Claim Review is based on an actual professional liability claim but is not intended to parallel exactly the events and proceedings. Certain facts have been altered slightly to emphasize risk-related issues. The lessons offered in the Risk Management Considerations section are applicable to healthcare professionals in all specialties. In this issue, a patient experiences postoperative complications.

A 39-year-old male patient was admitted to the hospital to undergo gastric bypass surgery.  At the time of admission, the patient weighed 361 pounds and had been suffering with sleep apnea. His surgical procedure included a Roux-en-Y gastric bypass and was performed by the defendant surgeon without complications. Postoperatively, he did well and was discharged to home after three days.  His first postoperative visit occurred one week later in the physician’s office. At that time, his condition was reported to be unremarkable, and he now weighed 331 pounds.  During the second visit the following week, the patient began complaining of symptoms of gastro esophageal reflux. He was diagnosed with GERD and given a prescription for Reglan.  He also had lost an additional ten pounds.  The physician’s progress note of a subsequent visit one month later described him as “happy,” and now weighing 273 pounds. 

The patient was scheduled to return for an office visit in three months but failed to keep his appointment, instead returning nine months later.  Now at 197 pounds, he was once again complaining of gastric reflux. Diagnostic studies, including a CT scan and a HIDA scan, were ordered. When the patient returned to the office the following month, the test results were reviewed with him. The CT scan revealed “leaking between the stomach division,” while the HIDA scan was inconclusive. The physician advised the patient that further tests were necessary and an Upper GI series was ordered.  Although the patient did, in fact, follow through and have the study done, he never returned to his physician’s office for the results.  The conclusion of the study was “a disruption of the bypass staple line.”

Six months following the Upper GI series, the patient consulted another surgeon, complaining of dumping syndrome, nausea and vomiting. Initially an exploratory laparotomy was performed, followed by a subsequent surgery which included a revision of the gastric bypass, and a small bowel resection and gastronomy.

Continuing to experience difficulties, the plaintiff sought treatment with a third physician specializing in Bariatric surgery.  His symptoms now included difficulty eating, vomiting of fecal matter, and excessive weight loss (now down to 120 pounds).  Nearly three years after the initial procedure, this surgeon performed a complete reversal of the gastric bypass.   In addition, he underwent a hernia repair within the next year, and regained his weight up to 200 pounds. 

Allegations & Damages