Medical Mistake Case, Pt.  3

MEDICAL MISTAKE CASE: SURGEON ALLEGEDLY FAILS TO GET INFORMED CONSENT FROM PATIENT FOR VAGINAL OPERATION THAT PIERCED THE PATIENT’S RECTUM.

(A summary of a medical mistake case, continued from my last post. During rectocele repair surgery, a New Jersey surgeon, Dr. Quartell,  accidently tore the rectum of a woman we’ll call Vivian.  Another physician, Dr. Hatangadi, was present during the surgery as a preceptor (supervising doctor). Vivian developed infections and hernias. She required many further procedures over the next several years.)

The scope and nature of a preceptor’s duties were key disputes at the trial. The question was whether it was a medical mistake for a surgical preceptor  to fail to assess independently whether the surgery was necessary.

Dr. Hatangadi testified that he arrived at St. Barnabas very shortly before the procedure.  He did not see Vivian until she was in the operating room. He never spoke to either Vivian or her husband. Dr. Quartell had told him that Vivian had a rectocele that was causing her problems. He relied on Dr. Quartell’s judgment as a board certified surgeon to determine whether the procedure was indicated. Hatangadi testified: “I was there to help him with a procedure, not in the assessment and the planning of a treatment.” So Hatangadi claimed there had been no medical mistake.

Dr. Stanford testified on behalf of Vivian   that he was familiar with accepted standards of practice.  He considered the terms “proctor” and “preceptor” to be distinct. He understood that proctoring could be simply “watching the clock and sitting there.” On the other hand, he viewed the role and duty of care owed by a preceptor to be much more involved.  He testified: “In order for me to fulfill my duties as a preceptor, I should be familiar with the patient and make a decision as to whether we should proceed with this type of procedure.” In Dr. Stanford’s opinion, Dr. Hatangadi didn’t fulfill the requirements of a preceptor. There had been a medical mistake.  Dr. Stanford testified that if Dr. Hatangadi had satisfied his obligations as a preceptor, “the surgery would not have occurred.”

But Dr. Hatangadi testified “you want a preceptor to take you through how this procedure is done. You don’t need a preceptor to tell you when a rectocele repair is required.”

Respecting Vivian’s informed consent for the 2006 surgery, Dr. Quartell and Vivian   gave conflicting testimony. Vivian   testified that Dr. Quartell did not provide adequate information about the risk of rectal perforation during the surgery. She also testified he did not tell her he had never performed a procedure with a mesh kit. Had she known that fact, she would not have agreed to let him perform the surgery. Also, she had no idea that incisions for the surgery would be made in her buttocks, and she would not have agreed to the surgery if she had known it was not restricted to the vagina.  Vivian thus asserted that there had been a medical mistake.

Respecting Vivian’s claim of medical mistake, her  husband testified that Dr. Quartell generally described the procedure and mentioned mesh.  But the doctor didn’t not name the product. The husband further testified that Dr. Quartell minimized the risks of the surgery and said “in all his years he has had no real complications from . . . this type of surgery.”

Vivian denied giving permission for Dr. Hatangadi to participate as a preceptor. Vivian’s husband agreed with her testimony.

Dr. Quartell’s version of the meeting was very different. He said he told Vivian   about the risks and complications attendant to the surgery. Dr. Quartell testified that he specifically recalled telling Vivian   this was his first surgery using mesh to repair a rectocele. He also testified he told Vivian   that, if he did the procedure using the Prolift mesh, he would “like to” have another surgeon from another hospital “come in and scrub with me and guide us through this operation.”

On the day of the surgery, Vivian   signed consent forms for the rectocele surgery and for the presence of “Visitors & Observers Professional/Non-Professional Manufacturer Representatives.” Vivian did not dispute signing the consent forms.  But she testified that she had already been given drugs when she signed them.

Vivian’s medical mistake case  then went to the jury. At the conclusion of an eleven-day trial, the jury …

(To be concluded in my next post.)

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