This case involves a patient who presented to the emergency room with cauda equina syndrome. There was one neurosurgeon on-call, but the physician did not report to the hospital for over 24 hours after being informed of the patient’s condition. Upon his arrival, the physician did not order an MRI or any other immediate treatment. The ER did not have MRI facilities on site on weekends, and no arrangements were made for the patient to undergo imaging elsewhere. The patient ultimately underwent surgery four days later at a different institution, well after the optimal window of treatment for patients with cauda equina syndrome had passed. An expert in neurosurgery is required to help determine whether there was a deviation from the standard of care.