You go in for a routine colonoscopy and wake up a day later with some awful smelling bag attached to your belly while you're in the intensive care unit.
Maybe you went in for a hernia repair.
When you awake from surgery the doctor tells you that he accidentally punctured your bowel.
Maybe you are having surgery to remove your appendix.
After surgery you develop an infection that keeps you in the hospital for days.
You then need a second surgery to clean you out.
When you wake up, your surgeon tells you he needed to do surgery on your bowel.
I get calls from injured patients who tell me this is what happened.
Each one of these callers want to know the same thing.
“Do I have a valid medical malpractice case?”
Here is their mindset...
They went in for a routine surgical procedure.
They were reassured by their doctor.
They were told this would be a relatively simple procedure.
Each one of these injured victims acknowledges that the doctor gave them a piece of paper to sign known as an informed consent sheet.
When I ask these callers whether they bothered to read the information on that sheet, some say yes.
Others say they trusted the doctor and did not need to read the details.
In the past 27 years of handling medical malpractice cases, I can tell you that in every single instance involving a bowel injury that occurred during a surgical procedure, the doctor has always testified that he had informed the patient that there was the possibility they could suffer an injury to the bowel or other organs.
This is a standard defense.
Every doctor is taught that the standard of care requires that they inform the patient about the risks, benefits and alternatives to any surgical procedure that is being recommended.
It happens to be good medical practice to educate a patient about their options.
However, in reality there are many instances where a physician does not want to delve into detail about every possible risk the patient can experience should they go forward with surgery. If they were to tell the patient about every single risk, no matter how small, it would take a tremendous amount of time and they would likely scare off most patients.
The fact is that every surgeon will tell you that the bowel injury is a risk of any abdominal surgery.
What that really means is that simply because you wind up with a bowel injury following your simple routine surgery, does not in and of itself mean that there was carelessness or wrongdoing.
The fact that you suffered a bowel complication during your hernia repair does not necessarily mean that a doctor violated the basic standards of good surgical care.
But then again it may not.
From and injured patient's perspective here's what happens...
You are told you need surgery.
Your doctor reassures you.
You trust your doctor.
The nurse gives you a series of papers to sign in order to allow you to have surgery.
You eagerly sign them since you want to get better.
The doctor has briefly discussed with you some of the risks associated with this surgery.
In order to continue reassuring you, the doctor makes light of any risks.
You quickly put the potential for any risks in the back of your mind.
You are quickly focused on how the surgery will improve your life.
Then, when you awaken from anesthesia and are in the recovery room or in the intensive care unit, you learn the devastating news.
Your surgeon inadvertently perforated your bowel.
You needed emergency surgery.
You needed to have a bowel surgeon come in to fix the problem.
This was a difficult emergency surgery.
They couldn't simply repair the bowel by sewing it closed like they do with a laceration on your skin.
Instead, the surgeon had to remove the area with the large gaping hole.
He had to cut your bowel open.
He then had to remove the defective part of your colon.
He then needed to sew the two ends together.
That's known as an end to end anastomosis.
You quickly learn that in order to allow that part of the bowel to heal, the surgeon needs to divert all of your waste through another separate opening.
Since we have only one bowel, the only other option is to create a diversion of the waste products.
How doe they do that?
The surgeon makes a hole in your bowel that now intentionally connects to the outside of your belly.
That's known as a colostomy.
When the surgeon makes this hole, all of your poop that would normally flow through your bowel instead gets diverted to this opening outside of your abdomen.
There's only one problem.
You need to have a container to capture all the waste product and poop that will be coming out of that hole.
That is known as a colostomy bag.
That bag must be changed multiple times each day.
It is not fun.
It is not pleasant.
It is embarrassing.
It puts a big damper on your social life.
It puts an even bigger damper on your sex life.
In order for your bowel to heal, this colostomy bag will need to remain in place for at least three months.
After that time, when the surgeon feels you are ready, you must now go back into surgery in order to close up this colostomy hole and get your colon working properly again.
There are some defense attorneys and surgeons who argue that after your colostomy is closed up, you should have no permament injury.
However, that type of thinking is not correct according to many surgeons.
The reason is that the colostomy can become infected.
You can suffer recurring infections at the colostomy site.
You can develop scar tissue, known medically as adhesions, which can cause problems later and disrupt the normal flow of your poop through your bowel.
The biggest problem with a bowel injury during surgery is not recognizing it when it happens.
You will find that when your doctor causes a bowel injury while doing a different surgical procedure, the most important thing is that the doctor recognizes when this happens.
If the surgeon recognizes immediately, before the surgery is completed, he now has the opportunity to fix and repair it while you are still under anesthesia.
The problem arises when the surgeon and his surgical assistants fail to timely recognize that an injury to your bowel has occurred.
In that instance, the surgery will have ended, you will go back to the recovery room and likely be discharged from the hospital shortly after.
A delay in diagnosis is often a significant part of a valid medical malpractice case against the surgeon who performed your surgery.
Even though we know that a bowel injury can occur even in good hands, it is the failure to timely diagnose and recognize this injury that often creates a valid medical malpractice case here in New York.
Another issue that we see from time to time is when the doctor creates a bowel injury during surgery and he feels that he has the ability and qualifications necessary in order to perform a surgical repair to the bowel by himself.
Let me share with you exactly how this arose in a recent case I handled...
A gynecologic surgeon attempted to repair the bowel on his own instead of calling in a bowel surgeon.
That decision turned out to be deadly for the patient.
Let me share with you briefly what happened.
A middle-aged woman learned that she had a hernia because of prior surgical incision.
She had cancer years earlier and all of her internal reproductive organs had been surgically removed by her GYN oncologist.
Years later, she returned back to the GYN oncologist's office to evaluate her incisional hernia that was giving her pain.
The doctor who originally performed surgery on her had since retired.
A new doctor was assigned to her.
He told her that he could perform this hernia repair easily.
He had plenty of surgical experience even though he was a relatively new doctor in this practice.
He was well credentialed.
He authored many medical articles in scholarly journals.
The patient asked whether this would be better handled by a general surgeon.
The GYN oncologist told the patient and her husband that he was fully qualified to handle such a simple procedure.
You should know that those words were the beginning of the end for this patient.
Years later, the husband would tell me, looking back on this tragic series of events, that had they follow their gut instinct and gone to a general surgeon, his wife would be alive today.
What happened here that resulted in his family meeting a medical malpractice lawyer?
During the hernia repair surgery, the doctor or his surgical assistant made a hole in the patient's bowel.
This was not intended.
This was not part of the surgery.
This should not have happened.
But, to the young doctors credit, he recognized this problem immediately.
The problem was that this doctor felt he was more than qualified to repair this bowel injury.
Rather than call in a general surgeon who is experienced in handling bowel injuries, he felt he could easily take care of this problem.
That was a conscious decision that this GYN surgeon made.
That was also the wrong decision.
That was a decision that clearly violated the basic standards of good medical and surgical care.
In deciding how to repair this bowel injury, he realized that he could not simply sew it together since the hole was too large.
What that really meant was that now he would have to cut out that part of the bowel that had this large gaping hole.
Then, he would need to connect the two ends of the bowel together.
That is known medically as an end-to-end anastomosis.
Within 24 hours, the patient experienced clinical signs and symptoms that indicated she had a massive infection.
She spiked a fever.
Her white blood cell count went up dramatically.
She developed cardiac palpitations which had been under control for many years.
Importantly, she looked really sick over the next 24 hours.
Finally, a different surgeon was called in to evaluate her belly.
A general surgeon.
Not a gyn oncology surgeon.
The general surgeon felt that there was a good likelihood that she was experiencing a bowel perforation or a bowel leak.
She had an acute abdomen.
It was painful to his touch.
It hurt when he palpated it.
The general surgeon decided that this patient had to be rushed into emergency surgery to see whether or not she had a bowel leak or perforation.
What he found was remarkable.
When he opened up this patient, he found that the two ends of the bowel that had been closed by the GYN surgeon were now wide open.
Her bowel contents were now leaking into her abdomen.
That should NOT be happening.
That explained why she was getting so sick and why she spiked a fever.
The problem was, this infection had now gone throughout her entire body.
She was massively septic.
Her organs were now shutting down because of this massive infection.
The doctors in this world-renowned hospital and all their fancy equipment couldn't help stop the spread of this massive infection that was literally killing her.
After this patient died, an autopsy confirmed that the ends of the bowel that were connected together by the GYN oncologist had separated and fully opened up within 24 hours after his original bowel repair.
Here was a tragic situation where the GYN surgeon immediately recognized the bowel injury.
The problem was that he never should have been done this procedure to begin with.
Because a GYN oncologist deals with cancer in the female organs.
Remember when I said earlier that this patient had all of her internal female reproductive organs removed?
My medical experts confirmed that this gyn oncologist had no business performing a general surgeon's job when doing a simple hernia repair.
He wasn't dealing with cancer of the uterus or cervix or ovaries or fallopian tubes.
This was a general surgeon's specialty; hernia repairs.
Now let's go back and answer the question I raised at the beginning of this article.
Simply because you experience a bowel injury during the course of a colonoscopy or some other type of abdominal surgery, does that automatically mean that there was wrongdoing?
The answer is no.
However, there are instances, as I have described above, were the doctor may not be qualified to perform a bowel repair.
There may be instances where the doctor may not be qualified to do the procedure that leads to the inadvertant bowel injury.
There may be instances where a doctor fails to recognize that he burned a hole in the bowel or cut a hole in the bowel or punctured the bowel.
In that instance, the next question will be when did the doctor recognize finally that there was a bowel injury?
And then the other important question will be “If he had recognized this injury earlier, would the outcome have been different?”