Every hospital in America has a critical-results policy. When a scan reveals something dangerous, the finding gets escalated urgently, personally, in a way that cannot fall through the cracks. Hospitals write these rules because they know a missed handoff kills as surely as a missed diagnosis.
In June, a jury in Aroostook County, Maine’s northernmost, most rural county, returned $23.1 million in what plaintiff’s counsel reports is the largest non-death medical malpractice verdict in the state’s history. The reason should unsettle every hospital administrator who believes a policy binder is the same thing as a safety system.
In December 2020, Robert Giordano, a 40-year-old from Madawaska, went to his local emergency room after a fall. A CT scan was performed. On it, according to trial evidence, was a bony growth invading his spinal canal, precisely the kind of finding the hospital’s own protocol required to be flagged and escalated. The radiologist missed it. The escalation never happened. The scan went into the file, and Mr. Giordano went home with a time bomb in his spine.
Over the next six weeks, his symptoms worsened. When he told his primary care provider he was in escalating pain and fell every time he stood up, the word that went into his chart was “malingering,” faking it, angling for opioids. The next day, he called 911. He was paralyzed from the chest down. He will not walk again.
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Two failures. Each carries a lesson that reaches far beyond northern Maine.
The first is this: A safety policy that isn’t enforced is worse than no policy at all, because it proves the hospital knew exactly what safe care required. The jury didn’t need dueling experts to define some abstract national standard. The standard was in the hospital’s own manual. Hospitals write these protocols after sentinel events, accreditation reviews, and lawsuits, and then treat compliance as an annual audit checkbox instead of a live process. The gap between the policy shelf and the radiology reading room is where patients like Robert Giordano fall.
The second failure is cultural, and it is epidemic: the reflex to disbelieve patients in pain. The opioid crisis made clinicians appropriately cautious about prescribing. Somewhere along the way, caution curdled into a habit of treating reported pain as a credibility problem instead of a clinical data point. A man who says he falls down every time he stands up is not describing drug-seeking behavior. He is describing progressive spinal cord compression, textbook material, and the image proving it was already in his record. No one connected the two, because the diagnosis had effectively been made and then lost.
Some will read $23.1 million and reach for the familiar language of jackpot justice. Consider what the number represents: a 40-year-old man facing four or five decades of paralysis, attendant care, home modification, lost earnings, and everything else that follows when the chest-down half of a body stops working. Thirteen experts testified across two weeks of trial. The jury needed roughly three hours. And here is the detail the tort-reform lobby will not mention. This verdict stands whole for one reason: Robert Giordano lived. Months earlier, a Maine judge cut a $25 million wrongful-death verdict to $15 million under the caps in the state’s Wrongful Death Act. Under the caps that industry keeps lobbying for, the worse the outcome, the less the wrongdoer pays.
When rural jurors in Maine and, the same month, rural jurors in Georgia return eight-figure verdicts in cases about ignored warnings, the story is not runaway juries. It is that ordinary people, shown the whole record, recognize a preventable catastrophe when they see one.
The fixes are known. Radiology groups can and do run double-read and AI-assisted safety nets for spine-threatening findings. Critical-results compliance can be audited in real time, not annually. And every clinician can adopt one simple discipline: Before attributing worsening symptoms to a character flaw, re-read the imaging already in the chart. Belief is not a controlled substance. It costs nothing to dispense.
Hospitals like to say patient safety is their first priority. The policies they write prove they know how. Verdicts like this one measure the distance between the two, in this case, $23.1 million and a man’s legs.
Nicole Kruegel is a medical malpractice attorney.
