Medical Malpractice

On May 7, 2001, my mother, Eileen Bialek {age 72} underwent elective surgery for correction of a prolapsed uterus and cystocle. The surgeon in the department of Urology at a major medical facility in Cleveland agreed to perform an open laparotomy with a uterine suspension. Eileen’s past medical history included colon resection for bowel cancer 18 years prior. The surgeon was aware that she had previous abdominal surgery but decided that open laparotomy was the procedure of choice and did not discourage Eileen from this type of surgery despite the risk of complications. He did not offer her a second opinion. No prior medical conditions pertinent to this surgery were present. With the exception of symptoms of urgency and a visually prolapsed uterus, Eileen had no other medical problems. She was active in her church and community as well as taking care of her spouse.
Postoperative course initially was normal until discharge when she started to vomit bile and was readmitted 18 hours post discharge. The surgeon evaluated Eileen and suspected she developed a postoperative ileus. His initial treatment consisted of telling her daughter to " give her a milkshake" to encourage her bowel to move. She did indeed follow the surgeon's advice; however, Eileen’s condition continued to deteriorate. Conservative treatment over the following two weeks consisted of clear liquids and nothing by mouth. Total parenteral nutrition {TPN} was then initiated and finally bowel decompression via nasogastric tube. Preliminary x-rays were done but results were not followed up on.At two weeks postop a computed tomography {CT} scan was done which revealed a blockage in the small bowel. The surgeon advised Eileen of the need to return to surgery because he suspected that an adhesion was causing the blockage and it needed to be released. Eileen consented to the surgery and requested that her previous surgeon {bowel cancer} be in attendance. The current surgeon said he was out of town and he was asking another colorectal surgeon to be on hand.Eileen was taken to surgery May 17, 2001. After 5.5 hrs of surgery the surgeon informed her daughter that he found a portion of the small bowel had twisted and he had to resect a portion of it. Because there were enterotomies, a jejunostomy was placed along with two mucous fistuals. Blood loss required transfusion of six units of blood during surgery. Eileen was transferred to the surgical intensive care where she required full fluid resuscitation and mechanical ventilation for two weeks. She sustained atrial fibrillation, required seventeen units of blood and clotting factors secondary to developing large retroperitonal hematoma. She remained in the ICU for 4 weeks and transferred to the floor for two more weeks at which time she was admitted to a long term acute care hospital. Before discharge the resident informed her that she had a rectal laceration and would need to have that repaired when her jejunostomy would be reversed in one year. She remained at the acute care hospital for 4 weeks then transferred to a nursing home to continue her recovery. Eileen was so debilitated from the surgery she required daily physical and occupational therapy.During this entire time she experienced daily nausea and vomiting. Physicians at two different hospitals were consulted and determined that gallstones in the common bile duct were causing her symptoms along with elevated liver function. Eileen underwent repeated endoscopic retrograde cholangio pancreatopography {ERCP} over the next several months as no surgeon would remove her gallbladder for risk of causing more bleeding and complications.Eileen had two episodes of sepsis treated by antibiotics during several readmits to the original surgical facility.Finally in December of 2002, she became acutely septic and unresponsive and was transferred to the emergency room of a nearby hospital. The hospital surgeon determined that removing her gallbladder was probably her only chance to survive. She was placed on full life support, aggressive antibiotic management, vasopressor agents and taken to surgery. The surgeon successfully removed the gallbladder and informed the family that her organs were stuck together like cement. He gave no guarantees but stated that with antibiotics and life support she may be able to survive but with an arduous recovery. The bilirubin continued to rise; she was severely jaundiced and no longer responded to increase vasopressors or dialysis. Eileen Bialek expired on January 8, 2002. The postmortem documents indicated that she died of organ failure secondary to sepsis. The origin of the infection was vancomycin resistant enterococci {VRE} in the common bile duct probably secondary to the ERCP or the residual retroperitoneal hematoma.I believe she was deceived by her surgeon in terms of the full disclosure of the risks involved in this kind of surgery. Anyone who knew her would testify that she was not one to take un-necessary risks. Accordingly, I am asking Congress to pass "Do No Harm" legislation requiring a neutral third party to be present during all pre-surgical consultations.

That sounds like a pretty dumb idea.1) What about the presence of a "neutral third party" makes it any more likely that risks will be adequately disclosed? Or are you proposing that this third party should be a medical expert?2) Who pays for the neutral third party? If it's the hospital or the HMO, doesn't that make them rather un-netural? If its the patient, doesn't that make health care prohibitively expensive for almost everybody? If its the government, what are the odds that the government is going to hire enough experts to go around?3) What about the privacy issue? Are people as likely to bring sensitive medical issues before their physician, or seek out desired medical procedures like abortions or tubal ligations if they know some federally-mandated busybody is going to be horning in on the discussion?Phenomenally ill-considered idea.

I'd have to agree with all the points that Crash made and add:There are, of course, incompetant doctors. However, having some insight into the medical area through friends and family I know there are also what we might uncharitably describe as incompetant patients.In general, I'd guess that it is a minority of them that actually listen to what they are being told. In addition, very few of us are equipped to understand the information and make a reasonable risk assessment.I don't see how your idea would help. It maybe that doctor's would agree (or even insist on) haveing a video tape of conversations in case of subsequent problems. (I could see insurers doing the same). I think that the video taping would be the only practical way of instituting some sort of quality control.However, I think we'd find that the information was disclosed in nearly all cases. But the patient would not remember or understand it.It strikes me that the bigger issue wasn't the risk disclosure but some not very careful following of her condition and a lack of agressive action to treat the complications. That wouldn't be solved by someone present during initial dicussions.

First off, condolences on your loss, made extra tragic by the (appearance anyway) of {unnecessary\improper} procedures.There is a system in place, but people rarely use it: a second opinion by a different doctor.I have a friend that went in for cosmetic surgery to correct an {underbite\recessed} chin. After two years of re-corrective surgury by 3 other doctors to try to fix the mistakes of the first one, she has absolutely no feeling in her jaw and cannot tell if food is dribbling down her chin and other socially problematic things, and this has transformed a vibrant person into a recluse. Oh, and she still has the same chin profile.I think anyone getting surgury should get at least two opinions on what needs to be done and how to do it: if there is conflict in those opinions, get a third. The cost of a consult is nothing compared to the agony that can result, and it is frequently covered by insurance (they don't want problems either).

---

we are limited in our ability to understand
by our ability to understand RebelAAmerican.Zen[Deist
{{{Buddha walks off laughing with joy}}}

A medical ombudsman would serve well as a checks and balance between doctor and patient. Mandatory second opinions may be needed or perhaps as with finance companies, the conversation should be recorded.

My father battled cancer for the last 10 years of his life. The last 4 years, after a relapse when he was at his worst, I didn't feel that he and my mother were understanding the doctors concerning his medication, etc. I then started researching and going to all his appointments with them.I did find that my parents weren't comprehending what the doctors were saying, the doctors were overlapping medicine, they weren't listening to what my father was saying, and they ran him around the ring of doctors. Since he was at a Veteran's hospital and I'm a former Marine, I knew how to make noise.Ultimately, the final decision is still up to the patient unless legally stated otherwise.As with the issues that Crash raised, you also have the problem of accountability. A third party can make a mistake also. Will they be protected from getting sued?My mother is getting into her 70's and her comprehension skills are waning.I think if the patient and the family want to record the conversations with doctors, that would be useful.Condolences on your loss.

---

A gentle answer turns away wrath, But a harsh word stirs up anger.