Today I have been working with medical experts to prepare a new medical malpractice wrongful death case for filing in Brazos County, Texas.
The patient was a healthy lady in her early 60s who went to the emergency room at a College Station area hospital because of sudden severe abdominal pain. The emergency physician ordered some tests and quickly concluded that she had appendicitis. He ordered a consult with a general surgeon, who performed a laparoscopic appendectomy.
During a laparoscopic procedure, the surgeon makes a few small incisions to insert a port and surgical instrumentation, rather than the large incision that is done for an open procedure. Our surgical expert believes that the surgeon accidentally nicked and perforated the patient’s transverse colon while inserting the port. As you can imagine, it’s not a good thing to have the contents of your colon leaking out into the abdominal cavity.
In many cases, causing a puncture or perforation of the colon during a laparoscopic surgery is not considered negligence. In such instances, the perforation itself is an unavoidable risk of having the surgery. The issue requiring investigation by a competent medical malpractice attorney is whether the surgeon did a thorough visual inspection to look for bleeding or perforation before closing the patient and, if a problem is identified, it was appropriately repaired.
Our surgical expert determined that the surgeon in our College Station case did not perform a reasonable inspection of the surgical area before closing up the patient. As a result, he did not recognize that he had perforated her colon, and proceeded to discharge the patient from the hospital the same day with a prescription for hydrocodone to help with the pain.
By the evening after her discharge from the hospital, the lady’s pain was so bad that hydrocodone was not helping. The family called the surgeon’s office and a nurse told them to supplement the hydrocodone with ibuprofen. The next day, her condition was no better. Beginning that morning, the family made a total of four additional calls to the surgeon’s office, and eventually decided to take her back to the hospital emergency room (ER) to get seen.
Even though the surgeon knew that his patient was returning to the emergency room, he didn’t call ahead to suggest an abdominal MRI to rule out the possibility of a perforated colon. Instead, the patient and her family faced a rather long wait in the emergency room with little care being provided.
What surprised me upon reviewing the medical records is how dire her condition looked as soon as she showed up in the ER.
Sepsis and SIDS
Sepsis is a life-threatening complication of an infection. Sepsis occurs when chemicals released into the bloodstream to fight an infection trigger inflammation all over the body. This inflammation can trigger a cascade of changes that can damage and cause failure of multiple organ systems.
When a patient recently had surgery and goes back to an ER for evaluation because of extreme pain, the standard of care requires doing a workup for sepsis and another condition that can be a sign that sepsis is getting underway.
That related condition is systemic inflammatory response syndrome (SIRS). To diagnose a patient with SIRS, the ER or other physician must find two of the following four factors:
(1) temperature greater than 100.4 or less than 96.8
(2) heart rate over 90 beats per minute;
(3) respiratory rate over 20 breaths per minute;
(4) white blood count greater than 12,000 or less than 4,000 per mL.
When this lady presented back to the hospital emergency room in College Station, the ER providers documented in the medical record that she already had two of the four factors to establish SIRS, with an elevated heart rate and respiratory rate. In other words, she already met the criteria for diagnosis and treatment of SIRS the moment she walked into the door.
The ER physician ordered some blood work, which came back about 45 minutes later and demonstrated that the patient had a third SIRS factor, an abnormally low white blood cell count.
Unfortunately, despite these well-documented signs, the ER physician and staff made no apparent attempt to workup and treat the patient for SIRS or sepsis. Similarly, the surgeon was in no hurry to order an abdominal MRI to determine if he had accidentally perforated her colon.
As a result, this patient who walked into the hospital door with SIRS and likely early sepsis was left in the ER for hours on end with no treatment, while her perforated colon continued to leak its contents into her abdominal body, worsening her infection.
Eventually, she went into septic shock and died.
What should have happened
As a Houston Texas medical malpractice attorney, I have handled many cases where the misdiagnosis and inadequate treatment of sepsis was a key issue.
For two decades, the medical literature has been clear that patients who have SIRS or sepsis need immediate treatment. Patient survival and results are better the center treatment is initiated.
In early shock, the body compensates with mechanisms that attempt to restore blood flow and pressure to vital bodily organs. Eventually, these mechanisms begin to fail and lead to cell death. Once enough cells from vital organs die, septic shock can become irreversible, and death can occur despite treating the underlying cause for sepsis.
Critical care physicians recommend a number of specific treatments for sepsis.
The principal treatment focus is on hemodynamic support. Patients need fast and vigorous fluid resuscitation to improve tissue and organ perfusion. They need to be admitted to an intensive care unit with continuing heart and arterial oxygenation monitoring. Other interventions may be required, including arterial cannulation and central venous or pulmonary artery catheterization.
Experts also recommend initiation of vasopressor therapy (commonly called pressor support) by administering medications like dopamine and norepinephrine, which help increase arterial blood pressure.
The medical literature reflects that the initial priority in managing a patient and septic shock is to maintain a reasonable mean arterial pressure and adequate cardiac output to keep the patient alive. At that point, the medical team must turn its attention to finding and eradicating the source of the infection. In this lady’s case, the obvious source of her sepsis shock-causing infection was her perforated colon.
Unfortunately, both the ER physician and the surgeon completely botched her care by failing to, respectively, workup and treat the patient for sepsis and return her to surgery to repair the perforation and clean out the infected fluid from her abdominal cavity.
Sadly, as a result of their negligence, this lady in her early 60s died prematurely, leaving behind a grieving husband and children.
We are here to help
If you or a loved one has been seriously injured or even died because of poor medical, surgical, or hospital care, then the experienced medical malpractice attorneys at Painter Law Firm, in Houston, Texas, are here to help. Click here to send us a confidential email via our “Contact Us” form or call us at 281-580-8800.
All consultations are free, and, because we only represent clients on a contingency fee, you will owe us nothing unless we win your case. We handle cases in the Houston area and all over Texas. We are currently working on medical malpractice lawsuits in Houston, The Woodlands, Sugar Land, Conroe, Dallas, Austin, San Antonio, Corpus Christi, Bryan/College Station, and Waco.
Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2018, by H Texas as one of Houston’s top lawyers. Also, in 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.