In routine gall bladder surgery, the surgeon mistakenly punctures the patient's aorta, a major artery supplying oxygen-rich blood to the body. The inpatient is 20-year-old Airman Colton Reid. His fiancé watches as Reid's feet turn blue from lack of blood flow; yet there are more than eight hours of delay before Reid is transferred from the teaching hospital at Travis Air Force Base to Uc Davis medical town in Sacramento, where Reid can get enough treatment. Because of the lack of blood flow from the punctured aorta, and the delay, doctors at Uc Davis are finally forced to amputate his legs.
Gall bladder surgery is one of the most base surgical procedures performed in hospitals, but the online video segment by Abc News described above shows gall bladder surgery is not without its risks. In Reid's case, what went wrong?
The Inflamed Gall Bladder
The gall bladder, tucked away near the liver, is small and resembles a pear. The liver produces bile and the gall bladder market it until bile is needed for digestion of food.
In some cases, gall bladder surgery (cholecystectomy) is performed to treat abnormal gall bladder function or cancer, but in the majority of cases the gall bladder becomes inflamed or obstructed because of gallstones, and the inpatient elects to have it removed.
Gallstones are hard, tiny pebbles of cholesterol that form for a estimate of reasons, from poor diet to genetic inheritance, and cause symptoms that range from lasting indigestion to intense abdominal pain. Removing the gall bladder through laparoscopic surgery helps to alleviate the symptoms.
Laparoscopic surgery, colloquially known as "Band-Aid" surgery because of its tiny incisions, became popular among general surgeons in 1990 due to technical advances. It is now the suitable course largely replacing the more invasive techniques of open surgery. The surgeon makes incisions no greater than one centimeter, inflates the patient's abdomen with carbon dioxide to make room, and inserts a small video camera (the laparoscope). Once inside, the surgeon locates the gall bladder's vessels and ducts, cuts them, and removes the gall bladder through the navel.
Laparoscopic surgery is less risky, less painful, and more cosmetically pleasing compared to traditional open surgeries, in which incisions are much larger and internal organs lay bare. But laparoscopic surgery still requires convention and palpate on the part of the surgeon.
The Laparoscopic Surgeon
Laparoscopic surgery carries risks beyond those inherent in general anesthesia, the patient's ample health, and his or her individual diagnosis and recovery. Laparoscopic surgery is a small exercise. Any hand tremors are amplified, compounding any lack of eye-hand coordination. And the surgeon must be comfortable using the laparoscope; chiefly, dexterity of the wrists, hands and fingers is required to safely manipulate the instrument inside the patient's body.
The surgeon must know the relevant anatomy. Since gallstones often cause inflammation, the anatomy can be distorted and difficult to identify, and an inexperienced surgeon could mistakenly pierce the wrong organ or clamp the wrong duct--like the bile duct, requiring emergency room treatment and reconstructive surgery--or, in Reid's case, the aorta. In other words, the surgeon must correctly illustrate the image displayed by the laparoscope and couple that with his or her palpate and dexterity; if the surgeon fails at this, the complications are serious.
From Pierced Aorta to Legal Culpability
For Airman Colton Reid, whose legs were amputated, the central issue is the apparent negligence of the laparoscopic surgeon who cut his aorta--as the triggering event--made worse by the fact that Reid's change was delayed much longer than the few hours a inpatient can go without blood flow to his limbs before he risks losing them.
As applied in a case with facts similar to Reid's (Reid does not have way to civil malpractice laws because he was treated by a forces doctor), New York pattern jury instructions define medical malpractice as the negligence of a doctor, in which the doctor does something that a reasonably economical doctor would not do under the circumstances, or fails to do something that a reasonably economical doctor would do under the circumstances.
Reid would have to prove both proximate cause and resulting damages; typically, a jury would determine either there was surgical malpractice in piercing the aorta, either the pierced aorta caused the amputation, or either it was primarily due to the eight hour delay.
Gallstones Surgery:Excising the Gall Bladder: The Risks of 'Band-Aid' surgical operation
ไม่มีความคิดเห็น:
แสดงความคิดเห็น