Medical Malpractice Case Report: $440,000 settlement for failure to timely diagnose ischemic bowel

June 2009

Firm partner Peter A. Schmit achieved a settlement of $440,000,on the behalf of a healthy young man who had undergone gastric bypass. He was later admitted to hospital with severe pain but doctors failed to timely diagnose his ischemic bowel (inadequate flow of oxygenated blood to the intestines) which led to bowel ischemia. Read the following Minnesota Association for Justice (MAJ) Minnesota Case Report, Vol.28, No.3, June, 2009

Selected Results*

Date of Disposition: April, 2009

L.P. underwent gastric bypass surgery in 2004. Until about one hour after lunch on August 31, 2005, L.P. was a healthy young man who suddenly began to experience severe abdominal pain and nausea. L.P. was admitted to a local hospital wherein his pain remained severe (10/10) despite aggressive narcotic treatment. Defendants admitted the fact that he continued to have severe pain despite being on pain narcotics is a factor they need to consider in determining whether surgery is needed.

Deposition testimony established that the defendants knew of L.P.'s bypass surgery and knew that a complication of bypass surgery was an internal hernia and also knew that internal hernias can lead to bowel ischemia. Signs and symptoms of ischemic bowel include acute onset of severe abdominal pain, severe nausea and vomiting, absent or hypoactive bowel sounds and swollen bowel on diagnostic imaging. After admission the ER doctor requested a surgical consult. After performing his exam, surgeon Dr. R. admitted that bowel ischemia was in his differential.

After exam, Dr. R.'s working diagnosis was fecal stasis with gas distension. An enema was ordered in an effort to relieve pain and produce a bowel movement. Based upon testimony, it was clear there was no pain reduction from the enema, no significant bowel movement was produced, and no improvement in bowel sounds. All relevant information was communicated to Dr. R. Additional evidence that demanded Dr. R. re-evaluate and promptly act came from a CT report which was communicated to Dr. R. by a radiologist by telephone.

L.P.'s clinical condition deteriorated. Ultimately, Dr. R. gets L.P. back into the operating room and by that time nearly all of the small bowel is gangrenous. Dr. R. arranged for transfer to a major facility where exploratory laparotomy and resection of the small bowel was performed. L.P. was seriously ill and required TPN for a long period of time. L.P. made a remarkable recovery given his condition such that his weight has stabilized and he has returned to the majority of his activities of daily living. L.P. does have to be careful what he eats and his stamina has been reduced.

The defense hotly contested all issues particularly causation. Given the relatively short time of delay, defense experts were prepared to testify that even had Dr. R. immediately recognized L.P. suffering from ischemic bowel, given that he needed to be transferred to a larger facility for supportive care, there was little to no chance of salvaging any of his ischemic bowel. The defense contended L.P. unfortunately suffered from a complication from his prior bypass through no fault of anyone.

Settlement: $440,000

Peter A. Schmit


Chair, National Personal Injury and Medical Malpractice Group

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