A Medical-Legal Review Regarding the Standard of Care for Epidural Injections, with Particular Reference to a Closed Case

Interventional pain management is an evolving field, with a primary focus onthe safety of the patient. One major source of risk to patients is intraarterial orintraneural injections. Interventional pain physicians have considerable interestin identifying techniques which avoid these complications. A recent article hasreviewed complications associated with interventional procedures and concludedthat the complications were due to deviation from a specific prescribed protocol.One of the cases reviewed went to jury trial and the record of that case is in thepublic domain. Two of the authors of the recent review were expert witnessesin the trial. They provided conflicting testimony as to alleged violations of thestandard of care. Their criticisms also differed from a third criticism contained inthe article as well as the protocol being advocated in the article, thus contraveningthe claim that there is one prescribed protocol which must be followed.The definition of standard of care varies amongst jurisdictions, but is generallydefined as either that care which a reasonably well-trained physician in thatspecialty would provide under similar circumstances or as what would constitutereasonable medical care under the circumstances presented. Analysis of the casewhich went to trial indicates that there is not one prescribed protocol which mustbe followed; the definition of standard of care is broader than that. Interventionalpain management is an evolving field and the standard of care is broadlydefined.Key words: Spine injection, complications, medical legal, standard of care,transforaminal injections, compression fracture, low back pain