Top 25 Medical Malpractice Cases of a 25 Year Career – Pituitary Cyst

By Angela Price-Stephens
Categories: Blog, Medical Malpractice

Medical malpractice cases are very complex.

In this series of articles BC and Alberta personal injury and medical malpractice lawyer Angela Price-Stephens describes her top 25 notable medical malpractice cases of her 25-year career to date. Her selection of cases is a representation of the breadth of her experience, the complexity of cases, the twists and turns in the evidence and the dramatic benefit to her clients and their respective families by successfully pursing their claim with Angela and her team.

Angela has litigated cases across Canada and England and Wales. The names and distinguishing details of the cases referred to in this series of articles have been changed to protect the client. In all cases of settlement for medical malpractice the lawyers for the defendant healthcare providers insist on a confidentiality clause in which the existence of a settlement (payout of money to the former patient, irrespective of whether an admission of liability was made) must remain a secret.

In the third of this series of articles we look at the case of Steven, a 28-year-old maintenance technician who experienced negligent surgical removal of a giant pituitary cyst and negligent post-op follow up care which caused blindness.

Steven was an otherwise healthy individual when he started to notice imperfections in his vision. It was initially hard to define, but after some time he realized that he appeared to have blind spots. Although it was not causing pain, or interfering with his daily activities or work, he was concerned enough to see his family doctor who suggested he have a vision test. The result of the vision testing led to a series of referrals, ending in a referral to a neurosurgeon at the local hospital. It was the neurosurgeon who explained to Steven that an extremely large pituitary cyst was pressing on his optic nerve, causing the vision impairment. The surgeon recommended removal of the cyst to save the vision and further damage to the brain structure. The surgical approach was through the nose.

Following surgery Steven experienced a dripping nose. Later tests confirmed this dripping was cerebral-spinal fluid, the watery substance in which the brain is bathed. If CNS fluid can leak out, the danger is infection can creep in (to the brain). At the time of discharge his nose continued to drip with CNS fluid. In the weeks following the initial surgery Steven was forced to attend the emergency department on more than one occasion with increasingly debilitating headaches and, closer to collapse, a stiff neck. The surgeon recognized the fluid was CNS fluid and attempted more than once to surgically repair the leak. Nevertheless, the leak continued until Steven collapsed with symptoms of meningitis.

Steven and his family sought legal advice from Angela when he awoke blind from his coma.

Inappropriate Surgery for Giant Cyst?

The complete care received by Steven was considered and questioned. With appropriate experts the case theory was developed and further tested. It became apparent that the giant cyst was highly unusual because of its size and that the usual method of removing such a cyst would be insufficient. Rather than ‘simply’ removing the cyst, the cavernous hole left by the removal of the cyst ought to have been filled. The brain structures, which had been supported by the cyst, required alternative support. Without this support the brain had herniated (dropped down) in on itself into the hole causing brain damage, loss of vision and coma.

The method of surgery was highly contentious. Just because one surgeon would have performed the surgery differently does not mean that the first surgeon was negligent. Also, it must be recognized that each and every surgery carries risks of complications and/or outright failure. A poor outcome does not necessarily equate with negligence.

Post-Surgical Care is Just as Important as the Surgery

One factor of this case that was highly influential in leading to a settlement was the duration of the CNS fluid leak. Angela argued that it was almost inevitable that losing so much CNS fluid was going to cause a serious problem. The repeated failures in closing the defect and stopping the leak ought at the very least have prompted a referral to a larger teaching hospital with more experienced neurosurgeons. By a careful review of the multiple hospital and emergency visits and the mapping out of those visits with the associated symptoms and reports of leaking CNS, it was possible to illustrate the extent of the poor care.

Detailed evidence from a neuro-ophthalmologist and neurosurgeon confirmed that had the surgery been carried out in a non-negligent manner or had Steven received more experienced neurosurgeon care shortly thereafter, Steven’s vision and other brain damage would likely have been avoided. Indeed, it was the evidence of the defendant neurosurgeon that he expected Steven to make a full recovery from the surgery, with the minor vision impairments experienced at the time of the initial surgery to likely recover spontaneously following surgery.

The primary difficulty with this case was the lack of one precise moment, or action/inaction taken by the defendant neurosurgeon that was negligent. While Angela argued the original surgery was negligent, there was a real risk the court would find it met the standard of care. A CNS leak is a risk of such surgery, but at what point in time does the inability to seal the leak become negligent, if at all?

Expert neurosurgeons retained to advise on the case opined that the leak could not be expected to cease using the method employed by the defendant neurosurgeon. While the defendant’s lawyers argued that the leak had (eventually) been sealed by the defendant neurosurgeon, the experts retained for Steven noted that it was in fact the catastrophic brain herniation into the cavernous hole that had led to the leak sealing itself, not the last surgical intervention by the defendant neurosurgeon.

By the use of experts, graphs and tables Angela built a case that illustrated the extent and duration of the poor care and the continued ineffectual action on the part of the neurosurgeon. It became apparent that there was a real risk to the neurosurgeon that a court would find his overall care provided to Steven fell below the standard of a competent neurosurgeon.

The case was settled just before trial on terms favourable to Steven.


Angela Price-Stephens is an English and Canadian lawyer who focuses on serious personal injury arising from the negligence of others, mostly health care professionals. Of her 25-year career approximately half of that time has been spent defending heath authorities, doctors and other healthcare professionals. That experience is now used exclusively for the benefit of injured patients.

For more information on this article, or for a confidential discussion of your claim, contact Angela Price-Stephens at 250 869 1124, or send her a confidential email at price-stephens@pushormitchell.com.