The client, a retired but active male, underwent a laparoscopic gallbladder removal. During this surgical procedure, the defendant general surgeon inadvertently perforated the client’s bowel, and the perforation went undetected. During the twelve-hour period that followed surgery, the client went into a precipitous decline. The client experienced a distended abdomen, worrisome fever and abnormally high respiration and heart rates. He also experienced severe pain that required repeated doses of morphine.
A rapid assessment team was called to the client’s bedside by his nurse to assist in the evaluation of the client in light of his downward spiral. Testing of the client’s blood gases showed a critical level of lactate, an infection byproduct often seen with sepsis.
the defendant did not respond to the client’s bedside for more than eight hours after the onset of the client’s worrisome signs and symptoms despite five phone calls from nurses who communicated the above data about his deterioration. When the defendant did come to the client’s bedside, he charted a note ruling out bowel perforation as the cause of the client’s decline. In deposition, the defendant conceded that all of the above signs and symptoms were consistent with bowel perforation and sepsis. The defendant also conceded that bowel perforation is “always on the differential diagnosis list” and that bowel perforation constituted a surgical emergency. Nevertheless, the defendant denied that there was substandard care in failing to diagnose the client’s bowel perforation contending that a pulmonary infection was the most likely cause for the client’s deterioration. The defendant cited a “surgical dictum” that fevers that occur within 24 hours of surgery are usually pulmonary in origin. The defendant also contended that four other physicians in other specialities failed to make a timely diagnosis of bowel perforation and sepsis.
We countered that the client’s post-op chest x-ray did not reveal any significant pulmonary findings that would account for his downward spiral. We also countered that the client’s constellation of signs and symptoms provided overwhelming evidence of bowel perforation and sepsis – that the client’s presentation constituted bowel perforation until proven otherwise. We additionally noted that proper application of differential diagnosis required that the defendant re-operate to investigate for bowel perforation and then repair the perforation well within the 12-hour period in which the client began to deteriorate. We noted that none of the four other physicians called in to evaluate the client’s deterioration was surgeons and that all four physicians were likely to have been influenced in their evaluations of the client by the defendant’s charted opinion that his decline was not likely to have been secondary to bowel perforation since the surgery did not take place near the client’s bowel.
Because the defendant did not re-operate until more than 30 hours after the client began to exhibit signs and symptoms of bowel perforation, the client’s sepsis progressed to septic shock, a life-threatening condition which required the administration of presser drugs to restore blood pressure but which also carried the side effect of constricting small blood vessels. This side effect compromised the small blood vessels in the client’s extremities to such degree that blood flow was significantly blocked, thus leading to gangrene and amputation. The client required approximately five months of hospital treatment which included multiple surgeries for abdominal infections. He also required a permanent ileostomy.
The case settled at mediation for $850,000. Damage caps that apply to medical malpractice cases limited the amount of the settlement.