Gynecology Malpractice

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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

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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

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PREPARED BY: xxxx, RN, CCM, CPUR, LCP

Life Care Plan Completed:

TELEPHONE PRE-EVALUATION: 05/02/12

DATE OF EVALUATION: 05/18/12

DATE REPORT INITIATED: 06/02/12

REPORT FINALIZED: 06/11/1

SUMMARY/INTRODUCTION:

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.

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Joint Commission (JC) Standards Report

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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.

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Radiology Expert Witness Report

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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.

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Hospital Administrator Expert Witness Report

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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.

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Orthopedic Foot and ankle Expert Witness Report

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To Whom it May Concern:

Re: Medical Records of Carl K. and litigation filed by wife and children.

I, ********, M. D., have been asked to review the medical records of the above-named individual, now decedent, in a malpractice action pertaining to a simple foot surgery with resulting pulmonary embolism and death. The wife has filed a wrongful death suit. I have no financial interest in the outcome of this suit.

I am a board-certified surgeon with 35 years of active full-time practice. I have performed foot and ankle surgery all these years and my current job duties at the ********** Medical center involve performing foot and ankle surgery. I have performed talo -navicular foot fusions as well as other fusions in the foot and ankle. While at the Tucson VA from 2003-2007, I served as Chief of Orthopedics but also was involved in serving as an attending on the podiatry service and performing complicated foot and ankle surgery with the podiatry residents. The risk of post-op VTE was always considered and acted upon with these cases.

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Orthopedic Expert Witness Report: Severe Thumb Injury

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To Whom It May Concern:

Re: Medical records review and treatment of severe thumb injury of Jackson G.

I, ******, MD, am a board-certified orthopedic surgeon who has been in continuous active practice for 35 years. During my t residency, the chairman of my residency program was a hand surgeon. Also during my residency, I had a mini-fellowship in hand surgery and reconstructive hand surgery. During the first 28 years of my practice experience, I was very active in having hand surgery as my subspecialty of orthopedics and treated hundreds of finger injuries. For several years I was the company hand surgeon of choice for a large steel mill which frequently had not only single but multiple traumatic finger amputations. I have also treated pediatric hand injuries, not only crush injuries but blast injuries and sharp lacerations as well. In the adult population in addition to all forms of trauma, I also performed carpal tunnel releases; Dupuytren’s excisions and joint reconstruction surgery with implants for severe arthritis. I am very familiar with and have used various means of fracture fixation in the hand, frequently with staged procedures.

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Gynecologic Oncology Expert Witness Report

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I have reviewed the medical records in this case and as requested, providing my opinion regarding the medical care given to Mrs. Annita S. I am certified by the Division of Gynecologic Oncology of the American Board of Obstetrics and Gynecology and in active clinical practice in the state of **.

Materials reviewed:

Medical records from ** medical center, including H&P and operative report of Dr. H and consultation by **, M.D. and operative report by **, M.D.

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Cardiology Expert Witness Report

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Summary of Record Review: Ray ******, DOB Records Reviewed:  J.S. *******, M.D. expert witness report 1/19/2011 Depositions: Ray ****** Debra M A.J, M.D. K. T. Mr. ****** is a 54-year-old male with a history of mild hypertension and hyperlipidemia. Mr. ****** was admitted to North Central Baptist Hospital, San Antonio, Tx., 7/11/2008 for new onset […]

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