An IV needle may have caused the nerve injuries to a patient's wrist, but neither the nurse who inserted the IV nor the hospital she worked at are liable for the damage, according to a Texas appeals court.

The patient alleged that an initial IV start caused nerve injuries she sustained to her wrist. A doctor's expert report supported that claim, but his failure to define an appropriate standard of care or specifically implicate any of the individuals named in the suit led to its eventual dismissal.

While a patient at Laredo Medical Center in March 2008, Evangelina Gonzalez claimed, an attempt to insert an IV needle into her left wrist resulted in the development of a neuroma in the wrist's radial nerve. Surgery to excise the neuroma was eventually required, in addition to physical therapy and medication for neuropathic pain. Ms. Gonzalez subsequently sued the center, one of its physicians and 2 employees for medical negligence in the insertion of the IV needle.

Lowery Thompson, MD, authored an expert report claiming that the sensory branch of Ms. Gonzalez's left radial nerve was damaged by the first insertion of the intravenous catheter. In the report, Dr. Thompson concluded that the injury led to neuroma, and that initial efforts at physical therapy didn't resolve the pain that resulted from this injury, according to court documents.

Dr. Thompson did not identify who performed the initial IV insertion, however, and didn't attempt "to state the applicable standard of care, how any defendant failed to meet that standard, or even if a failure in the standard of care occurred," court records indicate. Based on those omissions, the appeals court found the report to be "legally defective," and was compelled to reverse a trial court's earlier order denying the motion to dismiss the case.

Attorneys for Laredo Medical Center and Ms. Gonzalez did not respond to requests for comment.

Mark McGraw