Legal Review & Commentary: Perforation found during surgery causes settlement
Perforation found during surgery causes settlement
By Jan J. Gorrie, Esq., and Blake Delaney, Summer Associate
Buchanan Ingersoll PC,
Tampa, FL
News: A woman underwent surgery to remove her gallbladder. During the procedure, the surgeon noticed a hole in the patient’s intestine, which he immediately repaired. However, he completed the surgery without examining the rest of the intestine.
After the procedure, the woman exhibited symptoms of an abdominal infection. Doctors reopened the woman’s abdomen and discovered a second perforation that had caused intestinal contents to leak into her abdominal cavity. Although they attempted to repair the hole, the delay had irreversibly exacerbated the woman’s condition and she died.
Upon filing a lawsuit for medical malpractice, the patient’s estate settled with the surgeon for $1.75 million and with the hospital for $350,000.
Background: The 67-year-old woman with a history of abdominal surgery required a cholecystectomy to remove her gallbladder. The attending surgeon decided to perform a laparoscopic cholecystectomy, a newer technique using several small incisions and a small, thin tube with a scope on its tip to see inside the patient.
During the surgery, however, the surgeon experienced difficulty. He altered the surgical method to the traditional open cholecystectomy, whereby he removed the woman’s gallbladder through a 5-inch to 8-inch long incision in her abdomen, stretching from below her ribs to just below her waist. During the procedure, the surgeon happened noticed a hole in the patient’s intestine, which he immediately repaired.
After the cholecystectomy, the patient was septic and hypotensive. Doctors scheduled a second surgery to examine the woman’s abdominal cavity. This second procedure, performed 36 hours after the cholecystectomy, revealed another hole in the patient’s intestine, through which intestinal contents had leaked into her abdomen, causing massive contamination. Although the doctors attempted to repair the second perforation, she died soon afterward from abdominal infection.
After the patient’s estate filed suit alleging negligence against the surgeon, the surgeon’s professional association, and the hospital, the parties reached a settlement agreement. The surgeon agreed to pay the plaintiff $1.75 million, and the hospital contributed an additional $350,000.
What this means to you: "There are several risk concerns to consider in this case. Given the patient’s previous history of abdominal surgery, she had an increased risk for tissue scarring and adhesions. Laparoscopic procedure may not have been the optimal method for this patient, which placed her at increased risk for injury that unfortunately occurred. This is of course a physician judgment call and hopefully the surgeon discussed this with the patient during the informed consent process. As each patient is individual, so are the surgical risks. It’s not one size fits all. What may not be a risk for one patient may be a significant risk for another. Risk managers should include this as part of their education on informed consent," notes Patti L. Ellis, RN, BSN, LHRM, CPHRM, corporate risk manager at Pediatrix-Obstetrix in Sunrise, FL.
"Perforation is a well-recognized risk of laparoscopic surgery and the most likely cause of this patient’s intestinal injuries. Unfortunately, had the surgeon taken the time to fully examine the entire intestine, the complications that ensued including the need to take the patient back to surgery to repair the other hole may have been avoided and changed the outcome for this patient," she states.
"What we don’t know from the facts of the case provided are the reasons for the 36-hour delay in returning the patient to surgery, and so we don’t know whether it was related to patient monitoring, surgeon availability, or operating room availability. However, given allocation of damages, it is more likely than not that the hospital was somewhat at fault. Patient monitoring and delays in care and treatment are common causes of malpractice litigation and should be part of your risk management education. Case study presentations and evidence based risk assessments are very effective ways to educate and communicate this to your hospital and medical staff," explains Ellis.
"While we don’t know whether there was a claim for negligent credentialing, the risk manager plays a valuable role in reducing these types of risks to their organization by ensuring that there are established written policies and procedures for the credentialing process. Part of that includes delineation of privileges, which identifies the surgeon’s qualifications and competence in performing specific types of procedures and should be reviewed at the time of medical staff appointment and reappointment," she notes.
"This case sounds like Murphy’s Law. Everything that could go wrong did go wrong. While liability rested mainly with the surgeon, it was prudent to settle this case rather than run the risk of a more costly jury verdict," notes Ellis.
A woman underwent surgery to remove her gallbladder. During the procedure, the surgeon noticed a hole in the patients intestine, which he immediately repaired. However, he completed the surgery without examining the rest of the intestine. After the procedure, the woman exhibited symptoms of an abdominal infection. Doctors reopened the womans abdomen and discovered a second perforation that had caused intestinal contents to leak into her abdominal cavity. Although they attempted to repair the hole, the delay had irreversibly exacerbated the womans condition and she died.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.