Trigeminal Neuralgia
Ronald Brisman, M.D.

Trigeminal Neuralgia Law


 

Introduction

Many issues that are raised in a medical malpractice case will be decided by a jury based on the presentations of the opposing attorneys and their expert witnesses. Dr. Ronald Brisman has recently testified successfully as an expert witness on behalf of a dentist (the defendant) who was accused of causing a patient’s Trigeminal Neuralgia and an organization where a patient fell and claimed the fall caused Trigeminal Neuralgia. He has also testified successfully on behalf of a neurosurgeon whose treatment was alleged to be negligent.

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What are Legal Issues Associated with Trigeminal Neuralgia?

  1. The cause of trigeminal neuralgia is sometimes alleged to be trauma, such as an accident (motor vehicle accident or other) or something done by a dentist. Whether or not this event is causally related to the trigeminal neuralgia is often disputed.
  2. A procedure done to treat trigeminal neuralgia may sometimes cause unpleasant and undesired consequences. Issues of possible malpractice by the treating healthcare professional may be raised. Malpractice usually refers to a deviation from an accepted standard of care that has caused an injury.
  3. Before doing a procedure, the physician should obtain a proper informed consent advising the patient of risks, benefits and alternatives to the proposed treatment (American College of Surgeons website: https://www.facs.org/education/patient-education/patient-resources/informed-consent ).

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What is Trigeminal Neuralgia?

Although the main feature of Trigeminal Neuralgia is paroxysmal face pains that are often triggered by light touch about the face and talking, eating or brushing the teeth, there are other characteristics (http://www.trigeminalneuralgia-ronaldbrismanmd.com/Trigeminal-Neuralgia.html#symptoms ). There are many different kinds of face pain and not all face pain is Trigeminal Neuralgia (http://www.trigeminalneuralgia-ronaldbrismanmd.com/Trigeminal-Neuralgia.html#diagnosis ) (http://www.sciencedirect.com/science/article/pii/S1878875012002276).

Even the phrase “Trigeminal Neuralgia” may be used to refer to different conditions.

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What Causes Trigeminal Neuralgia?

The most usually accepted cause of trigeminal neuralgia refers to an impairment of the covering (myelin) of the trigeminal nerve close to (or in the brain). This impairment is most likely caused by a blood vessel compressing the nerve, but may also be caused by a demyelinating disease such as multiple sclerosis or, infrequently, a brain tumor. Sometimes the exact cause of the nerve impairment is not determined.

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Is Disclosure of Experience a Risk Factor in Informed Consent?

In the Case of Johnson v Kokemoor, a Wisconsin court ruled that patients in Wisconsin can regard their treating surgeon’s level of experience (or relative inexperience) as a risk factor that should be revealed to them before they agree to undergo surgery (AMA Journal of Ethics, formerly Virtual Mentor. January 2015. Volume 17, Number 1:69-73 http://www.ncbi.nlm.nih.gov/pubmed/25594719 ).

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Is There a Relation between Negligent Adverse Events and the Outcomes of Medical-Malpractice Litigation?

In a study of 51 malpractice claims brought in New York State, 46 had been closed as of December 31, 1996, the severity of the patient’s disability, not the occurrence of an adverse event or an adverse event due to negligence, was predictive of payment to the plaintiff. There was only one jury trial, and that resulted in a verdict for the defense (N Engl J Med 1996 335:1963-1967 December 26, 1996 http://www.nejm.org/doi/full/10.1056/NEJM199612263352606 ).

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