Medical Malpractice
On this page we will look at medical malpractice lawsuit involving carotid endarterectomy procedures. We will discuss the common types of malpractice claims arising out of this procedure and the settlement value of these cases.
Carotid Endarterectomy
A carotid endarterectomy is a serious medical procedure designed to reduce the risk of a stroke for patients with atherosclerotic debris (plaque) that can block the flow of blood. It is a routine yet significant procedure that usually requires a hospital stay.
Arterial plaque of concern is often found from carotid Doppler studies and/or an echocardiogram. The purpose of an endarterectomy is to remove the plaque that can block the flow of blood. The procedure is seemingly simple. The doctor goes in through the neck and exposes the artery of concern and then opens the artery and removes the plaque. The surgeon may have to insert a tube to redirect the blood around the artery being repaired.
Again, this is serious surgery and it comes with risks. Even with the best surgeon in the world, this is not a risk free procedure. But medical care can help to reduce those risks. One reoccurring malpractice case involving this procedure is damaging critical nerves in the neck. In particular, surgeons performing an endarterectomy should identify the hypoglossal nerve and retract it to prevent cutting the nerve. If this is not properly done, the patient may have tongue deviation or dysphagia (an awful condition that may make swallowing difficult or painful).
Hypoglossal Nerve Damage
The hypoglossal nerve (cranial nerve XII) controls the movements of the tongue, playing a vital role in swallowing, speech, and maintaining airway patency. Damage to the hypoglossal nerve and a very serious risk during carotid endarterectomy procedures. The reason for this is because the location of the hypoglossal nerve is located very close to the arteries involved in a carotid endarterectomy.
Symptoms of hypoglossal nerve injury can vary depending on the extent of the damage. They may include:
- Tongue Weakness or Paralysis: This is the hallmark of hypoglossal nerve damage. Weakness on one side of the tongue can cause it to deviate toward the injured side when extended.
- Difficulty Speaking: Since the tongue plays a key role in articulation, damage to the nerve can result in slurred speech.
- Swallowing Difficulties (Dysphagia): Tongue dysfunction may impair swallowing, which can increase the risk of choking or aspiration.
- Atrophy and Fasciculations: If the damage is severe or permanent, the affected side of the tongue may atrophy (shrink) or develop muscle twitching, known as fasciculations.
Cranial nerve injuries are typically diagnosed through a physical examination, though imaging such as MRI or nerve conduction studies may be used for a more precise diagnosis. Treatment options focus on managing symptoms and may include physical therapy, speech therapy, and surgical nerve repair.
Defense to Malpractice Lawsuits Involving Cutting the Hypoglossal Nerve
You would think that failing to identify and protect the cranial nerve would lead the doctor to concede medical malpractice. Yet these cases are routinely defended, even those that appear to be slam dunk malpractice lawsuits for cutting the hypoglossal nerve and causing injury to the patient.
Doctors’ medical malpractice lawyers’ typically argue that injury to the hypoglossal and other nerves are a known risk to an endarterectomy. It is true. There are risks to almost anything. It is a known risk that you might get hit by a drunk at a bar. But that does not absolve the drunk of responsibility.
Another frequent—and maddening—defense by the doctors’ attorneys in these cases is the claim of “unusual anatomy,” suggesting that the patient’s unique physiological structure made the surgery more challenging or made the nerve harder to locate and protect. This all-too-common defense can be persuasive in some cases where the doctor is looking to find for the jury. It difficult for plaintiffs to counter without detailed anatomical evidence. How do you prove you did not have unusual anatomy? This defense usually relies on vague assertions and is commonly used as a fallback explanation, even in cases where no other medical staff observed any unusual anatomical challenges. Ultimately, the principle remains: a surgeon should not make an incision or proceed without clear identification of critical structures, especially a major nerve like the hypoglossal.
Endarterectomy Malpractice Settlements Amounts and Jury Payouts
Not many of these cases go to trial so there are not a lot of plaintiffs’ verdicts in these cases around the country. As with many medical malpractice cases, the good ones are often settled confidentially. It is also fair to note that a lot of defense verdicts we found are not included in these sample verdicts. That said, here are a few verdicts/settlements:
- 2023: New York – Verdict of $800,000. The patient with a pre-existing heart disease, a pacemaker and prior stent placements, died of myocardial infarction after undergoing an endarterectomy for which he received care and treatment from the defendant. The lawsuit alleged that the defendant recognize the significance of the decedent’s pre-existing conditions, failed to recommend a Swan-Ganz or any form of cardiac anesthesia, failed to perform a stress test and failed to recognize a drop in blood pressure at the beginning of the endarterectomy and complaints of back pain post-op.
- 2021: Illinois – Verdict of $1,200,000. This wrongful death action was brought after a 63-year-old female reportedly suffered cardiac arrest, required multiple resuscitations, fell into a coma and died following a right carotid endarterectomy, while under the care of defendant anesthesiologist. The lawsuit claimed that the defendant negligently injected bupivacaine into a blood vessel. The defendant denied the allegations, denied he was negligent and denied proximately causing the decedent’s death. The decedent was survived by two adult daughters and an adult son.
- 2019: Washington – Verdict of $2,950,000. The patient, a female in her 50s, underwent a carotid endarterectomy to treat a blocked artery. The lawsuit alleged that while the defendant was in the process of ligating and cutting branches of her facial vein, he mistakenly cut her hypoglossal nerve. The defendant claimed that the hypoglossal nerve was in an unexpected anatomical position never before encountered, but the jury apparently did not accept this defense.
- 2018: Illinois – Verdict of $4,000,000. The decedent, a 51-year old male, died following a left carotid endarterectomy with hemashield patch angioplasty. The lawsuit contended the defendant’s nurses negligently failed to objectively measure the patient’s neck swelling, failed to contact a physician or the physician who performed the surgery to assess the patient and/or failed to request a physician or the surgeon who performed the surgery come to the patient’s bedside.
- 2011: New York – Settlement of $250,000. Plaintiff was a surgical patient at the VA for bilateral carotid stenosis. During the surgery, his hypoglossal nerve was damaged. His lawsuit was against the VA (which is really the U.S. government). The man later died of heart failure that was allegedly related to his injuries during surgery.
- 2009 Washington – Verdict of $2,954,000. A 63 year-old surgical nurse had a partially blocked carotid artery. During a carotid endarterectomy, the surgeon thought he was cutting a vein and cut a nerve.
- 2007: Maryland: Defense Verdict. An 80 year old woman, underwent a carotid endarterectomy because she had an occlusion of the internal carotid artery. During surgery, the patient had unexpected bleeding from the distal internal carotid artery. Things went downhill from there. Attempts to repair the carotid artery failed and the artery was ligated. Plaintiff suffered a neuropraxis cranial nerve injury and alleged stroke from the doctor’s failure to try to repair the artery. Plaintiff found a cranial nerve injury lawyer to take the case but this case was a tough argument and a Baltimore City jury quickly came back with a defense verdict.
- 2004: Rhode Island – Verdict of $200,000. A 63 year old-plaintiff had carotid endarterectomy surgery after a minor stroke, hoping to remove plaque from her carotid artery. Her surgeon accidentally cut her hypoglossal nerve. The doctor defense – the usual “abnormal anatomy” defense – failed but the jury obviously questioned the extent and scope of Plaintiff’s injuries.
- 2002 California – Verdict of $1.2 Million. A 39-year-old man who was a personal trainer was diagnosed with hypercalcemia caused by an elevated parathyroid hormone. During surgery to fix the condition, the doctor cut the hypoglossal nerve causing a paralyzed vocal cord and constant nausea and vomiting. Plaintiff’s lawsuit successfully contended that the doctors negligently failed to identify and steer clear of the vagus nerve.
Getting a Lawyer for Your Cut Nerve Case
Our malpractice lawyers handle cases where the hypoglossal nerve has been cut during surgery. If you or a loved one sustained a serious injury as a result of an error or mistake during surgery, call our malpractice attorneys at 800-553-8082 or get a free online consultation.