It was the case of missing the appendix during surgery. Buckeye Surgeon discusses an interesting scenario. A surgeon discovers after taking out a patient's appendix that it wasn't the appendix removed, but rather a piece of fat. Buckeye Surgeon describes how this can happen when everything is so inflamed it's nearly impossible to tell the difference in tissues. I have had heard of experiences at Happy's Hospital where surgeons have done end to end anastomosis in metastatic cancers where the anastomosis ended in a blind loop because the tissues where so matted down that the surgeon could not tell the difference on what was what.
In Buckeye's case, the patient ended up going back to surgery to have the ruptured appendix removed. It probably wasn't a bloodless surgery. They lived and everything was fine. BUT, I ask you America, had the patient died and a lawsuit was filed, and you were on the jury, would you considered this negligence/malpractice? Or would you consider it a complication of illness in a small percentage of patients?
I think it's the latter and that the patient's estate should not be compensated for anything, even though a bad outcome occurred. Unfortunately, in America, patients view any outcome other than success as somehow negligence on the part of the physician.
Perhaps not malpractice, but certainly fraud in that the patient was billed (one may presume) for an appendectomy. If the appendix was not removed, this is fraudulent billing.
ReplyDeleteIf you asked your auto mechanic to replace your alternator and they instead put a second alternator in place of your water pump and your engine overheats, would that be considered a "complication" in a small number of vehicles that may have an engine structured a little differently? Does that mechanic have any liability beyond the fraudulent bill of "replacing" your alternator?
Bad outcomes alone do not justify malpractice, but they do often provide the impetus to search out any failure to maintain the accepted standards of care. Should the tissues be so inflammed that the surgeon cannot make positive ID on the appendix, perhaps the best course of action would be to be straightforward with the patient (after removing the presumed-appendix-but-certainly-not-anything-else-vital) and advise them that additional treatment/imaging may be necessary to make certain that the structure was the appendix. Acknowledgment that a small percentage of patients may require this additional care may be a battle with insurers, but that is likely the best course in the customer interaction and medical treatment.
You may, of course, disagree. But the world offers no guarantees; medicine is both an art and science. Being honest with patients about the limitations of medicine/surgery offered in their individual circumstances is likely the best defense against malpractice claims.
Surgeon should have said he was doing an "Appendix Preserving Appendectomy" and charged extra...
ReplyDeleteCall me Cynical, but I bet if you were "the Happy Litigator" who had to make a second trip through the double doors you'd want your pound of flesh...
Heck, I would, and I'm a Doctor...
Frank
this not malpractice, put the same scenario with no folow up and will be malpractice, but if you keep an eye on the patient, and a complication show up, is your duty as a surgeon, to do a folow up, and try to treat complications. this is not fraud, there is not fraud, the surgeon doesnt even know it was a fatty tissue.
ReplyDeleteif it wasnt the apendix, the patient wont get better, if the patients doesnt get better he will need revaluation. not taking the apendix because it wasnt recognized, can happen, what cant happen is not reevaluating a patient after surgery, thats irresponsable.
thats not what happy is asking, Im sure he already thinks in that way, and nost of doctors will think that too.
the jury will consider this malpractice/negligence and the jury will say "he is a doctor he should know doctors knows everything".
negligence is care provided deviates from accepted "standards of practice in the medical community" and causes injury or death to the patient.
how can you define standard of practice on uncommon situations?
there is a standard recognition in a inflamated tissues, confusing a fatty tissue with the appendix, it isnt.
What was the patient/family told after the first surgery? "Everything went great, we got the appendix out, he'll be fine." Or, "It was a difficult procedure because of how inflamed the tissues were, due to the appendicitis. We're pretty sure we got everything out, but we'll do some follow-up tests to be sure."
ReplyDeleteIf it was the former, I can see a family being more prone to litigation when it turns out the surgeon took out some fat instead of the appendix. You've given your god-like stamp of assurance that the outcome is and will be good. And that's the attitude I most often (not always, but usually) see from surgeons, so it's no wonder they get sued when someone discovers they aren't really gods.
http://www.startribune.com/lifestyle/health/43366837.html?elr=KArksCCCWiaEyayP4O:DW3ckUoaEyqyP4O:DW3ckUiacyKUnciaec8O7EyUr
ReplyDeleteThis is the original article, I havent read this until now. well in this case the patient might have died, i guess there wasnt folow up at all. policy of the hospital or policy of the surgeon? to send home their postoperatory patients, immediately.
also there seems to be some kind of litigation on this case, right now.
In my personal opinion postoperatory patients, shouldnt be discharged immediatly.
Make that
ReplyDelete"Appendix Sparing Appendectomy WITH Lipo-suction"
Frank