Showing posts with label preforation. Show all posts
Showing posts with label preforation. Show all posts
Monday, April 07, 2014
Thursday, January 26, 2012
Texas Jury Orders Kelsey-Seybold to Pay $1.9 Million for "Secret" Surgeon
Texas Jury Orders Kelsey-Seybold to Pay $1.9 Million for "Secret" Surgeon
Attorneys Randy Sorrels and Chelsie King Garza of Abraham, Watkins, Nichols, Sorrels, Agosto & Friend recently received a $1.9 million verdict from a Texas jury for a medical malpractice client.
HOUSTON, TX, January 24, 2012 /24-7PressRelease/ -- On Friday, January 20, 2012, a Harris County jury ordered Kelsey-Seybold Medical Clinic, PLLC, and its employee, Jim Patrick Benge, MD, to pay $1.9 million for permanently injuring Lauren Williams for her past and future damages, including a lifetime of colostomy care and medications.
In August 2008, Ms. Williams had a hysterectomy understanding that Dr. Benge would be her surgeon. After she went under anesthesia, a resident came in and performed at least 50 percent of the surgery without the patient's knowledge. This was the first time the resident had performed the procedure. "The jury rejected Kelsey Seybold's position that an unknown resident can perform surgery on a patient without full disclosure to the patient," said Williams' attorney Randall O. Sorrels.
During that August 2008 surgery, two of Ms. Williams' organs, including her bowel, were perforated. The injuries were not discovered until three days later at which point Ms. Williams was septic and her injuries were irreversible. Ms. Williams spent three weeks in a coma as a result, and thereafter spent months re-learning to walk, talk and care for herself. Ms. Williams now lives with a permanent colostomy and testimony was presented that she will be an intestinal cripple as she grows older, due to the dense internal adhesions resulting from gastrointestinal damage. She has undergone five major surgeries following the August 26, 2008 procedure.
Dr. Benge, his colleague Dr. Thornton (a co-defendant who was not found liable for her role in Ms. Williams' post-operative care), and the experts for Kelsey-Seybold offered testimony that a patient does not have the right to know when a resident would be operating on them or cutting inside their bodies. By virtue of this medical malpractice verdict, a Harris County jury has rejected this as the standard of care. "When a doctor agrees to perform surgery on a patient, it should be that surgeon who operates, unless the patient agrees otherwise," said Williams' lawyer Chelsie King Garza.
For further information, please contact attorney Randall O. Sorrels or attorney Chelsie King Garza by calling 713-222-7211 or via email at rsorrels@abrahamwatkins.com and cgarza@abrahamwatkins.com. Ms. Williams is available for comment upon request.
Attorneys Randall O. Sorrels and Chelsie King Garza are attorneys at the Houston law firm of Abraham, Watkins, Nichols, Sorrels, Agosto & Friend. Since 1951, the firm has advocated for the rights of thousands of catastrophically injured clients in cases involving car and truck accidents, work-related injuries, medical malpractice, defective products, aviation accidents and other types of personal injury matters. For more information on the firm, visit their website at www.abrahamwatkins.com.
http://world.einnews.com/247pr/258879
Attorneys Randy Sorrels and Chelsie King Garza of Abraham, Watkins, Nichols, Sorrels, Agosto & Friend recently received a $1.9 million verdict from a Texas jury for a medical malpractice client.
HOUSTON, TX, January 24, 2012 /24-7PressRelease/ -- On Friday, January 20, 2012, a Harris County jury ordered Kelsey-Seybold Medical Clinic, PLLC, and its employee, Jim Patrick Benge, MD, to pay $1.9 million for permanently injuring Lauren Williams for her past and future damages, including a lifetime of colostomy care and medications.
In August 2008, Ms. Williams had a hysterectomy understanding that Dr. Benge would be her surgeon. After she went under anesthesia, a resident came in and performed at least 50 percent of the surgery without the patient's knowledge. This was the first time the resident had performed the procedure. "The jury rejected Kelsey Seybold's position that an unknown resident can perform surgery on a patient without full disclosure to the patient," said Williams' attorney Randall O. Sorrels.
During that August 2008 surgery, two of Ms. Williams' organs, including her bowel, were perforated. The injuries were not discovered until three days later at which point Ms. Williams was septic and her injuries were irreversible. Ms. Williams spent three weeks in a coma as a result, and thereafter spent months re-learning to walk, talk and care for herself. Ms. Williams now lives with a permanent colostomy and testimony was presented that she will be an intestinal cripple as she grows older, due to the dense internal adhesions resulting from gastrointestinal damage. She has undergone five major surgeries following the August 26, 2008 procedure.
Dr. Benge, his colleague Dr. Thornton (a co-defendant who was not found liable for her role in Ms. Williams' post-operative care), and the experts for Kelsey-Seybold offered testimony that a patient does not have the right to know when a resident would be operating on them or cutting inside their bodies. By virtue of this medical malpractice verdict, a Harris County jury has rejected this as the standard of care. "When a doctor agrees to perform surgery on a patient, it should be that surgeon who operates, unless the patient agrees otherwise," said Williams' lawyer Chelsie King Garza.
For further information, please contact attorney Randall O. Sorrels or attorney Chelsie King Garza by calling 713-222-7211 or via email at rsorrels@abrahamwatkins.com and cgarza@abrahamwatkins.com. Ms. Williams is available for comment upon request.
Attorneys Randall O. Sorrels and Chelsie King Garza are attorneys at the Houston law firm of Abraham, Watkins, Nichols, Sorrels, Agosto & Friend. Since 1951, the firm has advocated for the rights of thousands of catastrophically injured clients in cases involving car and truck accidents, work-related injuries, medical malpractice, defective products, aviation accidents and other types of personal injury matters. For more information on the firm, visit their website at www.abrahamwatkins.com.
http://world.einnews.com/247pr/258879
Thursday, June 30, 2011
PATTEN v. GAYLE Trocar Injury
PATTEN v. GAYLE
CHARLOTTE M. PATTEN, ET AL., Plaintiff-Appellant,v.CHRISTOPHER GAYLE, M.D., Defendant-Appellee.
No. 46,453-CA.
Court of Appeals of Louisiana, Second Circuit.
June 22, 2011.
NELSON & HAMMONS, A Professional Law Corporation, John L. Hammons, James Paul Lambert, Annis Cornell Flournoy, Counsel for Appellant.
WATSON, BLANCHE, WILSON & POSNER, Peter T. Dazzio, Garrett S. Callaway, Counsel for Appellee.
Before GASKINS, PEATROSS and DREW, JJ.
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DREW, J.:
The primary issue is whether the jury erred in finding the doctor's negligence during surgery did not cause any injury to the patient. Charlotte Patten and her husband, Rodney L. Patten, appeal the judgment rejecting their demands and dismissing the action with prejudice. They also seek review of the trial court's denial of their motion for judgment notwithstanding the verdict ("JNOV"). For the reasons discussed herein, the judgment1 is reversed in part and affirmed in part and rendered, awarding plaintiffs a portion of the damages sought.
FACTUAL AND PROCEDURAL BACKGROUND
Charlotte Patten became a patient of Dr. Christopher Gayle, an OB-GYN at Willis-Knighton Pierremont, in 1997 when Dr. Gayle performed a total abdominal hysterectomy, leaving her ovaries in place. In early 2001, Mrs. Patten began suffering from pain in her lower right abdomen which Dr. Gayle suspected was a cystic lesion on her right ovary. On August 14, 2001, at Willis-Knighton Pierremont, Mrs. Patten was admitted for laparoscopic2 evaluation and possible removal of her ovaries.
Dr. Gayle, assisted by Dr. Mary Taylor, began the procedure by inflating the abdominal cavity with carbon dioxide in order to create space between the abdominal wall and internal organs. Once the cavity was inflated, Dr. Gayle inserted an operative trocar3 through the umbilicus.
The operative trocar blade is covered with a protective sheath. When the doctor applies pressure to the trocar, the blade is unsheathed, allowing the trocar to penetrate the skin, muscle, and fascia. Once the trocar encounters "empty space" in the body cavity, the sheath re-covers the blades and locks in place. Since the initial trocar insertion is performed blind, most laparoscopic injuries occur during this part of the procedure.4 In this case, Dr. Gayle inserted the first trocar without complication.
After removing the blade from the trocar tube, Dr. Gayle inserted a laparoscope into this first trocar to allow him to see the inside of the abdominal cavity. Dr. Gayle noted adhesions of the small bowel to the abdominal wall. Because he was unable to determine whether he would be able to proceed laparoscopically, Dr. Gayle intended to insert a second trocar so he could better visualize the ovaries and abdominal cavity.
After using the laparoscope in the first trocar to find an area that was free of adhesions, Dr. Gayle testified he tried to angle the second trocar so it would enter the abdominal cavity in a particular direction. The second trocar unexpectedly entered the patient's abdomen. The doctor claimed the amount of force he applied should not have been sufficient for the trocar to enter the abdomen. The second trocar entered the abdomen in a different direction than Dr. Gayle intended and came out near a bowel adhesion.
Although Dr. Gayle could see the tip of the trocar, he could not determine whether the trocar had penetrated or avoided the bowel. Dr. Gayle left the second trocar tube in place but removed the blade. He then inserted a third trocar (without incident) and placed the laparoscope into the third trocar to evaluate the bowel. Dr. Gayle observed no bleeding or bowel content but was still unable to determine whether the bowel had been punctured.
Dr. Gayle decided he needed to open the patient's abdomen because there were numerous adhesions of the bowel to the abdominal wall. The doctor also concluded that the right ovary, which was cystic and densely adhered to the pelvic wall, needed to be removed, a procedure that could not be performed laparoscopically. Finally, he was still concerned about the possibility of bowel injury by the second trocar.
After making a Pfannenstiel incision5 and lysing6 some of the adhesions of the bowel from the abdominal wall, Dr. Gayle saw the second trocar had penetrated Mrs. Patten's small bowel "through and through." Dr. Gayle brought approximately 20 inches of bowel out of the abdominal cavity and called for Dr. Craig Bozeman, a general surgeon, to perform emergency surgery to remove the trocar7 and repair the bowel.8
Dr. Bozeman decided to connect the two holes to facilitate the surgical repair. He did so by cutting across the circumference of the bowel between the two holes. After sewing up the bowel, Dr. Bozeman "ran the bowel"9 to inspect it and found the repair was effective (not leaking) and that no further injuries could be seen. Dr. Gayle and Dr. Taylor then finished the surgery by removing Mrs. Patten's right ovary, placing the bowel back inside the abdomen and closing the incisions.
After the operation, Mrs. Patten was kept under observation by Dr. Bozeman to ensure her bowel was causing no further problems. Over the next few days, she showed some signs of improvement in her gastrointestinal functions but also had indications of trouble, most notably swelling. Five days after the operation, Mrs. Patten was examined by Dr. Schwalke, who was on call for Dr. Bozeman. That morning, Mrs. Patten's abdomen was distended. Later that day, feculent material began exuding from her incision.
Dr. Schwalke performed emergency exploratory surgery, which required him not only to reopen her horizontal incision but to make a vertical "midline" incision up to the sternum. He discovered a 3mm perforation of the bowel two inches from where the bowel had been repaired by Dr. Bozeman five days earlier. Also, approximately three liters of feculent material was in Mrs. Patten's abdominal cavity, necessitating extensive cleaning and drainage.
As a result of the feculent material having leaked into her abdominal cavity, Mrs. Patten developed peritonitis (an abdominal infection) and pneumonia. She was hospitalized until August 30. Mrs. Patten has subsequently suffered from abscesses (some of which ruptured) and herniating of her incisions, both of which have required further surgeries, and additional medical problems.
On June 6, 2002, Mrs. Patten and her husband filed a petition for a medical review panel against Dr. Gayle, Dr. Taylor, and Dr. Bozeman. The Pattens alleged negligence against the three doctors with respect to the August 14 surgery performed by Dr. Gayle and Dr. Taylor, in which Mrs. Patten's bowel was penetrated by a trocar, and Dr. Bozeman's emergency surgical repair.
The medical review panel (composed of Dr. Daniel Carroll, Dr. Edwin Byrd, and Dr. Timothy Hart) ruled that the evidence did not support the conclusion that Dr. Gayle, Dr. Taylor, or Dr. Bozeman failed to meet the applicable standards of care. Specifically, the panel found no evidence indicating the perforation discovered by Dr. Schwalke was present on August 14 and missed by Dr. Bozeman during his repair. The panel concluded that this perforation was most likely the result of undetectable microvascular damage that was unrelated to the trocar injury. Further, the panel opined that Dr. Gayle did not "lose control" of the trocar because there are many factors10 outside of the surgeon's control that can affect the passage of the trocar through the abdomen.11
On February 6, 2004, Mrs. Patten, together with her husband, filed a medical malpractice suit against Dr. Gayle.12 Following a four-day jury trial on the merits in May 2010, the jury returned a verdict that Dr. Gayle had deviated from the applicable standard of care and had committed malpractice.13 The jury, however, found Dr. Gayle's negligence had not caused any injury that would otherwise not have been incurred by Mrs. Patten. Finding a lack of causation, the jury awarded no damages to Mrs. Patten or her husband. At the request of counsel, the jury was polled, revealing the jury was split 10-2.
Following entry of the judgment denying plaintiffs' recovery and dismissing the action at their cost, Mrs. Patten and her husband moved for a JNOV, arguing the jury's finding that Dr. Gayle's negligence caused no injuries was manifestly erroneous. Following a hearing, the trial court denied the motion, finding the jury's verdict was reasonable, and entered judgment accordingly on August 27, 2010.
Mrs. Patten and her husband appealed, arguing: (1) the jury manifestly erred in finding a lack of causation; (2) the trial judge manifestly erred in denying the motion for JNOV; and (3) the jury erred in failing to award damages.
DISCUSSION
In a medical malpractice action, the plaintiff has the burden of proving: (1) the applicable standard of care, (2) that the standard of care was breached, and (3) that as a proximate result of the breach the plaintiff sustained injuries that would not otherwise have been incurred. La. R.S. 9:2794(A). The third element, causation, is subject to the manifest error standard of review. Lovelace v. Giddens, 31,493 (La. App. 2d Cir. 2/24/99), 740 So.2d 652, writ denied. Under the manifest error standard, an appellate court cannot substitute its own inferences and conclusions about the facts. Johnson v. Morehouse GeneralHosp., 2010-0387 (La. 5/10/11), 2011 WL 1759932; Wooley v. Lucksinger, 2009-0571 (La. 4/1/11), 2011 WL 1205136. Findings of fact cannot be set aside or overturned by the appellate court unless they are clearly wrong. Johnson, supra. Factual conclusions are not clearly wrong when the factfinder chooses a view of the evidence that an appellate court disagrees with as long as the factfinder's view is permissible. Id. Manifest error occurs only when there is "no reasonable factual basis for the [factfinder's] conclusion[.]" Johnson, 2010-0387 at p. 6. In a medical malpractice claim, great deference should be given to the factfinder when medical experts express different opinions relevant to causation. Lovelace, supra.
Initial Trocar Injury
While recognizing that Mrs. Patten suffered injuries, the Medical Review Panel unanimously found that Dr. Gayle was not negligent. In its written reasons, the panel stated there were other factors outside of Dr. Gayle's control that could have caused the second trocar to become misdirected, including scarring of the abdominal wall, defects from her prior surgeries and differences in the degree of sharpness of trocars.
Dr. Robert Zurawin, a board-certified OB-GYN and an associate professor at Baylor Medical School, testified by affidavit, deposition, and at trial on behalf of Mrs. Patten. Disagreeing with the medical review panel, Dr. Zurawin believed Dr. Gayle was negligent. Dr. Zurawin stated the factors mentioned by the review panel were relevant only to a blind trocar insertion. Since Dr. Gayle had already inserted one trocar, he should have been able to see (and thus avoid) any problems inside the abdominal cavity. At trial, Dr. Zurawin testified the trocar must have penetrated bowel that was adhered to the abdominal wall. Otherwise the protective sheath would have covered the blade after entering the abdomen and the through-and-through puncture never would have occurred.
Dr. Zurawin also noted that Dr. Gayle had apparently been holding the second trocar improperly. In his deposition, Dr. Gayle indicated he was not yet holding the second trocar in the proper position when it penetrated the abdomen. Dr. Zurawin testified the way Dr. Gayle was holding the trocar contributed to the trocar penetrating the abdomen without Dr. Gayle intending it to as well as how deep it penetrated. Further, Dr. Zurawin believed the second trocar should never have been inserted because Dr. Gayle should have converted to an open surgery once he saw the numerous, dense adhesions through the laparoscope in the first trocar.
Dr. Gayle admitted the puncture of the bowel by the second trocar was an injury. In his original answer to the complaint, Dr. Gayle stated that Dr. Bozeman was called in for "repair of a bowel injury." Moreover, at trial, Dr. Gayle admitted on cross-examination that Mrs. Patten "was injured and she suffered as a result of that injury[.]" Dr. Gayle claimed that the trocar injury was insignificant as far as the medical malpractice claim was concerned.
Dr. Gayle relied upon the testimony of Dr. Taylor, Dr. Schwalke, and Dr. Byrd, each of whom testified the initial bowel injury from the second trocar was insignificant. Both Dr. Taylor and Dr. Byrd testified the only harm done to Mrs. Patten was having approximately an extra hour of surgery by Dr. Bozeman to repair the bowel. Dr. Schwalke testified similarly, stating the injury was insignificant because it was immediately recognized and repaired and there were no further damages resulting from that injury.
Dr. Gayle also relied upon two consent forms that Mrs. Patten signed prior to the surgery. When obtaining consent from a patient for any treatment or procedure, physicians have a duty to advise the patient of associated risks. Roberts v. Cox, 28,094 (La. App. 2d Cir. 2/28/96), 669 So.2d 633; Broadway v. St. Paul Ins. Co., 22,433 (La. App. 2d Cir. 1991), 582 So.2d 1368. A physician does not have to inform a patient of "every conceivable possibility" but only "those that can reasonably be anticipated." Steinbach v. Barfield, 428 So.2d 915 (La. App. 1st Cir. 1983) (reversed on other grounds); see also, Roberts, supra; Broadway, supra.
A risk of bowel injury was among the risks listed on the consent forms signed by Mrs. Patten. Dr. Hart testified at trial that this risk would include bowel injury due to a misdirected trocar. Dr. Hart also testified, however, that a patient never consents to negligent treatment. This court agrees. Consent forms should not shield physicians and other healthcare providers from liability for injuries caused by their negligence simply because the injuries are a known risk of the procedure. While patients can be held to reasonably anticipate that procedures carry certain risks that may occur without any fault from their physician, patients should also reasonably anticipate a physician will not negligently injure them. Being injured as a result of negligence by one's physician is not a reasonably foreseeable risk of receiving medical treatment.
The through-and-through perforation of Mrs. Patten's bowel was undoubtedly an injury. Downplaying the significance of the injury is a defense to damages but not a defense to the injury actually having occurred. The two consent forms signed by Mrs. Patten do not exonerate Dr. Gayle for negligently injuring her by puncturing her bowel with the second trocar. Therefore, the jury's finding that Dr. Gayle's negligence caused no injury to Mrs. Patten is manifestly erroneous with respect to the trocar's penetration of the bowel. As a result, this court reviews the merits of this issue de novo.
De Novo Review of the Merits — Initial Trocar Injury
Dr. Gayle negligently punctured Mrs. Patten's bowel with a trocar, necessitating the emergency repair by Dr. Bozeman. According to Dr. Gayle, aside from the repair of the punctured bowel, all other surgical steps taken on August 14 would have been required even if there had been no bowel injury.
First, Dr. Gayle stated in his deposition that Mrs. Patten had to be "opened up" in order to remove her ovary. Therefore, the decision to open her abdomen would have been made even if there were no bowel injury. This view was shared by Dr. Taylor. Even Dr. Zurawin agreed, stating in his affidavit that Mrs. Patten should have been opened up after Dr. Gayle viewed Mrs. Patten's numerous abdominal adhesions through the laparoscope in the first trocar.
Second, Dr. Gayle testified the bowel adhesions had to be lysed from the abdominal wall in order to remove the right ovary. Both Dr. Schwalke and Dr. Hart agreed that lysing the adhesions would have been necessary without the trocar injury. Moreover, even had the trocar injury been the sole reason for lysing the bowels, Dr. Zurawin testified that Dr. Gayle did not breach the applicable standard of care by lysing the bowel adhesions to prepare for the surgical repair of the bowel injury by Dr. Bozeman.
Third, Dr. Zurawin stated in his deposition that it is within the applicable standard of care to run the bowel after lysing any bowel adhesions to ensure it has not been injured. Therefore, the bowel would necessarily have been run whether or not the trocar repair was performed.
Fourth, Dr. Gayle stated in his motion in limine to exclude medical expenses that, even without the trocar injury, Mrs. Patten would have stayed in the hospital a few days following the surgery for observation. Dr. Gayle stated this was necessary because having to lyse her bowel adhesions created a possibility of a perforation developing.
In contrast, Dr. Zurawin stated in his affidavit that, but for the trocar injury to the bowel, Mrs. Patten would not have undergone the repair procedure which placed her at a greater risk of a subsequent bowel perforation. However, Dr. Zurawin acknowledged that Dr. Gayle had to open Mrs. Patten up and lyse the bowel adhesions to complete his surgery whether or not there had been a bowel injury.
Aside from the repair of the through-and-through bowel puncture, all other treatments and steps taken (opening her up, lysing the adhesions, etc.) would have been necessary even had there been no bowel injury and therefore were not causally related to Dr. Gayle's negligence. The only injuries Mrs. Patten suffered on August 14, 2001, that were causally connected to Dr. Gayle's negligent handling of the second trocar and would not otherwise have been incurred are: (1) the puncture of the bowel; and (2) the time and expense of Dr. Bozeman repairing the bowel.
Subsequent Perforation
The cause of the subsequent perforation that was discovered by Dr. Schwalke five days after Mrs. Patten's first operation was the primary topic throughout this case. In Dr. Gayle's opinion, this subsequent perforation was most likely the result of a microvascular injury that was undetectable at the time of Dr. Bozeman's repair. The medical review panel had a similar opinion, finding the perforation was unrelated to the initial trocar injury and most likely the result of microvascular damage.
Dr. Zurawin stated in his affidavit that while the cause of the perforation was "not clear," he believed it was most likely caused directly by the second trocar striking a loop of bowel after making its through-and-through puncture. Dr. Hart, Dr. Bozeman, and Dr. Schwalke all testified that the trocar tip could have directly harmed another section of bowel, causing damage that eventually led to the subsequent perforation. Dr. Hart qualified his testimony, stating this scenario was highly unlikely.
Both Dr. Gayle and Dr. Taylor testified the trocar penetrated the abdomen in an area where there was an upside-down "U-shaped" section of bowel hanging from the abdominal wall. Thus, according to the only two people who saw the location of the bowel before Mrs. Patten was opened up, there was no other portion of bowel for the trocar to damage. Assuming the bowel was adhered in this position, Dr. Byrd testified it would have been "spectacular" for the tip of the second trocar to have directly injured another part of the bowel.
Moreover, the bowel was run and inspected by Dr. Bozeman after he repaired the initial puncture. This inspection was done in the presence of both Dr. Gayle and Dr. Taylor. Dr. Bozeman testified he examined a significant portion of the surrounding bowel. The perforation that was found five days later was only two inches from the repair site. Dr. Hart testified it would be almost impossible for Dr. Bozeman, Dr. Gayle, and Dr. Taylor all to have missed any visible injury to the bowel that was only two inches away from the site of the trocar puncture.
In addition, the opinion of the review panel was that the timeline indicated the perforation was not present on August 14. The panel opinion was supported by both Dr. Hart's and Dr. Schwalke's testimony that the perforation likely opened two or three days after Dr. Gayle's operation, based on when Mrs. Patten began having swelling problems and the amount of feculent material found in her abdominal cavity. Dr. Zurawin disagreed, stating in his deposition that a small perforation might have taken five days to manifest and therefore the timeline was not definitive.
In view of all the evidence presented, it seems unlikely the trocar tip directly caused damage to the bowel that led to the subsequent perforation. However, Mrs. Patten also presented evidence of another theory: that the trocar injury indirectly caused the perforation because it led to the bowel sustaining a partial thickness injury14 which ruptured in the days following Dr. Gayle's surgery. This partial thickness injury could have been caused either when the adhesions were lysed from the abdominal wall or when Dr. Bozeman was performing his repair of the initial trocar injury.
Dr. Carroll stated in his deposition that any partial thickness injury caused by Dr. Bozeman repairing and running the bowel should have occurred immediately adjacent to the original injury. Since the perforation was two inches away from the original injury, Dr. Carroll stated it was highly unlikely Dr. Bozeman's repair caused the perforation. Additionally, none of the medical experts who testified believed that either repairing or running the bowel indirectly caused the perforation
Dr. Schwalke testified that the most likely cause of the perforation was a partial thickness injury that occurred when the bowel adhesions were lysed from the abdominal wall. Both Dr. Hart and Dr. Byrd also agreed the cause of the perforation was most likely a partial thickness injury due to lysing adhesions. According to Dr. Gayle, the portion of bowel where the perforation occurred was adhered to the abdominal wall, making it more susceptible to a partial thickness injury. Dr. Bozeman testified that a partial thickness injury is a known risk of having to lyse bowel adhesions.
In his deposition, Dr. Zurawin stated it was within the applicable standard of care for Dr. Gayle to lyse the bowel adhesions. Dr. Zurawin also noted that it was unclear whether Dr. Gayle or Dr. Bozeman lysed the bowel that was two inches away from the trocar injury. Therefore, assuming the lysing of the bowel caused a partial thickness injury, it would be impossible to know to whom to attribute it. Moreover, even if the lysing caused an undetectable injury, Dr. Zurawin testified there would not have been a breach of any standard of care by Dr. Gayle.
The medical experts were in agreement that the bowel adhesions necessarily had to be lysed in order to remove Mrs. Patten's right ovary. Therefore, had no trocar injury ever occurred, the bowel adhesions would nonetheless have been lysed. This possibility was explicitly supported in the deposition testimony of all three members of the medical review panel (Dr. Byrd, Dr. Hart, Dr. Carroll) as well as the trial testimony of both Dr. Schwalke and Dr. Byrd.
Mrs. Patten had to be opened up and her adhesions had to be lysed. The evidence did not show that, more likely than not, the initial trocar injury was either a direct or indirect cause of the subsequent perforation and the resulting peritonitis and pneumonia which kept Mrs. Patten hospitalized until August 30, 2001. As Dr. Zurawin testified, the cause of this perforation is simply not clear "within a reasonable medical probability." Therefore, the jury finding no causation of damages with respect to the subsequent perforation is not manifestly erroneous.
Injuries Suffered by Mrs. Patten Since August 30, 2001
Mrs. Patten has suffered from many medical problems following her release on August 30, 2001, after recovering from peritonitis and pneumonia. She alleges that these subsequent injuries are traceable to Dr. Gayle's negligence. Among the injuries Mrs. Patten has suffered, according to her First Supplemental and Amending Petition:
abscesses . . . excruciating pain and suffering, mental anguish and embarrassment . . . extensive scarring, abdominal adhesions and extensive internal adhesions . . . and repeated surgical procedures[.]
Mrs. Patten also claims hernias of her incisions as an additional injury attributable to Dr. Gayle.
According to Mrs. Patten's own testimony, she had a history of abdominal pain and discomfort ever since the birth of her second child. Her first laparoscopic procedure was performed in 1993. She also had multiple abdominal surgeries performed prior to the surgery on August 14, 2001. As Dr. Zurawin stated in his deposition, the more surgeries a person has, the more likely she is to have bowel adhesions in the future that could lead to the injuries Mrs. Patten has suffered. Mrs. Patten also testified she had off-and-on undergone treatment for depression prior to Dr. Gayle's 2001 surgery.
In the months following the surgeries by Dr. Gayle and Dr. Schwalke, Mrs. Patten was treated by Dr. Bozeman for multiple abscesses of her surgical wounds. In his deposition, Dr. Bozeman stated these abscesses were likely not related to Mrs. Patten's peritonitis but rather a reaction to the sutures used by Dr. Schwalke.
In 2002, Mrs. Patten was treated by Dr. Charles Black for hernias of her incisions. Dr. Black's deposition was read at trial; he was unable to testify in person because he was suffering from health problems and subsequently died. In his deposition, Dr. Black stated that incisional hernias occur around 5% of the time even in the absence of negligence. Dr. Black further stated that, considering Mrs. Patten's history of abdominal surgeries, there was no reason to attribute her hernias in 2002 to either Dr. Gayle's or Dr. Schwalke's surgeries in 2001.
Dr. Dale McGinty treated Mrs. Patten for abdominal adhesions sporadically between 2005 and 2008. In his deposition, Dr. McGinty stated he had no reason to connect those adhesions to Dr. Gayle's surgery. Further, Dr. McGinty stated there was no way to know whether the adhesions he treated were caused by Dr. Gayle's surgery, any of Mrs. Patten's prior or subsequent abdominal surgeries.
Dr. Hart testified that hernias of the midline incision are traceable to Dr. Schwalke's surgery, as this was the first time such an incision had been made on Mrs. Patten. Hernias of any other incisions, though, are not necessarily connected to Dr. Gayle's surgery because any of Mrs. Patten's pre-2001 surgeries could have been the underlying cause.
After sitting on the medical review panel, Dr. Byrd testified in his deposition that it is hypothetically possible none of the injuries Mrs. Patten suffered are causally connected to Dr. Gayle. In other words, even had there been no trocar injury, it is possible that the subsequent bowel perforation would have occurred, that Mrs. Patten would develop an abdominal infection from the material leaking from the perforation, and that all of her hernias, abscesses, and adhesions might have occurred as anticipated risks of the surgeries performed by Dr. Gayle and Dr. Schwalke.
Having failed to show the subsequent perforation of her bowel was causally connected to Dr. Gayle's negligence, Mrs. Patten did not establish that injuries she has suffered since August 30, 2001, were caused by Dr. Gayle. Thus, the jury finding no causation of any damages with respect to Mrs. Patten's medical problems since August 30, 2001, is not manifestly erroneous.
Damages
The only injuries that Mrs. Patten has suffered as a result of Dr. Gayle's negligence are the puncture of her bowel by the second trocar and the time and expense of Dr. Bozeman repairing the bowel injury.
Dr. Gayle claimed the trocar injury itself was insignificant. Three medical experts (Dr. Taylor, Dr. Schwalke, and Dr. Byrd) also testified the injury was insignificant because it was immediately recognized, repaired, and no future harm resulted from it. Mrs. Patten presented no evidence showing the bowel injury from the second trocar caused any significant harm after its repair.
In his motion in limine to exclude certain medical expenses, Dr. Gayle argued the only medical expenses that were related to his August 14 surgery on Mrs. Patten are as follows: Dr. Gayle ($3,331.20); Willis-Knighton Pierremont ($18,546.85), Pierremont Anesthesia Consultants ($1,647.00), and Dr. Bozeman ($1,803.00), totaling $25,328.05.
Dr. Gayle's fee for the operation would have been incurred even without a bowel injury. Therefore, these expenses ($3,331.20) are not recoverable as damages.
Most of the expenses owed to Willis-Knighton Pierremont also would have been incurred even if there were no bowel injury. Some of the expenses, however, are causally connected to Dr. Gayle's negligence. Upon review of the Willis-Knighton medical bills, this court awards $1,726.00 owed to Willis-Knighton as damages attributable to Dr. Gayle negligently puncturing Mrs. Patten's bowel.
Mrs. Patten was placed under anesthesia for Dr. Gayle's surgery. However, additional anesthetic gases were necessary due to the extra time required for Dr. Bozeman to perform his repair. This court awards $1,281.00 in damages recoverable against Dr. Gayle for services performed by Pierremont Anesthesia Consultants.
The services performed by Dr. Bozeman were necessitated by the bowel injury and would not otherwise have been required. All expenses owed to Dr. Bozeman ($1,803.00) are causally connected to Dr. Gayle's negligence and recoverable as damages.
Accordingly, Mrs. Patten is awarded $4,811.00 in medical expenses attributable to injuries resulting from Dr. Gayle's negligence.
There is next the issue of general damages, such as pain and suffering, which cannot be definitively measured in monetary terms. See McGee v. A C and S, Inc., 2005-1036 (La. 7/10/06), 933 So.2d 770. Mrs. Patten claimed general damages for pain and suffering, mental anguish, disfigurement, and decreased quality of life. In closing arguments, counsel for plaintiff recommended general damages totaling $800,000 to Mrs. Patten as well as $250,000 to Mr. Patten for decreased quality of life and loss of consortium.
These claims all are connected to the perforation discovered by Dr. Schwalke and Mrs. Patten's subsequent medical problems, not the initial trocar injury. Because the jury did not manifestly err in finding Dr. Gayle's negligence was not the cause of the subsequent perforation, no general damages are warranted for these claims.
The claims for pain and suffering and mental anguish are compensable. While the majority of Mrs. Patten's pain and suffering and anguish are attributable to the subsequent perforation, the initial trocar injury also caused some general damages. Mrs. Patten testified at trial that the day of Dr. Gayle's surgery was her daughter's first day of school. Rather than going home that afternoon, as she expected, Mrs. Patten was hospitalized for a total of 16 days. When she awoke after the first surgery and was told by her husband that there was a problem, Mrs. Patten thought she had cancer. Mrs. Patten also testified she is now somewhat paranoid because Dr. Gayle was unable to explain what went wrong.
Accordingly, Mrs. Patten is awarded $10,000 in general damages for pain and suffering and mental anguish.
CONCLUSION
The portions of the final judgment concluding plaintiffs suffered no injuries from Dr. Gayle puncturing Mrs. Patten's bowel are manifestly erroneous and are reversed. Judgment is rendered awarding her special and general damages. In all other respects, the judgment is affirmed.
DECREE
The judgment of the trial court is REVERSED IN PART and AFFIRMED IN PART, and judgment is rendered in favor of appellants, awarding them the amount of $14,811.00. Appellee is cast with all costs of the appeal.
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Footnotes
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1. As a result of partially reversing the first judgment, consideration of the second judgment is unnecessary. The denial of the JNOV would, however, be affirmed and reversed along the same grounds.
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2. Laparoscopic surgery involves inserting small, hollow tubes, known as trocars, into the patient and operating by inserting scopes and instruments down the tubes. A small camera (laparoscope) can be inserted into these tubes for evaluation. Surgical instruments can also be inserted into trocars. A laparoscopy is a minimally invasive procedure because it does not involve "opening the patient up."
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3. An operative trocar is a trocar with a sharp blade at the tip. It is used for initial penetration of the trocar into the abdominal cavity.
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4. Dr. Robert Zurawin, medical expert for Mrs. Patten, testified that 95-98% of trocar-related injuries occur during insertion of the first trocar.
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5. A Pfannenstiel incision is a long horizontal abdominal incision, also called a "bikini" incision.
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6. Lysing is a term used to describe the detachment of bowel adhesions from the abdominal wall by cutting it with specialized surgical scissors.
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7. Dr. Gayle testified he left the trocar in place to allow Dr. Bozeman to remove it. Dr. Bozeman testified the trocar had already been removed when he arrived. This point is of no consequence to the disposition of this appeal.
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8. All medical experts and the medical review panel agreed that calling in a general surgeon for the purpose of repairing the bowel injury was within the applicable standard of care.
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9. Running the bowel is the inspection of the bowel by hand, moving it back and forth in one's hands, squeezing and applying pressure to check for leaks, bruises, cuts, and other damage.
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10. These factors explicitly included "fascial scarring or defects from prior surgery and differences in the degree of sharpness of disposable trocars." (Opinion of Medical Review Panel, p. 2)
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11. Members of the panel admitted to placing greater weight on Dr. Gayle's operative note than on his sworn deposition, in which he admitted to losing control "in a generic sense." (Deposition of Dr. Gayle, p. 67-68; Deposition of Dr. Hart, p. 18-19; Deposition of Dr. Carroll, p. 23)
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12. On October 23, 2007, Mrs. Patten amended her complaint and added Dr. Bozeman as a defendant. Dr. Bozeman filed peremptory exceptions of prescription and peremption, which were granted, and Dr. Bozeman was dismissed from the suit.
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13. Dr. Gayle has not contested this finding on appeal so we will not discuss the issue in depth.
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14. The bowel has multiple layers. A partial thickness injury is when some of the layers have been damaged. A partial thickness injury can later develop into a perforation due to pressure within the bowel.
http://www.leagle.com/xmlResult.aspx?page=2&xmldoc=In LACO 20110622396.xml&docbase=CSLWAR3-2007-CURR&SizeDisp=7
CHARLOTTE M. PATTEN, ET AL., Plaintiff-Appellant,v.CHRISTOPHER GAYLE, M.D., Defendant-Appellee.
No. 46,453-CA.
Court of Appeals of Louisiana, Second Circuit.
June 22, 2011.
NELSON & HAMMONS, A Professional Law Corporation, John L. Hammons, James Paul Lambert, Annis Cornell Flournoy, Counsel for Appellant.
WATSON, BLANCHE, WILSON & POSNER, Peter T. Dazzio, Garrett S. Callaway, Counsel for Appellee.
Before GASKINS, PEATROSS and DREW, JJ.
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DREW, J.:
The primary issue is whether the jury erred in finding the doctor's negligence during surgery did not cause any injury to the patient. Charlotte Patten and her husband, Rodney L. Patten, appeal the judgment rejecting their demands and dismissing the action with prejudice. They also seek review of the trial court's denial of their motion for judgment notwithstanding the verdict ("JNOV"). For the reasons discussed herein, the judgment1 is reversed in part and affirmed in part and rendered, awarding plaintiffs a portion of the damages sought.
FACTUAL AND PROCEDURAL BACKGROUND
Charlotte Patten became a patient of Dr. Christopher Gayle, an OB-GYN at Willis-Knighton Pierremont, in 1997 when Dr. Gayle performed a total abdominal hysterectomy, leaving her ovaries in place. In early 2001, Mrs. Patten began suffering from pain in her lower right abdomen which Dr. Gayle suspected was a cystic lesion on her right ovary. On August 14, 2001, at Willis-Knighton Pierremont, Mrs. Patten was admitted for laparoscopic2 evaluation and possible removal of her ovaries.
Dr. Gayle, assisted by Dr. Mary Taylor, began the procedure by inflating the abdominal cavity with carbon dioxide in order to create space between the abdominal wall and internal organs. Once the cavity was inflated, Dr. Gayle inserted an operative trocar3 through the umbilicus.
The operative trocar blade is covered with a protective sheath. When the doctor applies pressure to the trocar, the blade is unsheathed, allowing the trocar to penetrate the skin, muscle, and fascia. Once the trocar encounters "empty space" in the body cavity, the sheath re-covers the blades and locks in place. Since the initial trocar insertion is performed blind, most laparoscopic injuries occur during this part of the procedure.4 In this case, Dr. Gayle inserted the first trocar without complication.
After removing the blade from the trocar tube, Dr. Gayle inserted a laparoscope into this first trocar to allow him to see the inside of the abdominal cavity. Dr. Gayle noted adhesions of the small bowel to the abdominal wall. Because he was unable to determine whether he would be able to proceed laparoscopically, Dr. Gayle intended to insert a second trocar so he could better visualize the ovaries and abdominal cavity.
After using the laparoscope in the first trocar to find an area that was free of adhesions, Dr. Gayle testified he tried to angle the second trocar so it would enter the abdominal cavity in a particular direction. The second trocar unexpectedly entered the patient's abdomen. The doctor claimed the amount of force he applied should not have been sufficient for the trocar to enter the abdomen. The second trocar entered the abdomen in a different direction than Dr. Gayle intended and came out near a bowel adhesion.
Although Dr. Gayle could see the tip of the trocar, he could not determine whether the trocar had penetrated or avoided the bowel. Dr. Gayle left the second trocar tube in place but removed the blade. He then inserted a third trocar (without incident) and placed the laparoscope into the third trocar to evaluate the bowel. Dr. Gayle observed no bleeding or bowel content but was still unable to determine whether the bowel had been punctured.
Dr. Gayle decided he needed to open the patient's abdomen because there were numerous adhesions of the bowel to the abdominal wall. The doctor also concluded that the right ovary, which was cystic and densely adhered to the pelvic wall, needed to be removed, a procedure that could not be performed laparoscopically. Finally, he was still concerned about the possibility of bowel injury by the second trocar.
After making a Pfannenstiel incision5 and lysing6 some of the adhesions of the bowel from the abdominal wall, Dr. Gayle saw the second trocar had penetrated Mrs. Patten's small bowel "through and through." Dr. Gayle brought approximately 20 inches of bowel out of the abdominal cavity and called for Dr. Craig Bozeman, a general surgeon, to perform emergency surgery to remove the trocar7 and repair the bowel.8
Dr. Bozeman decided to connect the two holes to facilitate the surgical repair. He did so by cutting across the circumference of the bowel between the two holes. After sewing up the bowel, Dr. Bozeman "ran the bowel"9 to inspect it and found the repair was effective (not leaking) and that no further injuries could be seen. Dr. Gayle and Dr. Taylor then finished the surgery by removing Mrs. Patten's right ovary, placing the bowel back inside the abdomen and closing the incisions.
After the operation, Mrs. Patten was kept under observation by Dr. Bozeman to ensure her bowel was causing no further problems. Over the next few days, she showed some signs of improvement in her gastrointestinal functions but also had indications of trouble, most notably swelling. Five days after the operation, Mrs. Patten was examined by Dr. Schwalke, who was on call for Dr. Bozeman. That morning, Mrs. Patten's abdomen was distended. Later that day, feculent material began exuding from her incision.
Dr. Schwalke performed emergency exploratory surgery, which required him not only to reopen her horizontal incision but to make a vertical "midline" incision up to the sternum. He discovered a 3mm perforation of the bowel two inches from where the bowel had been repaired by Dr. Bozeman five days earlier. Also, approximately three liters of feculent material was in Mrs. Patten's abdominal cavity, necessitating extensive cleaning and drainage.
As a result of the feculent material having leaked into her abdominal cavity, Mrs. Patten developed peritonitis (an abdominal infection) and pneumonia. She was hospitalized until August 30. Mrs. Patten has subsequently suffered from abscesses (some of which ruptured) and herniating of her incisions, both of which have required further surgeries, and additional medical problems.
On June 6, 2002, Mrs. Patten and her husband filed a petition for a medical review panel against Dr. Gayle, Dr. Taylor, and Dr. Bozeman. The Pattens alleged negligence against the three doctors with respect to the August 14 surgery performed by Dr. Gayle and Dr. Taylor, in which Mrs. Patten's bowel was penetrated by a trocar, and Dr. Bozeman's emergency surgical repair.
The medical review panel (composed of Dr. Daniel Carroll, Dr. Edwin Byrd, and Dr. Timothy Hart) ruled that the evidence did not support the conclusion that Dr. Gayle, Dr. Taylor, or Dr. Bozeman failed to meet the applicable standards of care. Specifically, the panel found no evidence indicating the perforation discovered by Dr. Schwalke was present on August 14 and missed by Dr. Bozeman during his repair. The panel concluded that this perforation was most likely the result of undetectable microvascular damage that was unrelated to the trocar injury. Further, the panel opined that Dr. Gayle did not "lose control" of the trocar because there are many factors10 outside of the surgeon's control that can affect the passage of the trocar through the abdomen.11
On February 6, 2004, Mrs. Patten, together with her husband, filed a medical malpractice suit against Dr. Gayle.12 Following a four-day jury trial on the merits in May 2010, the jury returned a verdict that Dr. Gayle had deviated from the applicable standard of care and had committed malpractice.13 The jury, however, found Dr. Gayle's negligence had not caused any injury that would otherwise not have been incurred by Mrs. Patten. Finding a lack of causation, the jury awarded no damages to Mrs. Patten or her husband. At the request of counsel, the jury was polled, revealing the jury was split 10-2.
Following entry of the judgment denying plaintiffs' recovery and dismissing the action at their cost, Mrs. Patten and her husband moved for a JNOV, arguing the jury's finding that Dr. Gayle's negligence caused no injuries was manifestly erroneous. Following a hearing, the trial court denied the motion, finding the jury's verdict was reasonable, and entered judgment accordingly on August 27, 2010.
Mrs. Patten and her husband appealed, arguing: (1) the jury manifestly erred in finding a lack of causation; (2) the trial judge manifestly erred in denying the motion for JNOV; and (3) the jury erred in failing to award damages.
DISCUSSION
In a medical malpractice action, the plaintiff has the burden of proving: (1) the applicable standard of care, (2) that the standard of care was breached, and (3) that as a proximate result of the breach the plaintiff sustained injuries that would not otherwise have been incurred. La. R.S. 9:2794(A). The third element, causation, is subject to the manifest error standard of review. Lovelace v. Giddens, 31,493 (La. App. 2d Cir. 2/24/99), 740 So.2d 652, writ denied. Under the manifest error standard, an appellate court cannot substitute its own inferences and conclusions about the facts. Johnson v. Morehouse GeneralHosp., 2010-0387 (La. 5/10/11), 2011 WL 1759932; Wooley v. Lucksinger, 2009-0571 (La. 4/1/11), 2011 WL 1205136. Findings of fact cannot be set aside or overturned by the appellate court unless they are clearly wrong. Johnson, supra. Factual conclusions are not clearly wrong when the factfinder chooses a view of the evidence that an appellate court disagrees with as long as the factfinder's view is permissible. Id. Manifest error occurs only when there is "no reasonable factual basis for the [factfinder's] conclusion[.]" Johnson, 2010-0387 at p. 6. In a medical malpractice claim, great deference should be given to the factfinder when medical experts express different opinions relevant to causation. Lovelace, supra.
Initial Trocar Injury
While recognizing that Mrs. Patten suffered injuries, the Medical Review Panel unanimously found that Dr. Gayle was not negligent. In its written reasons, the panel stated there were other factors outside of Dr. Gayle's control that could have caused the second trocar to become misdirected, including scarring of the abdominal wall, defects from her prior surgeries and differences in the degree of sharpness of trocars.
Dr. Robert Zurawin, a board-certified OB-GYN and an associate professor at Baylor Medical School, testified by affidavit, deposition, and at trial on behalf of Mrs. Patten. Disagreeing with the medical review panel, Dr. Zurawin believed Dr. Gayle was negligent. Dr. Zurawin stated the factors mentioned by the review panel were relevant only to a blind trocar insertion. Since Dr. Gayle had already inserted one trocar, he should have been able to see (and thus avoid) any problems inside the abdominal cavity. At trial, Dr. Zurawin testified the trocar must have penetrated bowel that was adhered to the abdominal wall. Otherwise the protective sheath would have covered the blade after entering the abdomen and the through-and-through puncture never would have occurred.
Dr. Zurawin also noted that Dr. Gayle had apparently been holding the second trocar improperly. In his deposition, Dr. Gayle indicated he was not yet holding the second trocar in the proper position when it penetrated the abdomen. Dr. Zurawin testified the way Dr. Gayle was holding the trocar contributed to the trocar penetrating the abdomen without Dr. Gayle intending it to as well as how deep it penetrated. Further, Dr. Zurawin believed the second trocar should never have been inserted because Dr. Gayle should have converted to an open surgery once he saw the numerous, dense adhesions through the laparoscope in the first trocar.
Dr. Gayle admitted the puncture of the bowel by the second trocar was an injury. In his original answer to the complaint, Dr. Gayle stated that Dr. Bozeman was called in for "repair of a bowel injury." Moreover, at trial, Dr. Gayle admitted on cross-examination that Mrs. Patten "was injured and she suffered as a result of that injury[.]" Dr. Gayle claimed that the trocar injury was insignificant as far as the medical malpractice claim was concerned.
Dr. Gayle relied upon the testimony of Dr. Taylor, Dr. Schwalke, and Dr. Byrd, each of whom testified the initial bowel injury from the second trocar was insignificant. Both Dr. Taylor and Dr. Byrd testified the only harm done to Mrs. Patten was having approximately an extra hour of surgery by Dr. Bozeman to repair the bowel. Dr. Schwalke testified similarly, stating the injury was insignificant because it was immediately recognized and repaired and there were no further damages resulting from that injury.
Dr. Gayle also relied upon two consent forms that Mrs. Patten signed prior to the surgery. When obtaining consent from a patient for any treatment or procedure, physicians have a duty to advise the patient of associated risks. Roberts v. Cox, 28,094 (La. App. 2d Cir. 2/28/96), 669 So.2d 633; Broadway v. St. Paul Ins. Co., 22,433 (La. App. 2d Cir. 1991), 582 So.2d 1368. A physician does not have to inform a patient of "every conceivable possibility" but only "those that can reasonably be anticipated." Steinbach v. Barfield, 428 So.2d 915 (La. App. 1st Cir. 1983) (reversed on other grounds); see also, Roberts, supra; Broadway, supra.
A risk of bowel injury was among the risks listed on the consent forms signed by Mrs. Patten. Dr. Hart testified at trial that this risk would include bowel injury due to a misdirected trocar. Dr. Hart also testified, however, that a patient never consents to negligent treatment. This court agrees. Consent forms should not shield physicians and other healthcare providers from liability for injuries caused by their negligence simply because the injuries are a known risk of the procedure. While patients can be held to reasonably anticipate that procedures carry certain risks that may occur without any fault from their physician, patients should also reasonably anticipate a physician will not negligently injure them. Being injured as a result of negligence by one's physician is not a reasonably foreseeable risk of receiving medical treatment.
The through-and-through perforation of Mrs. Patten's bowel was undoubtedly an injury. Downplaying the significance of the injury is a defense to damages but not a defense to the injury actually having occurred. The two consent forms signed by Mrs. Patten do not exonerate Dr. Gayle for negligently injuring her by puncturing her bowel with the second trocar. Therefore, the jury's finding that Dr. Gayle's negligence caused no injury to Mrs. Patten is manifestly erroneous with respect to the trocar's penetration of the bowel. As a result, this court reviews the merits of this issue de novo.
De Novo Review of the Merits — Initial Trocar Injury
Dr. Gayle negligently punctured Mrs. Patten's bowel with a trocar, necessitating the emergency repair by Dr. Bozeman. According to Dr. Gayle, aside from the repair of the punctured bowel, all other surgical steps taken on August 14 would have been required even if there had been no bowel injury.
First, Dr. Gayle stated in his deposition that Mrs. Patten had to be "opened up" in order to remove her ovary. Therefore, the decision to open her abdomen would have been made even if there were no bowel injury. This view was shared by Dr. Taylor. Even Dr. Zurawin agreed, stating in his affidavit that Mrs. Patten should have been opened up after Dr. Gayle viewed Mrs. Patten's numerous abdominal adhesions through the laparoscope in the first trocar.
Second, Dr. Gayle testified the bowel adhesions had to be lysed from the abdominal wall in order to remove the right ovary. Both Dr. Schwalke and Dr. Hart agreed that lysing the adhesions would have been necessary without the trocar injury. Moreover, even had the trocar injury been the sole reason for lysing the bowels, Dr. Zurawin testified that Dr. Gayle did not breach the applicable standard of care by lysing the bowel adhesions to prepare for the surgical repair of the bowel injury by Dr. Bozeman.
Third, Dr. Zurawin stated in his deposition that it is within the applicable standard of care to run the bowel after lysing any bowel adhesions to ensure it has not been injured. Therefore, the bowel would necessarily have been run whether or not the trocar repair was performed.
Fourth, Dr. Gayle stated in his motion in limine to exclude medical expenses that, even without the trocar injury, Mrs. Patten would have stayed in the hospital a few days following the surgery for observation. Dr. Gayle stated this was necessary because having to lyse her bowel adhesions created a possibility of a perforation developing.
In contrast, Dr. Zurawin stated in his affidavit that, but for the trocar injury to the bowel, Mrs. Patten would not have undergone the repair procedure which placed her at a greater risk of a subsequent bowel perforation. However, Dr. Zurawin acknowledged that Dr. Gayle had to open Mrs. Patten up and lyse the bowel adhesions to complete his surgery whether or not there had been a bowel injury.
Aside from the repair of the through-and-through bowel puncture, all other treatments and steps taken (opening her up, lysing the adhesions, etc.) would have been necessary even had there been no bowel injury and therefore were not causally related to Dr. Gayle's negligence. The only injuries Mrs. Patten suffered on August 14, 2001, that were causally connected to Dr. Gayle's negligent handling of the second trocar and would not otherwise have been incurred are: (1) the puncture of the bowel; and (2) the time and expense of Dr. Bozeman repairing the bowel.
Subsequent Perforation
The cause of the subsequent perforation that was discovered by Dr. Schwalke five days after Mrs. Patten's first operation was the primary topic throughout this case. In Dr. Gayle's opinion, this subsequent perforation was most likely the result of a microvascular injury that was undetectable at the time of Dr. Bozeman's repair. The medical review panel had a similar opinion, finding the perforation was unrelated to the initial trocar injury and most likely the result of microvascular damage.
Dr. Zurawin stated in his affidavit that while the cause of the perforation was "not clear," he believed it was most likely caused directly by the second trocar striking a loop of bowel after making its through-and-through puncture. Dr. Hart, Dr. Bozeman, and Dr. Schwalke all testified that the trocar tip could have directly harmed another section of bowel, causing damage that eventually led to the subsequent perforation. Dr. Hart qualified his testimony, stating this scenario was highly unlikely.
Both Dr. Gayle and Dr. Taylor testified the trocar penetrated the abdomen in an area where there was an upside-down "U-shaped" section of bowel hanging from the abdominal wall. Thus, according to the only two people who saw the location of the bowel before Mrs. Patten was opened up, there was no other portion of bowel for the trocar to damage. Assuming the bowel was adhered in this position, Dr. Byrd testified it would have been "spectacular" for the tip of the second trocar to have directly injured another part of the bowel.
Moreover, the bowel was run and inspected by Dr. Bozeman after he repaired the initial puncture. This inspection was done in the presence of both Dr. Gayle and Dr. Taylor. Dr. Bozeman testified he examined a significant portion of the surrounding bowel. The perforation that was found five days later was only two inches from the repair site. Dr. Hart testified it would be almost impossible for Dr. Bozeman, Dr. Gayle, and Dr. Taylor all to have missed any visible injury to the bowel that was only two inches away from the site of the trocar puncture.
In addition, the opinion of the review panel was that the timeline indicated the perforation was not present on August 14. The panel opinion was supported by both Dr. Hart's and Dr. Schwalke's testimony that the perforation likely opened two or three days after Dr. Gayle's operation, based on when Mrs. Patten began having swelling problems and the amount of feculent material found in her abdominal cavity. Dr. Zurawin disagreed, stating in his deposition that a small perforation might have taken five days to manifest and therefore the timeline was not definitive.
In view of all the evidence presented, it seems unlikely the trocar tip directly caused damage to the bowel that led to the subsequent perforation. However, Mrs. Patten also presented evidence of another theory: that the trocar injury indirectly caused the perforation because it led to the bowel sustaining a partial thickness injury14 which ruptured in the days following Dr. Gayle's surgery. This partial thickness injury could have been caused either when the adhesions were lysed from the abdominal wall or when Dr. Bozeman was performing his repair of the initial trocar injury.
Dr. Carroll stated in his deposition that any partial thickness injury caused by Dr. Bozeman repairing and running the bowel should have occurred immediately adjacent to the original injury. Since the perforation was two inches away from the original injury, Dr. Carroll stated it was highly unlikely Dr. Bozeman's repair caused the perforation. Additionally, none of the medical experts who testified believed that either repairing or running the bowel indirectly caused the perforation
Dr. Schwalke testified that the most likely cause of the perforation was a partial thickness injury that occurred when the bowel adhesions were lysed from the abdominal wall. Both Dr. Hart and Dr. Byrd also agreed the cause of the perforation was most likely a partial thickness injury due to lysing adhesions. According to Dr. Gayle, the portion of bowel where the perforation occurred was adhered to the abdominal wall, making it more susceptible to a partial thickness injury. Dr. Bozeman testified that a partial thickness injury is a known risk of having to lyse bowel adhesions.
In his deposition, Dr. Zurawin stated it was within the applicable standard of care for Dr. Gayle to lyse the bowel adhesions. Dr. Zurawin also noted that it was unclear whether Dr. Gayle or Dr. Bozeman lysed the bowel that was two inches away from the trocar injury. Therefore, assuming the lysing of the bowel caused a partial thickness injury, it would be impossible to know to whom to attribute it. Moreover, even if the lysing caused an undetectable injury, Dr. Zurawin testified there would not have been a breach of any standard of care by Dr. Gayle.
The medical experts were in agreement that the bowel adhesions necessarily had to be lysed in order to remove Mrs. Patten's right ovary. Therefore, had no trocar injury ever occurred, the bowel adhesions would nonetheless have been lysed. This possibility was explicitly supported in the deposition testimony of all three members of the medical review panel (Dr. Byrd, Dr. Hart, Dr. Carroll) as well as the trial testimony of both Dr. Schwalke and Dr. Byrd.
Mrs. Patten had to be opened up and her adhesions had to be lysed. The evidence did not show that, more likely than not, the initial trocar injury was either a direct or indirect cause of the subsequent perforation and the resulting peritonitis and pneumonia which kept Mrs. Patten hospitalized until August 30, 2001. As Dr. Zurawin testified, the cause of this perforation is simply not clear "within a reasonable medical probability." Therefore, the jury finding no causation of damages with respect to the subsequent perforation is not manifestly erroneous.
Injuries Suffered by Mrs. Patten Since August 30, 2001
Mrs. Patten has suffered from many medical problems following her release on August 30, 2001, after recovering from peritonitis and pneumonia. She alleges that these subsequent injuries are traceable to Dr. Gayle's negligence. Among the injuries Mrs. Patten has suffered, according to her First Supplemental and Amending Petition:
abscesses . . . excruciating pain and suffering, mental anguish and embarrassment . . . extensive scarring, abdominal adhesions and extensive internal adhesions . . . and repeated surgical procedures[.]
Mrs. Patten also claims hernias of her incisions as an additional injury attributable to Dr. Gayle.
According to Mrs. Patten's own testimony, she had a history of abdominal pain and discomfort ever since the birth of her second child. Her first laparoscopic procedure was performed in 1993. She also had multiple abdominal surgeries performed prior to the surgery on August 14, 2001. As Dr. Zurawin stated in his deposition, the more surgeries a person has, the more likely she is to have bowel adhesions in the future that could lead to the injuries Mrs. Patten has suffered. Mrs. Patten also testified she had off-and-on undergone treatment for depression prior to Dr. Gayle's 2001 surgery.
In the months following the surgeries by Dr. Gayle and Dr. Schwalke, Mrs. Patten was treated by Dr. Bozeman for multiple abscesses of her surgical wounds. In his deposition, Dr. Bozeman stated these abscesses were likely not related to Mrs. Patten's peritonitis but rather a reaction to the sutures used by Dr. Schwalke.
In 2002, Mrs. Patten was treated by Dr. Charles Black for hernias of her incisions. Dr. Black's deposition was read at trial; he was unable to testify in person because he was suffering from health problems and subsequently died. In his deposition, Dr. Black stated that incisional hernias occur around 5% of the time even in the absence of negligence. Dr. Black further stated that, considering Mrs. Patten's history of abdominal surgeries, there was no reason to attribute her hernias in 2002 to either Dr. Gayle's or Dr. Schwalke's surgeries in 2001.
Dr. Dale McGinty treated Mrs. Patten for abdominal adhesions sporadically between 2005 and 2008. In his deposition, Dr. McGinty stated he had no reason to connect those adhesions to Dr. Gayle's surgery. Further, Dr. McGinty stated there was no way to know whether the adhesions he treated were caused by Dr. Gayle's surgery, any of Mrs. Patten's prior or subsequent abdominal surgeries.
Dr. Hart testified that hernias of the midline incision are traceable to Dr. Schwalke's surgery, as this was the first time such an incision had been made on Mrs. Patten. Hernias of any other incisions, though, are not necessarily connected to Dr. Gayle's surgery because any of Mrs. Patten's pre-2001 surgeries could have been the underlying cause.
After sitting on the medical review panel, Dr. Byrd testified in his deposition that it is hypothetically possible none of the injuries Mrs. Patten suffered are causally connected to Dr. Gayle. In other words, even had there been no trocar injury, it is possible that the subsequent bowel perforation would have occurred, that Mrs. Patten would develop an abdominal infection from the material leaking from the perforation, and that all of her hernias, abscesses, and adhesions might have occurred as anticipated risks of the surgeries performed by Dr. Gayle and Dr. Schwalke.
Having failed to show the subsequent perforation of her bowel was causally connected to Dr. Gayle's negligence, Mrs. Patten did not establish that injuries she has suffered since August 30, 2001, were caused by Dr. Gayle. Thus, the jury finding no causation of any damages with respect to Mrs. Patten's medical problems since August 30, 2001, is not manifestly erroneous.
Damages
The only injuries that Mrs. Patten has suffered as a result of Dr. Gayle's negligence are the puncture of her bowel by the second trocar and the time and expense of Dr. Bozeman repairing the bowel injury.
Dr. Gayle claimed the trocar injury itself was insignificant. Three medical experts (Dr. Taylor, Dr. Schwalke, and Dr. Byrd) also testified the injury was insignificant because it was immediately recognized, repaired, and no future harm resulted from it. Mrs. Patten presented no evidence showing the bowel injury from the second trocar caused any significant harm after its repair.
In his motion in limine to exclude certain medical expenses, Dr. Gayle argued the only medical expenses that were related to his August 14 surgery on Mrs. Patten are as follows: Dr. Gayle ($3,331.20); Willis-Knighton Pierremont ($18,546.85), Pierremont Anesthesia Consultants ($1,647.00), and Dr. Bozeman ($1,803.00), totaling $25,328.05.
Dr. Gayle's fee for the operation would have been incurred even without a bowel injury. Therefore, these expenses ($3,331.20) are not recoverable as damages.
Most of the expenses owed to Willis-Knighton Pierremont also would have been incurred even if there were no bowel injury. Some of the expenses, however, are causally connected to Dr. Gayle's negligence. Upon review of the Willis-Knighton medical bills, this court awards $1,726.00 owed to Willis-Knighton as damages attributable to Dr. Gayle negligently puncturing Mrs. Patten's bowel.
Mrs. Patten was placed under anesthesia for Dr. Gayle's surgery. However, additional anesthetic gases were necessary due to the extra time required for Dr. Bozeman to perform his repair. This court awards $1,281.00 in damages recoverable against Dr. Gayle for services performed by Pierremont Anesthesia Consultants.
The services performed by Dr. Bozeman were necessitated by the bowel injury and would not otherwise have been required. All expenses owed to Dr. Bozeman ($1,803.00) are causally connected to Dr. Gayle's negligence and recoverable as damages.
Accordingly, Mrs. Patten is awarded $4,811.00 in medical expenses attributable to injuries resulting from Dr. Gayle's negligence.
There is next the issue of general damages, such as pain and suffering, which cannot be definitively measured in monetary terms. See McGee v. A C and S, Inc., 2005-1036 (La. 7/10/06), 933 So.2d 770. Mrs. Patten claimed general damages for pain and suffering, mental anguish, disfigurement, and decreased quality of life. In closing arguments, counsel for plaintiff recommended general damages totaling $800,000 to Mrs. Patten as well as $250,000 to Mr. Patten for decreased quality of life and loss of consortium.
These claims all are connected to the perforation discovered by Dr. Schwalke and Mrs. Patten's subsequent medical problems, not the initial trocar injury. Because the jury did not manifestly err in finding Dr. Gayle's negligence was not the cause of the subsequent perforation, no general damages are warranted for these claims.
The claims for pain and suffering and mental anguish are compensable. While the majority of Mrs. Patten's pain and suffering and anguish are attributable to the subsequent perforation, the initial trocar injury also caused some general damages. Mrs. Patten testified at trial that the day of Dr. Gayle's surgery was her daughter's first day of school. Rather than going home that afternoon, as she expected, Mrs. Patten was hospitalized for a total of 16 days. When she awoke after the first surgery and was told by her husband that there was a problem, Mrs. Patten thought she had cancer. Mrs. Patten also testified she is now somewhat paranoid because Dr. Gayle was unable to explain what went wrong.
Accordingly, Mrs. Patten is awarded $10,000 in general damages for pain and suffering and mental anguish.
CONCLUSION
The portions of the final judgment concluding plaintiffs suffered no injuries from Dr. Gayle puncturing Mrs. Patten's bowel are manifestly erroneous and are reversed. Judgment is rendered awarding her special and general damages. In all other respects, the judgment is affirmed.
DECREE
The judgment of the trial court is REVERSED IN PART and AFFIRMED IN PART, and judgment is rendered in favor of appellants, awarding them the amount of $14,811.00. Appellee is cast with all costs of the appeal.
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Footnotes
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1. As a result of partially reversing the first judgment, consideration of the second judgment is unnecessary. The denial of the JNOV would, however, be affirmed and reversed along the same grounds.
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2. Laparoscopic surgery involves inserting small, hollow tubes, known as trocars, into the patient and operating by inserting scopes and instruments down the tubes. A small camera (laparoscope) can be inserted into these tubes for evaluation. Surgical instruments can also be inserted into trocars. A laparoscopy is a minimally invasive procedure because it does not involve "opening the patient up."
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3. An operative trocar is a trocar with a sharp blade at the tip. It is used for initial penetration of the trocar into the abdominal cavity.
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4. Dr. Robert Zurawin, medical expert for Mrs. Patten, testified that 95-98% of trocar-related injuries occur during insertion of the first trocar.
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5. A Pfannenstiel incision is a long horizontal abdominal incision, also called a "bikini" incision.
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6. Lysing is a term used to describe the detachment of bowel adhesions from the abdominal wall by cutting it with specialized surgical scissors.
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7. Dr. Gayle testified he left the trocar in place to allow Dr. Bozeman to remove it. Dr. Bozeman testified the trocar had already been removed when he arrived. This point is of no consequence to the disposition of this appeal.
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8. All medical experts and the medical review panel agreed that calling in a general surgeon for the purpose of repairing the bowel injury was within the applicable standard of care.
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9. Running the bowel is the inspection of the bowel by hand, moving it back and forth in one's hands, squeezing and applying pressure to check for leaks, bruises, cuts, and other damage.
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10. These factors explicitly included "fascial scarring or defects from prior surgery and differences in the degree of sharpness of disposable trocars." (Opinion of Medical Review Panel, p. 2)
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11. Members of the panel admitted to placing greater weight on Dr. Gayle's operative note than on his sworn deposition, in which he admitted to losing control "in a generic sense." (Deposition of Dr. Gayle, p. 67-68; Deposition of Dr. Hart, p. 18-19; Deposition of Dr. Carroll, p. 23)
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12. On October 23, 2007, Mrs. Patten amended her complaint and added Dr. Bozeman as a defendant. Dr. Bozeman filed peremptory exceptions of prescription and peremption, which were granted, and Dr. Bozeman was dismissed from the suit.
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13. Dr. Gayle has not contested this finding on appeal so we will not discuss the issue in depth.
Back to Reference
14. The bowel has multiple layers. A partial thickness injury is when some of the layers have been damaged. A partial thickness injury can later develop into a perforation due to pressure within the bowel.
http://www.leagle.com/xmlResult.aspx?page=2&xmldoc=In LACO 20110622396.xml&docbase=CSLWAR3-2007-CURR&SizeDisp=7
Wednesday, February 24, 2010
Laparoscopic versus open surgery in small bowel obstruction.
So no one's even bothered!.....
________________________________________
Cochrane Database Syst Rev. 2010 Feb 17;2:CD007511.
Laparoscopic versus open surgery in small bowel obstruction.
Cirocchi R, Abraha I, Farinella E, Montedori A, Sciannameo F.
Clinica Chirurgica Generale e d'Urgenza, Azienda Ospedaliera di Terni, Terni, Italy, 05100.
BACKGROUND: Acute intestinal obstruction is one of the most common surgical emergencies. The small bowel obstruction (SBO) is the site of obstruction in most patients (76%) and adhesions are the most common etiology (65%). Laparoscopy in SBO has no clear role yet as it may have a therapeutic and diagnostic function. In some settings laparoscopic or laparoscopy-assisted surgery is considered feasible and convenient more than conventional surgery for SBO; however little is known if laparoscopic or laparoscopy-assisted surgery is more suitable with respect to open surgery for patients with SBO. OBJECTIVES: The aim of this systematic review is to assess whether laparoscopic or laparoscopy-assisted surgery is feasible and safe for acute SBO, and whether laparoscopic and laparoscopy-assisted surgery present advantages compared to open surgery in terms of short-term and long-term outcomes. SEARCH STRATEGY: We searched for published randomised and prospective controlled clinical trials without language restrictions using the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1950 onwards) and EMBASE (1980 onwards). SELECTION CRITERIA: Randomised controlled trials and non randomised controlled prospective trials evaluating laparoscopic and laparoscopy-assisted surgery versus traditional open surgery for acute SBO were considered. DATA COLLECTION AND ANALYSIS: We conducted the review according to the recommendations of The Cochrane Collaboration and the Cochrane Colorectal Group as well, using Review Manager 5 to conduct the review. MAIN RESULTS: No published or unpublished randomised controlled trials or prospective controlled clinical trials comparing laparoscopy with open surgery for patients with SBO were identified. AUTHORS' CONCLUSIONS: Although data from retrospective clinical controlled trials suggest that laparoscopy seems feasible and better in terms of hospital stay and mortality reduction, high quality randomised controlled trials assessing all clinically relevant outcomes including overall mortality, morbidity, hospital stay and conversion are needed.
PMID: 20166096 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/20166096?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=14
________________________________________
Cochrane Database Syst Rev. 2010 Feb 17;2:CD007511.
Laparoscopic versus open surgery in small bowel obstruction.
Cirocchi R, Abraha I, Farinella E, Montedori A, Sciannameo F.
Clinica Chirurgica Generale e d'Urgenza, Azienda Ospedaliera di Terni, Terni, Italy, 05100.
BACKGROUND: Acute intestinal obstruction is one of the most common surgical emergencies. The small bowel obstruction (SBO) is the site of obstruction in most patients (76%) and adhesions are the most common etiology (65%). Laparoscopy in SBO has no clear role yet as it may have a therapeutic and diagnostic function. In some settings laparoscopic or laparoscopy-assisted surgery is considered feasible and convenient more than conventional surgery for SBO; however little is known if laparoscopic or laparoscopy-assisted surgery is more suitable with respect to open surgery for patients with SBO. OBJECTIVES: The aim of this systematic review is to assess whether laparoscopic or laparoscopy-assisted surgery is feasible and safe for acute SBO, and whether laparoscopic and laparoscopy-assisted surgery present advantages compared to open surgery in terms of short-term and long-term outcomes. SEARCH STRATEGY: We searched for published randomised and prospective controlled clinical trials without language restrictions using the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1950 onwards) and EMBASE (1980 onwards). SELECTION CRITERIA: Randomised controlled trials and non randomised controlled prospective trials evaluating laparoscopic and laparoscopy-assisted surgery versus traditional open surgery for acute SBO were considered. DATA COLLECTION AND ANALYSIS: We conducted the review according to the recommendations of The Cochrane Collaboration and the Cochrane Colorectal Group as well, using Review Manager 5 to conduct the review. MAIN RESULTS: No published or unpublished randomised controlled trials or prospective controlled clinical trials comparing laparoscopy with open surgery for patients with SBO were identified. AUTHORS' CONCLUSIONS: Although data from retrospective clinical controlled trials suggest that laparoscopy seems feasible and better in terms of hospital stay and mortality reduction, high quality randomised controlled trials assessing all clinically relevant outcomes including overall mortality, morbidity, hospital stay and conversion are needed.
PMID: 20166096 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/20166096?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=14
Tuesday, February 09, 2010
Rep. John Murtha dies after surgery complications
(CNN) -- Rep. John Murtha of Pennsylvania, a longtime fixture on the House subcommittee that oversees Pentagon spending, died after complications from gallbladder surgery, according to his office. He was 77.
The Democratic congressman recently underwent scheduled laparoscopic surgery at National Naval Medical Center in Bethesda, Maryland, to remove his gallbladder. The procedure was "routine minimally invasive surgery," but doctors "hit his intestines," a source close to the late congressman told CNN.
Murtha was initially hospitalized in December and had to postpone a hearing with Defense Secretary Robert Gates on the administration's strategy in Afghanistan. The congressman returned to work after a few days in the hospital and helped oversee final passage of the 2010 defense appropriations bill.
More:http://www.cnn.com/2010/POLITICS/02/08/john.murtha.obit/index.html?hpt=T2
The Democratic congressman recently underwent scheduled laparoscopic surgery at National Naval Medical Center in Bethesda, Maryland, to remove his gallbladder. The procedure was "routine minimally invasive surgery," but doctors "hit his intestines," a source close to the late congressman told CNN.
Murtha was initially hospitalized in December and had to postpone a hearing with Defense Secretary Robert Gates on the administration's strategy in Afghanistan. The congressman returned to work after a few days in the hospital and helped oversee final passage of the 2010 defense appropriations bill.
More:http://www.cnn.com/2010/POLITICS/02/08/john.murtha.obit/index.html?hpt=T2
Saturday, January 24, 2009
Adhesions Related Disorder News you can use ARDvark Blog
Novel Product for Post Surgical Scar Formation Entering Clinical ...PR Newswire (press release), NY - Jan 21, 2009Adhesions are bands of scar tissue that connect anatomic structures that should not normally be connected. These develop when the body's repair mechanisms ...
Feasibility of laparoscopy for small bowel obstruction7thSpace Interactive (press release), NY - Jan 19, 2009The first cause of laparotomic conversion is a difficult exposition and treatment of band adhesions. The incidence of laparotomic conversions is major in ...
Study Finds MRSA In Midwestern Swine, WorkersThe first study documenting methicillin-resistant Staphylococcus aureus (MRSA) in swine and swine workers in the United States has been published by University of Iowa researchers...[read article]
U.S. Government Finds 40% Of People Currently Receiving Long Term Care Are 18-64; Numbers Continue To Rise
Economic Stimulus Bill Mandates Electronic Health Records For Every Citizen Without Opt Out Or Patient Consent Provisions
Discovery Of A Key Protein Regulator Of Inflammation And Cell Death
Flowering Plants Speed Post-surgery Recovery
Research Finds Genetic Connection Between PTSD, Depression And Anxiety
Irritable Bowel Syndrome Can Have Genetic Causes
Increase In C-Section Deliveries Coincides With Increase In Complications During Birth, Study Finds
Tension Free Vaginal Tape Underneath Bladder Base: Does It Prevent Cystocele Recurrence?
Progress Made In Understanding Causes And Treatment Of Endometriosis
Prescription Opioid Abuse, Addiction Less Common Than Many Believe
FDA Approves Fibromyalgia Drug - Savella(TM) (milnacipran HCl), A Selective Serotonin And Norepinephrine Dual Reuptake Inhibitor
Bladder Pain Syndrome / Interstitial Cystitis (BPS/IC) - Exclusive Report From 2008 Asian IC Guideline Meeting
Pain Treatment Research Reports Often Cannot Be Trusted
Study First To Pinpoint Why Analgesic Drugs May Be Less Potent In Females Than In Males
Common Treatment For Men's Pelvic Pain Proves Ineffective, Queen's-led Study Shows
Feasibility of laparoscopy for small bowel obstruction7thSpace Interactive (press release), NY - Jan 19, 2009The first cause of laparotomic conversion is a difficult exposition and treatment of band adhesions. The incidence of laparotomic conversions is major in ...
Study Finds MRSA In Midwestern Swine, WorkersThe first study documenting methicillin-resistant Staphylococcus aureus (MRSA) in swine and swine workers in the United States has been published by University of Iowa researchers...[read article]
U.S. Government Finds 40% Of People Currently Receiving Long Term Care Are 18-64; Numbers Continue To Rise
Economic Stimulus Bill Mandates Electronic Health Records For Every Citizen Without Opt Out Or Patient Consent Provisions
Discovery Of A Key Protein Regulator Of Inflammation And Cell Death
Flowering Plants Speed Post-surgery Recovery
Research Finds Genetic Connection Between PTSD, Depression And Anxiety
Irritable Bowel Syndrome Can Have Genetic Causes
Increase In C-Section Deliveries Coincides With Increase In Complications During Birth, Study Finds
Tension Free Vaginal Tape Underneath Bladder Base: Does It Prevent Cystocele Recurrence?
Progress Made In Understanding Causes And Treatment Of Endometriosis
Prescription Opioid Abuse, Addiction Less Common Than Many Believe
FDA Approves Fibromyalgia Drug - Savella(TM) (milnacipran HCl), A Selective Serotonin And Norepinephrine Dual Reuptake Inhibitor
Bladder Pain Syndrome / Interstitial Cystitis (BPS/IC) - Exclusive Report From 2008 Asian IC Guideline Meeting
Pain Treatment Research Reports Often Cannot Be Trusted
Study First To Pinpoint Why Analgesic Drugs May Be Less Potent In Females Than In Males
Common Treatment For Men's Pelvic Pain Proves Ineffective, Queen's-led Study Shows
Monday, September 22, 2008
News you can use ARDvark Blog
Gut Bacterium Linked To Colon Cancer
Written by Catharine Paddock, PhD
US scientists found that a common bacterium found in the gut could play a role in the development of colon cancer by producing a fermentation byproduct that damages DNA and affects signalling pathways used by colon cancer...[read article]Gut Bacterium Linked To Colon Cancer
Introducing NEW Voltarol Pain-eze® Tablets - A New And Effective Way Of Treating Body Pain Voltarol® Launches First Ever OTC Diclofenac Tablet
Pelvic Disorders Affect Large Number Of Women
Stateline.org Examines State Ballot Measures Related To Health Care
Introducing NEW Voltarol Pain-eze® Tablets - A New And Effective Way Of Treating Body Pain Voltarol® Launches First Ever OTC Diclofenac Tablet
Gordon Brown Praises NHS Staff On Reductions In C. Difficile And MRSA Infections, UK
Vaginal Brachytherapy Versus External Beam Pelvic Radiotherapy For High-Intermediate Risk Endometrial Cancer - Randomised PORTEC-2 Trial
Could An Absorption Enhancer Be More Convenient And Helpful For Colitis Patients?
Editorial: Where's The Data? Association Of Faculties Of Medicine Of Canada
In Crohn's Disease A Case Of False Positive Octreoscan
Canadian Scientists Report On Pain Research At NIDCR's 60th Anniversary Symposium
Montreal Water Treatment Plants Dumping As Much As 90 Times The Critical Amount Of Estrogen Products Into The River
Suppressing Hunger Hormone Could Be As Effective As Bariatric Surgery
What Impact Does "Fertility Tourism" Have On The NHS?
Discovery Of Master Switch In The Brain That Regulates Appetite And Reproduction
Written by Catharine Paddock, PhD
US scientists found that a common bacterium found in the gut could play a role in the development of colon cancer by producing a fermentation byproduct that damages DNA and affects signalling pathways used by colon cancer...[read article]Gut Bacterium Linked To Colon Cancer
Introducing NEW Voltarol Pain-eze® Tablets - A New And Effective Way Of Treating Body Pain Voltarol® Launches First Ever OTC Diclofenac Tablet
Pelvic Disorders Affect Large Number Of Women
Stateline.org Examines State Ballot Measures Related To Health Care
Introducing NEW Voltarol Pain-eze® Tablets - A New And Effective Way Of Treating Body Pain Voltarol® Launches First Ever OTC Diclofenac Tablet
Gordon Brown Praises NHS Staff On Reductions In C. Difficile And MRSA Infections, UK
Vaginal Brachytherapy Versus External Beam Pelvic Radiotherapy For High-Intermediate Risk Endometrial Cancer - Randomised PORTEC-2 Trial
Could An Absorption Enhancer Be More Convenient And Helpful For Colitis Patients?
Editorial: Where's The Data? Association Of Faculties Of Medicine Of Canada
In Crohn's Disease A Case Of False Positive Octreoscan
Canadian Scientists Report On Pain Research At NIDCR's 60th Anniversary Symposium
Montreal Water Treatment Plants Dumping As Much As 90 Times The Critical Amount Of Estrogen Products Into The River
Suppressing Hunger Hormone Could Be As Effective As Bariatric Surgery
What Impact Does "Fertility Tourism" Have On The NHS?
Discovery Of Master Switch In The Brain That Regulates Appetite And Reproduction
Saturday, September 06, 2008
Find out about ARD, before you have any surgery!
September is Adhesion Related Disorder Awareness Month.
What are Adhesions?
An ADHESION is a type of scar that forms an abnormal connection between two parts of the body. Adhesions can cause severe clinical problems. For example, adhesions involving the female reproductive organs (ovaries, Fallopian tubes) can and do cause infertility, dyspareunia (painful intercourse) and debilitating pelvic pain. Adhesions involving the bowel can cause bowel obstruction or blockage. Adhesions may form elsewhere such as around the heart, spine and in the hand where they lead to other problems.
Adhesions occur in response to injury of various kinds. For example, non-surgical insults such as endometriosis, infection, chemotherapy, radiation and cancer may damage tissue and initiate ADHESIONS. By far the most common kind of ADHESION is the one that forms after surgery. ADHESIONS typically occur at the site of a surgical procedure although they may also occur elsewhere.
An ADHESION is a type of scar that forms an abnormal connection between two parts of the body. Adhesions can cause severe clinical problems. For example, adhesions involving the female reproductive organs (ovaries, Fallopian tubes) can and do cause infertility, dyspareunia (painful intercourse) and debilitating pelvic pain. Adhesions involving the bowel can cause bowel obstruction or blockage. Adhesions may form elsewhere such as around the heart, spine and in the hand where they lead to other problems.
Adhesions occur in response to injury of various kinds. For example, non-surgical insults such as endometriosis, infection, chemotherapy, radiation and cancer may damage tissue and initiate ADHESIONS. By far the most common kind of ADHESION is the one that forms after surgery. ADHESIONS typically occur at the site of a surgical procedure although they may also occur elsewhere.
Dr. David Wiseman - International Adhesions Society
Please visit these site for advocacy news and general education.
International Adhesion Society
International Adhesion Society
Education helps prevent Adhesions!
Wednesday, September 03, 2008
ARD Awareness : Adhesion Barrier News
Find out about ARD Before you have any surgery!
Adhesion Barrier News
SprayGel is not approved for sale in the United States.
SprayGel is currently under clinical investigations in the U.S.
http://www.spraygel.com/spraygel/usa_home.htm
After much controversy about its capabilities, Tyco, the new owners of Confluent have re-instituted clinical trials for SprayGel in the U.S.A.
If you are interested in becoming part of the study contact Dr. Alan Johns in Fort Worth, TX.
Baylor All Saints Location:
1325 Pennsylvania, Suite 350Fort Worth, Texas 76104
817-803-6621
Richland Hills Location:3700 Rufe Snow
Fort Worth, Texas 76180
817-803-6625 Email: DAJ@DAJMD.com
_______________________________________
Also Genzyme is requiting for its new product SepraSpray.
Adhesion Prevention
Genzyme has developed a suite of biomaterials used to help improve the outcome of certain types of surgeries. Its Sepra™ line of hyaluronic acid-based products has been clinically shown to reduce the incidence of adhesions following general abdominal and gynecologic surgical procedures. With world-class research and development capabilities, and nearly two decades of experience working with biomaterials, Genzyme is expanding its presence in adhesion prevention through the development of laparascopically applied formulations.Adhesion Prevention publications more >.
In Europe.
Adhesion Barrier News
SprayGel is not approved for sale in the United States.
SprayGel is currently under clinical investigations in the U.S.
http://www.spraygel.com/spraygel/usa_home.htm
After much controversy about its capabilities, Tyco, the new owners of Confluent have re-instituted clinical trials for SprayGel in the U.S.A.
If you are interested in becoming part of the study contact Dr. Alan Johns in Fort Worth, TX.
Baylor All Saints Location:
1325 Pennsylvania, Suite 350Fort Worth, Texas 76104
817-803-6621
Richland Hills Location:3700 Rufe Snow
Fort Worth, Texas 76180
817-803-6625 Email: DAJ@DAJMD.com
_______________________________________
Also Genzyme is requiting for its new product SepraSpray.
Adhesion Prevention
Genzyme has developed a suite of biomaterials used to help improve the outcome of certain types of surgeries. Its Sepra™ line of hyaluronic acid-based products has been clinically shown to reduce the incidence of adhesions following general abdominal and gynecologic surgical procedures. With world-class research and development capabilities, and nearly two decades of experience working with biomaterials, Genzyme is expanding its presence in adhesion prevention through the development of laparascopically applied formulations.Adhesion Prevention publications more >.
In Europe.
Tuesday, September 02, 2008
Project Awareness: another lesson to be learned
Dear sir,You are requested to read the attached real story, Which may bring into light about the working nature and mugging of the corporate hospitals in india.. It is shame to the strong governments. To eradicate this mugging and control the shameful medical practices a strong new Act is required. So kindly consider to do a strong Act, in future this type of malpractice should not take place in India.
Regards,
D T S REDDYMaruteru – Mobile
From,tsprasad. From: t.s.prasad ()To:Date: Friday, 29 August, 2008 10:30:51 PMSubject: [auce79-83] treatment tragedy in Chennai hospital!!!!
This is a true sad incident happened to one of our INDIAN Family in this great country. Read this in his own words....... . This is really an eye opening article about the state of affairs in our so called CORPORATE HOSPITALS. Its unfortunate that this had to come to light as the stake of someone's life. But I hope this is a true indicator and makes us act with caution from here on. This is not a philosophical statement on one's life after death, this is about my wife who died in a hospital in Chennai. Whatever I have seen only in movies so far, is experienced by me.* We were living in the UK for few years; our family includes me, my wife (Padma), and our 7 yr old son and 8months old daughter. My wife had a symptom ofventral hernia (slightly bulged abdomen), we had consulted General Physician and Surgeon in the UK and advice was that she needed a surgery to have a mesh to fix the problem with a few weeks rest. We were also told that this is not an emergency and it can be done anytime though earlier is good. In fact the surgeon whom we consulted in UK talked about an example of a lady having this done for 30 years of the ymptom. My wife did not have any specific pain or something except a small discomfort of bulgy abdomen (like a 2 months pregnant lady) and she was in her normal routine of taking care of our children, taking our son to school, household work, etc. We were planning for Christmas vacation in India Dec 2007, we thought we will consult some 'good' doctors over in India and take a decision of when we will do the surgery if required and possibly felt doing in India is good because of family support. We have got a reference of Dr J S Rajkumar of Lifeline hospital and we booked an appointment to meet him. We landed in Chennai on 14th Dec 2007 for a three weeks vacation, met Dr Rajkumar at his city hospital (Rigid hospital) in Chet put on 15th Dec 2007 (Sat) at about 730pm. We have explained him the background, shown him all the comments of UK surgeon, medical reports related to my wife pregnancy, deliveries, etc (she had delivered both our children normally). After few minutes of assessment Dr Rajkumar told us this hernia requires laparoscopic surgery and we can do this next day itself. We were little concerned initially of getting this surgery done the very next day (particularly we were still not out of jet lag and she was feeding our baby) and got convinced with the 'salesy' words given by the Doctors. To quote a comment from the Doctor *"she will run in two days time and can lifttwo suitcases and you can return to UK as per your plan on 3rd Jan 2008"*). Also Dr Rajkumar told us that he will be on travel for 3days from 17th Dec and moreover he was teaching Post Graduates on 16th Dec about laparoscopic surgery and let us get itdone on 16th Dec. Then my wife was put into all sorts of equipments in the hospital (in the name of assessment); blood, urine, ECG, MRI and so on and the tests Re-conducted till about 11pm on 15th Dec. In fact they have opened the labs after losing hours and got the test done and handed over the test results to us. They had someproblem in the ECG and we were told that ECG can be done on the next day at Lifeline hospital. We were asked to report to Rigid hospital at 5am in the morning. Think of it, we went our residence around midnight and my wife had rush on some food to keep compliance on the fasting 8 hrs prior to surgery. After preparing for the hospital visit that night and a couple of hours sleep (3 hrs or so) we reached Rigid hospital on 16th morning at 5am or so and from there we were transported by an 'ambulance' to Lifeline hospital in Perungudi (outskirts of Chennai). We reached the hospital at 630am, paid some initial advance for the surgery and we were given a room. Padma went through some more basic checks like height, weight, etc. Padma was taken to the operation theatre at about 10am in the morning on 16th Dec. After the laparoscopic procedure she was moved to post operative ward at about 12 noon and Ihave met her in the afternoon to say a small hello when she gainedconsciousness . Dr Rajkumar met us on 16th Dec afternoon and he in fact *congratulated* me for successful surgery and said he has used proceed mesh (costly one) and advised his staff to move Padma to normal ward in the evening as she had to feed her baby. But, Padma was moved to normal ward only on 17th Dec morning, she was on IV fluids as per normal post operative procedure. Padma started to develop some fluids in her abdomen which duty doctors / surgeons have 'rightly' observed. She was put in some series of tests on 17 th, 18th, 19th and 20th – tests include multiple ultra sound, multiple CT scans, pricked her abdomen and taken fluids, she had a long tube through her nose overnight to collect fluid for tests, etc. We were told the fluid is normal after surgery and it will be alright after she passes stool, etc. In the meanwhile Dr Rajkumar returned from his travel and seen Padma on 19thon 20th Dec evening along with other surgeons. He made an assessment and he told me that he might want to do one more laparoscopic surgery to find out what is the fluid about. He wanted to do a surgery on 20th Dec evening itself, but he could not proceed as the hospital has given solid food that afternoon – hence anesthesia could not be given. (*lack of co-ordination among departments, time lost here, may be she could have survived if they have did the surgery on 20th itself)* On 20th Dec night, fluid started oozing from Padma's abdomen stitches, after the duty Doctor's assessment she was shifted to ICU. We really did not know what complication she developed in the ICU. On 21st Dec (Friday) morning around 830am I was called in to the ICU to convey that they are going to perform a surgery and I had to sign "*high risk consent",* they were telling this in front of my wife *(just think of a patient hearing this before the surgery). *I was just shocked at that and had no options to sign whatever they wanted. I said "all the best" *(my last conversation with mywife)* to my wife and she was taken to Operation Theatre. While I was discussing with the Doctors at ICU, the cashier in the hospital kept on calling me on mymobile. When I met the cashier he asked for Rs.60,000 to be paid immediately and I told him take Rs.40,000 and will give you the balance later in the day. Bang a reply came, "*you have to pay the money to for me to give clearance for surgery*". When I expressed my unhappiness about the comment, he insisted for me to sign a piece of paper saying that I will give the money later in the day. *(What money minded, in-human attitude!)*We had no news from the hospital on their own about the surgery, I had enquired the staff nurse and visited my wife in the ICU and learnt that she had a diagnostic laparotomy (open surgery) and there was hole in the intestine which was fixed.We have meet Dr Rajkumar at about 3:30pm on 21st Dec and understood that there was a *duodenum rupture* and he has fixed it, at the same time he removed the mesh which was fixed on 16th Dec. She was also paralyzed and put on ventilator as she was waking up. He explained it was between life threatening and beauty so they addressed the duodenum rupture problem. What we were puzzled were, how did the rupture happen? for that explanation given were - it could be due to ulcer. My wife had no evidence of ulcer in the past. Explanation given was 40%+ cases of ulcer is silent and there will be no symptom *(I lack medical knowledge to appreciate this)* - it could be due to post operative stress (*so many test post operation without any explanation of what we were doing could have created the stress on Padma is my argument)* On the same night (21st Dec) at about 930pm, I was called in to the ICU and Doctors conveyed that my wife condition is critical – her pulse is high, BP is low and they were attending to her. I insisted on talking to Dr Rajkumar immediately, but they refused to connect me to him at first and finally managed to speak to him. Dr Rajkumar came in around midnight and explained that the lungs are getting affected (shown X-ray of white patches on the lower portion of lungs) and she was the most serious patient in the whole hospital that time and they were trying their best. He also said, it will need another 12-24 hours of observation before they can say anything.We were completely panicked and just waiting outside the ICU and praying for Padma's recovery. We had to argue with the security outside the ICU to gain access to the Doctors to know her situation (*no courtesy from the security personnel, who just don't understand the situation)* At about 4:30am in the morning, my friend gained access the Doctors in the ICU and came out with the low face to tell me that Padma's condition is worsened. Again I tried to reach Dr Rajkumar and the hospital says they don't have his contact number (*just can't understand how they can behave like this). *Finally after some hue and cry Dr Rajkumar came on line to tell me that he is not God and don't think his visit can do any thing different. I cried, begged him to come over to give some ideas to his team to recover Padma. He came over at around 6am and said they are trying everything possible, etc; but her end came quickly. * The end came to our beloved Padma at 6:30am on 22nd Dec, throwing the entire family to rude shock and a life time sorrow. Our "LIVES AFTER DEATH" of Padma has changed for ever.* I can now think of so many questions retrospectively; 1. Why did the surgeon perform the surgery the very next day of consultancy, that too for a non-emergency one like this? (Padma had just traveled many miles, she was not even out of jet lag.) Was it for money? Was it for them to get one more sample for their post grads training?2. Did the Doctors made proper assessment on Padma's fitness for surgery, frankly did they even had time to go through the reports, after the tests till 11pm on the previous night for next day 8am surgery (particularly whenthe reports were with us till 730am on the day of surgery).3. Patient communication and counselling. Isn't it important to communicate to patient and their relatives on the development of patient condition (fluid collection started from the next day of laparoscopic)4. Did the absence of Dr Rajkumar for three days post the first surgery is one of the reason for this disaster? Were the other Doctors not able to diagnose or take a decision? Were they waiting for Dr Rajkumar return? 5. What is the real reason for duodenum perforation? My wife never had any history of ulcer to the best of my knowledge. Why did the hospital take so much of time to react (5 days after surgery) when such a crucial thing like preforation ICU has happened. 6. Was there any issue in the initial laparoscopic procedure which has caused the perforation? 7. Careless attitude by hospital staff? – my wife sex was recorded as "Male" initially and corrected after I told them. The staff was not even apologetic for this, he rather asked me "why didn't you inform". Can't he make out with the name Padma. *Think of it, if he has changed the blood group from A+ to B+; that is it!!* 8. Will anyone with basic common sense ask for high risk signature in front of the patient? I was asked to sign just minutes before surgery in front of my wife. 9. Is the hospital money minded?: They were demanding money on gun point almost. a. Prior to the first surgery the cashier said please give Rs.30000/- more for him to give clearance for surgery b. When my wife going for second surgery I was told by the cashier again, please give Rs.60000/- for clearance for surgery c. The hospital charged more than what was told for initial laparoscopic, without even communicating to me increase in chargesd. The final "bill" was just on letter head, without mention of currency, invoice number, etc. I had to insist on a proper invoice later. e. I was given to understand that they even made arguments on ambulance charges to send my wife dead body back home.!! *(making money on the dead body also)* 10. Why the hospital did not made me to talk to my wife when she gained consciousness after the second surgery? If not anything else, I could have held her hand. Even a criminal gets an opportunity to communicate his/her last wishes. Am I or my wife worse than? 11. *FALSE reports* - After all these hospital sends me false reports (on Jan 11, 2008 – three weeks after my wife's death) : a. They had mentioned she had LSCS (caesarean section) and large scar due to LSCS. When my wife delivered both the babies normally, how does one record as caesarean and *how there will be scar when there was no caesarean?*b. The hernia was mentioned "incisional hernia" – when there was no incision on her body how the hernia is categorised as incisional? It was actually ventral hernia. Don't think one can replace any term with any term just like that!c. Most importantly, the surgery was performed on 16th Dec 2007, the report said 17th dec 2007 12. *MISSING REPORTS - *From the hospital records Doctors notes were missing for 16th and 17th Dec. The first report is available for 17th Dec at 8:36pm. How come there are no Doctors' notes for *about 36 hours after the surgery?*Isn' t it fishy? Did something went wrong on the first laparoscopic procedure? Our entire family is still mourning and trying to reconcile the fact that our Padma is no more. My 7 year old son is aware that is Mom is not there, does he understand? My 1 year old daughter is too young to know what has happened. What will her questions be in future?My sincere advice to all isa) Do not get carried away by advertisement / TV shows / big buildings b) Please do not rush c) Do your own due diligence, particularly when things are not an emergency d) Try and understand the medical terms, do research prior e) Please ask questions, at every stage. f) Don't say "I can spend anything" g) Know patient rights * I am still not convinced that Padma has died after a 'simple' laparoscopic surgery? I am deeply upset of what has happened to Padma and for what is happening to us. What I could have done (or not done) which would have prevented this. What is that we cando to prevent this in future for others!!!************ ********* ********* ********* ********* ******Please join me in making awareness to others. While India is trying to woo many international Customers in the name of 'medical tourism'; first let the authorities make regulation on the health care system and take care of Indian people first. Our medical system must understand the differences between MEDICINE – TREATMENT and HEALTHCARE. What we get most of the time is medicine for the symptom while we need healthcare.
http://dtsreddy.spaces.live.com/blog/cns!13F578534B68D612!722.entry
Regards,
D T S REDDYMaruteru – Mobile
From,tsprasad. From: t.s.prasad ()To:Date: Friday, 29 August, 2008 10:30:51 PMSubject: [auce79-83] treatment tragedy in Chennai hospital!!!!
This is a true sad incident happened to one of our INDIAN Family in this great country. Read this in his own words....... . This is really an eye opening article about the state of affairs in our so called CORPORATE HOSPITALS. Its unfortunate that this had to come to light as the stake of someone's life. But I hope this is a true indicator and makes us act with caution from here on. This is not a philosophical statement on one's life after death, this is about my wife who died in a hospital in Chennai. Whatever I have seen only in movies so far, is experienced by me.* We were living in the UK for few years; our family includes me, my wife (Padma), and our 7 yr old son and 8months old daughter. My wife had a symptom ofventral hernia (slightly bulged abdomen), we had consulted General Physician and Surgeon in the UK and advice was that she needed a surgery to have a mesh to fix the problem with a few weeks rest. We were also told that this is not an emergency and it can be done anytime though earlier is good. In fact the surgeon whom we consulted in UK talked about an example of a lady having this done for 30 years of the ymptom. My wife did not have any specific pain or something except a small discomfort of bulgy abdomen (like a 2 months pregnant lady) and she was in her normal routine of taking care of our children, taking our son to school, household work, etc. We were planning for Christmas vacation in India Dec 2007, we thought we will consult some 'good' doctors over in India and take a decision of when we will do the surgery if required and possibly felt doing in India is good because of family support. We have got a reference of Dr J S Rajkumar of Lifeline hospital and we booked an appointment to meet him. We landed in Chennai on 14th Dec 2007 for a three weeks vacation, met Dr Rajkumar at his city hospital (Rigid hospital) in Chet put on 15th Dec 2007 (Sat) at about 730pm. We have explained him the background, shown him all the comments of UK surgeon, medical reports related to my wife pregnancy, deliveries, etc (she had delivered both our children normally). After few minutes of assessment Dr Rajkumar told us this hernia requires laparoscopic surgery and we can do this next day itself. We were little concerned initially of getting this surgery done the very next day (particularly we were still not out of jet lag and she was feeding our baby) and got convinced with the 'salesy' words given by the Doctors. To quote a comment from the Doctor *"she will run in two days time and can lifttwo suitcases and you can return to UK as per your plan on 3rd Jan 2008"*). Also Dr Rajkumar told us that he will be on travel for 3days from 17th Dec and moreover he was teaching Post Graduates on 16th Dec about laparoscopic surgery and let us get itdone on 16th Dec. Then my wife was put into all sorts of equipments in the hospital (in the name of assessment); blood, urine, ECG, MRI and so on and the tests Re-conducted till about 11pm on 15th Dec. In fact they have opened the labs after losing hours and got the test done and handed over the test results to us. They had someproblem in the ECG and we were told that ECG can be done on the next day at Lifeline hospital. We were asked to report to Rigid hospital at 5am in the morning. Think of it, we went our residence around midnight and my wife had rush on some food to keep compliance on the fasting 8 hrs prior to surgery. After preparing for the hospital visit that night and a couple of hours sleep (3 hrs or so) we reached Rigid hospital on 16th morning at 5am or so and from there we were transported by an 'ambulance' to Lifeline hospital in Perungudi (outskirts of Chennai). We reached the hospital at 630am, paid some initial advance for the surgery and we were given a room. Padma went through some more basic checks like height, weight, etc. Padma was taken to the operation theatre at about 10am in the morning on 16th Dec. After the laparoscopic procedure she was moved to post operative ward at about 12 noon and Ihave met her in the afternoon to say a small hello when she gainedconsciousness . Dr Rajkumar met us on 16th Dec afternoon and he in fact *congratulated* me for successful surgery and said he has used proceed mesh (costly one) and advised his staff to move Padma to normal ward in the evening as she had to feed her baby. But, Padma was moved to normal ward only on 17th Dec morning, she was on IV fluids as per normal post operative procedure. Padma started to develop some fluids in her abdomen which duty doctors / surgeons have 'rightly' observed. She was put in some series of tests on 17 th, 18th, 19th and 20th – tests include multiple ultra sound, multiple CT scans, pricked her abdomen and taken fluids, she had a long tube through her nose overnight to collect fluid for tests, etc. We were told the fluid is normal after surgery and it will be alright after she passes stool, etc. In the meanwhile Dr Rajkumar returned from his travel and seen Padma on 19thon 20th Dec evening along with other surgeons. He made an assessment and he told me that he might want to do one more laparoscopic surgery to find out what is the fluid about. He wanted to do a surgery on 20th Dec evening itself, but he could not proceed as the hospital has given solid food that afternoon – hence anesthesia could not be given. (*lack of co-ordination among departments, time lost here, may be she could have survived if they have did the surgery on 20th itself)* On 20th Dec night, fluid started oozing from Padma's abdomen stitches, after the duty Doctor's assessment she was shifted to ICU. We really did not know what complication she developed in the ICU. On 21st Dec (Friday) morning around 830am I was called in to the ICU to convey that they are going to perform a surgery and I had to sign "*high risk consent",* they were telling this in front of my wife *(just think of a patient hearing this before the surgery). *I was just shocked at that and had no options to sign whatever they wanted. I said "all the best" *(my last conversation with mywife)* to my wife and she was taken to Operation Theatre. While I was discussing with the Doctors at ICU, the cashier in the hospital kept on calling me on mymobile. When I met the cashier he asked for Rs.60,000 to be paid immediately and I told him take Rs.40,000 and will give you the balance later in the day. Bang a reply came, "*you have to pay the money to for me to give clearance for surgery*". When I expressed my unhappiness about the comment, he insisted for me to sign a piece of paper saying that I will give the money later in the day. *(What money minded, in-human attitude!)*We had no news from the hospital on their own about the surgery, I had enquired the staff nurse and visited my wife in the ICU and learnt that she had a diagnostic laparotomy (open surgery) and there was hole in the intestine which was fixed.We have meet Dr Rajkumar at about 3:30pm on 21st Dec and understood that there was a *duodenum rupture* and he has fixed it, at the same time he removed the mesh which was fixed on 16th Dec. She was also paralyzed and put on ventilator as she was waking up. He explained it was between life threatening and beauty so they addressed the duodenum rupture problem. What we were puzzled were, how did the rupture happen? for that explanation given were - it could be due to ulcer. My wife had no evidence of ulcer in the past. Explanation given was 40%+ cases of ulcer is silent and there will be no symptom *(I lack medical knowledge to appreciate this)* - it could be due to post operative stress (*so many test post operation without any explanation of what we were doing could have created the stress on Padma is my argument)* On the same night (21st Dec) at about 930pm, I was called in to the ICU and Doctors conveyed that my wife condition is critical – her pulse is high, BP is low and they were attending to her. I insisted on talking to Dr Rajkumar immediately, but they refused to connect me to him at first and finally managed to speak to him. Dr Rajkumar came in around midnight and explained that the lungs are getting affected (shown X-ray of white patches on the lower portion of lungs) and she was the most serious patient in the whole hospital that time and they were trying their best. He also said, it will need another 12-24 hours of observation before they can say anything.We were completely panicked and just waiting outside the ICU and praying for Padma's recovery. We had to argue with the security outside the ICU to gain access to the Doctors to know her situation (*no courtesy from the security personnel, who just don't understand the situation)* At about 4:30am in the morning, my friend gained access the Doctors in the ICU and came out with the low face to tell me that Padma's condition is worsened. Again I tried to reach Dr Rajkumar and the hospital says they don't have his contact number (*just can't understand how they can behave like this). *Finally after some hue and cry Dr Rajkumar came on line to tell me that he is not God and don't think his visit can do any thing different. I cried, begged him to come over to give some ideas to his team to recover Padma. He came over at around 6am and said they are trying everything possible, etc; but her end came quickly. * The end came to our beloved Padma at 6:30am on 22nd Dec, throwing the entire family to rude shock and a life time sorrow. Our "LIVES AFTER DEATH" of Padma has changed for ever.* I can now think of so many questions retrospectively; 1. Why did the surgeon perform the surgery the very next day of consultancy, that too for a non-emergency one like this? (Padma had just traveled many miles, she was not even out of jet lag.) Was it for money? Was it for them to get one more sample for their post grads training?2. Did the Doctors made proper assessment on Padma's fitness for surgery, frankly did they even had time to go through the reports, after the tests till 11pm on the previous night for next day 8am surgery (particularly whenthe reports were with us till 730am on the day of surgery).3. Patient communication and counselling. Isn't it important to communicate to patient and their relatives on the development of patient condition (fluid collection started from the next day of laparoscopic)4. Did the absence of Dr Rajkumar for three days post the first surgery is one of the reason for this disaster? Were the other Doctors not able to diagnose or take a decision? Were they waiting for Dr Rajkumar return? 5. What is the real reason for duodenum perforation? My wife never had any history of ulcer to the best of my knowledge. Why did the hospital take so much of time to react (5 days after surgery) when such a crucial thing like preforation ICU has happened. 6. Was there any issue in the initial laparoscopic procedure which has caused the perforation? 7. Careless attitude by hospital staff? – my wife sex was recorded as "Male" initially and corrected after I told them. The staff was not even apologetic for this, he rather asked me "why didn't you inform". Can't he make out with the name Padma. *Think of it, if he has changed the blood group from A+ to B+; that is it!!* 8. Will anyone with basic common sense ask for high risk signature in front of the patient? I was asked to sign just minutes before surgery in front of my wife. 9. Is the hospital money minded?: They were demanding money on gun point almost. a. Prior to the first surgery the cashier said please give Rs.30000/- more for him to give clearance for surgery b. When my wife going for second surgery I was told by the cashier again, please give Rs.60000/- for clearance for surgery c. The hospital charged more than what was told for initial laparoscopic, without even communicating to me increase in chargesd. The final "bill" was just on letter head, without mention of currency, invoice number, etc. I had to insist on a proper invoice later. e. I was given to understand that they even made arguments on ambulance charges to send my wife dead body back home.!! *(making money on the dead body also)* 10. Why the hospital did not made me to talk to my wife when she gained consciousness after the second surgery? If not anything else, I could have held her hand. Even a criminal gets an opportunity to communicate his/her last wishes. Am I or my wife worse than? 11. *FALSE reports* - After all these hospital sends me false reports (on Jan 11, 2008 – three weeks after my wife's death) : a. They had mentioned she had LSCS (caesarean section) and large scar due to LSCS. When my wife delivered both the babies normally, how does one record as caesarean and *how there will be scar when there was no caesarean?*b. The hernia was mentioned "incisional hernia" – when there was no incision on her body how the hernia is categorised as incisional? It was actually ventral hernia. Don't think one can replace any term with any term just like that!c. Most importantly, the surgery was performed on 16th Dec 2007, the report said 17th dec 2007 12. *MISSING REPORTS - *From the hospital records Doctors notes were missing for 16th and 17th Dec. The first report is available for 17th Dec at 8:36pm. How come there are no Doctors' notes for *about 36 hours after the surgery?*Isn' t it fishy? Did something went wrong on the first laparoscopic procedure? Our entire family is still mourning and trying to reconcile the fact that our Padma is no more. My 7 year old son is aware that is Mom is not there, does he understand? My 1 year old daughter is too young to know what has happened. What will her questions be in future?My sincere advice to all isa) Do not get carried away by advertisement / TV shows / big buildings b) Please do not rush c) Do your own due diligence, particularly when things are not an emergency d) Try and understand the medical terms, do research prior e) Please ask questions, at every stage. f) Don't say "I can spend anything" g) Know patient rights * I am still not convinced that Padma has died after a 'simple' laparoscopic surgery? I am deeply upset of what has happened to Padma and for what is happening to us. What I could have done (or not done) which would have prevented this. What is that we cando to prevent this in future for others!!!************ ********* ********* ********* ********* ******Please join me in making awareness to others. While India is trying to woo many international Customers in the name of 'medical tourism'; first let the authorities make regulation on the health care system and take care of Indian people first. Our medical system must understand the differences between MEDICINE – TREATMENT and HEALTHCARE. What we get most of the time is medicine for the symptom while we need healthcare.
http://dtsreddy.spaces.live.com/blog/cns!13F578534B68D612!722.entry
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