Case details

Appendectomy did not cause patient’s death, surgeon alleged

SUMMARY

$0

Amount

Verdict-Defendant

Result type

Not present

Ruling
KEYWORDS
appendicitis epidermis, death abdomen, gangrene, peritonitis abdomen
FACTS
On March 14, 2011, plaintiffs’ decedent Laura Collins, 32, a high school counselor, was admitted to Sherman Oaks Hospital in Los Angeles with acute appendicitis and underwent a laparoscopic appendectomy performed by Dr. Andrew Renner. Collins was discharged the same day. Collins was later readmitted to the hospital, on March 18, 2011, with abdominal pain and placed under the care of Dr. Michael Zadeh, who performed a laparoscopy, followed by an exploratory laparotomy. During the procedure, Zadeh observed a one-foot segment of infarcted terminal ileum, two inches proximal to the ileocecal valve. As a result, he performed an ileocecectomy to remove the segment. Zadeh reported “that the staple line of the appendectomy was identified and examined and was noted to be intact and free of leak.” He further reported “that on closer examination, it had appeared that the staple line [of the appendectomy] extended into the small bowel mesentery transecting the blood supply, which supplied this portion of distal ileum, which then caused it to become gangrenous.” Collins ultimately passed away on March 23, 2011. The autopsy report noted the cause of death as occlusion of blood supply to a one-foot segment of the small intestine during an appendectomy. It also noted that the postoperative course was complicated by acute renal failure and pancolitis, a severe form of ulcerative colitis that extends for the entire length of the colon, secondary to clostridium difficile, a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. The decedent’s parents, Cornelia and Gheorghe Bica, sued Renner; Zadeh; Prime Healthcare Services II LLC, which was doing business as Sherman Oaks Hospital; Dr. James Diaz; and Dr. Amir Bahadori. However, prior to trial, all of the defendants with the exception of Renner were dismissed from the case. Thus, the matter proceeded to trial against Renner only. Plaintiffs’ counsel contended that the surgical staple line of the appendectomy extended into the small bowel mesentery, transecting blood supply to a foot-long segment of the distal ileum, causing the gangrenous bowel. Thus, counsel argued that Renner made a surgical error during the appendectomy on March 14, 2011, ultimately causing the decedent’s wrongful death, and that this error constituted medical malpractice. Renner claimed that he acted within the standard of care while performing the appendectomy in question, and that the surgery did not cause the decedent any harm. He also claimed that the staple line of the appendectomy did not extend into the small bowel mesentery and, hence, did not transect the blood supply to the distal ileum. Renner further claimed that he was not consulted during the decedent’s readmission to the hospital on March 18, 2011. The defense’s pathology expert testified that the terminal ileum adjacent to the ileocecal valve was viable with no evidence of arterial infarct. The expert further testified that the gross and microscopic pathology demonstrated scattered venous thrombi in the mesentery with no evidence of the staple line in the mesentery or arterial compromise to the infarcted segment of the distal ileum. Renner’s counsel contended that the operating surgeon, Zadeh, at the time conjectured, but stated as fact, that the cause of the infarct was staple line impingement on the mesentery to the involved segment. Thus, counsel argued that Zadeh was clearly wrong in his operative assessment based upon expert testimony. However, Renner’s counsel contended that Zadeh’s operative assessment stayed with the decedent right through the coroner’s evaluation, so the cause of death was incorrectly determined to be a complication of the appendectomy. Counsel argued that, instead, the decedent’s cause of death was C. difficile colitis. Counsel contended that the presence of pseudomembranous enterocolitis in the bowel demonstrated that the pathology of the infarcted bowel was not vascular ischemic in nature and, hence, was not due to the staple line extending into the mesentery. Thus, Renner’s counsel contended that the cause of death was not a complication of the appendectomy and should have been classified as natural., Collins died on March 23, 2011. Her parents claimed that their daughter’s death was due to occlusion of the blood supply to a one-foot segment of the small intestine during an appendectomy. The decedent was 32 at the time of her death and she was survived by her parents. Collins’ parents ultimately sought recovery of $1.5 million in damages for their daughter’s wrongful death and $1,300 in funeral/burial expenses. Renner’s counsel disputed the cause of Collins’ death, arguing that the decedent’s actual cause of death was C. difficile colitis, a life-threatening inflammation of the colon, and was not a complication of the appendectomy. As a result, counsel contended that Collins’ death should have been classified as natural.
COURT
Superior Court of Los Angeles County, Van Nuys, CA

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