Tubal ligation with intestinal perforation-Medical Malpractice?

In order to perform a tubal ligation operation, the abdomen is distended with carbon dioxide gas through a large needle, and the patient is put in a somewhat head down position so that the intestines will move out of the pelvis.

Once the abdomen is inflated, a small incision is made wherein the trocar, a large spike-like device that is hollow, within which the laparoscope will pass, is inserted. Care is taken not to perforate the intestines, particularly if there was a lower abdominal incision in which the intestines can get stuck to the inside of that abdominal scar.

Each fallopian tube, the size of a thin pink straw which is extending like arms off of each side of the body of the pear shaped uterus, is identified. It is grass with a forceps device that is attached to the electrocautery machine, and a burn is created. In the alternative, the tube can be clipped with a metal clip that secures it’s obstruction so no egg can pass down for fertilization.

In performing this operation, it is critical that at all stages the intestines are protected. Before the electrocautery device is turned on, it is essential that the intestines are not touching the tip of the electrocautery forceps. Likewise, when the punctures or created into the abdominal cavity, care is taken to be sure there is no injury to the intestines. As soon as the laparoscope is inserted, the gynecologist must check and see that there has been no damage to the intestines which can result in a perforation, and peritonitis from leakage, which if not timely recognized, could be deadly.

Obstructed Labor, The Cause of Severe Brain Damage

Once a woman goes into labor, it usually progresses in a steady fashion. The pelvic exam can determine the head of the fetus in relationship to the inside of the bones in the birth canal, the pelvis. There is a bony landmark in the pelvis which will be used as the guide in centimeters, as to whether not the fetal head it is minus or plus centimeters as a guide to gauge the progression of the labor.  If this woman is a primigravida, that is pregnant for the first time, now and having a vaginal delivery, this is called an “untried pelvis.” And if she has a narrow pelvis, the android shape, more male-like, as opposed to the gynecoid shape of the fuller pelvis, then this is a red flag that there may be a problem with the head of the fetus passing through the birth canal.

If there is no progression of labor down the birth canal, centimeter by centimeter, then this is a problem that may require a cesarean section rather quickly. The fetal heart monitor under these circumstances is really not the better way to determine if they will be a problem. If the umbilical cord is compressed, then the oxygenated blood supply from the uterus to the fetus would be impaired and the fetal heart rate would drop dramatically. That requires it immediately Cesarean section. But in this case of the failure of progression of labor, the umbilical cord is not compressed, but the head is repetitively forced against the inside of the solid bone pelvis. Unlike football players wearing a helmet, this fetal skull has no helmet, and its head is forced under great compression pressure, every few minutes, as opposed to an occasional football concussion. This repetitive concussion will cause brain damage. The failure to observe an obstructed delivery is a departure from the accepted standard of care.

Compartment Syndrome and Medical Malpractice, the Facts

The forearm muscles are contained within three fibrous sheaths, unyielding as if they are leather. When there is a fracture of one or both of the forearm bones, the radius and/or ulna, there will be bleeding within that location. However, that bleeding is contained within the fibrous sheath, and will put pressure against the adjacent blood vessels, the muscles and nerves. If the bleeding is extensive, this creates an internal tourniquet-like effect, and unless relieved timely, this will result in irreversible gangrene of the muscles and nerves. These muscles and nerves control function of the hand.

If there is loss of motion and/or numbness in the hand, the first concern is that of a tight cast wherein the swelling from the fracture against the inside of the cast first appears to be caused by too tight a cast. The standard of care requires that both the cast and the padding beneath be severed longitudinally, and then the patient observed. If the problem was just from the cast, the hand will regain sensation and motion. Also by pinching the fingers, the capillary blood flow will be seen to have immediately resumed.

However, if that does not rapidly resolve the problem, then compartment syndrome is the correct diagnosis to be immediately treated. The the skin and the underlying fibrous sheath involved with that compartment is severed longitudinally to relieve the compression, this internal tourniquet-like effect. The failure to properly make this diagnosis and treat with urgent surgery is a departure from the accepted standards of care.

Surgical Mesh Complications in Hernia Repairs

A hernia is a weakness in the abdominal musculature, through which the intestines can protrude. For many years, since the late 1800s, surgeons have been repairing this weakness by suturing the layers of the adjacent fibrous flesh together.

However, because of the low but significant failure rate of the original suturing to hold, requiring a repeat hernia operation, which by itself is not a departure from the accepted standards of care, or when an operation was required to repair a very large hernia, surgeons have been using a plastic woven cloth, a mesh. This allows the body’s scar tissue to grow into this material, to serve as an internal girdle, a buttress, to decrease the failure of the surgical repair.

Whenever any foreign material is inserted into the human body, there is an increased risk of infection. The presence of foreign material makes it much more difficult for the body to fight off any infection. Even with the most sterile procedures, there is that very small risk of infection, including from the human body itself, such as from brushing teeth, where germs can enter the bloodstream and “seed out” at that surgical mesh site.

Furthermore, whenever any foreign material enters the human body, there is a small propensity for the body to eliminate it, as if it were a splinter working its way through the skin.

The standard of care requires that the surgeon explain the need for the use of the mesh to lower the failure rate for the hernia repair. And during this discussion, the surgeon also needs to inform the patient of the slight increased risk for infection, as well as the possibility for the foreign substance to work its way out of the body.

Gynecology Malpractice

Before you focus on what happened in the operation, you must focus on the question: Was the operation even indicated?
The most common operation is a hysterectomy, the surgical removal of the uterus. But this operation is usually done to control  heavy menstrual bleeding which continued to be a problem for the patient, including with so much blood loss that the patient became anemic. If the patient does not respond to hormonal therapy, such as birth control pills, then the dilatation and curettage, D and C operation is done to scrape out the lining of uterus to allow it to resume its normal cycle, and to examine what was in the lining of the uterus to be sure was not endometrial carcinoma, cancer of the lining of the uterus.
If the patient was rushed into the hysterectomy operation without more conservative therapy being attempted, then that would be a departure from the accepted standards of care, and any complication would be a measure of damages.
In performing the abdominal hysterectomy, it is essential that the surgeon identify each uteter, which are these two muscular straw sized tubes bringing urine from each kidney into the bladder. They have a whitish-tan color. If the surgeon pinches it, they can see the ureter contract, because of its inherent muscular, wave-like (peristaltic) action pushing urine downstream. 
If the patient had previous pelvic surgery or pelvic infections, then in anticipation of excessive scar tissue, the standard of care would be to have a urologist insert a tube up each ureter so that the surgeon can feel the hard plastic tube within the ureter for greater safe identification guidance.
It is essential that each ureter be identified so that it is not inadvertently tied shut in a suture, or cut into. This negligent complication can cause irreversible kidney damage, especially if this is not recognized within a few days because with a blocked ureter the patient would be complaining of significant pain on one side of their mid-back, where each kidney will be located adjacent to the spine. That localized one-sided pain demands a kidney x-ray study (intravenous pyelogram: IVP).

Proving the Hospital Caused the Infection

Too many patients who come to a hospital for an elective operation, unfortunately end up with an infection. Generally it’s a few percent, but that is many.

If you have a case where a patient came for an operation and ended up with an infection, here’s the issue:

The hospitals will claim, as will the doctor claim, that it is unfortunate and they did everything right, and the way it happens is there is a small risk of infection for any patient, and the germs may been in their body, but who knows….

Here’s what you do: You subpoena all of the hospital infectious disease control records, which they must keep, and although they can obviously leave the name of the infected patients out for confidentiality, you can determine whether or not there has been at that point of the patient’s admission any increased infection rate, including in the days or weeks before the admission.

Under those circumstances, was the patient informed that in this hospital, for their elective operation, they were at a higher risk of an infection and should not have the surgery at that time, or at least not in that hospital?

Through the discovery process you will find out which germs were involving which infections, and how they followed up to determine the cause of the infection, which they must investigate. Sometimes the sterilization procedure, through which all instruments including orthopedic surgery instruments, as well as general surgery, gynecology, urology, neurosurgery, cardio-vascular, and thoracic surgery instruments must must pass, and they have to be sure that in fact the sterilization documentation was complete.

You may determine that in fact there were failures to properly sterilize the instruments, the tools, which every patient would then have to be subjected to.

Through the infectious disease control records you may discover that the specific surgeon had a much higher rate of infection in their patients, and often could be from a chronic staph infection in their nose, and even though they wear a mask, germs do escape into the air. If the surgeon was a germ carrier, the hospital should have prevented him or her from being in the operating room until such time as antibiotic therapy had been administered and follow-up tests proved that this surgeon no longer was a carrier of these germs.

Life Care Plan


Life Care Plan Completed:






Stan XXXXX is a 69-year-old Caucasian male seen for evaluation in his residence accompanied by his wife, Suzie, on 5/18/12.  Prior to this on-site evaluation, a telephone pre-evaluation was accomplished by xxxx, on 5/2/12 for the purposes of identifying specific demographic information, establishing a list of treating professionals, equipment, supplies and past work history.

His attorney, XXXX, referred Stan for a rehabilitation evaluation.  The purpose of this evaluation is to assess the extent to which handicapping conditions impede his ability to live independently and handle all activities of daily living.

Read more

Joint Commission (JC) Standards Report

December 23, 2011

To Whom It May Concern:

Re: A v. Heart Hospital of Austin et al

My name is **********************. I have been a hospital chief executive officer and healthcare administrator for over 35 years and currently am a full-time educator and consultant to hospitals and health systems throughout the United States. Since 1978, I have been a Board Certified Fellow of the American College of Healthcare Executives (“FACHE”), which is the professional organization for hospital administrators, having passed the certifying examination and have been recertified as required by the College. I have lectured extensively to hospital administrators and students in hospital administration and have been a featured speaker at several national meetings. I am currently a faculty member in the graduate and undergraduate health administration programs at the University of ***** and teach at least one course every semester. I have also written a book entitled **************************. I have been continuously employed in the field of hospital and health care administration since 1973. I am familiar with the prevailing professional standards of care for acute care hospitals, such as the Heart Hospital of Austin, Texas, which is the subject of this letter for events occurring in January, 2011. More specifically, for such time period, I am familiar with standards of care and obligations applicable to such hospitals in their care of patients who present through an emergency room and are then admitted. Further information regarding my experience and qualifications is detailed on my attached CV.

Read more

Radiology Expert Witness Report

To Whom It May Concern

RE: A, John

Dear Sir/Madam:

At your request I have completed my review of the medical records kindly provided by your office in an organized binder and the imaging studies provided on four CDs concerning the care and treatment provided to Mr. A by the physicians and staff of the Kaiser Foundation Hospital, Santa Clara, California in regard to his traumatic cervical spine injury.

I am able to opine whether or not the standard of care was met and causation with regard to future disability. However, as is my practice in providing medical opinions with regard to the standard of care, deviations in the standard of care, or causation I do reserve the right to change or modify this medical opinion if new or undisclosed information becomes available for my review.

Read more

Hospital Administrator Expert Witness Report

To Whom It May Concern

RE:  S. B. v. Fayetteville, NC Veterans Administration Medical Center(VAMC)

My name is ****************** and I serve as a consultant to hospitals and attorneys regarding hospital administrative issues.  I have been a hospital chief executive officer and hospital administrator and currently am a consultant to hospitals and health systems throughout the United States. I am a Board Certified Hospital Administrator and a Fellow of the American College of Healthcare Executives, which is the professional organization for hospital administrators.  I have lectured extensively to hospital administrators and graduate students in hospital administration and have been a featured speaker at several national meetings.  I am currently a faculty member in the graduate and undergraduate health administration programs at the University of *****, **** University, and ****** University. I have also written a book entitled ************************** for the Hospital, and I recently contributed a chapter to an ACHE book entitled ***********************************************************. I have been employed in the field of hospital and healthcare administration since 1973. I am familiar with the prevailing professional standards of care for acute care hospitals. I have been actively involved in the management of acute care hospitals, including their emergency departments. Further information regarding my experience and qualifications is detailed on my CV.

Read more