Stab wound, necrotizing fasciitis, death (Case #327)

• Medical Probability: 8 / 10
• Medical Error Summary: A stab wound is always high risk for infection. The patient had risk factors for healing....ie DM, Obesity. DM creates a high glucose environment which can promote an infection and necrotizing. fasc...
• Causation Probability: 8 / 10
• Causation Summary: Causation can be seen in this case upon this visit to the emergency room. An obese patient with a stab wound. Range of motion was documented, BUT the patient's history of obesity with diabetes place...
• Expert Summary: I have been in practice for almost 16 years. I am a Board Certified General Surgeon and an Oral Board Examiner. My recent practice involved a rural hospital where we covered every surgical issue. T...
• Similar Summary: Probably every other month given the large amount of obese patients that enter the hospital and their associated co-morbidities.

Bilateral hernia mesh placement with complications (Case #337)

• Medical Probability: 7 / 10
• Medical Error Summary: I would want more details about the patient's "complications" after the surgery. The entire operative report would be helpful. The current standard of care is to only fix an inguinal hernia IF it is...
• Causation Probability: 4 / 10
• Causation Summary: I would want more details about the patient's "complications" after the surgery. The entire operative report would be helpful. The current standard of care is to only fix an inguinal hernia IF it is...
• Expert Summary: I have done 1000s of inguinal hernia repairs.
• Similar Summary: I have seen patient's with chronic pain after a bilateral inguinal hernia surgery. Normally, I do not recommend repairing both hernias at the same time. The recovery is longer and the complications ca...

Surgical Resection- Mass in Colon (Case #348)

• Medical Probability: 10 / 10
• Medical Error Summary: Unfortunately, there was medical error. A GI physician's estimation of where a lesion is not always accurate because of the redundancy of the bowel and the "according" that occurs when the scope is a...
• Causation Probability: 7 / 10
• Causation Summary: The error caused the patient to undergo a second surgery with associated risks.
• Expert Summary: I have been in practice for 16 years and have competed hundreds of laparoscopic and open colon resections. In addition, I do expert cases for law firms on both the defendant and plantiff's side.
• Similar Summary: I have never had this happen in my practice, but I am aware of similar cases. Especially with advances in laparoscopic and robotic surgery. I suspect we will see more.

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

• Medical Probability: 10 / 10
• Medical Error Summary: The CT report with patient’s clinical findings warranted surgery. A suspected ulcer with perforation and a dropping hemoglobin needs surgical intervention. The continued drop in hemoglobin demonst...
• Causation Probability: 9 / 10
• Causation Summary: The patient died from hemorrhagic shock that was diagnosed in 4/11. The CT was very detailed in the findings. The surgeon should have aggressively obtained the outside images OR repeat the study. The...
• Expert Summary: I have done general surgery for 17 years and a general surgery oral board examiner.. I have been at hospitals with bariatric surgeons and without bariatric surgeons. So, it provided a great deal of ex...
• Similar Summary: Almost on a monthly basis now due to the high of the roux en y surgery that use ti be the “gold standard.” Hopefully we will see less complications with the sleeve.

Patient Death following Cholecystectomy (Case #355)

• Medical Probability: 8 / 10
• Medical Error Summary: The entire management of the case is concerning. The patient is extremely complicated and should’ve been transferred to a tertiary care center. I questioned the reason for surgery given her history ...
• Causation Probability: 8 / 10
• Causation Summary: The patient clearly was not optimized prior to her surgery. I’m not sure the surgery was indicated based on the limited work up. I feel the HIDA scan was miss interpreted as being falsely positive....
• Expert Summary: I have a 17 year history of doing general surgery at a tertiary care center and in a community setting. In addition to working at critical access hospitals. The patient in question was extremely compl...
• Similar Summary: Quite often since Covid and during Covid.

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

• Medical Probability: 8 / 10
• Medical Error Summary: The patient had a significant injury to her c-spine and head. I have concerns as to why this patient was not taken to o the OR for a controlled tracheotomy.. Her cervical spine should have been immo...
• Causation Probability: 8 / 10
• Causation Summary: Please see above. A bedside trach is indicated for a healthy person not a patient with a protracted ETT or cervical spine injuries.
• Expert Summary: I have done trauma for 17 years. Our practice stopped bedside tracheostomies a few years ago. It is safer for the patient to be in a controlled operating room environment. The beside procedure is com...
• Similar Summary: We stopped doing the bedside procedure because of the associated risks

Hernia repair w/ fundoplication, later found to have esophageal perforation and also a surgical stitch in pericardium. (Case #380)

• Medical Probability: 9 / 10
• Medical Error Summary: The first operation did not follow the standard dissection. The surgeon did not mention removing or dividing the hernia sac from the pericardium. It is next to impossible to reduce a paraesophageal/...
• Causation Probability: 10 / 10
• Causation Summary: An ischemic/perforated stomach 3 weeks after the initial surgery is a rare event especially in a 50 year old patient. I suspect the operation failed early in the post-operative course and cause a tra...
• Expert Summary: I have completed 100s of the laparoscopic nissen fundoplication and repair of the hernia defect. I have never heard of such a complication. The appropriate steps of the surgery were not performed. ...
• Similar Summary: I encounter paraesophageal hernias weekly because of the high utilization of CT scans. However, not all are symptomatic, nor do all need surgery. It is a very advanced surgery and patient selection ...

52yo female right thyroid lobectomy and isthmusectomy, has significant burn injury to neck. (Case #399)

• Medical Probability: 7 / 10
• Medical Error Summary: I suspect the injury was from the ligasure or the bovie. If either instrument is not placed in a "holder" or on a wet towel both can easily burn a patient and the drapes. I can understand how it hap...
• Causation Probability: 7 / 10
• Causation Summary: The surgeon is responsible as is the scrub tech and assistant to ensure instruments, needles. etc are properly secured so a patient or OR personal does not get injured. A burn in a "sentinel" event...
• Expert Summary: I have completed 100s of thyroid procedures in my career and I have never seen this type of injury.
• Similar Summary: Thyroid cases are very common.

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: 8 / 10
• Medical Error Summary: 18 years as Board Certified General Surgeon and Oral General Surgeon Examiner
• Causation Probability: 6 / 10
• Causation Summary: The case has two concerning events that went unnoticed by the attending surgeon and the Anesthesiologist. 1. A 5mm port was placed under direct vision in the right upper quadrant. The surgeon was una...
• Expert Summary: 18 years as Board Certified General Surgeon and Oral General Surgeon Examiner This is a classic board question.
• Similar Summary: I have done 1000s of laparoscopic cases and i have one C02 emboli.

Breast Cancer Spread? (Case #463)

• Medical Probability: 9 / 10
• Medical Error Summary: Answers: 1. I don't think the recurrence was a real recurrence. It sounds like the initial cancer was not totally removed. The answers about the margins were vague. The final pathology should have a...
• Causation Probability: 9 / 10
• Causation Summary: As stated above, there appears to be a lack in the work-up of this patient. No genetics, MRI, Oncotype, US of the axilla and a complete metastatic work-up. I have a large number of questions about th...
• Expert Summary: I am a Fellow Trained Breast Surgical Oncology and Board Certified General Surgeon. I have been in practice for 19 years. I have reviewed a significant number of breast cases and have been fortunate t...
• Similar Summary: Every week. I see a large number of second or even third opinions for these types of patients.

Potential deviations in the SOC for surgical care in left scout-assisted lumpectomy with SLNB (sentinel lymph node biopsy). (Case #529)

• Medical Probability: 1 / 10
• Medical Error Summary: Based on the evidence provided an ALND was not indicated UNLESS the ultrasound (demonstrated additional suspicious LN). The metastatic lesion to the LN was small and contained, so the current recommen...
• Causation Probability: 1 / 10
• Causation Summary: See answer my answer above. The patient had an aggressive cancer Oncoyope 63 with a positive node at presentation. She declined therapy.
• Expert Summary: I am a Fellowship Trained Breast Surgical Oncologist and Board Certified General Surgeon. I have been in practice for 19 years and have had extensive experience with breast cancer. developing programs...
• Similar Summary: More now that people use Google as a "research" tool and social media platforms recommending alternative treatment. Plus the increasing number of misconceptions in the media.