The Texarkana Court of Appeals entered an opinion in a case dealing with the situation of a patient having concerning clinical signs, but a radiology scan or other testing shows no abnormalities.
In my experience, many patients are frustrated in the circumstances and feel that their doctors and healthcare providers are more interested in what a computer screen says that the patient sitting in front of them.
In the Texarkana case, the care at issue started with a rather routine laparoscopic hiatal hernia repair and endoscopy. Hiatal hernias occur when part of the stomach squeezes up through the hiatus at the diaphragm and moves into the chest. It can cause gastroesophageal reflux disease (GERD) and other symptoms, which may require surgery.
Many expert general and bariatric surgeons with whom we have worked describe hiatal hernia repair surgery as their bread-and-butter cases. Most hiatal hernia repairs are performed laparoscopically and involve mechanically reducing or pulling down the stomach into the proper location and sometimes some stitching to prevent it from recurring.
In this particular case, the patient had a robotic -assisted laparoscopic hiatal hernia repair with mesh and Nissen fundoplication with gastropexy. In this minimally-invasive procedure, the surgeon wraps the top of the stomach around the lower esophagus and then sutured it to the hiatus to fix it in place.
During the surgery, an upper endoscopy was done to look for any injury to the esophagus or stomach, but none was found.
After the surgery, the patient had a persistent elevated white blood cell count, which is a sign of infection, along with new atrial fibrillation, pneumonia, lung inflammation (pneumonitis), and collapsed lung (atelectasis).
The surgeon ordered an abdominal CT scan, which showed pneumomediastinum, which is an abnormal finding of air in the chest cavity. The surgeon felt that it could be an indication of a leak from the esophagus or stomach.
Unfortunately, when these complications occur, the course for the patient can be miserable. This patient had undergone multiple surgeries over a 10-month period for what was eventually diagnosed as esophageal perforation.
The esophagus is a muscular tube that transports food and liquids from the mouth to the stomach. When it’s torn or perforated, it’s a serious medical condition that can cause infections and even death.
The plaintiff filed a medical malpractice lawsuit alleging that her physicians were negligent in not timely diagnosing and treating the esophageal perforation.
In any case involving allegations of negligence against a physician or healthcare provider in Texas, the plaintiff must produce one or more medical expert reports early in the litigation. These reports have to detail the standard of care, exactly what happened that violated the standard of care, and how it caused harm.
The surgeon’s expert report in the Texarkana case made some excellent points. Specifically, the expert felt that the surgeon failed to timely diagnose the esophageal perforation, in a situation where the patient continued to demonstrate clinical findings consistent with an esophageal legal perforation. The report detailed that the patient had free air/pneumothorax on radiology films, pleural effusions, elevated white blood cell count, and a general poor overall clinical experience. In this clinical situation, the expert explained that the standard of care required additional investigation by endoscopy or returning the patient to surgery to rule out esophageal injury.
The bariatric surgery expert felt that the surgeon and healthcare team were negligent in reassessing the patient and working up the dreaded complication of esophageal perforation.
The appellate court was critical of the plaintiff’s bariatric surgery expert because his report did not adequately link the allegations of negligence to damages. For example, the report did not say whether absent negligence:
• The patient would’ve avoided any subsequent treatment
• The patient would’ve had a better outcome
• The patient would have avoided a dead esophagus and paper-thin trachea
The key deficiency identified by the appellate court was that the expert report didn’t distinguish between injuries that would’ve occurred because of a postoperatively work esophageal perforation, as opposed to injuries caused by a failure to timely diagnose the esophageal perforation.
If you’ve been seriously injured because of poor surgical or hospital care in Texas, then contact a top-rated experienced Texas medical malpractice lawyer for a free consultation about your potential case.
