LITTLE ROCK — Attorneys suing over botched brain surgery on a 15-year-old Little Rock boy at Arkansas Children’s Hospital rested their case Friday, ending eight days of proceedings with testimony from a Little Rock radiologist about how Cody Ryan Metheny’s brain had recovered.
The defense, representing Children’s Hospital’s insurance company, opens its case at 9 a.m. Monday in Pulaski County Circuit Court. Jurors are expected to hear closing arguments next Friday.
Dr. Steven Nokes testified that four years after the surgery, the results of Metheny’s surgery as shown on brain scans were subtle, involving an area the size of the tip of a pen, but could be discerned under close examination.Metheny’s brain doesn’t show any major deterioration, defense attorney Will Griffin pointed out.
“The films don’t show any withering away,” he said.
Griffin challenged Nokes’claim of injury by noting that the doctor had described Metheny’s brain structure as “essentially unchanged” in pretrial testimony. Nokes didn’t reject that description on the witness stand Friday.
“It’s a small difference,” Nokes said. “It’s hard to pick up.”
Nokes said he made his diagnosis based on a comparison of brain scans. The pictures were taken in 2005 and 2009. Before digital technology, brain scans could easily be overlaid for comparison, he said. Most radiologists now just look at the individual pictures to make a determination, but Nokes said he made a special effort to project the scans on sideby-side computers.
Metheny’s attorney Grant Davis asked how much cutting would injure the brain, and Nokes said any cutting would do damage.
“By definition, if you cut part of the brain, you cut neural pathways,” he said.
Metheny’s parents claim that their son, now 22, wasleft permanently brain-damaged by the August 2004 operation by Dr. Badih Adada, who initially operated on the wrong side of Metheny’s brain before performing the correct surgery to try to cure Metheny’s seizure disorder.
The neurosurgeon, Children’s Hospital’s former chief of pediatric neurosurgery, has admitted liability in a $1 million settlement with the family who also claim that the hospital shares responsibility because its staff was inadequately trained and failed to follow procedures, even delaying telling the parents the extent of what was done to their son for more than a year.
The hospital’s defense counters that Adada, now a neurosurgeon in Lebanon, is solely responsible for the surgical error. Despite his title, the defense said, Adada was employed by the University of Arkansas for Medical Sciences and wasn’t subject to the hospital’s authority.
Metheny was already developmentally delayed beforethe surgery, the defense attorneys claim, and the wrongside surgery didn’t make him worse but actually contributed to his improvement since Adada’s procedure fortunately removed unhealthy tissue.
Last week, jurors watched a video of attorneys questioning Metheny. The man spoke in a rhythmic tone, his head nodding slightly, as he described his senior year in high school and discussed his duties as a fire marshal at Parkview Arts & Science High School in Little Rock.
“The most striking thing is there’s no emotion,” Dr.Gregory O’Shanick, a specialist from Virginia in neuropsychiatry and neurorehabilitation, testified. “There’s no inflection [to Metheny’s voice]. There’s no life to it.”
Testifying for the Methenys, O’Shanick, who specializes in traumatic brain injuries, is a former medical school professor and has consulted on health care for the Obama administration and on brain injuries with the U.S. Department of Defense.
“Without question” the surgery damaged Metheny’s brain, O’Shanick told the jurors, saying the procedure left him with an injury similar to a gunshot to the head.
“He has damage to his brain that can easily be seen on MRIs,” he testified. “Over time, unfortunately, it’s going to get worse.”
Another sign of Metheny’s mental deficiencies is his posture, O’Shanick testified, pointing out that Metheny holds himself rigidly in the hour-long video and doesn’t change facial expressions or use any body language, like raising an eyebrow. Nonverbal communication is a critical part of healthy human communication, O’Shanick said.
Metheny also can’t keep a conversation on topic, the doctor pointed out. He said a conversation about Metheny’s interest in art devolved into Metheny talking about helping in the gym and being an athletic manager in school.
That behavior is more like a very young child than a grown man and a feature of his speech that reflects how childlike he is, the doctor said.
“Being able to abstract ... unfortunately, he doesn’t have that ability,” O’Shanick told jurors.
Metheny can’t comprehend open-ended questions, the doctor said.
“He wasn’t able to understand questions that are somewhat ambiguous like, ‘what do you like to eat for lunch,’” he said.
Arkansas, Pages 18 on 09/19/2010