LC, 70 years old, arrived by ambulance to Defendant, hospital, May 6, 2009 at 14:13. She reported left-sided abdominal pain radiating to the chest (5/10 in severity) that began about an hour earlier.
CT scan of the abdomen and pelvis without contrast was obtained about 18:09 that revealed a very large hiatal hernia, a markedly distended stomach, a small high density pelvic fluid collection consistent with hemorrhage and extensive diverticulosis. At 19:15, surgery consultation, requested to rule out pelvic bleed, recommended repeating the CT scan with contrast. The consultation was performed by a surgery resident (Dr. R) and discussed with Dr. P, the surgery attending.
On May 7, 2009 a repeat CT scan with IV contrast, done at 01:00, revealed a large hiatal hernia, dilated stomach, and findings suspicious for gastric volvulus or gastric outlet obstruction. The patient was seen that morning Dr. S who suggested gastroenterology consultation.
LC was intubated for hypoxia at 15:30. Thoracic surgery consultation was ordered at 15:38. Dr. AS, a thoracic surgeon, was contacted at 16:40 while the patient was in extremis. LC was taken to the operating room by Dr. S; operation began at 22:18 and ended at 21:50. Gastric volvulus was found with gangrenous stomach and an ischemic perforation with gross peritonitis and mediastinitis. Total gastrectomy with esophageal exclusion, jejunostomy tube placement and drain placement was performed. Pathology demonstrated gangrenous necrosis of the stomach with a perforation.
LC’s post-operative course was complicated by respiratory failure, septic shock, renal failure and bacteremia and died on May 11, 2009.
Plaintiff’s experts opined that the standard of care required nasogastric tube (NGT) placement after the first CT scan was reviewed demonstrating the markedly distended stomach. An NGT would have decompressed the stomach (which would have improved the blood flow to the stomach) and decreased the pain that LC was experiencing. Dr. P deviated from the standard of care by not placing an NGT after the first CT scan. The standard of care required urgent thoracic surgery consultation after the second CT scan was reviewed demonstrating gastric volvulus. Gastric volvulus, without urgent treatment, carries a high risk of mortality. By not contacting a thoracic surgeon until 16:40 on May 7, 2009, Dr. P and Dr. S deviated from the standard of care.
Dr. P and S contributed 50% each toward the settlement. Plaintiff requests that the identities of the defendants not be disclosed in the publication.
Date of verdict, judgment or settlement:
February 11, 2015
Superior Court, Monmouth County
Plaintiff: Charles A. Cerussi, Cerussi & Gunn, P.C., 600 Broad Street, Shrewsbury, New Jersey 07702. Attorneys for Plaintiff. (732) 936-9920
Defendant: Paul F. Schaaff, Jr., Esq., Orlovsky, Moody, Schaaff, Conlon & Gabrysiak, L.L.C., Monmouth Park Corporate Center, 187 Highway #36, West Long Branch, New Jersey 07764. Attorneys for Defendants, GP, M.D. and MS, M.D.
Defendant: Richard A. Amdur, Esq., Amdur, Maggs & Shorr, P.C., P.O. Box 190, Oakhurst, New Jersey 07755, Attorneys for Defendant hospital.
Defendant: Steve Drake, Esq., Reynolds & Drake, P.C., 29 North Shore Road, Absecon, New Jersey 08201. Attorneys for Defendants, JH, M.D. and AR, M.D.
Healthcare Providers Insurance Exchange (HPIX) insured Drs. P and S.