When a patient undergoes a surgical procedure, an unexpected outcome can be a nerve or skin injury caused by improper positioning. The surgical team is responsible for ensuring that the patient is positioned in such a way that there is not excessive pressure on any particular part of the body and a nerve is not stretched to the point of injury. There are cushions and other devices that are often used to avoid pressure on muscles, nerves, and bony parts of the body that can result in skin breakdown (decubitus ulcer or pressure sore).
Some positioning carries special risks to key nerves. The lithotomy position, often used in urological surgeries, requires the use of leg holders. Peroneal nerve injury, which can cause a foot drop or lower leg numbness, can result from prolonged stretching of that nerve. The surgical team must ensure that the patient is in the lithotomy position for the shortest amount of time possible. Other surgical positions have special risks for different nerves.
A dreaded complication is blindness caused by direct pressure on the optic nerve or on vessels carrying blood to that nerve. Such injuries can occur during lengthy spine surgeries. The proper padding and positioning of the head and face can avoid such an injury. As surprising as it may sound, nerve injuries have also occurred when a member of the surgery team leans on a portion of the body to perform a surgical task. Nerve injuries have also occurred from the use of retractors or other instruments that assist in exposing a surgical site.
It is often difficult to determine exactly how a positioning injury occurred or which members of the surgical team were responsible for it. An attorney representing an injured patient in this situation may have to rely on the legal doctrine of res ipsa loquitur (“the thing speaks for itself”), that allows a claimant to shift the burden to the health care providers to explain how an injury occurred. The doctrine applies when the means by which an injury occurs are entirely within the control of the health care providers and the injury would not ordinarily occur in the absence of negligence. A medical expert is usually needed, however, to testify to those matters.
Unfortunately, in surgical positioning injury cases it is usually necessary to name all of the members of the surgical team who had some responsibility for positioning the patient: the surgeon, assistant surgeon, anesthesiologist, and circulating nurse. Since each of them may have different employer and liability insurance, such cases can become very complicated and expensive to pursue.
