In a recent medical error case, a surgeon allegedly failed to get informed consent from the patient for a vaginal operation that pierced the patient’s rectum by mistake.
Continued from my last post. During rectocele repair surgery, a New Jersey surgeon, Dr. Quartell, accidentally tore the rectum of a woman we’ll call Vivian. Another physician, Dr. Hatangadi, was present during the surgery as a preceptor. Vivian developed infections and hernias. She required many further procedures over the next several years.)

Regarding the necessity of the rectocele repair surgery, the testimony at trial differed as to whether there was medical error. A Dr. Stanford testified on behalf of Vivian that complaints of frequent urination could not be associated with a rectocele. He noted that Vivian had been complaining of having to urinate frequently for years, long before she was diagnosed with a rectocele. If so, it would have been medical error to perform the rectocele repair surgery, without fully informing the patient that the operation likely would not cure her urinary problems.

On the other hand, the doctors being sued and their experts testified that, in some circumstances, a rectocele could place pressure on the urethra or bladder and contribute to urinary complaints. As we shall see, they claimed there had been no medical error.

Vivian’s experts admitted the theoretical possibility that a patient could have a rectocele that caused urinary complaints. But they said such a rectocele would have to be bigger than Vivian’s. It would have to be at least grade 3 or 4.

According to testimony at the trial, a patient with a rectocele has three choices. (1) She can live with the symptoms. (2) She can use a pessary, a device similar to a diaphragm that is placed in the vaginal area. (3) Or she can have surgery. Traditional rectocele surgery involves pulling the muscles between the vagina and the rectum and suturing them.

Dr. Quartell testified that he had done traditional surgery to repair hundreds of rectoceles. He further testified that a recently developed alternative to traditional rectocele surgery was to use a mesh kit to strengthen the repair. The mesh kit method offered several advantages, he claimed, over the traditional surgery. He stated that rectal perforation is an acknowledged risk of rectocele surgery, even if the surgeon performs the procedure properly. The risk is the same whether a mesh kit is used or not. Thus, a perforated rectum would not necessarily mean that there had been a medical error.

Before Vivian’s surgery, Dr. Quartell had never done a rectocele repair with a mesh kit of any kind. St. Barnabas, like most hospitals, had a protocol for a surgeon to perform a new type of surgery. St. Barnabas required that Dr. Quartell have a preceptor present during the surgery. Dr. Hatangadi had performed about forty or fifty mesh procedures to repair a rectocele.

(To be continued.)

medical error


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