Case #1108: Surgical Errors
The decedent, a 67 year old female, had a long standing history of idiopathic bronchiectasis. On March 29, she was seen by a thoracic surgeon. After reviewing x-rays, pulmonary lung function tests, as well as perfusion and ventilation tests, he recommended surgical resection of her right middle lobe. However, after reviewing additional records and assessing her physical condition, he discovered a dramatic decrease of her left ventricular ejection fraction. As a result of these findings, the surgeon forwarded the patient to cardiology for additional evaluation.
The patient was seen by a cardiologist at the Defendant Hospital on April 13, where an echocardiogram was performed. The patient had six ECHO’s done in six years. The last three were done in a period from September to the following April. Her EF dropped from 45% to 20% in less than seven months. The cardiologist noted that within the last four months, the patient could barely bend down to pick things up, could hardly take a shower without having to sit down, and used a wheelchair at the airports. Amazingly, he dismissed the findings on echocardiogram and concluded that she was fine to go ahead with surgery.
The patient underwent a flexible bronchoscopy, right thoracotomy, lysis of adhesions, right middle lobe lobectomy, and thoracic lymphadenectomy on April 27. Several days postoperatively, she suffered difficulty breathing and required reintubation and could not be weaned off the ventilator secondary to hypercapnia (increased CO2) respiratory failure. Postoperatively her ejection fraction remained 20%. On August 2, she was finally discharged to vent dependent facility.
From August 22, to September 20, she was hospitalized on multiple occasions for infections and chronic respiratory failure. There were no prospects of the ventilator being weaned, and after extensive consultations with her physicians, the family decided to discontinue life support on September 30. The decedent was survived by four adult daughters.
The Plaintiffs alleged that the Defendants breached the standards of care by failing to recognize that echocardiograms performed over the course of six to seven months, in conjunction with her clinical decline, revealed deterioration in the decedent’s cardiac condition such that she was not stable enough for surgery.