Right hemicolectomy following appendiceal adenocarcinoma (Case #175)

• Medical Probability: 3 / 10
• Medical Error Summary: While cancer can cause a hyperinflammatory state which can cause hypercoagulability the presence of the tumor is unlikely to have caused a PE. Even less likely if the patient had been on prophylactic ...
• Causation Probability: 2 / 10
• Causation Summary: Not sure how the two are connected. True, true but unrelated. Yes a DVT and PE occurred. Yes surgery for appendicitis that found cancer. The follow up operation was appropriate and the complication un...
• Expert Summary: I have treated several patients in this situation and routinely treat patients that have sustained pulmonary emboli.
• Similar Summary: This has not occurred in my practice but I do encounter patients with appendiceal cancer and patients that have had PE regularly as a surgical intensivist.

A Trauma Case in the ED (Case #232)

• Medical Probability: 3 / 10
• Medical Error Summary: Trauma is a difficult field with evolving conditions. Pulmonary contusions most often don't manifest this quickly but when they do they are very severe. This patient should have been intubated at ~170...
• Causation Probability: 2 / 10
• Causation Summary: There is fault to be found with the ED response but the trauma surgeon's response was appropriate and within the guidelines for resuscitation. I would have to review the full chart and am curious what...
• Expert Summary: I am board certified in general surgery and surgical critical care. I work as a Trauma/Acute Care Surgeon at a very busy Level 2 trauma center for >8 years. I have been the ICU director of my facility...
• Similar Summary: As a trauma surgeon I encounter cases similar to this multiple times per week.

Surgical Resection- Mass in Colon (Case #348)

• Medical Probability: 9 / 10
• Medical Error Summary: The mass in question is noted to be 15cm long in the GI note with a tattoo at the distal end. The surgeon resected 8cm proximal to the tattoo. While a 15cm long mass is abnormal and grounds for questi...
• Causation Probability: 9 / 10
• Causation Summary: Not completely resecting the causative site led to the subsequent events-as above.
• Expert Summary: I am a board certified general surgeon in practice for over 10 years and treat patients with both the initial surgical problem and as an acute care surgeon also with the subsequent complications.
• Similar Summary: The initial GI report is unusual, I suspect few surgeons encounter such unusual reports regularly. I do encounter patients with colonic masses and obstructions regularly (several times per month).

Death from diffuse alveolar hemorrhage over two months after motorcycle crash (Case #350)

• Medical Probability: 7 / 10
• Medical Error Summary: The autopsy report leaves a bit of doubt. Diffuse alveolar hemorrhage 2 months after the inciting trauma is very unusual. It is possible that the diffuse alveolar hemorrhage is a result of negative pr...
• Causation Probability: 7 / 10
• Causation Summary: As noted above if the tracheostomy tube was placed too distally there could be causation, though this is somewhat debated in the literature. Bleeding from a tracheostomy tube must always be treated se...
• Expert Summary: I am a trauma/acute care surgeon at a busy Level 2 trauma center and encounter patients that have been involved in high energy mechanism accidents daily. I have not treated a patient with a TI fistula...
• Similar Summary: I regularly encounter patients that present similarly to the described patient prior to the TI fistula. Unrelated subsequent care would be very similar to my normal patient population.

54 y.o. man dies of hemorrhagic shock after laparoscopic Roux-en-Y gastric bypass (Case #354)

• Medical Probability: 9 / 10
• Medical Error Summary: The records provided are somewhat incomplete but it is very concerning that the marginal ulcer with perforation vs ischemia was not more aggressively treated on 4/11. This should have been worked up f...
• Causation Probability: 9 / 10
• Causation Summary: As stated above, there was delay in obtaining an appropriate diagnosis to justify the radiology reads from 4/11. Outpatient follow-up is not appropriate for those findings. Then there is delay on the ...
• Expert Summary: As an Acute Care/Emergency General Surgeon at a very busy Level II trauma center/referral center. I am often presented with patients like this in my practice. While I am not a bariatric surgeon I am ...
• Similar Summary: I encounter patients very similar to this patient at least monthly and with similar complications weekly. Management of patients with these conditions is very common in my practice due to our proximit...

Abdominal bleed/anastomotic leak (Case #357)

• Medical Probability: 5 / 10
• Medical Error Summary: This is an unusual case in that the anastomotic breakdown should occur so late. The error included in this information however likely does not lie at the feet of the surgeon. I do not believe that the...
• Causation Probability: 4 / 10
• Causation Summary: As above, exploration on 6/17 would not be warranted from the information provided. If I reviewed the entire record I may find information to the contrary. I am deeply troubled that the patient was no...
• Expert Summary: I have been in clinical practice for over 10 years and I work as an acute care surgeon specializing in the management of acutely ill patients with surgical emergencies. As a general surgery division c...
• Similar Summary: As an acute care/emergency surgeon I am called upon to help manage surgical emergencies regardless of source (ie institution or surgeon). I encounter problems such as post-operative hemorrhage and/or ...

Possible failure to transfer to trauma center for trauma involving chest injuries with resultant death due to pulmonary decompensation and arrest. (Case #358)

• Medical Probability: 9 / 10
• Medical Error Summary: This unfortunate case is exactly why trauma institutions exist. Motorcycle accidents present a clinical situation unlike many other traumatic injuries. More often than is appreciated the pulmonary con...
• Causation Probability: 9 / 10
• Causation Summary: As above, there are likely at least two possibly more errors. This patient should have been transferred to an institution that manages these injuries more frequently and thus would recognize the probl...
• Expert Summary: I have been in clinical practice for over 10 years as a trauma/acute care surgeon at a very busy level II trauma hospital. I encounter patients with injuries like this on a nearly daily basis. I am bo...
• Similar Summary: I encounter patients with these types of injuries nearly daily at my institution.

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

• Medical Probability: 9 / 10
• Medical Error Summary: I do believe there was medical error but esophageal injuries are a known but unfortunate risk factor. I would need to see the operative report but if they used bronchoscopic guidance and visualized th...
• Causation Probability: 8 / 10
• Causation Summary: As above I suspect a step was omitted in the placement as it is not likely that this injury would occur if all the normal steps with bronchoscopic visualization occurred. This likely made the hole and...
• Expert Summary: I place about 100 tracheostomy tubes per year at a busy Level 2 trauma center and stroke referral center. I place these in both a percutaneous/bronchoscopic guidance method and traditional open method...
• Similar Summary: I perform about 100 tracheostomy procedures per year. I have seen complications as have all surgeons. I have not had an esophageal perforation from this procedure but have been called to treat several...