concept - risk factors & consent, medical negligence case-file

DISCLAIMER: Dr. Dalawari shares interesting and relevant medical-legal case verdicts & settlements from the public record. He has no professional or personal relationship to the cases.

Case Reference:

Plaintiff’s Expert: Alfred Culliford, M.D., cardiothoracic surgery, New York, NY.Defendant’s Experts: Bryan Foy, M.D., cardiovascular surgery, Naperville, IL. Holger Reed v. Baptist Health Lexington et al. Fayette County (KY) Circuit Court No. 16-1604. Charles C. Adams, Jr., Jerren& Adams for plaintiff.

Melanie S. Marrs and Tonya S. Rager, Kinkead & Stilz; Timothy H. Napier, Napier Gault Schupbach & Stevens for defendants.

Keywords:

risk factors & consent, risk potential, informed consent, open-heart surgery, chest pain, myocardial infarction, ischemia, ischemic event, heart stent, cardiothoracic surgeon, vein harvesting, vein graft, rare complication, idiopathic, nerve injury, nerve damage

Case Overview

Heart Patient Suffered Rare Complicated Foot Drop During Open Heart Surgery – Kentucky Defense Verdict.

The plaintiff, a forty-three year old over-the-road trucker, suffered chest pain while traveling. A myocardial infarction was diagnosed and a stent was placed in his heart.

He consulted with defendant cardiothoracic surgeon when he returned to his hometown.

The defendant surgeon performed open-heart surgery on May 11, 2015. A physician’s assistant, along with hospital nurses, assisted in the surgery.

The surgery was complex and involved harvesting and grafting a vein. It was an apparent success. However, when plaintiff awoke from the surgery, he had suffered a foot drop injury. It was related to an insult to his peroneal nerve.

The medical team denied that anyone had dropped, mashed or leaned on plaintiff in a way that was capable of causing injury. At the conclusion of a three-day trial, the jury returned a defense verdict.

Cardiothoracic Surgeon Consult:

A male patient received a stent placement after chest pain presentation while traveling as a truck driver.

He consulted with a local cardiothoracic surgeon when returning home and underwent successful, complex open-heart surgery involving vein harvesting and a vein graft.

However, a foot drop injury related to the damage of the peroneal nerve presented when the patient returned to consciousness postoperatively. As a result, a lingering and permanent limp affects the patient's gait which prevents returning to his occupation and is now considered a disability.

The plaintiff determined the injury as idiopathic and convinced that the damage should not have occurred during the surgery.

Additionally, his theory included that either a table or equipment positioning error or direct nerve compression created the muscle weakness or paralysis characteristic of foot drop.

 

Rare Complications: Nerve injury

The defendants denied the patient's theory for injury and justified it as a rare complication while insisting that the surgical team did not accidentally cause the nerve injury.

The patient was in contact with numerous medical professionals before undergoing extensive open-heart bypass surgery to prevent future ischemic attacks.

Neither the patient's medical history, prior complaints, or apparent reports of staff suggested that the patient presented with a limp or symptoms characteristic of foot drop on or before the day of surgery.

Additionally, no witnesses or the surgical team admitted to a possible injury to the patient's peroneal nerve within the fully staffed operating room.

 

Risk Factors & Consent:

The patient must understand and consent to the possible side effects and risk factors before medical professionals perform any surgery or procedure.

Although foot drop is classified as a rare complication when associated with open-heart surgery, it is unknown if the patient understood and consented to less likely or rare complications.

Unless the facility standardizes what possible complications to include when discussing the surgical procedure and gaining consent, the physician may not have disclosed every possible surgical complication.

It is also unknown if the patient would have provided consent with understanding the potential for nerve damage, permanent injury, or occupational disability. However, the patient should have received a general statement acknowledging possible disability or death as a result of any surgery.

 

Negligence or No?

With the lack of reasoning for the injury, the patient attempted to infer negligence of the damage without evidence, according to the res ipsa loquitur theory.

Although the patient has not exhibited foot drop or nerve damage symptoms before the surgery and understanding the likelihood of developing foot drop, determining the cause is difficult without direct evidence, when the reason may be idiopathic.

Nonetheless, the development of new symptoms is very frustrating for the patient; the premise of medicine is that the benefits must outweigh the risks.

The patient's surgery was essential to improve circulation and prevent another potentially fatal ischemic event, thus considered a life-saving priority over the resulting foot drop symptoms.

DISCLAIMER: Dr. Dalawari shares interesting and relevant medical-legal case verdicts & settlements from the public record. He has no professional or personal relationship to the cases.

Do you have questions about a medical case or need help understanding treatment plans and options?

Cardio Med Legal Dr. Jasdeep Dalawari

(804) 500-0685 - info@cardiomedlegal.com

Jasdeep Dalawari MD

About Jasdeep Dalawari MD

Experienced General and Specialist Physician with a demonstrated history of working in the medical practice industry. Skilled in Interventional, Endovascular, Vascular, and General Cardiovascular Medicine; Emergency Medicine; Healthcare Consulting, including Peer Review, Expert Witness, and Utilization Review; and Medical Education. Strong healthcare services professional with an MS focused in Health Administration from Virginia Commonwealth University.