery’s failure, as performed by the defendant neurosurgeon, the Plaintiff alleged that the surgery was completely unnecessary, since the plaintiff’s symptoms were consistent with increased intra-cranial pressure, following a spinal tap, which was done to see if his symptoms were due to Lyme’s disease. The plaintiff contended that as a result of that spinal tap, there was a continued loss of cerebral spinal fluid, which was the cause of his symptoms, and that in time, with additional blood patches, the condition would resolve. In fact, the plaintiff alleged that the plaintiff did not have Chiari I malformation, but rather, intracranial hypotension, which did not require any surgery.

Our contention was factually supported by the medical chart and the MRI, MRA, and CT scans of the brain, which shows that there never was a radiological diagnosis of Chiari I malformation. In fact, the MRI of the brain, taken at Northern Westchester Hospital, indicates an impression of intracranial hypotension.

The plaintiff’s expert opined, within a reasonable degree of medical certainty, that had the proper differential diagnosis been made, and had the plaintiff been treated for intracranial hypotension, rather than Chiari I malformation, then the cranial decompression surgery would have been unnecessary. Had this surgery not been done, it would not have failed, as it did, and the plaintiff would not have been required to undergo yet a second decompression surgery.

The plaintiff further contended that even if the diagnosis were correct, the procedure itself was fatally flawed. More particularly, the plaintiff contended that the surgeon wrongly chose to use a Duragen Patch for the duraplasty (a synthetic material), to patch the section of the back part of his brain where the bone was removed. The plaintiff contended that this material was fatally flawed for this type of intra-cranial surgery, and that in fact, there was a black box warning, which advised against the use of this product in this type of surgery.

In keeping with what the plaintiff contended were the risks for this type of surgery and for the material that was used, the surgery failed. The plaintiff was therefore required to undergo additional neurosurgery, which consisted of the following: with different surgeons at another medical institution, he underwent a posterior fossa revision consisting of drainage and excision of pseudomeningocele fat extending from the suboccipital to C5; enlargement of suboccipital craniectomy; widening of the narrow C1 laminectomy; C2 laminectomy; excision of partially absorbed Duragen duraplasty patch; untethering of tortuous left posterior inferior cerebellar artery from right dural suture line; microneurolysis of both posterior inferior cerebellar arteries; both cerebellar tonsils; both spinal accessory nerves, and vermis of the cerebellum; bipolar shrinkage of the cerebellar tonsils; expansile duraplasty employing autogenous pericranium; and creation of an extradural blood patch, at the North Shore University Hospital.

As a result of the negligence of these defendants, the plaintiff sustained severe and permanent personal and psychological injuries, including, but not limited to, ringing in both ears; vision changes including blurring of vision; photophobia; halos; light sensitivity; facial numbness; tremors of left arm; paresthesias in both hands and feet; neuropathy in hand and feet that is permanent; severe headaches with physical activity; neck weakness with range of motion deficits; persistent intermittent dizziness; neck tires easily; fatigues easily; reduced stamina; chronic pain syndrome mainly to neck and back of head; changes in sexual activity; changes in sense of identity and well-being; unable to perform prior work duties; anxiety due to trauma of injury and change in level of function; cannot lift heavy weights without experiencing severe headache; panic attacks requiring medical management; cervical spine instability; GI bleeding which required hospitalization and transfusion; portion of skull permanently removed; and that he will require spinal fusion in future to stabilize neck.

The matter was settled before trial for a sum which cannot be disclosed based upon a confidentiality agreement among the parties.

On August 27, 2004, the decedent, a 78-year-old woman who was suffering a disease of her kidneys, underwent cardiac catheterization. During the minutes that followed the completion of the catheterization, the decedent experienced a sharp decline of her condition, and passed away several hours later.

The plaintiff (the decedent’s daughter), maintained that the decedent’s death was the result of a perforation of her external iliac artery, which occurred during the catheterization. She further contended that the defendants’ failure to diagnose the decedent was the proximate cause of death. Ultimately, the parties reached a trial settlement of $400,000 for the plaintiff.

Plaintiff died from systemic infection in hospital after routine hernia repair. The defendants, who inserted a mesh hernia repair that led to infection and sepsis, killing the plaintiff within eight days of surgery, settled the case for $350,000 on the eve of trial.

In this medical malpractice case, the plaintiff had a workplace accident in which he fractured both the first and second toe of his left foot.

The basis of liability is that the defendant doctor, a Board Certified orthopedist, failed to appropriately diagnose the severity of the fracture. He indicated to Mr. Dipippo that the fracture could be successfully healed with conservative (non-surgical) treatment. The doctor failed to properly document and make necessary recommendations for surgery, but proceeded to treat the patient inappropriately with conservative treatment. The attempt at conservative treatment led to the delay in a timely surgical procedure, an open reduction with internal fixation (ORIF), that was the only appropriate procedure for this type and severity of injury. This delay caused the fracture to become more difficult for subsequent successful surgical intervention. Shortly after the first surgery was done by another doctor, it was evident from x-rays that healing was not progressing well, due to the changes in the bone matrix and scarring that had already occurred, making a successful union of the fracture more difficult. Therefore, a subsequent, and more complex surgery, had to be undertaken, which held the fracture fragments together through the toe’s joint making it more likely that Mr. Dipippo would suffer traumatic arthritis.

As a consequence, Mr. Dipippo suffers from a frozen great toe and the inability to “push off” when walking, and traumatic arthritis of the great toe, leading to his inability to do the same kind of physical things that he was capable of doing before. It has also made him physically unable to return to the same job he had before the accident, thereby diminishing his earning capacity.

Had the surgical procedure been done earlier, plaintiff’s expert opined, the outcome, within a reasonable degree of medical certainty, could have reasonably been expected to be complete healing of the fracture with no residual deficits.

The matter was settled during jury deliberations for a sum with a confidentiality agreement regarding the amount of the settlement.

Plaintiff was pregnant with her third child and it was her intention to limit her family to three children. She discussed with her doctor a tubal ligation after the birth of her child. Later, after repeat ultrasounds the fetus was diagnosed with bilateral hydronephrosis, a renal anomaly that is almost always fetal. After delivery by emergency Cesarean Section, the newborn died within 2 hours of delivery. Despite this, and with no written permission, the doctor performed a tubal ligation permanently sterilizing her. The case settled for $300,000.