Daniel E. Holloway
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Emory Brain Health Center complaint alleges Botox dose increases and unguided injections before loss of swallowing

The complaint alleges that a physician at Emory Brain Health Center treated a patient’s essential tremor and cervical dystonia with Botox injections, increasing the dose from 100 units to 300 units over about ten months. The first and last rounds of injections were given without EMG or ultrasound guidance. Ten days after the 300-unit injections the patient arrived by EMS at the Phoebe Putney Memorial Hospital emergency department with difficulty swallowing and breathing and was admitted.

System
Emory Healthcare
Facility
Emory Brain Health Center
Providers involved
Emory Healthcare, Inc. / The Emory Clinic, Inc. / Emory Brain Health Center / Christopher Caughman, M.D. / Phoebe Putney Memorial Hospital
Pattern
Alleged escalation of Botox dosing for tremor and cervical dystonia, with injections given without EMG or ultrasound guidance
Harm
Alleged difficulty swallowing and breathing, emergency hospital admission, and placement of a PEG feeding tube

Overview

This page concerns a public complaint alleging that a physician at Emory Brain Health Center increased a patient’s Botox dosing and injected without EMG or ultrasound guidance before she lost the ability to swallow.

Chronology

The complaint alleges as follows:

  1. The patient presented to the Emory Brain Health Center movement disorders clinic on July 3, 2023 with tremors and head tilting, and Dr. Caughman diagnosed essential tremor and cervical dystonia.
  2. On September 8, 2023 Dr. Caughman administered injections totaling 100 units of Botox without using EMG or ultrasound guidance.
  3. At a telemedicine follow-up on November 2, 2023 the patient reported that the injections helped the tremor but caused weakness, and Dr. Caughman increased the next dose to 200 units.
  4. Dr. Caughman administered 200 units of Botox with EMG guidance on December 15, 2023 and again on March 29, 2024, then increased the next dose to 300 units.
  5. On July 10, 2024 Dr. Caughman administered 300 units of Botox without EMG or ultrasound guidance and noted a plan to increase to 400 units at the next visit.
  6. The patient arrived by EMS at the Phoebe Putney Memorial Hospital emergency department on July 20, 2024 with dysphagia and dyspnea and required placement of a PEG tube because she could not swallow.

Alleged failures

The complaint alleges the following failures:

  • The complaint alleges that Dr. Caughman breached the standard of care by increasing the amount of Botox in a manner inconsistent with accepted medical standards and safe clinical practice.
  • He failed to properly use EMG or ultrasound guidance during the July 10, 2024 injections into the patient’s deep cervical muscles.
  • The complaint alleges that Emory Healthcare, Inc. and The Emory Clinic, Inc. are vicariously liable for the acts and omissions of Dr. Caughman as their agent or employee.
  • The complaint states that an expert affidavit under O.C.G.A. § 9-11-9.1 is attached.

Entities and tags

Emory Healthcare, Inc.The Emory Clinic, Inc.Emory Brain Health CenterChristopher Caughman, M.D.Botox injectionsEssential tremorCervical dystoniaEMG guidanceDysphagiaPEG tubePhoebe Putney Memorial HospitalDeKalb CountyMedication errorSurgical errorNeurologyMovement disordersOutpatient care