Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Kidney Damage After Surgical Clip Left on Ureter
A woman underwent surgical removal of her left Fallopian tube and ovary for treatment of an ovarian tumor. Adhesions noted around the right Fallopian tube were lysed. The surgery was performed by the defendant.
Almost two years later, the patient underwent a second surgery which included a laparoscopy, lysis of adhesions, and biopsy of the right ovary. No mention was made at that time of a clip on the left ureter, but the area may not have been visible. This surgery was performed by a different physician.
The patient underwent a third surgery three months later, an exploratory laparotomy with lysis of adhesions and right ovarian cystectomy and partial omentectomy. During this procedure, performed by a third surgeon, visual inspection of the left kidney revealed that it appeared a bit enlarged, compared with the right. The right ureter was identified and noted to be separate from the surgical area during the operation on the right ovary.
Ten years later, the patient underwent CT urography to evaluate complaints of left-sided abdominal pain. She was diagnosed with hydronephrosis of the left kidney. CT revealed a chronically obstructed left kidney, likely attributable to a surgical clip that was obstructing the distal third of the left ureter. Her left kidney was essentially nonfunctioning. The urologist noted that the surgical clip was likely placed at the time of the patient’s ovarian surgery “10 years ago” (although the surgery in question had actually been performed 12 years earlier).
The plaintiff alleged negligence by the defendant in placing the clip on the left ureter, resulting in kidney damage.
The defendant moved for dismissal and summary judgment based on the statute of limitations and the statute of repose. Both motions were denied. The defendant also argued that it would have been impossible to clip the ureter at the time of the original surgery without the plaintiff experiencing immediate excruciating pain. He admitted, however, that one could have a partial obstruction without pain. The defendant also acknowledged that a partial obstruction could lead to total obstruction and death of the kidney years later.
An arbitration award of $450,000 was made.
Conservative Advice for Postprandial Symptoms
Four years after undergoing gastric bypass surgery, a 48-year-old woman experienced nausea, dry heaves, and a sensation of fullness about 20 minutes after eating. She called her surgeon’s office and reported her symptoms to a representative of his answering service. Dr. M., an internist who was covering for the surgeon that night, called the patient back to discuss her symptoms. She instructed the patient to drink some hot tea, lie down, and call back in an hour or two.
When the patient did not call as requested, Dr. M. phoned her. Her husband, who took the call, reported that the woman was feeling better and had gone to sleep. Dr. M. instructed him to call her if there were further symptoms or problems. She received no additional calls.
The patient awoke in the very early morning hours with shortness of breath, and her husband drove her immediately to the hospital. She had a strangulated bowel and lactic acidosis, which led to full cardiac arrest. The necrotic bowel was surgically removed, but the woman was brain-dead as a result of her arrest. She was taken off life support three days later.
The plaintiff claimed that Dr. M. should have directed the decedent to go to the emergency department. Dr. M. claimed she was never told that the decedent had previously had a small bowel obstruction that was not surgically repaired. The defendant also claimed that the decedent probably experienced an acute bowel obstruction in the early morning hours, which could not have been foreseen.
According to a published account, a defense verdict was returned. A posttrial motion was pending.
Failure to Diagnose Testicular Torsion
A 12-year-old boy presented to his pediatrician with complaints of left groin pain. He reported that the pain had begun when he slid into third base during a baseball game six days earlier.
The pediatrician found trauma to the groin with questionable blood in the sac versus torsion of the testes. He sent the boy to a local hospital for an ultrasound to rule out testicular torsion. A physical examination by the nursing staff at the defendant hospital revealed that the boy’s left testicle was three times larger than the right testicle; the emergency physician noted the left testicle to be markedly enlarged, spongy, and tender. There was no evidence of scrotal swelling or ecchymosis. The physician also noted that the testes were mobile in the scrotal sac with no evidence of a hernia.