Expert Witness Case #38
If you’re a fan of medical literature, you’re probably familiar with Oliver Sacks’ book The Man Who Mistook His Wife for a Hat.
I wouldn’t compare myself to Sacks, but I will borrow his naming convention and adapt it for today’s case: The Surgeon Who Mistook A Vagina for a Rectal Stump.
Mrs. L was a 66-year-old woman who presented to the ED with abdominal pain.
Workup revealed perforated diverticulitis.
She was admitted and had a diverting colostomy.
18 months later she had a take-down of her colostomy.
The general surgeon who did the initial surgery and a fellowship-trained colorectal surgeon operated together.
Allegedly, they mistakenly formed a complete anastomosis between her vagina and colon.
The patient hired an attorney and a lawsuit was filed.
Both the general surgeon and colorectal surgeon are named Dr. M.
A colorectal surgeon was hired as an expert witness:
The plaintiffs also disclosed another surgeon (Dr. N) as an expert.
He is a general surgeon (not a colorectal specialist).
The attorney’s summary of his opinions is shown here:
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The plaintiffs offered to settle.
They requested $2,000,000 from the colorectal surgeon and his practice, as well as $2,000,000 from the general surgeon and the hospital that employed him.
After extensive negotiations, the lawsuit was settled for a confidential amount.
MedMalReviewer Analysis [written prior to the settlement]:
The defendants would be wise to settle this case prior to trial. Even if there is an alternative explanation for how the colovaginal anastomosis was created, it is unlikely to change the expert’s opinion of negligent care.
Medical malpractice is often a nuanced subject and juries can easily be confused by complex standard-of-care arguments. This case is neither nuanced nor difficult to understand. Any lay person can understand it’s severity. It is a dream case for a plaintiff’s attorney.
Specialty: Cardiology
Synopsis: Patient with non-ischemic cardiomyopathy has chest pain, not worked up by cardiologist, patient has MI and requires LVAD and ultimately heart transplant.
Specialty: OBGYN
Synopsis: Delayed C-section after only dilating to 9cm and attempting multiple rotation attempts with forceps. Baby critically ill on delivery and died.
Resident not named in lawsuit
Specialty: Psychiatry
Synopsis: A woman in her 30s sees her psychiatrist because she is upset that her sister will not let her move in with her. 2 dies later the patient dies by suicide, hanging herself within feet of the sister’s backyard.
Settlement Offer: $1,000,000
My wife, a double certified radiologist, was once asked to perform a fistulogram on a patient with a previous colostomy and a small bowel obstruction.
She injected contrast into the ostomy, under realtime fluoroscopy, which flowed immediately through the distal colon and out through the rectum onto the table.
Another surgeon called her once about a suspected appendicitis. Her interpretation from the CT was positive to which the surgeon responded, "I took his appendix out two years ago." She told him, "Well, you didn't get it all."
The patient did fine after the 'repeat' appendectomy.
Hard as it is to believe, these things happen more than we'd like to admit.