Case details

Defense denied patient had bile leak at the alleged location





Result type

Not present

bile duct, death, digestive, gastrointestinal, sepsis
On Dec. 24, 2012, plaintiff’s decedent Mike Midani, 67, underwent a laparoscopic cholecystectomy, which involved removal of the gallbladder. The procedure was performed by Dr. Bharti Jain, a general surgeon, at St. Bernardine Medical Center, in San Bernardino. Following the surgery, Midani developed a bile leak that was thought to be from an accessory duct to the gallbladder. Despite subsequent treatment by Jain and Dr. J. Robert Evans, a gastroenterologist who performed two endoscopic retrograde cholangiopancreatography procedures to examine the pancreatic and bile ducts, Midani’s medical conditions worsened. As a result, Midani began dialysis in late 2013. In June 2017, Midani was in a skilled nursing facility when he fractured a hip in a fall. He developed wound infections and became septic. He died on Aug. 13, 2017. The death certificate identified the cause of death as sepsis with other factors being end stage renal disease and non-alcoholic liver cirrhosis. Midani’s wife, Hilda Tawil, sued Jain; Evans; St. Bernardine Medical Center; and the operator of the medical center, Dignity Health. The decedent’s children, Daniel Midani and Laressa Tawil-Midani, were included as nominal defendants. Tawil alleged that the defendants were negligent in the treatment of her husband and that the defendants’ negligence constituted medical malpractice. After Mr. Midani died, his wife amended her lawsuit to include a wrongful death claim. St. Bernardine Medical Center and Dignity Health were let out of the case on a motion for summary judgment, and Evans settled for an undisclosed amount. The matter continued against Jain only. Plaintiffs’ counsel contended that Mr. Midani most likely suffered a thermal injury during the laparoscopic cholecystectomy, resulting in damage to the bile duct. Counsel argued that Jain should not have used cautery during the procedure and that such a use in the triangle of Calot, the area dissected during the gallbladder surgery, was below the standard of care. Counsel also argued that Jain and Evans damaged the bile ducts during their respective procedures. However, plaintiffs’ counsel argued that the contributing cause of death of liver failure was the result of Jain’s negligence. Jain’s counsel called Evans, who previously settled out, to testify. Evans claimed that he reviewed the images from the ERCPs and that he did not see any leaks during the two procedures, which he claimed indicated that there was likely an accessory duct leak. Jain’s counsel disputed the cautery contention, arguing that there was no evidence of a bile leak in the area where plaintiffs’ counsel contended a thermal injury occurred. However, counsel contended that Midani did develop a stricture in an aberrant right hepatic duct, which may have been caused by the initial stent or blockage from that stent. The defense’s general surgery expert opined that the laparoscopic cholecystectomy was indicated; that the operative technique was within the standard of care, in particular, the use of cautery; and that the post-operative care was appropriate. The expert also opined that bile leaks can happen in the absence of negligence and that a duct of Luschka, or accessory duct, is a normal variant in some people and cannot be avoided, as it attaches to the gallbladder. The general surgeon testified that, normally, the leak is resolved with a stent, and he opined that the two ERCPs were the most likely cause of the stricture of the right hepatic duct, which resulted in upflow or backflow to the duct of Luschka and led to the increasing leak or some other pre-existing liver dysfunction. In addition, the expert opined that Jain’s care was exemplary and within the standard of care. The defense’s cardiology and critical-care experts opined that Midani died from complications related to the subsequent fall and fractured femur, which led to non-healing wounds and sepsis. The defense’s gastroenterology expert opined that there was no leak even though the plaintiffs’ medical experts opined that a leak occurred., Midani passed away on Aug. 13, 2017, a couple of weeks shy of his 72nd birthday. He was survived by his wife, Hilda Tawil; his son, Daniel Midani, and his daughter, Laressa Tawil-Midani. Tawil, acting individually and on behalf of her husband’s estate, sought recovery of over $200,000 in past medical expenses, which were paid by Medi-Cal and Medicare, and the maximum amount of allowable general damages for Mr. Midani’s wrongful death.
Superior Court of San Bernardino County, San Bernardino, CA

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