A Huntington Beach neurosurgeon received a public reprimand from the Medical Board of California for her treatment of a man who complained of neck and shoulder pain with loss of strength in his arm.
According to the acceptance letter signed by Menoni and her attorney Jason E. Gallegos in February, the following account from the medical board investigation is true.
A physical examination performed in July 2010 at Desert Regional Medical Center (DRMC) in Palm Springs indicated the patient, identified only as R.G., suffered posterior cervical tenderness or back and neck pain. Though no comprehensive neurological exam was done at the time, Menoni presumed R.G. had suffered a stroke-like attack.
A computed tomography (CT) scan on R.G.’s head documented bilateral upper extremity weakness, multi-level degenerative disease and spine pain from spine root narrowing. Magnetic resonance imaging (MRI) and magnetic resonance angiogram (MRA) tests were also performed on the patient.
A handwritten note from a couple days after the initial visit indicated that Menoni had consulted with another physician and both co-signed the note that documented R.G.’s pain levels, physical history and reason for the consultation. The note indicated the MRI findings concerning the cervical spine, but it did not state whether a fall or other recent trauma was behind R.G.’s pain.
The record for a second visit by R.G. in July 2010 showed that he also complained additionally of leg weakness and trouble walking. No indication was made that surgery was discussed with the patient.
A handwritten note from the day following indicated R.G. was being treated for spinal cord swelling, but nothing was noted about him or his family being told of possible risks and complications from surgery or whether there were alternative treatments.
A pre-operative note from Aug. 1, 2010, indicated R.G. had a history of acute-chronic cervical stenosis (the spine root narrowing) post fall with cord contusion and marked weakness in bilateral upper extremities. But a fall and radiographic findings of acute stenosis had never before been noted in R.G.’s record, the board found.
A post-operative report stated Menoni had talked with R.G. and his family on July 31, 2010, about risks and complications from surgery but, according to the medical board, not all the adverse possibilities were listed. Menoni documented that there were no complications or unanticipated events during surgery.
However, R.G. was worse, not better, after surgery. Menoni blamed anesthesia for the patient having problems moving his neck. He also had pain in all of his extremities. A lumbar drain provided no relief.
Testing the following day indicated R.G. required a tube in his body and that he suffered from minimal movement in all four extremities. The record shows that R.G. and his family were told of possible risks and complications from a second surgery performed on his spine on Aug. 3, 2010, but the medical board says nothing indicates when this actually occurred, and the patient had no memory of such a conversation.
Menoni, with her attorney present, acknowledged in a March 16, 2016, interview that performing a surgery when a patient’s condition is worsening can result in a worse outcome.
The board found the treatment was grossly negligent in that no regard is shown for considering whether the surgery should have been performed, that nothing shows possible risks were fully laid out for the patient and his family, that a complication was falsely blamed on anesthesia and that results from R.G.’s history and exams were not appropriately considered. Menoni also committed repeated negligent acts with R.G.’s care and failed to maintain adequate and accurate records, according to the board.
As part of the public reprimand to Menoni’s license, she must complete a medical records course. Failure to comply could lead to additional board discipline.