As a Houston, Texas medical malpractice attorney, I have represented many clients in lawsuits involving all kinds of surgical care, from heart surgery to hernias, from cholecystectomies (gallbladder removal) to colorectal surgeries.
Surgical anesthesia negligence
In many operating room cases, the problem is not really with the surgeon, but rather with the anesthesia provider.
Operating room anesthesia providers could be a medical doctor anesthesiologist or, more commonly, a certified registered nurse anesthetist (CRNA). One common problem that I have seen with anesthesia care is over-sedating or overdosing anesthetic medications, causing the patient to stop breathing.
Another problem is extubating, or removing the breathing tube, too quickly after the surgery is finished, when patients are unable to breathe on their own. Both situations often lead to a frantic shuffle when mistakes are made.
Negligence post-operative care by surgeons
When a surgeon is negligent, it most often is because of follow-up care in the hospital or office, rather than what occurs in the operating room. Today, I was in The Woodlands, Texas to take the deposition of a plastic surgeon in a case where this happened.
My client started having some lower abdominal pain and consulted a general surgeon. He ordered an abdominal CT scan, which showed that she had a hernia. Because the patient had a past history of abdominal hernias, the general surgeon consulted with a plastic surgeon to assist in the operating room and perform part of the surgery.
As is common with abdominal procedures, at the end of my client’s surgery, the plastic surgeon inserted four Jackson Pratt (JP) drains. JP drains are designed to help drain blood and other fluids from the abdominal cavity and wall and also apply negative pressure to help close the surgical wound.
The day after surgery, the general surgeon saw the patient and wrote in the medical records that everything looked fine. A few hours later, the plastic surgeon saw her and documented that she had a high volume of drainage that had a dark appearance.
At his deposition today, the plastic surgeon explained that the volume of fluid coming out of her JP drains was two or three times more than he expected for this type of surgery.
The color of the drainage also concerned him. Normally, the drainage would have a reddish tint from the blood. He testified that the dark color indicated that there was some bilious fluid, which could mean a problem caused by a fistula. A fistula means an unwanted hole or communication between two parts of the body.
The plastic surgeon admitted that the only cause of dark-colored drainage would be bilious fluid, but it sometimes goes away on its own. That was what he was counting on, but somehow he lost sight of the fact that it could be something much more serious.
When I deposed him today, the plastic surgeon said that he was not responsible for evaluating or working up these findings. Instead, he said it was up to the general surgeon and his group. He called the general surgeon’s physician’s assistant—he could not remember her name and did not document it in the medical records—and told her what he saw. He did not do anything else for the patient that day.
In my view, this was a rather “hands off” approach for a patient that he continued to see daily and bill for his care. Yet, the plastic surgeon felt that this satisfied his obligation to the patient and her safety.
Meanwhile, the general surgeon was nowhere to be found for at least four days. There is no indication that the general surgeon, or anyone covering for him, was seeing the patient and taking a lead to look out for postoperative complications. During that time, the plastic surgeon kept seeing and billing the patient, but did not reach out to the general surgeon or his group again.
Eventually, the general surgeon re-appeared, found that the JP drains were discharging a lot of green fluid, and ordered a CT scan. The CT scan showed that she had a small intestine (bowel) perforation. That dark, green color of her JP line drainage had been caused by the leakage of intestinal contents, which were causing serious problems, including life-threatening sepsis.
The general surgeon took her back to the operating room to repair the bowel. Guess what? The plastic surgeon also participated in that surgery, even though, at deposition, he claimed that he had no responsibility for working up or managing these types of complications.
As part of our review and development of this medical negligence case, we retained a board certified general surgeon to review the care that was provided.
The expert said that both the general surgeon and plastic surgeon are responsible for not ordering an abdominal CT scan two days after the first surgery to figure out the cause of the large volume of dark drainage from her JP lines. That CT scan would have shown the bowel perforation, which means she would have had it repaired five days earlier, before it caused such significant, long-term damage to her.
What you can do
As a patient recovering from surgery, it is hard to keep up with all the people going into and out of your hospital room. I think most patients also expect that the healthcare providers communicate with each other—the right hand knows what the left hand is doing, so to speak. That is not always the case.
I recommend that you consider two things that can help improve your safety as a hospitalized patient after surgery.
First, I recommend that you keep a healthcare journal. Write down the name of every doctor, nurse practitioner, and physician’s assistant who comes to see you, along with their groups or specialties. Surgeons often have mid-level providers, like nurse practitioners and physician’s assistants, see their patients for them after surgery. Other times, surgeons take time off and have a different surgeon cover for them while they are gone. Your goal is to be like a broken record, repeating your condition, concerns, and questions to every new provider.
Second, because this is a lot to keep up with while you are recovering and in pain, have a family member or friend stay with you, preferably 24/7.
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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 2017, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.
