Robotic Surgery Causes Fatal Bowel Injury
Case #119
A 69-year-old man was diagnosed with prostate cancer and seen by a urologist.
A robotic-assisted prostatectomy was recommended.
Following the procedure, he developed worsening abdominal pain and sepsis.
He was ultimately diagnosed with a bowel injury.
Over the following months he was taken back to the OR multiple times.
He ultimately died 4 months later of complications.
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The events following the surgery are described here by the plaintiff.
The patient’s wife has sued the hospital, the urologist who did the surgery, as well as a separate urologist who reassessed him while he was on call.
The plaintiff hired a urology expert witness.
The plaintiff’s attorney demanded the urologist’s personnel file from the hospital, including any disciplinary records.
The hospital refused to produce this, and they were not compelled to do so by the judge.
They also requested the hospital’s policy on robotic surgery credentialing, which is shown here:
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The plaintiff has offered to settle with both urologists for $2.75 million.
The hospital reached a confidential settlement after an initial offer of $5 million.
The lawsuit is still ongoing.
MedMalReviewer Analysis:
This expert opinion lacks any substantial claims of how the urologist was actually negligent. They simply identified a bad medical outcome and are working backward to make up vague claims of negligence. A bad medical outcome alone does not prove negligence.
Furthermore, it is painfully clear that the expert did not actually write this opinion. The plaintiff’s attorney wrote it, then shopped around until he found a urologist who was willing to sign their name to it for the right price. There is no medical discussion of the case, simply a regurgitation of legal talking points.
The credentialing policy for using the robot seems relatively lax, requiring only 8 hours of training. If you use a DaVinci robot in your practice, is this a standard credentialing policy?
Previous Cases:
It seems there may be some documentation missing regarding the credentialing process. What's included shows "Step I" which concludes with stating the surgeon must operate under continuous proctoring. It then skips to a description of the requirements for proctors. What appears to be omitted are the steps that would lead to a surgeon operating independently (without which no surgeon would ever qualify as a proctor). Presumably there is a missing Step II or even more.
Credentialing for robotic surgery is extremely lax and really just a formality. It is treated as a tool that the surgeon ultimately takes responsibility for. The "8 hours" are typically an online certification course with the robot manufacturer. It is assumed however that you are not using a tool unless you are trained in it, which almost all urologists heavily use the robot in training now. My current hospital credentialing requested prior robotic case numbers in addition to the 8 hour course certificate, but I don't know that they had a minimum case load.
Unclear what this urologist's robotic surgery training was back in 2016. I agree with your review about the generic statement from the expert witness saying this was a bad outcome. I have seen very talented urologists perform successful robotic surgeries on patients who have complex abdominal surgical histories, so that is not a contraindication alone.