Gastric Bypass Botched Dialation: $1 Million Settlement
2010 Medical Malpractice Trial Report
Patient who had 5 follow up surgeries to gastric bypass suffered serious neurological impairment
The plaintiff was a 39 year old woman who had a gastric bypass in 2003 because she was “extremely overweight. ”The plaintiff was injured following an invasive procedure to manage a stricture (narrowing) of where her stomach connected to her small intestine. Inflammation and scar tissue made the opening (between the stomach and small intestine) smaller than it should be, causing a functional obstruction. Therefore, it needed to be opened up so that food could pass. The opening is made bigger during an endoscopic balloon dilatation procedure. The defendant, a gastroenterologist, did this dilatation procedure five times for the plaintiff.
During the first procedure, in April of 2004, the defendant put a scope down her esophagus and into the stomach where he did find a stricture at the anastamosis of her stomach pouch and the small intestine. This scope procedure was done using conscious sedation only (no anesthesiologist, no intubation) and no fluoroscopy. When he was dilating that strictured opening, she started “becoming uncooperative” which means she basically started moving around so they stopped the procedure and decided to see if they amount they dilated helped her symptoms. The procedure did help the plaintiff’s symptoms somewhat, but they needed to do it again so that further scar tissue didn’t form and make the problem worse.
In May of 2004, the defendant did a repeat dilatation, again using conscious sedation and no fluoroscopy. The plaintiff again became agitated a number of times during the procedure and the defendant had difficulty passing the instrumentation such that he noted it was unwise to continue without the benefit of fluoroscopy. In fact, the defendant wrote in his procedure note, “In the future, this should be done with MAC and Fluoroscopy. ” MAC means Monitored Anesthesia Care and involves a more controlled anesthesia with an anesthesiologist or nurse anesthetist present.
In June of 2004, the defendant did a third dilatation, this time under general anesthesia. No problems occurred. Following this third procedure, the defendant notes that the plaintiff’s pre-dilatation symptoms have resolved by 90%. In July of 2004, the defendant performed a fourth dilatation procedure and, again, used a form of general anesthesia with the use of fluoroscopy to assist in the passing of the guidewire. Again, there were no complications.
However, on September 3, 2004, the defendant did a fifth dilatation procedure, and opted to use conscious sedation without fluoroscopy, the methods he used in the first two procedures that led to agitation of the patient. During this procedure, the plaintiff became very agitated and she dropped her pulse and her breathing became labored. Her oxygen saturation dropped. A CT scan showed air bubbles in the region of her liver. Later that night (early the next a.m. ) she started having seizures secondary to encephalopathy. Following her hospitalization, the plaintiff was left with neurologic impairments. Specifically, she is legally blind and does not drive. She cannot read because of the vision problem. Because she could not see the computer to do her job, she was disabled from her employment. She was able to navigate her home without assistance and can see well enough to walk outside in her neighborhood. Additionally her left arm was affected and limits what she can use it for. Her left leg also drags behind somewhat when she walks.
The plaintiff claimed that the defendant did not have the benefit of fluoroscopy and that, because he didn’t use general anesthesia, as his note indicated should be used for this patient), the patient became agitated, causing him to push an air embolus into a vein in the area of her liver, which resulted in her decompensation and lack of oxygen to her brain. The defendant vigorously disputed the claim that the patient’s agitation led to the perforation (of the vein), noting that he specifically remembered the sequence of events of this procedure. The defendant maintained that perforation (which is a well-known and recognized risk of the procedure) happened before any agitation was noted because, he claimed, the patient’s vital signs changed before the patient became agitated. Therefore, the defendant claimed that the agitation was the result of the non-negligent perforation and its effect on her oxygenation, not the precipiting cause of the perforation.
Lubin & Meyer attorneys represented the plaintiff in this gastric bypass surgery lawsuit.
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