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Continued from Page 5 of clot formation (thrombus) at the surgical site. This can produce neurologic complications like weakness in the upper and/or lower extremity on the same side as the surgery, slurred speech, facial drooping, and changes in the level of consciousness. The nursing staff is expected to know about, look for, and immediately report any such changes to the surgeon. When stroke due to thrombosis at the operative site occurs, rapid evaluation and return to the operating room for reexploration of the operative site and removal of the thrombosis is the standard. The procedure has low morbidity and mortality associated with it, and the results are excellent, with better than 60% of all patients who are re-explored in a timely fashion having little or no significant neurologic deficits, compared with those patients who are not reexplored. Time is of the essence, as the literature establishes that re-exploration done within the first four hours has the best results, although re-exploration within 24 hours of the onset of neurologic deficits is advocated by many surgeons. When evaluating a potential case of stroke associated with carotid artery endarterectomy, the following questions should be considered: Was there a proper preoperative workup to establish that the carotid endarterectomy was medically justified? Was the surgeon experienced in the performance of carotid endarterectomy? Did the hospital audit the surgeon's complication, morbidity and mortality rate to determine if the results were in line with established national norms? Was the surgery done properly? Was the post operative care appropriate and timely? P r a c t i c e   T i p s Venue Options: Getting Your Case Out of a Hostile Forum In Kansas wrongful death cases where at least one "heir-at-law" is or becomes a citizen of another state, federal court may be an option, even if other heirs are Kansas citizens. The selection of the heir to serve as plaintiff is the key to venue. An out-of-state heir selected to be the nominal plaintiff for all the heirs will create diversity jurisdiction allowing the case to be brought in federal court, assuming that is otherwise judged to be an advantageous venue. This creation of diversity principle was recently upheld by the Tenth Circuit in a case our firm handled, Tank v. Chronister, 60 F.3d 597 (10th Cir. 1998). Lynn Johnson of our firm represents the Tank family in their ongoing wrongful death case against a Wilson County, Kansas hospital and doctor. A major consideration, and prerequisite to the entire strategy, is that the "survival action" must be waived. The survival action destroys diversity because the legal representative of the estate is deemed to be a citizen of the same state as the decedent. 28 U.S.C. § 1332(c)(2). In a given case it may be worth waiving the survival action to be in federal court, as in the Tank case brought against popular local health care providers in a small town. For a more in depth discussion of Kansas wrongful death law, see the accompanying article in this issue of the Newsletter on page 7. Ask any plaintiff's lawyer - Do you think you can have a fair and impartial jury in a medical malpractice case against a popular local doctor or the only hospital in town? Most of the time the answer is "I hope so", because there is no choice in the matter, since malpractice cases tend to be local actions governed by state courts. In a small but important group of Kansas cases, there is another venue option - federal court in Wichita, Topeka or Kansas City based on diversity of citizenship.