Case details

Patient: Surgeon negligent in transecting testicular artery





Result type

Not present

On Feb. 25, 2010, claimant James Plante, 44, a construction supervisor, underwent surgery by a general surgeon at Kaiser to repair a recurrence of an inguinal hernia when complications arose. Plante originally underwent hernia repair surgery with the Kaiser surgeon in December 2008. However, approximately one year after the surgery, Plante reported a recurrence of the hernia and returned to the same surgeon. Plante was evaluated and again requested the problem be surgically repaired. As a result, he returned to surgery in February 2010. During the 2010 procedure, the surgeon encountered substantial scarring and adhesions from the previous surgery, distorting the normal anatomical architecture, significantly complicating the surgery. When the surgeon was unable to identify the hernia sac, he had the anesthesiologist awaken Plante so that some intraoperative maneuvers could be performed in order to increase intra-abdominal pressure in an effort to unmask the hernia sac. This was also unsuccessful and, accordingly, the surgeon elected to conclude the surgery without having identified or repaired the recurrent hernia defect because of fear that further surgical dissection and exploration placed Plante at an unacceptably high risk of potential injury. The surgeon also decided to allow Plante to recover and have him return at a later date to approach the problem laparoscopically, from a different surgical plane so as to avoid having to further dissect the spermatic cord and its various structures that were virtually cement-plastered together with adhesion and scar tissue in the inguinal canal. Thereafter, Plante departed the hospital after having met discharge criteria. Approximately six hours after leaving the hospital, at approximately 1 a.m., Plante had a syncopal episode when he got up to use the bathroom. Paramedics subsequently transported Plante to a local non-Kaiser emergency room with complaints of severe groin and testicular pain. The ER physician suspected an incarcerated inguinal hernia and summoned the on-call general surgeon for consultation. Plante was then taken to surgery, at which time the outside/non-Kaiser surgeon found a large hematoma in Plante’s groin and scrotum, which was evacuated. As a result, the surgeon proceeded to perform an extensive dissection and surgical exploration in an effort to repair the hernia from below. However, this attempt was unsuccessful because of the distorted anatomy secondary to the scarring and adhesions, as the previous surgeon had seen. During the course of the dissection and exploration, the non-Kaiser surgeon reported encountering a transected testicular artery, which he documented to be a complication attributable to the previous surgery. He thereafter converted to a laparoscopic approach so as to be able to identify and repair the hernia. Plante was subsequently transferred to Kaiser, where he remained for several days before being discharged home. Plante sued Kaiser Foundation Health Plan Inc. and its other entities, Kaiser Foundation Hospitals and Southern California Permanente Medical Group. He alleged that Kaiser’s surgeon failed to properly perform the initial 2010 surgery and that this failure constituted medical malpractice. The matter subsequently proceeded to arbitration. Plante claimed that the Kaiser surgeon transected the right testicular artery, and then failed to timely recognize and repair it during the course of the surgery on Feb. 25, 2010. The claimant’s surgical expert testified that the injury to the testicular artery is one that does not occur in absence of negligence on the part of the operating surgeon and that the mere fact that it did happen showed that Plante’s care at Kaiser was below the standard of care. Kaiser’s surgeon claimed that Plante was evaluated and informed of the increased risk of bleeding, injury/loss of the testicle and potential chronic neurologic groin pain inherent in recurrent surgery of this nature before performing the procedure on Feb. 25, 2010. Kaiser claimed that despite the warnings, Plante gave his informed consent and requested that the inguinal hernia be surgically repaired again. Respondents’ counsel contended that the problems Kaiser’s surgeon encountered during Plante’s 2010 surgery were unfortunate, but were recognized complications of the surgery performed, of which the patient had been specifically and unequivocally advised. Counsel also contended that the vascular injury, while in all probability occurred during the recurrent hernia surgery performed at Kaiser, was undetectable because the vessel had gone into spasm when injured, such that there was no bleeding in the operative field or other evidence of a problem intraoperatively, and thereafter began bleeding when the vessel relaxed after Plante had been home for many hours. Thus, the respondents’ counsel argued that there was simply no reasonable way for the Kaiser surgeon to have been able to identify the injury. Counsel also noted that the Plante’s expert concurred that this was the most reasonable explanation. In addition, Kaiser’s surgeon claimed that Plante and his wife were both told that the surgery was stopped due to the unacceptably high risk of potential injury that further surgical dissection and exploration placed on Plante, and to allow Plante to recover and have him return at a later date to approach the problem laparoscopically. All experts agreed that once the injury occurred, it was not one amenable to vascular repair, such that if Plante’s unique circulatory status was not adequate to support the testicle, the outcome was inevitable. The respondents contended, however, that this was a recognized risk of surgery, which can occur without negligence on the part of the surgeon., Plante sustained a transected testicular artery. After the final hernia repair, Plante continued to complain of chronic groin and testicular pain over the next several months, for which he was seen and worked up at another Kaiser facility. Approximately three months after the recurrent hernia repair, in June 2010, Plante presented to the emergency room at an outside hospital with severe groin and abdominal pain. He was then transferred to a Kaiser hospital, where he was taken to surgery that same day. It was determined that Plante’s right testicle was nonviable, secondary to circulatory impairment, and was thus removed. Plante claimed that the transection caused the circulation to his right testicle to become compromised, such that the testicle became ischemic, necrotic and ultimately required removal. Additionally, it was found that he had a perforated colon, which was also repaired. Plante remained in the hospital for approximately one week, and was then discharged home. Plante claimed he experienced a very difficult post-operative course, characterized by significant and permanent chronic neurologic pain syndrome in his groin and abdomen, requiring ongoing pain management intervention and narcotic analgesic therapy. He has likewise, by virtue of physical-weight lifting restrictions, been reportedly unable to return to his usual and customary employment in the construction industry. As a result, Plante claimed he became depressed, requiring ongoing psychological and psychiatric care and counseling. It was further asserted that this has caused a significant and adverse effect on his marital relationship. Plante’s wife also brought a derivative claim, seeking recovery for loss of consortium. The respondents disputed the nature and extent of the claimants’ and damages.
Arbitration Company, CA

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