A closed claims study identified the most common themes in bariatric medical malpractice cases.
Studies like this remind me of the old saying about how experience teaches.
In health care, experience is certainly important. This includes learning from mistakes. That’s why when there are certain bad outcomes—sentinel events—accreditation standards and the standard of care require a root cause analysis. The idea is to figure out why health care mistakes happen and to incorporate training to prevent them from being repeated.
Sometimes, though, hospitals, doctors and health care providers don’t learn from their bad experiences and outcomes. Mistakes get repeated over and over at the cost of patient safety. In my experience, medical malpractice lawsuits hold the health care industry accountable, forcing them to take the time to learn from their mistakes and bad experiences.
Bariatric or weight loss surgeries are common in the United States. According to the American Society for Metabolic and Bariatric Surgery, the number of annual procedures has grown every year since 2011. In 2011, around 158,000 bariatric surgeries were performed. In 2019, which is the most recent year for which data are available, the number was 252,000 surgeries.
Currently, the most common surgery is the gastric sleeve, which accounts for around 61% of all bariatric surgeries. The Roux-en-Y gastric bypass is the next most common surgery on the list, at 17% of all surgeries. Interestingly, number three on the list of most common bariatric procedures is the revision procedure—15% of all bariatric surgeries—where a patient goes back to the operating room for a surgery to revise a previous surgery.
A study of closed claims revealed some key points about the provision of bariatric surgery in America, risks to patient safety, and opportunities for the field to improve. The study also provides some eye-opening information for bariatric patients and family members:
• 35% of cases involved a patient death. In my mind, this underscores the fact that bariatric surgery isn’t as simple and straightforward as some people think. It involves a major surgical modification to the gastrointestinal (GI) system, in patients who already have significant health problems.
• 18% of cases involved leaks. One of the researchers in the closed claims study commented that they saw delays in diagnosis and treatment of leaks over and over.
This is consistent with my experience as a Texas medical malpractice attorney. Most bariatric surgeons have robust procedures for bringing patients to the office and signing them up for surgery, but anemic procedures for post-operative and follow-up care. Many surgeons tend to downplay patient complaints of post-operative pain, nausea, and vomiting, that are sure-fire signs that something’s wrong.
• 10% of cases involved bowel obstruction. In my experience, bowel obstruction is sometimes caused in the operating room by stitching that’s too tight or leaving a kink in the newly-modified GI system that won’t allow the contents to flow through.
• 4.4% involved vascular injury from access. Most bariatric surgeries are done laparoscopically, which is the minimally-invasive method. Small incisions are made in the abdomen for insertion of surgical instruments called trocars. Sometimes trocar insertion can cut or perforate a vein or artery, causing internal bleeding. It’s important for the surgeon to recognize and repair this complication.
• Defendant surgeons were foreign medical graduates in 27.5% of cases. Defendant surgeons were board certified in 75.9% of cases.
It’s always a good idea to research surgeons (and other physicians and even lawyers, for that matter) before making a hiring decision. As crazy as this sounds, given the scope creep of nurse practitioners and physician assistants trying to perform surgeries independently, start by making sure your doctor is really a physician! Then, ask where they went to medical school, the field of their residency or fellowship, how long they’ve been practicing, if they’re board certified, and how many of the specific surgeries at issue they’ve performed.
• Only 43% of the hospitals where bariatric surgeries were performed were accredited. Ask your surgeon about the facility that he or she wants to use for the surgery and whether it’s accredited. You can also ask the facility. Some are accredited by The Joint Commission. Others may be accredited by DNV Healthcare.
As a former hospital administrator, I’m a big believer in the importance of accreditation. It shows a commitment by a facility to accountability and forces hospital leaders to have robust patient-safety policies, procedures, and education in place.
• The study concluded that the complications reflected in the closed claims were caused by the surgeon in 50% of the cases, and system-related in 29% of the cases.
• The study concluded that the surgeon could’ve prevented the complication in almost 60% of the cases.
If you’ve been seriously injured from a bariatric surgery or follow-up care in Texas, then contact a top-rated experience Texas medical malpractice lawyer for a free consultation about your potential case.