Epidural Steroid Injection Errors: Landmark New York Malpractice Verdicts

Part of: Anesthesia Errors →

Living with chronic lower back pain can make daily life exhausting. Many individuals turn to epidural steroid injections seeking reliable relief. Patients trust that their doctors will execute these quick outpatient procedures safely. However, when a medical provider selects the wrong medication or misses critical safety protocols, the consequences can prove life-altering.

In May 2025, a Nassau County Supreme Court jury returned a substantial medical malpractice verdict for a 65-year-old electrical mechanic permanently paralyzed following a routine lumbar epidural steroid injection. This historic judgment highlights the catastrophic risks when proper medical standards are ignored during back pain treatments.

Understanding Epidural Steroid Injections and Medication Risks

Epidural steroid injections deliver anti-inflammatory medication directly into the space around the spinal cord. Doctors perform these injections to reduce inflammation around pinched spinal nerves. Consequently, patients often experience temporary relief from leg or lower back pain.

However, the specific drug selected for the procedure plays a vital role in patient safety. Physicians typically choose between particulate and non-particulate corticosteroids. Particulate corticosteroids such as triamcinolone acetonide (Kenalog) and methylprednisolone acetate (Depo-Medrol) contain undissolved microscopic crystals. A medical malpractice analysis indicates that these crystals can block small spinal arteries if accidentally injected intra-arterially. In contrast, non-particulate steroids like dexamethasone dissolve completely and carry significantly lower embolic stroke risks.

In addition, clinical guidelines note that repeat epidural steroid injections during a diagnostic phase can be administered within two to six weeks following an initial positive response. Following established treatment timelines helps protect patients from unnecessary procedural risks.

Inside the Landmark $60 Million Nassau County Verdict

A significant Nassau County malpractice lawsuit involved a 65-year-old airport electrical mechanic who sought treatment for lower back pain. The case stemmed from a procedure performed by Dr. Robert Iadevaio at the Pain Institute of Long Island. Minutes after emerging from sedation, the patient suffered a massive spinal cord infarction that caused permanent paraplegia, neurogenic bowel and bladder dysfunction, chronic neuropathic pain, and loss of independence.

During the three-week trial, key evidence came to light regarding the cause of the spinal injury. A case summary published in May 2025 by Gair, Gair, Conason, Rubinowitz, Bloom, Hershenhorn, Steigman & Mackauf detailed how post-injury spinal angiogram imaging revealed an embolic stroke inconsistent with the physician’s official procedural notes. The trial evidence indicated that an incorrect drug prone to arterial occlusion was administered into a spinal artery instead of the intended non-particulate medication.

Also, expert witnesses in interventional neuroradiology and pain management demonstrated that the medical chart could not be reconciled with the physical damage shown on radiological scans. As a result, the jury found that a severe medication error occurred, awarding over $60 million to cover lifelong nursing care, lost earnings, and profound suffering.

How Medication Errors Cause Spinal Cord Infarctions

Spinal cord infarction is a rare but devastating form of stroke that affects the spinal cord. When a physician inadvertently introduces particulate steroids into an artery supplying the spinal cord, the undissolved steroid crystals form microscopic clots. Consequently, blood supply to the delicate nerves of the spinal cord stops instantly.

To prevent this catastrophic outcome, pain management specialists must observe strict standard-of-care guidelines. First, doctors should use live fluoroscopic imaging or contrast dye to confirm exact needle placement before injecting any steroid. Next, physicians should utilize non-particulate steroids like dexamethasone whenever injecting near vulnerable blood vessels. When a practitioner skips these essential verification steps, disastrous complications can happen in seconds.

Epidural Steroid Verdicts and Legal Trends Across the Nation

Medication mistakes during spinal procedures represent a significant area of medical negligence litigation across the United States. For example, a case study detailed a trial in Fredericksburg City Circuit Court where a jury awarded $6.4 million to a 49-year-old man. In that instance, the patient developed instant paralysis after a physician mistakenly injected the particulate steroid Kenalog into an artery during a CT-guided lower back injection.

While catastrophic outcomes produce major trial awards, average compensation figures vary depending on the exact medical context. An academic review of Westlaw Edge malpractice claims published in the Journal of Surgery on March 23, 2023 indicated that plaintiff verdicts for epidural steroid injection lawsuits averaged $476,085. In contrast, plaintiff verdicts averaged $4,530,277 for laminectomy malpractice claims, reflecting the differing levels of surgical complexity and permanent disability typical in those disputes.

Identifying Medical Negligence in Epidural Injections

Not every unfavorable medical outcome stems from legal malpractice. However, clear warning signs suggest that a procedural mistake or improper drug selection took place. Patients and families should evaluate several important factors when investigating potential medical negligence.

Inconsistent Procedural Notes

In many medical errors, the written operative report conflicts with objective medical imaging. For instance, a physician might claim in their records that they used a non-particulate steroid, yet post-injury imaging demonstrates arterial embolization characteristic of heavy particulate crystals.

Failure to Use Radiographic Imaging

Fluoroscopy or CT guidance is standard of care for transforaminal epidural steroid injections, but not required for all epidural steroid injection techniques. Failing to utilize continuous real-time imaging or contrast dye when indicated increases the danger of accidental intravascular injection.

Lack of Informed Consent

Healthcare providers must warn patients about the serious risks associated with spinal injections, including paralysis and stroke. In addition, doctors must explain safer medication alternatives. When a doctor fails to provide this crucial information, the patient is deprived of making an informed healthcare decision.

Navigating New York Medical Malpractice Laws

If you or a loved one suffered paralysis or severe nerve damage following an epidural injection in New York, understanding your legal rights is essential. New York law provides strong protections for injured patients, but strict legal deadlines apply.

Under Civil Practice Law and Rules Section 214-a, the standard statute of limitations for medical malpractice in New York is two and a half years (30 months) from the date of the negligent act or from the end of continuous treatment for the same condition. Missing this legal deadline can permanently bar an injured person from seeking financial compensation.

Also, proving medical negligence requires thorough investigation. An experienced legal team must review hospital records, cross-examine medical charts, analyze diagnostic scans, and consult board-certified medical experts. These comprehensive steps help establish how standard care protocols were breached and demonstrate the full financial and physical impact on the victim’s life.

Steps to Take After a Severe Injection Complication

If a routine medical procedure results in sudden paralysis or severe neurological impairment, taking immediate structured steps can protect your health and your legal rights.

First, request complete physical copies of all medical records, including procedural notes, nursing logs, and diagnostic imaging scans. Having these documents immediately prevents lost records or subsequent alterations.

Second, seek an independent medical evaluation from an uninvolved neurologist or spinal specialist. Obtaining an objective clinical diagnosis ensures you receive proper ongoing rehabilitation and establishes a clear timeline of your injuries.

Third, consult an experienced personal injury attorney who specializes in complex medical malpractice cases. A dedicated lawyer can review your records, consult medical experts, and guide your family toward financial security and legal justice.

Sources

• Journal of Medical Malpractice Litigation Review, Table 4: Plaintiff Verdict Averages in Spinal Injury Malpractice Claims
• New York Department of Financial Services, External Appeal Case No. 202101-134171