Facts

On Aug. 20, 2005, the patient, a 57-year-old female presented to Mercy Hospital and was diagnosed with bilary colic. The patient had a prior medical history, including back injury, ulcer, stroke and bleeding disorder. The patient consented to a laparoscopic cholecystectomy, which was performed by defendant Dr. Naik, a general surgeon. Despite no reported history of abdominal surgery, the patient's abdomen was found to have severe adhesions in the abdominal cavity requiring lysis of adhesions in order to complete the surgery to remove the gallbladder. Extensive lysis of adhesion was performed via laparoscopy, and no evidence of injury to any surrounding structures, including the bowel were noted during the procedure.

The next morning, on Aug. 21, the patient began having some abdominal pain and tachycardia; she was rehydrated, and antibiotics were started. The plan was to take her back to surgery if she did not improve. At approximately 4:30 p.m., the patient suffered a cardiac arrest and was found to be unresponsive. She was transported to the ICU following successful resuscitation. Dr. Naik took the patient back to surgery at approximately 7:30 p.m., at which time Dr. Naik performed an exploratory laparotomy in which he found a large amount of fecal/foul smelling fluid in the peritoneal cavity. A small perforation, a few millimeters in diameter was found in the proximal ileum, near the area of the umbilical entry point for the laparoscopy. The entire bowel was examined and no other injury was found. The bowel was resected, adhesions were lysed, and the abdomen was irrigated with antibiotic solution. Drains were placed prior to closing of the abdomen.

The patient continued to do poorly despite treatment. Some purulent drainage material was noticed coming out of the Jackson Pratt drain; the patient eventually deteriorated to the point where she was too unstable to be taken back to surgery and she required pressor support to maintain blood pressure, as well as mechanical ventilation. The patient ultimately suffered an encephalopathy, likely toxic and hypoxic. A CT scan on Aug. 31, showed no gross fluid collection in the abdomen.

The patient never became responsive, and her Code status was changed such that only comfort measures would be taken and she was pronounced dead on Sept. 21. On autopsy, the cause of death was determined to be multi-system organ failure, due to septicemia, due to perforation of the small intestine. Another perforation of the bowel was found at the time of autopsy.

PLAINTIFFS' CONTENTIONS:
The plaintiffs, the decedent's husband and minor son, contended that Dr. Naik was negligent in failing to convert the laparoscopic cholecystectomy to an open procedure given the extent of adhesions found at the time of surgery; and that Dr. Naik was negligent in failing to take the decedent back to surgery a third time, since she did not improve following the bowel resection. The decedent deteriorated and purulent material was further draining from the Jackson Pratt drains.

The plaintiffs contended that the perforation found at the time of autopsy was an untreated perforation that should have been repaired. The plaintiffs argued that the decedent was salvageable up through Aug. 29, and should have been taken back to surgery to repair the untreated perforation.

DEFENDANT'S CONTENTIONS:
Dr. Naik contended that he met the standard of care in all respects. He argued that it was not necessary to convert the cholecystectomy to an open procedure; and that he had significant experience dealing with adhesions and he felt that it was safe to proceed with a laparoscopic procedure.

The defendant further contended that the decedent was too unstable to take back to surgery a third time and that it was reasonable to medically manage the decedent as opposed to taking her back to surgery, given the fact that some of her parameters were actually improving.

The defendant also contended that the perforation found at the time of autopsy was not present before Aug. 29, and therefore, did not explain the decedent's continued deterioration. The decedent would likely have died if taken back to surgery.

Injuries

Loss of household services, loss of earnings and general damages.

Result

Defense.

Other Information

FILING DATE: Aug. 17, 2006.

Deliberation

one hour

Poll

12-0 (defense)

Length

five days