Verdict in Bowel Aspiration Death is $2.06 Million*

2010 Medical Malpractice Trial Report

Wrongful Death Medical Malpractice Lawsuit: Failure to recommend and perform surgery on a bowel obstruction results in the death of a 73 year-old woman

This case involved a 73 year-old woman who died from the aspiration of fecal material as the result of an untreated bowel obstruction. The plaintiff, the decedent’s son, claimed that his mother was known to have a bowel obstruction that needed surgical intervention at least 5 days prior to her aspiration. During her week and a half hospitalization at Baystate Medical Center, the defendants failed to recommend or perform surgery in time to prevent the aspiration, which led her death death. Life support was discontinued 10 days following the aspiration event.

The plaintiff claimed that his mother’s condition deteriorated over the course of her hospital admission, signaling to providers the need for urgent surgery. The plaintiff further claimed that the defendants, Dr. David Rose, the hospitalist and Dr. David Earle, the attending surgeon, overlooked the risks of aspiration while they were working the decedent up for suspicions of esophageal and colon cancer. Repeated testing had shown no definitive evidence of cancer, a finding which was confirmed on autopsy.

The decedent was a 73 year-old woman with a medical history that included arthritis, a prior hip replacement, hypertension, peptic ulcer disease and COPD. In early January 2004, she had presented to the emergency room with complaints of shortness of breath of a few months’ duration, poor appetite, nausea, vomiting, diarrhea, and a single episode of hematemesis. Workup revealed severe anemia, and pointed to a lower GI bleed of unknown etiology. An esophageal gastroscopy and barium enema were performed. The gastroscopy revealed a lesion in the esophagus that was suspicious for cancer, while the barium enema was negative. A colonoscopy was attempted but unable to be completed. A repeat gastroscopy approximately two weeks later showed some improvement of the esophagus, but the suspicion of esophageal cancer persisted among the defendants.

The decedent returned to the emergency room two days after the repeat gastroscopy with complaints of abdominal pain, nausea, vomiting, and diarrhea. An abdominal x-ray showed a bowel loop but no gross obstruction, and the decedent was diagnosed with viral gastroenteritis vs. partial small bowel obstruction. Her abdomen was increasingly distended, and her respiratory rate was elevated. A nasogastric (NG) tube was placed, which began draining brown, foul-smelling liquid.

The defendant hospitalist noted that the decedent was still anemic, and that her presumed partial small bowel obstruction was unchanged in 24 hours. A consultation was then obtained from the surgical service. The second defendant, the attending surgeon, did not believe that the decedent’s significant bowel obstruction required surgical intervention. The plaintiff was noted to vomit fecal matter that same day. Also on that day, a barium enema revealed a high-grade partial large bowel obstruction of an apple core shape. Because of the shape and presentation of the lesion, both defendants incorrectly presumed it to be colon cancer. A staging workup began, and the surgical defendant informed the family of the decedent’s likely advanced stage colon cancer and poor long-term prognosis.

Over the ensuing three days, the decedent continued to deteriorat. Nurses reported that the decedent had vomited foul-smelling material despite the presence of an NG tube. No attempt for surgical intervention was made by either the hospitalist or the attending surgeon, despite a worsening in the decedent’s clinical condition. Instead, the defendants planned to discuss surgical options with the family the next day. Throughout the next 24 hours, the NG tube continued to drain a large amount of fecal matter.

Seven days following her admission to the hospital, and just hours after the family told the surgeon that they wanted surgery, the decedent vomited and aspirated fecal matter into her lungs. She suffered respiratory arrest and was intubated. Fecal material was found over her vocal cords. Over the next several days, her condition deteriorated and life support was eventually withdrawn. Autopsy revealed a benign mass that caused an intestinal blockage, leading to feculent vomiting, aspiration pneumonia, and her death. No cancer was noted in any of the tissues sampled, including the esophagus and the colon.

The defendants argued that the decedent did not deteriorate during her admission to the hospital and that she had multiple comorbidities, making her a complicated surgical patient. Both defendants contested that they were reasonable in working the decedent up for cancer before they took her to the operating room. They further argued that taking the decedent to the operating room would actually increase her risk of vomiting and aspiration.

The Hamden County jury, consisting of 12 men and 1 woman, deliberated for 8 hours and returned a verdict for the plaintiff against both the attending surgeon and the hospitalist, awarding $1,365,000 without interest.

* The Globe reported the amount without interest (above), with interest the amount awarded is $2,061,057,00.

Lubin & Meyer attorneys represented the plaintiff in this lawsuit.

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