Jury Faults Penn Medicine Doctor for Missing Spinal Fistula for Four Years, Reduced to $18.49 Million

A Philadelphia Court of Common Pleas jury returned a verdict of $19,665,000 in September 2022 against a Penn Medicine primary care physician and his practice group, Clinical Care Associates of the University of Pennsylvania Health System. Because the jury assigned the patient 6 percent of the fault, the judgment was molded to $18,485,000. The Legal Intelligencer reported it as the largest state-court medical malpractice verdict in Pennsylvania in 2022.

The patient, Melendez, first reported mid-back pain and tingling around her ribcage in 2012. Over the next several years she came back with fatigue and back pain, then with tingling in her right foot, then with bilateral knee pain and more pronounced tingling in late 2016. Her primary care physician, Dr. Gyi Mo, did not refer her to a neurologist when the symptoms began and did not order radiological testing until years later. She was not seen by a neurologist until January 2017, and the fistula was diagnosed early that year.

The underlying condition was a spinal dural arteriovenous fistula, an abnormal connection between blood vessels that can be treated when it is caught early. It was not caught early. After surgery, Melendez was left an incomplete paraplegic. She has bowel dysfunction and incontinence, cannot walk without a walker, falls regularly, and needs help with most activities of daily living.

The case was tried before Judge Craig Levin, with Thomas Bosworth of Kline & Specter representing the plaintiff. At trial, Dr. Mo said that chart entries recording findings of a serious condition were typing errors, and that he had advised anti-inflammatory medication, stretching and rest rather than further testing. The jury rejected that account and found him 94 percent negligent, pointing to the failure to order imaging sooner and to refer her to a neurologist when she first reported symptoms. It put the remaining 6 percent on Melendez for slow follow-up on referrals, which accounts for the reduction from the original figure.

The defendants appealed to the Pennsylvania Superior Court, arguing in part that plaintiff's counsel had repeatedly referred to Melendez's termination from the Hospital of the University of Pennsylvania to inflame the jury. The trial judge had called that conduct deplorable. On September 11, 2026, the Superior Court affirmed the judgment in full, holding the defendants had forfeited the argument by not seeking a mistrial at the time or otherwise preserving the issue.