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Wrongful Death From Perforation Of Esophogus (1 viewing) (1) Guest
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TOPIC: Wrongful Death From Perforation Of Esophogus
#1937
tbm1231 (User)
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Wrongful Death From Perforation Of Esophogus 10 Years, 3 Months ago Karma: 0  
Hello, What do you members think about this case I have?

My client had a stricture in her esophogus that made it uncomfortable for her to eat certain foods. About 2 years ago she had a outpatient procedure from a local doctor which stretched the stricture. She was in and out with no problems at all. The stricture came back this year and the client/patient went to a new doctor because of medicare co-pay.

This time however the 2nd doctor used size 33 tube and increased it gradually to size 48 tube. This continued stretching caused a rupture and perforation of the client/patients esophogus. Believe it or not, all this was done in site of an endoscope visualization. After the procedure the doctor sent client/patient home and said everything was just fine. Within 30 minutes or so, the client/patient went to the ER with sever pain and breathing troubles. ER physicians discovered a hole in client/patients esophogus. The same ER doctor waited untill she got worse then she was airlifted to another hospital where she had to have an emergency surgery to "patch" the hole, the 2nd doctor caused. In addition, the surgical physician said that all her organs were severly burned. In about a week, they tried another surgury where they took the esophogus out and put in a feeding bag on the stomach. Client/patient coded blue the next day and died.

Doctor #2 apologized to clients/patient's family. The cause of death on the death certificate was "perforation of esophogus."

The endoscopy before the procedure the pictures show a clean esphogus with no holes, the after procedure pictures show the esophogus all bloody and tore up which the docotor said was normal.

So, the case looks like a slam dunk....Unsure who is more at fault - Doctor #2; the ER Doctor for the delay; or the Surgical physican.

Here is my question:
What is the prefered method of enlarging an esophogus?
How many streches is normal procedure?
What were the surgical options for the ER doctor other than removing the esophogus?
 
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#1938
Sumo (User)
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Re:Wrongful Death From Perforation Of Esophogus 10 Years, 3 Months ago Karma: 5  
Honestly, I don't know what the standards are you are asking for, but I will tell you this - name both doctors in the suit and get a couple of really good experts. You case is going to be decided at case eval and likely move close to trial because I imagine that your figure is going to be a fairlly significant one. Your experts and the right family members are going to make all the difference. Good luck.
 
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#1939
Mike Sareta (User)
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Re:Wrongful Death From Perforation Of Esophogus 10 Years, 3 Months ago Karma: 0  
What type of dilation did the original dr do (if you know)?

Quote:
This time however the doctor used size 33, then on up to size 48 tubes, causing a rupture and perforation. all this was done in site of an endoscope visualazation.

This is half correct. This procedure is called an EGD and consents should have read "EGD with possible dilatation" or something to that effect but to include the dilatation. This is importand bc they are actually 2 seperate things and you need "extra" permission to do the dilatation. The EGD (scope thru the esophagus, stomach and to the first portion of small intestine.) The stricture would have been found right away as they are in the esophagus. This is all done and seen visually. As far as the dilatation goes, the sizes represent dilator using what are called Maloney dilatators (there are also balloon dilatators). This is a physician preference thing. These "tubes" are inserted or "swallowed" and then left there for about 3 seconds to "stretch" the esophagus so food can pass. The sizes go up the thicker the diameter the larger the number and I believe they go up to size 62. This is NOT a visual thing. This is considered a "blind" insertion, meaning that the physician can not see is there is a perforation. The sizes used appear normal for the procedure/history. The physician didn't lie, according to him everything was just fine. After the dilatation, he went back in with an endoscope and took pictures and looked for a perforation which obviously he didn't see. They can be very small in nature and grow over time.

Why was she sent home within 30 minutes of being dilated? Wasnt she put out for this procedure? It is a very painful procedure and she should have been knocked out or a twilight sleep. Then home within 30 minutes? Or did she "recover" for an hour or so and then discharged.

Quote:
where they took the esophogus out of the side of her neck, sealed the stomach where it attached and put a feeding bag on the stomach.

This statement does not make sense to me. She had to have some sort of an esophagus and was the feeding tube in the stomach? This would have been necessary to give her the nutritional support she needed while allowing the surgical area to heal.

Quote:
She coded blued

Need lots more information here. Resp arrest? Cardiac arrest?

Quote:
cause of death on certificate was "perforation of esophogus"

Sounds correct.

Quote:
by the way on the endoscopy before the procedure the pictures show a clean esphogus with no holes, the after procedure pictures show the esophogus all bloody and tore up which the doctor said was normal

The physician is correct. This is normal. As the tissue is "stretched" it does bleed and looks quite chewed up. This is why it makes it difficult to see if there is/was a perforation.

Was this done at a hospital or an outpatient surgery center, ie, free standing office type place?

I can tell you that from your post, I see no error on the physician part. Perforation is a complication, possibilty and is covered in the surgical consent for the perforation up to and including death.
 
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#1940
tbm1231 (User)
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Re:Wrongful Death From Perforation Of Esophogus 10 Years, 3 Months ago Karma: 0  
thank you.

Let me try to clear-up a few things.

After the maloney dialater were used, doctor #2 used french dialaters. Also from my research the doctor should have used the rule of threes or three gradual procedures.

Regarding the 30 minutes, let me clarify: After client/patient got out from the hospital and went home she returned in 30 minutes. So when the ER found out the medical problem, the client/patient was not airlifted for 6-7 hours and teh ER doctor didnt even send the records like he was supposed to on the helicoper. So, when the client/patient arrived at the hospital for surgery the surgeon had to rely on the patient advocate (spouse) to explain what had happened.

The tear was two inches long. When she coded blue it caused her heart to stop. The surgeon put a feeding tube in her stomach and was going to let the esohugus heal for a few months then re-attach it.
 
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#2158
tbm1231 (User)
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Re:Wrongful Death From Perforation Of Esophogus 10 Years, 1 Month ago Karma: 0  
Just an interesting update that my post.

We hired an independent MD consultant/expert to review the file and the case to determine the probable outcome of the case. According to his review, the likely hood of positive outcome for the decedent's estate was less than 50%. According to the MD-expert juries are increasingly sympathetic toward physicians and do not like to rule against them.

This has become true especially in California, Nevada, and other states that have enacted tort reform.

So, if the decedent's estate wants to go forward with the litigation, it will have to be an hourly engagement, as my firm can not risk the costs of going to trial where the jury pool is tainted.

In the end, tort reform protects the negligent and injures the victim further.
 
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