Death Caused by Unnecessary Gallbladder Surgery – Sanders

The Sanders Case

Case Summary

This was a medical negligence case regarding the death of Brian Sanders following an unnecessary gallbladder surgery, which resulted in Mr. Sanders’ untimely death caused by internal bleeding.

Case Details

This case involved a 65-year-old man, Brian Sanders, who underwent an ultrasound on March 30 due to slightly elevated bilirubin and abnormal SGOT lab values. The ultrasound performed found a large gallstone in his gallbladder and non-specific gallbladder wall thickening. Mr. Sanders was then referred to a surgeon, Dr. Molly, for a consultation on April 7.

At the April 7 appointment, Dr. Molly noted that Mr. Sanders’ liver was enlarged. He also diagnosed biliary colic, and he recommended a laparoscopic cholecystectomy (surgical removal of the gallbladder). Dr. Molly did not order any further testing, any further blood work, or any tests prior to surgery. Additionally, Dr. Molly did not suggest any referral to a specialist to determine the reason for Mr. Sanders’ enlarged liver and abnormal lab values.

On April 15, Mr. Sanders underwent surgery with Dr. Molly to remove his gallbladder. During the surgery, Dr. Molly noted a cirrhotic liver with a surface nodule, yet he decided to proceed with the cholecystectomy. Dr. Molly proceeded to retract the gallbladder and liver and encountered difficulty in attempting dissection of the gallbladder due to adhesions around the neck region of the gallbladder. After several attempts at dissection, Dr. Molly decided to take the gallbladder from the top down first and peeled the fundus of the gallbladder off the gallbladder fossa. Electrocautery was required due to some bleeding from the gallbladder fossa. Pathology reported the gallbladder was received previously opened with miniscule amount of green-yellow bile and multiple black gritty stones.

Surgery ended around 8:52 a.m. and Mr. Sanders was discharged home later that morning at 11:50 a.m. For the rest of the day on April 15 and on April 16, Mr. Sanders relaxed and waited to ensure that the surgery went well.

Early on the morning of April 17, Mr. Sanders began experiencing difficulty breathing. An ambulance was called, and EMS transported him back to the Hospital where his surgery was performed. At the ER, Mr. Sanders was unresponsive, bradycardic, and required intubation and nasogastric suction (NG). He had a massive black/coffee ground emesis and his abdomen was distended. Arterial blood gasses indicated a pH of 6.80 (normal range: 7.35-7.45), and a CT showed an 8.5 x 8 cm density adjacent to the gallbladder, which could be a hematoma in the subhepatic region. A chest CT noted nodular densities around the gastroesophageal junction.

Mr. Sanders coded in the CT room and was resuscitated. Due to his deteriorating condition, Mr. Sanders was admitted to the ICU in critical condition under the care of Dr. Molly. An EGD (endoscopy) performed showed severe esophagitis (with some oozing) and a questionable varices at the gastroesophageal junction. Following the EGD, significant abdominal distention caused difficulties with ventilation. Therefore, Dr. Molly performed abdominal compartment syndrome and exploratory laparotomy surgery, noting sero-sanguineous fluid in the peritoneal cavity and a hematoma in the sub-hepatic space. A drain was placed, and Mr. Sanders was packed open. Following surgery, Mr. Sanders was taken to radiology for an angio/TIPS procedure, but prior to the start of the procedure, Mr. Sanders coded and could not be resuscitated. Brian Sanders died on April 17 at 12:50 p.m.

Lawsuit

We filed a lawsuit on behalf of Gail Sanders, the wife of Bruce Sanders. We alleged that Dr. Molly was negligent in recommending the cholecystectomy surgery, performing the surgery, and most especially failing to abort the surgery after observing Mr. Sanders’ cirrhotic liver. A cirrhotic liver presents a host of surgical risks for what should otherwise be a routine surgery. Mr. Sanders did not require his gallbladder to be removed that day. He was not acutely ill, and he demonstrated no signs of cholecystitis that would explain his lab abnormalities. Dr. Molly should have admitted Mr. Sanders to the hospital and had a GI evaluation performed to discover the severity of the cirrhosis and potential implications. Instead, Dr. Molly failed to appreciate the degree of Mr. Sanders’ cirrhotic liver, proceeded with the surgery (despite identifying the cirrhotic liver), and discharged him home, only for Mr. Sanders to return with internal bleeding due to decompensated liver dysfunction, which ultimately caused his death.

Though a jury trial was scheduled for this matter, the parties agreed to binding arbitration instead. Binding arbitration is a private process where disputing parties agree to an individual (the arbitrator) making a final decision regarding the issues being disputed after the parties present evidence and state their arguments. The arbitration process is much like a trial, but it can usually be completed more quickly and in a less formal manner. Following the arbitration hearing, the arbitrator issues an award, which can be enforced by a court due to its binding nature.

Our considerations in consenting to binding arbitration rather than a jury trial include the fact that binding arbitration creates less expense that ultimately would be borne by the client, there is less of a wait involved in getting to the binding arbitration, and this case took place in a very rural jurisdiction where plaintiffs’ verdicts are sparse. We were assured of the arbitrator and we selected someone in whom we were confident would lead a fair proceeding and determine a just outcome.

Binding arbitration is rarely agreed to by defendants in medical malpractice cases. Usually, defendants will only agree to binding arbitration where liability is fairly clear, even if not admitted by defendants. The biggest value for defendants in binding arbitration is that there is little to no likelihood of an extreme or excessive verdict by the arbitrator. A great value of binding arbitration to us is that if a plaintiff recovers in binding arbitration, there is finality to the decision, because binding arbitration awards can only be appealed on very narrow grounds.

Result

Following a hearing, the arbitrator issued a substantial verdict in favor of the Plaintiff.