$________ - MEDICAL MALPRACTICE - NEGLIGENT USE OF DAMAGED NASOGASTRIC TUBE DURING GASTRIC BYPASS SURGERY - PERFORATION OF ESOPHAGUS - SUBPHRENIC ABSCESS - EMERGENCY SURGERY PERFORMED - EXTENDED HOSPITALIZATION.

Philadelphia County

The plaintiff alleged that the defendant general surgeon negligently continued her gastric bypass surgery with a nasogastric (NG) tube which had been damaged by surgical staples.

As a result, the plaintiff claimed the NG tube perforated her esophagus leading to a subphrenic abscess which necessitated emergency surgery. The defendant denied that the NG tube was damaged during the surgery and maintained that the plaintiff suffered a spontaneous rupture of the esophagus which occurred after her discharge from the hospital. The hospital where the surgery was performed was also named as a defendant in the case on a vicarious liability theory, but was dismissed from the case prior to trial.

The plaintiff was a 46-year-old morbidly obese female who was more than ________ pounds overweight. She underwent gastric bypass surgery performed by the defendant general surgeon. The procedure involves placement of a nasogastric tube into the stomach and formation of a pocket around the tube to create a small stomach pouch. Surgical staples are then used to close the main portion of the stomach. The plaintiff alleged that during the gastric bypass surgery, surgical staples went through the plaintiff’s stomach and lodged in the NG tube. The plaintiff acknowledged that such an occurrence is a risk of the procedure and did not constitute negligence on the part of the defendant. The plaintiff claimed that the defendant recognized the NG tube had been stapled, removed the staples from the plaintiff’s stomach and NG tube and continued the surgery with the same nasogastric tube.

The plaintiff did well until the second day after her discharge, when she felt poorly and developed a temperature of ________ degrees.

The plaintiff presented to her family physician who performed an EKG and recorded an elevated heart rate of ________ beats per minute when 60 to 80 is normal. The non-party family physician sent the plaintiff to the emergency room. The plaintiff’s elevated heart rate was confirmed and a collection of air and/or fluid was identified adjacent to the plaintiff’s diaphragm and base of her lung. The plaintiff was diagnosed with a subphrenic abscess.

The plaintiff’s treating physicians suspected a small tear in the esophagus. They performed surgery and drained the abscess, but were not able to identify any clear tears in the esophagus nor any leaks in the gastric pouch. The plaintiff was treated with antibiotics and was hospitalized for a month and a half. She missed four months from her employment as a claims examiner for the Social Security Administration.

The plaintiff alleged that when the defendant inadvertently stapled the NG tube during the gastric bypass surgery, he caused tears in the tube or left staples remaining in it. The plaintiff claimed the damaged NG tube caused a puncture of the esophagus as it was being removed. The plaintiff’s medical experts opined that it was a deviation from the required standard of care for the defendant to continue the surgery with a damaged NG tube and he should have eliminated the damaged portion of the tube. The plaintiff’s experts opined that leakage from the esophageal puncture led to the plaintiff’s subphrenic abscess and the necessity for emergency surgery.

The defendant testified that the NG tube was not stapled during the plaintiff’s surgery. He testified that the operative note, which stated the NG tube was stapled, was the result of a "garbled transmission" when he dictated the report. The defendant contended that the staples never entered the NG tube and he examined the tube to insure that it was not damaged before proceeding with the surgery.

The defendant’s surgical expert opined that the defendant’s examination of the NG tube and his observation that it was not damaged met the required standard of care and the defendant appropriately continued the procedure. The defendant’s medical experts testified that the plaintiff did not suffer from an subphrenic abscess, but exhibited fluid caused by a spontaneous rupture of the esophagus which occurred after her discharge from the hospital. The defense also stressed that the plaintiff’s symptoms had completely resolved.

The jury found for the plaintiff in the amount of $________ comprised of $________ to the plaintiff and $________ to her husband for his loss of consortium claim.