Malpractice defense: Stroke after lung surgery

In addition to my consulting work and writing the Health Business Blog, I’m chairman of the board of Advanced Practice Strategies, a medical risk management firm that provides litigation support for malpractice defense and an eLearning curriculum focused on enhancing patient safety. Last month I posted a fetal assessment and response case study. I’ve posted this month's example below. 

Illustrated Verdict by APSEvery month APS's Demonstrative Evidence Group shares case examples from our archives to show how a visual strategy can support the defense effort. We hope that it is of value in your practice as you develop your defense strategies on behalf of healthcare providers. Please feel free to forward it to colleagues or clients.About UsAPS is a leading provider of demonstrative evidence for the defense of medical malpractice claims. Our team of medical illustrators consults with defense teams to educate the lay jury audience about the complexities of medical care. We do this by developing a visual strategy with expert witnesses including high-quality case-specific medical illustrations, x-ray enhancements, and multimedia presentations. To learn more, e-mail us or call 877.APS.4500.Case RequestIf you have an upcoming case in any of the following areas, please send us an e-mail about it and we’d be happy to show you some relevant examples of our work:Bariatric/Gastric BypassBirth Injury & DefectsBrain InjuriesCancersCosmetic SurgeryDelayed/MisDiagnosisDental IssuesDigestive Tract IssuesEmergency RoomFemale ReproductionHeart Attack & CardiacInfectionLasik Eye SurgeryMale ReproductionMedication IssuesSpinal Cord InjuriesSurgical IssuesGeneral Inquires

Judgment for the DefenseStroke After Lung SurgeryPLAINTIFF'S CLAIM:After surgery to remove a pulmonary sequestration (a cystic piece of abnormal lung tissue), post-operative bleeding occurred in a patient. The plaintiff alleged that the surgeons should have responded more aggressively by removing additional lung tissue. They further alleged that the post-operative care and drug administration caused the patient's stroke and subsequent death. DEFENSE'S ARGUMENT:Post-operative bleeding is a well-known complication of Video Assisted Thoracic Surgery (VATS). Every attempt was made to stabilize the patient post-operatively and, while there was an adverse outcome, it was not the result of negligence.VISUAL STRATEGY:This was a complicated surgery with complex post-operative issues including atelectasis (the collapse or incomplete expansion of part of a lung) and fibrinolysis (the breakdown of blood clots), that had to be explained to the jury.Prior to trial, APS assisted in the preparation of visuals for a Focus Group and worked in direct consultation with the defendant to create all of the medical Illustrations for trial.Our involvement throughout the defense effort enabled us to help the defendant tell his story—first, locating the sequestration in the lung tissue; then performing surgery to remove it; identifying the post-operative complications; and finally, undertaking appropriate treatments to correct them. The visuals pulled together the complicated nature of the case and allowed the defendant to explain to a lay audience the medicine and care involved. This included: Normal anatomy of the lungs and the surrounding structures. Location of sequestration growth in the lung and surrounding structures, with dense adhesions. The steps taken during the VATS: Entry and lysing of adhesions between the lung and pleura. Excision of a sequestration growth with stapler. Video assisted closure showing that the closure was under direct visualization and could not have caused injury to the vessels in the chest wall. Post-operative care and complications: Immediately post-op, PEEP (Positive End-Expiratory Pressure) was applied to reinflate the lungs. Two to three hours later, under normal respiration, a clot began to form in the area of atelectasis. At the same time, regional fibrinolysis began breaking down the clot and caused bleeding out of the chest tube. Treatments were applied to stop excessive bleeding from the chest tube. PEEP was utilized to fully inflate the lung and to tamponade bleeding with pressure. The drug, Amicar, was administered to neutralize fibrinolysis and stop further break down of the clot. The treatments were successful in stopping any further post-op bleeding. Despite the unfortunate outcome of stroke, the health care provided both during the surgery and also post-operatively was appropriate and within the standard of care.RESULT:Judgment for the defense.