Re: US malpractice (long)
From: Gail Waldby (gwaldby@willinet.net)
Mon Aug 4 19:35:04 2003
This is remarkably similar to the famous Libby Zion case. I strongly
suspect there were signs and symptoms of ischemic and then dead bowel long
before the first reoperation (second operation).
Gail Waldby, MD
Huron Clinic SD
On Mon, 4 Aug 2003 06:00:30 -0500, deborah stephens <DSTEPHENS@peacehealth.org>
wrote:
> At Wed, 4 Sep 2002, RModugno@aol.com wrote:
>>
>> This is from the August 2002 issue of Contemporary OB/Gyn: (Legally
>> Speaking
>> section)
>>
>> Necrotic bowel found following ovarian mass removal
>>
>> In 1999, a Texas woman who went to the emergency room complaining of
>> back and
>> abdominal pain was diagnosed with a left ovarian mass and admitted for
>> the
>> night. The next day she was sent home and told to come back for a
>> "cancer
>> workup." Two days later she returned to the emergency room with a
>> ruptured
>> mass. Two days after that, the woman underwent surgery, which was
>> performed
>> by the chief resident, with a gynecological specialist as the attending,
>> and
>> a general surgeon. The surgeons removed the mass and resected the
>> omentum but
>> did not do a frozen section because of the tumor's size and necrotic
>> state. A
>> pathology report returned 2 days later was negative for cancer. Over the
>> next
>> 8 days, the patient's nasogastric tube output increased and she
>> experienced
>> increasing pain and need for analgesia. Her primary physician then went
>> on
>> vacation and another gynecologic specialist was covering. When the
>> original
>> physician returned on the patient's 9th post-op day, her bowel sounds
>> were
>> still erratic. He ordered a gastroenterology consult, and while waiting
>> for
>> it, noted bowel contents leaking from the abdominal incision. Surgery
>> was
>> performed for what was presumed to be a fistula repair, but 80% of the
>> woman's small bowel was found to be necrotic. After undergoing, over the
>> next
>> several days, four operations to remove gangrenous bowel and a
>> hysterectomy,
>> she was left with only 10 inches of her small bowel. The woman sued all
>> the
>> physicians involved with her care, contending that the covering
>> physician did
>> not order appropriate tests or x-rays to determine the reason her bowels
>> were
>> not working postoperatively. An x-ray on the fifth post-op day showed a
>> likely ileus but could not rule out a mechanical obstruction, and she
>> claimed
>> that further investigation should have been done. The physicians argued
>> that
>> the diagnosis and surgeries were appropriate and all agreed there was an
>> ileus. Two theories were presented as to why the bowels did not work:
>> obstruction of the small bowel or development of a clot in the mesentery
>> that
>> led to infarction of the small bowel. No obstruction was found at the
>> time of
>> surgery and there were clots on the venous side of the mesentery. The
>> patient
>> promoted the theory that she had an obstruction that should have been
>> recognized and treated sooner, and that the clots had formed after that.
>> The
>> physicians argued that it was an ileus with the rare complication of
>> infarcts
>> in the bowel. The jury awarded the patient $1 million, assigning 60%
>> liability to the covering physician and 40% to the attending
>> gynecologist. A
>> high/low agreement of $750,000/$100,000 was executed, however, before
>> closing
>> arguments. Legal perspective A high/low agreement can be useful when an
>> amount cannot be agreed upon by both parties to settle a malpractice
>> case.
>> The trial proceeds, but the parties agree in advance on a "low" amount
>> that
>> will be paid if the jury returns a defense verdict and a "high" amount
>> that
>> will be paid if the jury awards more than that amount to the plaintiff.
>> In
>> this case, the patient would have received $100,000 if the jury had come
>> back
>> with a defense verdict. Since the jury here awarded $1 million, the
>> agreed-upon $750,000 will be paid to the patient. While this does mean
>> the
>> plaintiff gets something even though the jury did not necessarily think
>> there
>> was negligence, sometimes most of the award is used to pay expenses, and
>> a
>> high/low agreement can prevent the physician or his/her insurance
>> company
>> from paying out a ridiculously huge award.
>> ********************************************************
>>
>> ********************************************************
>>> From the "legal" and "financial/economic aspect" I can see the logic in
>>> a
>> high/low ageement. From a potential defendant's view it seems immoral
>> and
>> unjust. Why should the plaintiff receive one cent if the jury finds the
>> defendant not negligent!
>> This is but one of the reasons why we have a professional liability
>> insurance
>> "crisis" in the US today!
>>
>> Comments?
>>
>> Robert Modugno MD MBA FACOG
>> Marietta, GA
>> http://www.novaobgyn.yourmd.com
>
--
Gail Waldby
