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Common Bile Duct Cut During Gallbladder Surgery

Filed under Surgical Errors

The Beclane Case

Stephanie Beclane, a school teacher and married mother of three, began experiencing abdominal pain. Her pain began to worsen - especially after eating certain types of fatty foods - and radiated to her back and shoulder. Her PCP suspected that her pain was related to her gallbladder and referred her to the Defendant general surgeon.

The Defendant surgeon saw Stephanie at his office, reviewed an ultrasound report, diagnosed her with gallstones, and recommended that she undergo a laparoscopic cholecystectomy – the removal of the gallbladder through small incisions in the abdomen.

As scheduled, two days later, Stephanie was admitted to UPMC-Bedford for surgery.

To remove the gallbladder, surgeons are first required to clearly identify the cystic duct at its junction with the gallbladder using a standard, recognized technique called the “critical view of safety”. Then, after the cystic duct is unequivocally identified, the surgeon places clips on each end of the duct, cuts the duct and the cystic artery, and removes the gallbladder. It is imperative to use the critical view of safety because the cystic duct (which gets cut) can be confused with the common bile duct (which does not get cut). If a surgeon takes his time and traces the duct back to the junction with the gallbladder, the two ducts should never get confused, i.e. measure twice cut once.

Here, the Defendant surgeon chose not to use any technique to verify what he thought was the cystic duct was in fact the cystic duct. Instead, less than 1-minute into surgery, he essentially grabbed the first duct he saw, clipped it, and cut it. As it turns out, it was not the cystic duct; it was the common bile duct. Completely severing the common bile duct is a severe and potentially life-threatening mistake. That is precisely why the cardinal rule in cholecystectomies is to conclusively identify the cystic duct before cutting. Notably, the surgery was being videotaped using new equipment that the hospital had recently acquired.

As a result, Stephanie had to be life-flighted to UPMC-Presbyterian in Pittsburgh where she was hospitalized. Her abdomen was completely opened up and she underwent a complex, major reconstructive surgery of the intestinal tract known as a Roux-en-y hepaticojejunostomy (in this surgery, a part of the small intestine, the jejunum, is looped up and adjoined to the hepatic ducts, allowing the flow of bile from the liver directly into the intestine). This surgery resulted in numerous gastrointestinal related complications such as severe gastroparesis, abdominal pain, epigastric pain, nausea, vomiting, bloating, diarrhea, early satiety, etc. for which Stephanie continues to treat and has drastically reduced her quality of life. It also left Stephanie with significant scarring and a decreased sensation/numbness in her lower abdominal, both of which affect her self-esteem and intimacy with her husband. Moreover, Stephanie was placed at an increased risk for other complications such as bile strictures, additional surgeries, etc.

The defense was to ignore the clear negligence caught on video and to frame the injury as a “risk of the procedure” even though negligence is not an accepted risk of the procedure. Practically speaking, the true “defense” was that the Defendant surgeon was a very likable guy who was one of a few general surgeons in the entire country, and the defense was relying on the jury to be conservative, anti-lawsuit, and biased in favor the doctor. Also, as the judge pointed out, a patient had never won a medical practice lawsuit in the history of the county. As a result, the Defendant surgeon’s insurance company did not offer a nickel to settle the case.

During jury selection, it became known that numerous potential jurors were past patients of the Defendant surgeon. The jurors that had negative experiences with the surgeon said they could not be fair and were removed from the jury for cause. The jurors that had positive experiences with the surgeon claimed they could be fair, so the judge allowed them to remain on the jury (and we did not have enough strikes to remove them all).

The case was then tried for one week. The jury was out to deliberate for two days but in the end, they could not reach a verdict (in a civil case, there needs to be 10/12 in agreement; criminal cases need a unanimous agreement). The judge then declared a mistrial meaning the case would have to be rescheduled and tried again at a later date. Notably, the holdouts for the defense were the Defendant surgeon’s former patients whom had a positive experience with him.

Prior the scheduled retrial of the case, the parties agreed to a binding arbitration instead. A binding arbitration is where the parties agree to try the case to a private arbitrator (typically an attorney or retired judge) who then decides the outcome with both sides agreeing that the arbitrator’s decision is final. In this case, it was an attorney who specializes in serving as an arbitrator.

Following the binding arbitration, the arbitrator found in our favor and awarded a substantial confidential amount to our clients.

It is believed that the hung jury in this case in Bedford County is now the closest that a patient has ever come to winning a medical malpractice case in the history of the county.