The plaintiff, a retired but active male, underwent a laparoscopic gall bladder removal. During this surgical procedure, the defendant general surgeon inadvertently perforated the plaintiff’s bowel, and the perforation went undetected. During the twelve-hour period that followed surgery, the plaintiff went into a precipitous decline. The plaintiff experienced a distended abdomen, worrisome fever and abnormally high respiration and heart rates. He also experienced severe pain that required repeated doses of morphine.
A rapid assessment team was called to the plaintiff’s bedside by the plaintiff’s nurse to assist in the evaluation of the plaintiff in light of his downward spiral. Testing of the plaintiff’s blood gases showed a critical level of lactate, an infection byproduct often seen with sepsis.
The defendant did not respond to the plaintiff’s bedside for more than eight hours after the onset of the plaintiff’s worrisome signs and symptoms despite five phone calls from nurses who communicated the above data about his deterioration. When the defendant did come to the plaintiff’s bedside, he charted a note ruling out bowel perforation as the cause of the plaintiff’s decline. In deposition, the defendant conceded that all of the above signs and symptoms were consistent with bowel perforation and sepsis. The defendant also conceded that bowel perforation is “always on the differential diagnosis list” and that bowel perforation constituted a surgical emergency. Nevertheless, the defendant denied that there was substandard care in failing to diagnose the plaintiff’s bowel perforation contending that a pulmonary infection was the most likely cause for the plaintiff’s presentation. The defendant cited a “surgical dictum” that fevers that occur within 24 hours of surgery are usually pulmonary in origin. The defendant also contended that four other physicians in other specialties failed to make a timely diagnosis of bowel perforation and sepsis.
The plaintiff’s counsel countered that the plaintiff’s post-op chest x-ray did not reveal any significant pulmonary findings that would account for the plaintiff’s downward spiral. The plaintiff’s counsel also countered that the plaintiff’s constellation of signs and symptoms provided overwhelming evidence of bowel perforation and sepsis – that the plaintiff’s presentation constituted sepsis until proven otherwise. The plaintiff’s counsel additionally noted that proper application of differential diagnosis required that the defendant re-operate to investigate for bowel perforation and then repair the perforation well within the 12-hour period in which the plaintiff began to deteriorate. Finally, the plaintiff’s counsel noted that none of the four other physicians called in to evaluate the plaintiff’s deterioration were surgeons and that all four physicians were likely to have been influenced in their evaluations of the plaintiff by the defendant’s charted opinion that the plaintiff’s decline was not likely to have been secondary to bowel perforation since the surgery did not take place near the plaintiff’s bowel.
Because the defendant did not re-operate until more than 30 hours after the plaintiff began to exhibit signs and symptoms of bowel perforation, the plaintiff’s sepsis progressed to septic shock, a life-threatening condition which required the administration of presser drugs to restore blood pressure but which also carried the side effect of constricting small blood vessels. This side effect compromised the small blood vessels in the plaintiff’s extremities to such degree that blood flow was significantly impeded, thus leading to gangrene and amputation. The plaintiff required approximately five months of hospital treatment which included multiple surgeries for abdominal infections. The plaintiff also required a permanent ileostomy.
Settlement for $850,000.