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Surgical Error – Failure To Diagnose – Delayed Treatment


FACTS & ALLEGATIONS On March 2, 2007, plaintiff E.G., 61, an attorney, underwent laparoscopic surgery, a cholecystectomy, which involved the removal of an inflamed portion of her gallbladder. The procedure was performed by Dr. R.B., at W.H.M.C. The surgery also included the insertion of a drain that was intended to promote the proper drainage of bile.

During the days that followed the surgery, Dr. B. observed increasing drainage of bile. A gastroenterologist recommended the performance of a cholangiopancreatography, which would have allowed the inspection of plaintiff’s ductal systems, but Dr. B. did not perform the procedure. Plaintiff was discharged on March 5, 2007, but Dr. B. performed several follow-up examinations.

During the four months that followed the surgery, plaintiff experienced sequelae that included nausea, jaundice, the continued drainage of bile, a rash, and changes of the color of her stool and urine. Another doctor performed a cholangiopancreatography, and the procedure revealed that plaintiff was suffering a stricture of the common hepatic duct, which controls the drainage of bile. The doctor determined that the stricture prevented the proper drainage of bile. He contended that rerouted bile entered plaintiff’s bloodstream and liver, and he opined that plaintiff’s post surgical symptoms were a result of the stricture. Plaintiff claimed that the stricture was a result of the improper performance of the cholecystectomy.

Plaintiff sued Dr. B. She alleged that Dr. B. failed to properly perform the cholecystectomy, that he failed to render proper post surgical care and that his failures constituted malpractice.

Plaintiff’s expert surgeon submitted a report in which he opined that CT scans indicated that plaintiff’s stricture was caused by clips that Dr. B. applied during the surgery. The expert contended that the clips were not properly applied.

Plaintiff’s counsel also claimed that Dr. B. failed to diagnose the stricture. They noted that the stricture was ultimately diagnosed via the same test that was recommended during the immediate wake of the cholecystectomy, and they contended that prompt treatment would have eliminated or lessened the stricture’s residual effects.

Defense counsel contended that a stricture is an accepted risk of the procedure that Dr. B. performed, and he claimed that the injury did not establish that the procedure was improperly performed.

INJURIES/DAMAGES back; bile duct; decompression surgery; incisional hernia; jaundice; laparotomy; nausea; perforated duodenum; perforated intestine; rash; soft tissue adhesions.

On March 2, 2007, plaintiff sustained damage of her hepatic duct. The resultant stricture caused nausea, a rash, pain that stemmed from her back and jaundice.

One August 9, 2007, plaintiff underwent the insertion of a stent that relieved the stricture. However, the stent migrated to her small intestine, and it caused a perforation of the duodenum, which is the intestine’s leading end. The wound necessitated performance of laparotomic surgery that involved the decompression of plaintiff’s biliary tree. In April 2008, she underwent a hepaticojejunstomy, which involved the joining of a hepatic duct and the small intestine’s jejunum, which is an area that is located beyond the duodenum. She subsequently developed an incisional hernia, which necessitated additional surgery.

Plaintiff has developed extensive residual adhesions of soft tissue, and her doctors believe that she may develop another stricture or hernia. Plaintiff’s counsel claimed that a stricture or hernia would necessitate surgery that could be complicated by plaintiff’s adhesions.

Plaintiff sought recovery of damages for her past and future pain and suffering.

RESULT The parties negotiated a pretrial settlement. Dr. B.’s insurer agreed to pay $825,000 from a policy that provided $1.3 million of coverage.

INSURER: Medical Liability Mutual Insurance Co.

PLAINTIFF EXPERT: Paresh Shah, general surgery, New York, NY

DEFENSE EXPERT: None reported