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Complications From Disk Repair Result In Million Dollar Settlement For Man’s Family | Deltona Medical Malpractice Lawyer

Complications From Disk Repair Result In Million Dollar Settlement For Man’s Family

A patient going into surgery to repair a herniated disk was told that he would likely be discharged the next day.

The laminectomy, he was told by the surgeon during the consent discussion, was a simple procedure.

But when complications occurred following the surgery, medical staff ignored the signs and pain complaints from the patient that should have prompted a call for help. The post-op team’s lack of response led to the 38 year-old man bleeding to death internally.

The patient’s family sued the residents and the attending surgeon alleging negligent surgery and a delay in recognizing postoperative complications. This medical malpractice case was settled for more than $1 million.

The 38-year-old man underwent surgical repair of his herniated left L4-L5 disk. The staff neurosurgeon scheduled the operation and was on hand during the initial positioning. The surgery was performed by the chief neurosurgical resident, who had done approximately 100 of these procedures. Near the end, the staff neurosurgeon returned to inspect the site and removed a small disk fragment.

Post-operatively, the patient’s blood pressure dropped to 90/30 (40 points below his pre-operative systolic reading) and his heart rate increased. The chief neurosurgery resident saw the patient and ordered extra fluids. The patient’s systolic pressure came up to 100; soon after, the chief neurosurgery resident went off duty and an anesthesia resident assumed responsibility.

Three times, nurses informed the anesthesia resident of the patient’s persistent low blood pressure. No further diagnostic testing was performed and the patient was not examined.

At 8:30 p.m., the anesthesia resident decided to transfer the patient to the floor. Upon arrival to the floor, the patient’s blood pressure was 86/43. At 10 p.m., he was given Percocet for abdominal pain relief.

No other record of his vitals signs was made until 10:40 p.m. At that time, the patient again became unresponsive when his systolic blood pressure dipped below 60. After the first event, fluids and oxygen helped, but a second event was followed by progressive respiratory decline leading to apnea — at which point a code was called. At that time, his hematocrit, the volume of red blood cells in the blood, was 14.

The patient was transferred to the medical intensive care unit. His abdomen was distended; an emergency thoracotomy was done to open the chest wall and the aorta clamped. He was taken to the OR for a laparoscopy to open his stomach; a large amount of blood was found in the peritoneal cavity or stomach lining and the surgeon could see that the left iliac vein was avulsed or town away from the inferior venacava or large blood vein (apparently triggered when bone fragments adhered to it were removed).

After receiving massive amounts of blood and blood products, the patient developed a coagulopathy or blood disorder. With no chance for his recovery, the patient’s family chose to discontinue life support.

The patient suffered a rare vascular injury when the bone fragments were removed (by the attending surgeon just before the procedure was completed). That weakened the wall of the iliac vein, which later developed into active bleeding.

However, the surgical complication per se did not cause the patient’s death, rather it was the post-op team’s response that led to the adverse outcome.

Missing multiple signs of trouble with his blood pressure and the loss of critical information at the handoffs meant that the patient’s underlying problem went undetected until it was too late to intervene.

The missed signs and opportunities, which led to settlement of this medical malpractice case, included:

  • a recognized complication of the procedure (vascular injury) is a potential cause of low blood pressure;
  • the patient received three liters of intravenous fluid in the recovery room and his systolic pressure, which had been in the 140s prior to surgery, never rose above 100;
  • no one monitored the vital signs on a frequent basis;
  • no one ordered a hematocrit or blood gases;
  • no one performed an abdominal exam following the lumbar surgery;
  • no one re-examined the facts following repeated episodes of unresponsiveness; and
  • neither the neurosurgery resident, the anesthesia resident, nor the nurses called for help from senior staff.

The patient’s blood pressure was interpreted by the residents as normal, obscuring the potential that he was bleeding internally. The residents were not expecting that disk surgery would cause trouble in the recovery period — and therefore did not recognize the significance of his blood pressure — and the need to call for help.

For more on medical issues, see the library of articles by Daytona Beach medical malpractice attorney.

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