Patient Cites Failure of Physician to Check Up Following Postoperative Symptoms

Allegation:

After the patient complained of constipation, mild abdominal pain, fever, and nausea the day after surgery, the ob-gyn was required to call her on a daily basis to determine she was not suffering from a surgical complication.

The Case: 

The patient, an obese 44 YOF, who had issues with ongoing pelvic pain, was a long-time patient of the ob-gyn. She had two prior surgeries to address the issue but continued to suffer from pelvic pain and was diagnosed with extensive abdominal adhesions. The ob-gyn recommended and the patient consented to a third surgery. 

Day 1: The ob-gyn performed a diagnostic laparoscopy with extensive lysis of adhesions. The procedure went as expected with no complications noted. The patient was kept in the hospital overnight for postoperative desaturation and severe nausea. 

Day 2: In the morning she began experiencing severe abdominal pain; however, her issues resolved, and she was discharged in good condition later that afternoon. 

Day 3: The patient’s husband contacted the ob-gyn. He reported that his wife was constipated, nauseous, in mild pain (controlled with ibuprofen and acetaminophen/hydrocodone), and had a fever of 102°. The ob-gyn discussed comfort strategies with the husband and called in an order for ondansetron. She did not advise the patient to go to the ED. 

Day 5: The patient presented to her primary care physician complaining of constipation. He prescribed a laxative. 

Day 6: At 19:30, the patient presented to the ED with complaints of abdominal pain and difficulty breathing. A CT of the chest, abdomen, and pelvis demonstrated free fluid in the lower pelvis and right anterior abdomen but did not definitively diagnose a perforation. She was admitted. At 22:30, The ob-gyn examined the patient, planning to obtain blood cultures and a consultation from a surgeon. 

Day 7: At 09:07, the patient was examined by a surgeon who, based on the CT and her examination of the patient, decided to do an immediate exploratory surgery. By 10:13 the surgery was underway. The surgeon identified multiple interloop abscesses as well as a subhepatic abscess on the right, and a large pelvic abscess as well. After draining pus and stool and irrigating the abdomen, the surgeon identified a large hole within the anterior surface of the patient’s sigmoid colon. She dissected the sigmoid colon and took down adhesions using electrocautery. She performed a colostomy, a temporary ostomy, and placed an abdominal wound vac. 

The patient was transferred to the ICU, where she remained intubated and sedated for several weeks. She was eventually transferred to a rehabilitation facility. She was re-hospitalized on several occasions for suspected bowel obstructions. The plaintiff filed a lawsuit against various members of her healthcare team. Her allegations against the ob-gyn included: negligently perforating her bowel during the laparoscopy and subsequently failing to diagnose and treat the perforation causing complications and further surgery. 

The allegations relating to the original bowel surgery were time-barred, due to the patient failing to file her lawsuit within the statute of limitations for those claims. The only remaining allegation against the ob-gyn going into trial was her alleged failure to call the patient to check-up on her on a daily basis after being informed of the patient’s post-operative symptoms. The defense team and defendant determined, based on strong standard of care and causation expert support, that the case should be defended through trial. 

Good documentation by the ob-gyn created a clear treatment timeline, which facilitated dismissal of many of the allegations based on a statute of limitations argument. Her documentation of her telephone discussion with the plaintiff helped her argue that she met the standard of care. Finally, her overall documentation facilitated defense expert review of the case and provided evidence that she met the standard of care. 

The Verdict: 

The judge entered a directed verdict for the ob-gyn, meaning the judge determined there was no legally sufficient evidentiary basis for a reasonable jury to find for the plaintiff. 

---  

If you have questions on this topic, please email RiskAdvisor@ProAssurance.com or call 844-223-9648.