Case details

Injured nerves not near incision point, surgeon claimed





Result type

Not present

nerve, neurological
On June 8, 2009, plaintiff Jeanne Duncan, 52, a bookkeeper, underwent a laparoscopic sigmoid colectomy by Dr. Mark Takata at Scripps Green Hospital. Duncan was previously referred by her primary care physician to Takata in April 2008 after conservative treatment for her diverticulitis failed. She subsequently presented to Takata on May 19, 2008, complaining of recurrent abdominal pain and diverticulitis for the past four years. As a result, Takata requested that Duncan obtain the April 2008 CT scan previously ordered by her primary care physician so that he could confirm her diagnosis. Due to personal reasons, Duncan did not return to Takata until April 30, 2009. At that time, Takata confirmed that Duncan’s April 2008 CT scan showed diverticulitis, and ordered a barium enema prior to surgery. He claimed he discussed with Duncan the risks, benefits and alternatives of undergoing a laparoscopic sigmoid colectomy to treat her disease, and explained that there was a possibility that the surgery would need to be converted to an open procedure. The surgeon alleged that after explaining this, Duncan still wished to proceed. During the June 2009 surgery, Duncan was placed in the lithotomy position and Takata made four incisions in Duncan’s abdomen along her previous pfannenstiel incision: one above her umbilicus; one in the right lower quadrant; one in the right mid-abdomen; and one in the left lower quadrant. The incision along her previous pfannenstiel incision was made to convert the area to a hand assisted port. The surgery was completed without complication, but when Duncan got out of bed for the first time, she complained of left anterior lateral thigh pain and numbness. Duncan was prescribed pain medication and discharged on June 12, 2009, with orders to follow up in two to three weeks. On June 25, 2009, Duncan returned to Takata on crutches, complaining of left anterior lateral thigh pain, and was referred to a neurologist. She then presented to the neurologist the following day and was found to have a diminished perception to temperature corresponding to distribution of the lateral femoral cutaneous nerve of her left thigh. As a result, the neurologist suspected potential neuropraxia, as the patient had pain from the distribution of the nerve, which meant the nerve was still intact, and prescribed pain medication. On Nov. 3, 2009, Duncan was diagnosed with meralgia paresthetica, a condition consistent with her symptoms of persistent pain and numbness. Duncan sued Takata and Scripps Clinic Medical Group. She alleged Takata made a surgical error by at Scripps Green Hospital causing a nerve injury and all corresponding symptoms, and that this error constituted medical malpractice. She also alleged a lack of informed consent in regards to where the incision for the sigmoid colectomy would take place, but this cause of action was eventually dismissed. Plaintiff’s counsel contended that Takata either transected or ligated the lateral femoral cutaneous nerve, in that the incision was too low, causing Duncan’s anterior lateral thigh numbness and pain. Duncan claimed that she never experienced any pain or numbness in her left anterior lateral thigh prior to the sigmoid colectomy surgery and that Takata’s negligent incision most likely damaged her lateral femoral cutaneous nerve. Takata claimed that his treatment met the standard of care and that Duncan’s injury was not caused by any negligence or surgical error, including transaction or litigation. Defense counsel contended that the location of the incision was within the standard of care in that Takata’s incision was done along a prior scar, where Duncan had three prior cesarean sections and one hysterectomy. Counsel argued that even if the incision was slightly below where Tanaka typically placed the incision on patients with previous cesarean scars, the three nerves in question are retroperitoneal and nowhere close to the incision point. Defense counsel further argued that the most likely cause of Duncan’s injury was the lithotomy position she was placed in during the sigmoid colectomy, which has been known to cause nerve ., Duncan claimed persistent pain and numbness, and was ultimately diagnosed with meralgia paresthetica on Nov. 3, 2009. As a result, she underwent a femoral nerve block on Jan. 28, 2011, which she claimed failed. On Dec. 8, 2011, she underwent ablation to the lateral femoral cutaneous nerve, which she claimed provided some relief. Despite undergoing two procedures after the underlying sigmoid colectomy, Duncan claimed that she still experiences residual symptoms of pain and numbness in her left anterior lateral thigh. She alleged that as a result, she has to continue to treat with specialists. Duncan also claimed that she can no longer go running because of her condition, and that gardening and playing with her grandchildren causes too much pain. Thus, Duncan sought recovery of $250,000 in damages for her past and future pain and suffering, but made no claim for special damages. Defense counsel argued that Duncan should be awarded zero damages, as there was no negligence on the part of Takata or the medical group.
Superior Court of San Diego County, San Diego, CA

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