Necrotizing Pancreatitis s/p lap chole (Case #115)

• Medical Probability: 1 / 10
• Medical Error Summary: The patient presented with clear indications for surgery. Standard of care in this particular case did not require any additional tests. Postoperative course was in no way related to any below sta...
• Causation Probability: 1 / 10
• Causation Summary: This is one of those cases where no matter what the surgeon does there is always the possibility of a bad outcome There was a clear indication for surgery, No indication to work up the biliary tree...
• Expert Summary: Over 25 years of performing surgery, Continue to teach training educate both medical students and residents The ability to explain complex medical issues in a simple understanding manner to the cou...
• Similar Summary: very common. . Gallbladder issues are very common whether it be problems with the biliary tree or pancreatitis.This is one of the more common scenarios that we see on daily basis In our academic insti...

Lap Colectomy: failure to recognize transection of ureter (Case #118)

• Medical Probability: 6 / 10
• Medical Error Summary: Iatrogenic ureteral injuries can occur during various abdominopelvic and retroperitoneal surgical procedures [8-10], as well as during endoscopic manipulation, or dissolution of ureteral calculi. Reco...
• Causation Probability: 10 / 10
• Causation Summary: Very unusual location for an injury in a transverse colectomy. The surgeon should not have been in the pelvis for the mobilization and anastomosis.
• Expert Summary: Been involved in many cases over 20+ years. Very good at explaining complex medical issues at a simple level.
• Similar Summary: Yes. One of the more common injuries.

"Subclavian" port-a-cath is placed in the thoracic aorta (Case #130)

• Medical Probability: 9 / 10
• Medical Error Summary: would be important to review in detail the operative note. Was fluoro used? How many times did it take to access the vein? When was the injury recognized? These types of errors are usually not subt...
• Causation Probability: 6 / 10
• Causation Summary: Thi sound like more "actual cause" If the SOC was met, more likely than not, the injury does not occur, prevention major heart surgery
• Expert Summary: Been teaching, training and education for over 20 year. Lots of case reviews Active practice familiar with this procedure ability to explain complex cases in simple terms
• Similar Summary: often Board certified in general and colorectal place my own ports in my colon cancer patients.

Testicular ischemia following inguinal hernia repair (Case #172)

• Medical Probability: 10 / 10
• Medical Error Summary: Testicular complications — The incidence of testicular complications ranges from 0.3 to 7.2 percent. Interference with blood supply to the testicle, typically resulting from the dissection of an ind...
• Causation Probability: 10 / 10
• Causation Summary: no doubt. The immediate action of the surgeon would have resulted in saving the testicle.
• Expert Summary: Teach , train and educate the medical students and residents. Academic appointment at VCU. Very active busy general surgery and colon and rectal surgery practice. Case report Orchiectomy as a res...
• Similar Summary: Perform plenty of hernias, many with mesh.

Right hemicolectomy following appendiceal adenocarcinoma (Case #175)

• Medical Probability: 8 / 10
• Medical Error Summary: Postoperative VTE is more frequent in patients with known cancer than in the general population, occurring in as many as 40 percent of patients in clinical trials employing venography for diagnosis. A...
• Causation Probability: 7 / 10
• Causation Summary: BAsed on the timing of event, the PE more likely than not started with a DVT. Was there any anticoagulation for the 8 days? was the patient ambulatory? Was there any prevention attempted prior to the ...
• Expert Summary: Experience with both plaintiff and defense. Decades of chart review. Ability to look at a complex issue and explain it in a simple fashion. Will give you an honest answer of what happened in this case...
• Similar Summary: Yes, Have had similar cases like this. Work in an academic setting where complication like this are not uncommon. This one may have been preventable. Although, everything may have been done correc...

Elective sigmoidectomy breakdown and death (Case #293)

• Medical Probability: 1 / 10
• Medical Error Summary: Sounds like a bad outcome. Leaks are common (7-12%), sounds like it was found in a timely fashion, and all of the subsequent issues are related to the leak. Outcome is not relevant in assessing th...
• Causation Probability: 1 / 10
• Causation Summary: As above. Surgery seems indicated, correct surgery, had a known complication, fixed appropriately.
• Expert Summary: This would be a good case to defend. I have reviewed many cases like this and continue to perform this type of surgery.
• Similar Summary: several per month. Still active clinically.

Colon perforation while inpatient (Case #316)

• Medical Probability: 10 / 10
• Medical Error Summary: The CT was completed around 1 pm and read as showing a small bowel obstruction with a transition point in the left mid abdomen and minimal contrast beyond that point. It also again showed the marked w...
• Causation Probability: 10 / 10
• Causation Summary: Failure to timely operate. Sounds like there was enough clinical signs and symptom as well as diagnostic imaging to proceed to the OR. sounds the delay was more than 12 hours.
• Expert Summary: Decades of reviews for both the plaintiff and defense. The ability to explain complex medical problems to the court and jury. Extremely thorough in reviews
• Similar Summary: In his new position, Dr. C. is leading the way for improved surgical care for those who have served our great country. Dr. C. has joined the surgical team at the Hunter Holmes McGuire Veterans Adminis...

No Surgery for Abdominal Bleed (Case #321)

• Medical Probability: 1 / 10
• Medical Error Summary: Conservative treatment of rectus sheath hematoma includes rest; analgesics; hematoma compression; ice packs; treatment of predisposing conditions; and if necessary, more aggressive therapies of intrav...
• Causation Probability: 1 / 10
• Causation Summary: lots of co morbid conditions. 0131 hct is stable. died relatively quickly. Fortunately, the majority of cases of rectus sheath hematoma can be successfully managed nonoperatively. Multiple cas...
• Expert Summary: This would be an easy case for me to defend based on the treatment for this condition as stated above.
• Similar Summary: 5/6 times per year. This is a frequent consult as many of our patients are on anti coagulation.

Bilateral hernia mesh placement with complications (Case #337)

• Medical Probability: 1 / 10
• Medical Error Summary: It is not uncommon to repair both sides, especially with a large cord lipoma that was seen and removed as dictated in the operative note. In addition, more likely than not whether the mesh was onl...
• Causation Probability: 1 / 10
• Causation Summary: Mesh complications are extremely common. Placement of mesh for inguinal. Hernia pairs has become standard of care. Was there anything in the operative note stating it was done incorrectly or tacked in...
• Expert Summary: Board-certified in general and Colorectal Surgery. Lots of experience operating on these types of patients taking care of them both Preop and postoperatively.
• Similar Summary: Inguinal hernias are one of the more common things that we see

Patient Death following Cholecystectomy (Case #355)

• Medical Probability: 4 / 10
• Medical Error Summary: INR of 1.9 is ok to proceed with surgery. this operation has a low risk of bleeding The surgeon’s operative note describes a markedly abnormal appearing liver. The gallbladder was contracted and ...
• Causation Probability: 4 / 10
• Causation Summary: This is common in massive bleeding....no source found....just oozing would be importation to see the hematology note to see what they recommended.
• Expert Summary: Familiar with this surgery, sickle cell disease and post op bleeding Have previously testified in a plaintiff case where sickle cell was at the center.
• Similar Summary: monthly with gallbladder disease. Post op bleeding always a concern.

Abdominal bleed/anastomotic leak (Case #357)

• Medical Probability: 6 / 10
• Medical Error Summary: This is a potentially challenging case. The patient definitely presented with signs and symptoms of hypovolemic shock and you have to assume it’s coming from your anastomosis. A plain CAT scan...
• Causation Probability: 6 / 10
• Causation Summary: Based on the way, this patient presented, the standard of care would have been a CTA, which would’ve led to emergency surgery, and re-doing the anastomosis or colectomy with colostomy. That would...
• Expert Summary: Involved in teaching training and educating medical students and residents for the past three decades. This is the kind of operation I do on a monthly basis.
• Similar Summary: Colectomy 1 to 2 times per month. Partial bowel resection and the management of postoperative patients after surgery is the mainstay of my current practice.

Colorectal stricture case with large stent placement. Subsequent stent embedded/necrotic requiring resection and multiple procedures. (Case #364)

• Medical Probability: 9 / 10
• Medical Error Summary: The indications for stent placement in patients with malignant colonic obstruction include: ●Palliation of surgically incurable colorectal cancer. ●Stenting as a bridge to surgery to avoid an...
• Causation Probability: 9 / 10
• Causation Summary: Colorectal self-expanding metal stents (SEMS) may be uncovered (meshwork is bare wire) or covered (meshwork is covered to decrease tissue growth into the stent). All colorectal SEMS function very simi...
• Expert Summary: Decades of experience with colon surgery/obstruction. Most colorectal surgeons do NOT place stents, but GI physicians do this all the time. Have experience with placing stents, the indications...
• Similar Summary: Large bowel obstruction is common. Why wasn't this patient offered surgery?

Bedside tracheostomy has multiple complications including esophageal perforation and repair procedures. (Case #372)

• Medical Probability: 10 / 10
• Medical Error Summary: Based on the anatomy, an injury to the esophagus is very unusual. Perforation of the posterior wall of the trachea through to the esophagus is rare The risk of this complication can be reduced by d...
• Causation Probability: 10 / 10
• Causation Summary: Once the procedure is noted to be difficult, a reasonable surgeon would stop, and proceed to the operating room. Choosing between surgical or percutaneous tracheostomy depends upon several factors, ...
• Expert Summary: Understand the reasons to perform, have done these at the bedside and in the OR. The ability to explain complex medical issues to the court and jury.
• Similar Summary: 1-2 year. Most Tracheostomies are done by ENT in our hospital. Still have more experience than most in this area.

Young male needs CVC for sickle cell treatment, surgeon perforates subclavian artery bedside, has multiple complications (Case #376)

• Medical Probability: 4 / 10
• Medical Error Summary: This is a known complication of this procedure. The internal jugular vein can be accessed using a standard introducer needle with or without the aid of a seeker needle, angiocatheter over needle combi...
• Causation Probability: 10 / 10
• Causation Summary: A potential complication associated with central venous access is inadvertent needle puncture of an associated artery (eg, common femoral artery, carotid artery, innominate artery, subclavian artery, ...
• Expert Summary: Lots of experience with these procedures and cases. I have reviewed this type of case and still perform these procedures. If everything was done correctly, this complication could still occur e...
• Similar Summary: In our facility we see this type of injury unfortunately all to common. This is a residents run facility and we have a lot of learners and even though we teach the proper technique these complications...

Sigmoid diverticulitis with contained perforation and abscess. Hartmann’s procedure done and develops fistula and large wound, multiple complications. (Case #381)

• Medical Probability: 1 / 10
• Medical Error Summary: This is a common complication of complicated diverticulitis. The patient had an abscess from the perforation, and the developemtn of an intra abdominal abscess or abdominal wall abscess does not b...
• Causation Probability: 1 / 10
• Causation Summary: Common complication from a Hartmanns procedure, especially with perforation and abscess. The surgery was done correctly. The develpement of an abscess after colectomy is not a breach in the SOC
• Expert Summary: This is the type of surgery I do monthly. Very common complication from perforated diverticulitis with abscess
• Similar Summary: very often. I have performed hundreds of these types of operations. High risk for abscess and infection especially after a perforation

78yo M with SBO with distention/poss GI bleed, confused and pulls NG tube out. It is electively not replaced by surgeon and PC later arrests. (Case #390)

• Medical Probability: 10 / 10
• Medical Error Summary: It is certainly within the standard of care to treat a bowel obstruction by conservative measures. NPO, IVF and NGT. The initial CT is concerning. However, once there is clinical signs of sepsis like ...
• Causation Probability: 10 / 10
• Causation Summary: This is a preventable complication. Seems like there are enough clinical signs of failed medical therapy for a bowel obstruction, and surgery would have prevented the eventual outcome.
• Expert Summary: This is the kind of patient I treat weekly. There is definitely judgment of when to convert a patient from medial to surgical therapy, however, that judgment needs to remain within the standard of car...
• Similar Summary: Weekly. Bowel obstruction is a very common admission to our hospital. They ALL get admitted the our surgical service.

Injury to the aorta inferior mesenteric vein, jejunum during elective robotic assisted laparoscopic sleeve gastrectomy (Case #397)

• Medical Probability: 5 / 10
• Medical Error Summary: Unfortunately, this is a known complication of lap surgery. The question is. 1. properly trained 2. had the volume to support this technique
• Causation Probability: 10 / 10
• Causation Summary: Res Ipsa Loquitur. There is not doubt, the injury was the direct and proximate cause.
• Expert Summary: Decades of med mal work, clinically active, academic appointment at a major University, and the ability to explain complex medical issues in a simple manner
• Similar Summary: Yes. I have been involved and opined on many of these types of cases.

Patient with history of prior abdominal surgery, dies during laparoscopic procedure. End tidal co2 dropped immediately after a Veress needle was inserted into the peritoneum. (Case #452)

• Medical Probability: 6 / 10
• Medical Error Summary: There are credible arguments that the standard of care was breached in the areas of (1) pre-operative cardiopulmonary optimization and (2) choice of access/management of a suspected CO₂ gas embolism...
• Causation Probability: 10 / 10
• Causation Summary: Diminished Physiologic Reserve – During the 48-hour window before surgery, the team skipped low-burden cardiac, pulmonary, and glycemic optimization (ACC/AHA risk stratification, assessment of the a...
• Expert Summary: I am uniquely qualified to opine on this case because I am a board-certified colorectal and general surgeon who has spent more than three decades in active operative practice, managing over 400 small-...
• Similar Summary: In more than three decades as a colorectal and general surgeon I have treated well over 400 small-bowel obstructions—roughly a dozen each year between my clinical practice, call coverage, and tertia...