Posted by Bill Sandweg on 12 December 2018.
There is a lesson to be learned from every medical malpractice verdict. A recent verdict in New York City is no exception.
A 43 year old wife and mother of three underwent what should have been a minor procedure to remove a polyp from her colon. The polyp was burned off using an electric cautery device. Although he did not know it at the time, the surgeon burned a hole in the patient’s small bowel. The hole allowed bowel contents to escape into the body. Infection is almost always the result and that is just what happened here.
I frequently see cases in which there is an accidental injury to the bowel. It occurs most often in laparoscopic surgery where the surgeon does not have the same ability to see the operative field as he or she does in an open surgical procedure. Usually it is not medical malpractice to cause an accidental injury during one of these procedures. An accidental bowel injury is a risk of the procedure. However, because it is a known risk of the procedure, the surgeon must be careful at the end of the procedure to inspect the area and look for evidence of a bowel injury. Even then the surgeon may not find the bowel injury and may send the patient home with bowel contents leaking into the abdominal cavity.
Because patients can be sent home with bowel injuries even when the surgeon has been careful during the procedure and even when there was no evidence of an injury during the end-of-surgery inspection, the surgeon must be alert for post-operative complications that could be the result of a bowel injury.
The patient here was in excruciating pain for days after the surgery and had to take lots of pain medication. Although the newspaper story does not mention it, it is almost certain that her vital signs and lab values were abnormal. These are red flags that should have caused the surgeon to order tests for possible bowel injury. However, it was not until four days later that the surgeon ordered a CT scan of the abdomen which revealed the likely bowel injury. Although the surgeon took the patient back for immediate, emergency surgery, the infection had progressed so far that she could not be saved.
The jury deliberated for less than a day before awarding $3M to each of the three children, whose ages were from 17 to 13, and $7M to the husband.
So what are the lessons to be learned here? The first and most important is that the patient and the patient’s family must also be alert for the possibility of an unrecognized bowel injury following laparoscopic surgery in the abdominal area. They should be alert for unexpectedly severe pain that does not go away. If severe, unrelenting pain is present or there are any other signs of infection, they need to be proactive in insisting that something is wrong. Don’t let yourself be put off with the reassurance that severe pain following these procedures is normal. It is not. Keep after the doctor and the doctor’s staff until something is done to rule in or rule out the presence of a bowel injury.
Bowel injuries produce infections. If the infection is caught in time, all will be well. On the other hand, if the infection is allowed to persist, it will enter the bloodstream and overwhelm the body’s ability to fight it. When that happens, blood pressures crash and organs fail. This is called septic shock. Many patients, like the poor lady here, cannot recover from it.
Be alert. Be proactive. Don’t accept every reassurance, especially if you think something is wrong.