A Johnson County jury returned a rare plaintiff’s verdict in a medical negligence case this spring, providing compensation to a woman sent home from a surgical center despite suffering from a bowel perforation.
The case stemmed from a lap-band surgery in Overland Park, Kan. Several prior abdominal procedures on our client had resulted in significant abdominal adhesions, which the lap-band surgeon had to take down before placing an adjustable band around the stomach—an increasingly popular weight-loss method. Removing adhesions increases the risk of bowel perforations. At least two bowel perforations occurred during the lap-band procedure.
Because bowel perforations are recognized complications of the procedure, we did not allege that the surgery was negligently performed. However, in light of our client’s surgical history, attorneys Matt Birch and David Morantz argued that the surgeon should have had a higher degree of suspicion for bowel perforations when the patient’s vital signs began deteriorating the evening following surgery and into the next morning.
While staying overnight at the surgical center, the patient’s temperature increased despite the administration of Tylenol. Her pulse rose above 100 beats/minute. And her respiratory rate increased to 20 breaths/minute and above. These increases helped establish that the patients was experiencing systemic inflammatory responses syndrome, or SIRS. The SIRS criteria—elevated temperature, elevated heart rate, elevated respiratory and elevated white blood cell count—help physicians determine whether a patient is suffering from post-surgical complications, including bowel perforation. If a patient meets two of the criteria, the patient is considered to be septic.
Another marker proved a troubling trend. The patient’s blood pressure, which had been high prior to the procedure, dropped sharply throughout the evening and into the following morning. A decrease in blood pressure combined with the SIRS indicators is an early sign of shock.
The patient was sent home shortly before noon after undergoing an x-ray study that required her to drink contrast material in order to see if it passed through the banded portion of the stomach. That evening, she lost the use of her legs and was rushed to the emergency department, where a CT scan showed the contrast material and free air outside of the bowel. A surgeon performed an emergent open procedure to remove a portion of the leaking bowel and the lap-band.
The most difficult aspect of the case was establishing which injuries resulted from the delayed diagnosis versus which injuries would have occurred despite the delay, which lasted approximately 14 hours. Expert testimony helped prove that the delay significantly lengthened the patient’s long and difficult course of treatment after the bowel resection, largely because leaking bowel content resulted in peritonitis and organ damage. Complicating matters, however, was the absence of any hematology studies on the patient prior to being sent home that could have been compared to studies when she was admitted to the emergency department.
The juror agreed with plaintiff’s arguments that the delay resulted in approximately $103,000.00 in medical expenses. After several hours of deliberation, the jury returned a verdict in plaintiff’s favor for $178,860.90.
