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Failure to Recognize and Treat Internal Bleeding Following a Gallbladder Surgery - The Scott Case

The Scott Case

Case Summary

This was a medical negligence case regarding the death of Mrs. Scott following a laparoscopic cholecystectomy (gallbladder removal surgery). Mrs. Scott was rushed to surgery and the Defendants failed to wait long enough to allow her antiplatelet medications to clear her system, which led to them failing to recognize the signs of internal bleeding. Mrs. Scott was ultimately discharged too early and died while at home due to internal bleeding.

Case Details

Mrs. Scott was 46 years old when she presented to the Hospital ER on October 15, 2014 complaining of right upper quadrant abdominal pain. At the Hospital, she was initially treated with IV fluids and was subsequently admitted under the care of a hospitalist, Dr. Simpson. Blood work was drawn, and Dr. Simpson stopped Mrs. Scott’s antiplatelet medications (Plavix) until it was determined whether surgery would be necessary.

The plan was to resume Mrs. Scott’s antiplatelet medications as soon as possible. An ultrasound was taken and showed a mildly enlarged liver and a normal gallbladder. A CT scan indicated extensive aortic and iliac atherosclerotic disease and her HIDA scan showed low ejection fraction.

The next day, on October 16, 2014, surgery consult, Dr. Steve, examined Mrs. Scott and diagnosed her with biliary dyskinesia, which is a disorder of the gallbladder and bile ducts. Due to this diagnosis, Dr. Steve’s recommendation was a laparoscopic cholecystectomy (gallbladder removal). Dr. Steve noted her lengthy diagnostic list including Takayasu’s Arteritis, as well as her lengthy medication list including the antiplatelet medication.

Mrs. Scott’s laparoscopic cholecystectomy surgery was performed on October 16, 2014, less than 24-hours after presenting to the ER and being taken off her blood thinners. According to Dr. Steve’s testimony at his deposition, the reason for the urgent surgery was due to the severity of Mrs. Scott’s pain, and the fact that she was taking both Plavix (an antiplatelet medication and/or blood thinner) and aspirin did not affect his decision to operate as quickly as he did. However, he also testified that in a non-emergent situation, a patient should be taken off Plavix and aspirin 3-5 days prior to surgery.

Dr. Steve’s used electrocautery to remove the gallbladder and to obtain hemostasis due to bleeding from the gallbladder fossa. Blood loss was noted to be minimal and Mrs. Scott was in recovery less than an hour after surgery began. Her postoperative order included a blood thinner.

The day after surgery, at 7:59 a.m., Dr. Steve ordered labs. His progress note indicated a plan to advance Mrs. Scott’s diet and to get her out of bed. At around 8:21 a.m., a different hospitalist, Dr. Katz, noted that Dr. Steve had examined Mrs. Scott. The blood for the labs was collected at 9:42 a.m. At 10:30 a.m., Dr. Katz signed a discharge transition form and discharge medications form, discharging Mrs. Scott with instructions to take her antiplatelet medications and to see her PCP within 3-5 days.

The results of Mrs. Scott’s labs ordered at 7:59 a.m. were released into the electronic medical record system at 10:15 a.m. indicating results of a low H/H, a high BUN, and an extremely high SGPT/SGOT (liver function tests). Additionally, Mrs. Scott’s blood pressure taken prior to discharge was low. The discharge instructions were printed at about 11:00 a.m. and were reviewed with Mrs. Scott at about 2:00 p.m. She was discharged to home shortly after on October 17th.

It was undisputed that none of Mrs. Scott’s healthcare providers were aware of her abnormal lab results (reported at 10:15 a.m.) prior to her discharge (at approximately 2:00 p.m.). Additionally, a written report for the abnormal lab work was generated the day after Mrs. Scott’s discharge and would have been faxed, couriered or mailed to both Dr. Steve and Dr. Simpson.

Unfortunately, three days after Mrs. Scott was discharged, her husband called 911 from his workplace after receiving a phone call from his wife stating that she was having trouble breathing. Upon arrival to her home, the EMT’s found Mrs. Scott with a heart rate in the 20’s and agonal respirations (struggling to breathe or gasping for air). Mrs. Scott was transported back to the Hospital where she required resuscitation in the ER. A CT showed an intra-abdominal hemorrhage at the gallbladder fossa. Mrs. Scott was given blood and transferred to another Hospital where she ultimately died three days later.

Mrs. Scott’s autopsy noted hypovolemic shock, large intra-abdominal hematoma in the gallbladder fossa, multiple foci of liver disruption, parenchymal hemorrhage, and cautery effect. No vascular injury was identified. The final neuropathological diagnosis was severe global acute anoxic damage.

In summary, Mrs. Scott was admitted to the Hospital, diagnosed with biliary dyskinesia, and underwent an urgent surgery to remove her gallbladder less than 24 hours after presenting to the ER and being taken off her blood thinners. Following her surgery, her abnormal labs displayed signs of internal bleeding at least 4 hours prior to her discharge. Yet, Mrs. Scott was placed back on her blood thinners, was discharged home, and ultimately bled to death due to the simple fact that not one of her healthcare providers at the Hospital bothered to look at the results of the blood work taken prior to her discharge. Mrs. Scott was just 46 years old when she died unnecessarily. At the time of her death, she left behind a husband, four adult children, four grandchildren and several brothers and sisters, all who still miss her dearly.

Lawsuit

We filed suit on behalf of Mrs. Scott’s husband against (1) the Hospital for the failures in the surgical system that were in place that let Mrs. Scott’s care fall through the cracks, (2) the surgeon, Dr. Steve for the choice he made in performing surgery, and (3) the discharging hospitalist, Dr. Katz for his failure to recognize abnormal test results and discharging Mrs. Scott too early.

Insufficient communication amongst caregivers, as seen in this case, is a recurrent theme we see in the types of errors that significantly harm patients. These miscommunications can cause failures in the overall care of patients that result in catastrophic injuries, and in some cases death. It is imperative for caregivers to recognize the individual issues with each patient and ensure that all caregivers involved in a patient’s care are aware of such issues. Efficient communication is one way to give patients the best chance of recovery.

As for damages, Mrs. Scott was not employed at the time of her surgery, which presented a problem for monetizing her injury. Loss of future income can often be a large component of damages when dealing with the death of a woman Mrs. Scott’s age, but in this case, there were none. In addition to not working, Mrs. Scott also had a long list of comorbidities, which the Defense would argue would lead to a reduced life expectancy regardless of the gallbladder surgery. This is a relevant factor for the jury to consider when assessing damages in a Wrongful Death lawsuit such as this one. While relevant, it is not dispositive, and our job is to show the extent of the life that Mrs. Scott would have lived had it not been for the Defendants’ negligence. 

The Defendants also attempted to exploit Mrs. Scott’s husband’s remarriage during the extremely long pendency of this action. The Defendants tried to use his remarriage as evidence that he was not actually devastated by the loss of his wife. This is not an unusual tactic used by Defense attorneys and one we have seen in several cases.

Despite the Defense’s litigation tactic, the depositions taken of Mrs. Scott’s husband and children revealed very compelling testimony. Mrs. Scott’s husband testified that he could never be truly happy for the rest of his life because of the tremendous guilt he felt for the death of his wife, despite the fact that he remarried. Additionally, Mrs. Scott’s children testified how much they missed their mother, especially around the holiday seasons. From their testimony, it was clear that Mrs. Scott’s family was crushed by her loss.

It is important for us, in prosecuting these cases, to know about the individual family dynamics because we are invested in our clients’ livelihoods. For this reason, we do not have a high-volume business where we accept any case that may come our way. We want the opportunity to get to know each of our clients on a personal level. 

Result

Prior to trial, we reached an agreement to settle this case for a confidential 7-figure amount.