Facts

On April 19, 2016, plaintiff's decedent, Guadalupe Morris, was admitted to Citrus Valley Medical Center to undergo a dual robotic surgery consisting of a hysterectomy and salpingo-oophorectomy by codefendant Dr. Bill Tang followed by a sacrocolpopexy (bladder lift) by defendant Dr. John Lee. It was anticipated that decedent would be discharged from the hospital the following day.

On April 20, 2016, decedent's individual examinations by Dr. Lee and Dr. Tang revealed a non-tender, non-distended abdomen, without any signs of peritonitis. However, soon after surgery decedent complained of chest pain and began demonstrating persistent tachycardia (elevated heart rate) that resulted in Dr. Tang requesting a consultation from the on-call hospitalist. In the early evening of April 21, 2016 (day two post-surgery) plaintiff reported persistent abdominal pain and her white blood cell count, kidney function tests and liver function tests were abnormal. Dr. Lee's examination revealed a diffusely tender abdomen with signs of peritonitis due to either a bowel injury or obstruction. He immediately requested a surgical consultation to determine if decedent required an exploratory procedure. In addition to the abnormal laboratory and physical examination findings, decedent was hypotensive and anemic.

Dr. Saguan felt that decedent needed to be resuscitated with intravenous fluids and blood products prior to considering an exploratory procedure. On April 22, 2016, decedent was transferred to the intensive care unit but clinically appeared to be responding to the resuscitation regimen. On April 23, 2016, Dr. Saguan took decedent back to the operating room due to succus (small bowel) drainage from a left flank trocar port site. His pre and post surgery diagnosis was intraabdominal sepsis. At surgery, Dr. Saguan found a sizeable defect in the small intestine that resulted in free spillage of enteric contents. Dr. Saguan resected the area of the small bowel defect and performed an anastomosis. He did not discover any openings or holes in the large intestine.

Decedent improved clinically after the April 23, 2016 surgery until May 7 when it was noted that she began spilling feculent (large intestine) drainage associated with a fever. As a result, decedent was taken back to the operating room at which time Dr. Saguan noted the presence of two holes widely open in the anterior portion of the large bowel that were associated with draining feculent material. Dr. Saguan resected the involved areas of the large intestine and created a transverse loop colostomy. After the May 7, 2016, decedent remained hospitalized and ventilator dependent in the Intensive Care Unit until July 19, 2016 when she suffered a fatal cardiac arrest. In the interval between the May 7, 2016 and decedent's passing, Dr. Saguan performed multiple surgical wound debridements.

PLAINTIFF'S CONTENTIONS: Plaintiff alleged that Dr. Lee fell below the standard of care as a co-surgeon during the April 19, 2016, robotic surgery by directly or indirectly being responsible of negligently placing a trocar that injured both the large intestine and small intestine and failed to recognize these injuries. Plaintiff claimed further that had Dr. Lee timely recognized the bowel injuries, decedent would have received treatment that would have prevented her death. Finally, plaintiff claimed that Dr. Lee was attempting to avoid taking responsibility for the small bowel injury by denying he was present at the time the adhesions were lysed and the fifth trocar was placed.

Plaintiff alleged that Dr. Saguan negligently failed to diagnose the large bowel injuries during his initial exploratory procedure on April 23, 3026, due to his inadequate inspection of the bowel at that time. Plaintiff alleged further that Dr. Saguan's negligence was a substantial factor resulting in the subject death.

DEFENDANTS' CONTENTIONS: Dr. Tang testified that prior to his procedure, he placed 4 of the 5 trocars prior to the commencement of the hysterectomy. He indicated that when he noted the presence of adhesions in and around the area where the fifth trocar was to be placed in the left upper quadrant, he called Dr. Lee into the operating room to take down the adhesions and place the fifth trocar under direct visualization. Dr. Tang's role at this point according to his testimony was to use the surgical camera to guide Dr. Lee in placing the trocar and removing or freeing up the adhesions. Dr. Lee testified that he did not enter the operating room until after the fifth trocar was placed and the adhesions had been lysed by Dr. Tang.

Defendant Lee contended that his care and treatment during the April 19, 2016 surgery was reasonable and well within the standard of care. Further, that the small bowel injury was not caused by the placement of the fifth trocar, but resulted, more likely than not, as a complication of the lysis of the adhesions.

Defendant Dr. Saguan contended that his examination of the large intestine on April 23, 2016, was within the standard of care and had he attempted to mobilize the colon further it would have increased the likelihood of an iatrogenic injury. In fact, he contended that the injury to the large bowel did not occur until nearly two weeks after the initial exploratory procedure based on decedent's post operative clinical course and the subsequent imaging studies performed prior to the May 7, 2016 surgery.

Insurer

Select MD for Dr. Lee; The Doctors Company for Dr. Saguan

Damages

Loss of love, companionship, comfort and moral support. During closing argument plaintiff's counsel asked the jury for a $1 million award.

Injuries

Death of mother

Result

Defense verdict for Dr. Lee and Dr. Saguan

Other Information

Codefendant Dr. Bill Tang settled prior to trial.

Deliberation

3.5 hours

Poll

10-2 for Dr. Lee on the question of negligence; 11-1 for Dr. Saguan on question of negligence

Length

14 days