Guess v. Escobar6/20/2000
Appeal From: Circuit Court of Buchanan County, Hon. Randall R. Jackson
Opinion Vote: AFFIRMED. Spinden and Newton, JJ., concur.
Opinion:
On January 22, 1986, Terry Guess was involved in a single-vehicle accident in which he lost control of his vehicle, causing it to leave the roadway, roll over, and throw Guess from the vehicle. When paramedics arrived, he complained of neck and back pain. Paramedics evaluated Guess at the scene and determined he had normal sensation and the ability to move his extremities. The paramedics placed him in a cervical collar and transported him to Heartland Hospital in St. Joseph, Missouri (Heartland).
Upon arrival at Heartland, Guess began complaining of numbness and tingling in his extremities. Guess had a blood alcohol level of .159. Nelson Escobar, M.D., a physician trained in neurosurgery and rehabilitation medicine, examined him and determined Guess had lost function of his lower extremities, with no sensory function below the chest. From his analysis of an x-ray, Dr. Escobar diagnosed Guess as having suffered a severe cervical spinal cord injury and possible mild brain injury. However, he determined that the spinal canal was not compromised, nor was there any ongoing compression of the spinal cord. Dr. Escobar concluded that the cervical spine was stable due to a locking of bony portions, or facettes, of the C7 -T1 vertebrae that had resulted from the accident. He maintained Guess in the cervical collar put in place by the paramedics at the accident scene and transferred him to the intensive care unit. On January 26, 1986, four days later, Guess sneezed violently and reported that he felt his neck "pop."
On January 27, 1986, five days after his admission to Heartland, Dr. Escobar ordered a CT scan of Guess' upper back and neck, which revealed fractures of the seventh cervical vertebra with lateral displacement. The following day, Dr. Escobar ordered a "Terry brace," a rigid brace extending from the chin to the chest, to restrict Guess' head and neck movement in anticipation of physical therapy.
At the time of his admission on January 22, 1986, Ellis Berkowitz, M.D., at the request of Dr. Escobar, evaluated Guess. Dr. Berkowitz, an internal medicine specialist, followed Guess during his hospitalization at Heartland for non-neurological internal medicine issues. On January 30, 1986, Dr. Berkowitz prescribed antibiotics for what was diagnosed as adynamic ileus, a condition involving weak or absent contractions of the colon necessary to digestion. Guess exhibited a loss of appetite, distended abdomen and elevated body temperature. His condition continued to worsen, and, on February 7, 1986, Guess underwent abdominal surgery which revealed a condition known as pseudomembranous colitis, an infection which had resulted in severe swelling and gangrene of the colon, requiring removal of the majority of the colon. On March 11, 1986, an x-ray revealed a fractured left scapula and healing fractures of his left ribs.
Guess remained at Heartland until March 12, 1986. During that time, the cervical collar was removed periodically due to skin reactions, without the provision of alternative neck stabilization. On March 12, 1986, Guess was transferred to Rusk Rehabilitation Institute in Columbia, Missouri (Rusk). Due to its initial evaluation of a suspected unstable cervical fracture and pulmonary problems, Rusk immediately transferred him to University Hospital, where he was placed in traction and a CT scan showed impingement of the C7 - T1 vertebrae. Guess underwent surgery to align and fuse the vertebrae on March 17, 1986. Following surgery, his condition gradually improved and he was transferred back t
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