An urologic oncology expert witness advises on unnecessary cancer surgery that resulted in woman’s death. Decedent saw defendant surgeon after lab tests came back with possible indicators of cervical cancer. Defendant performed a colposcopy and found white epithelium going into the cervical canal, which he considered unsatisfactory. He did not perform a biopsy. He diagnosed a malignant neoplasm of the endocervix. There is no indication that he reviewed the pathology reports or the pathology slides from the two labs that performed tests on the plaintiff while she was under her gynecologist’s care.
The surgeon told the decedent and her husband that a modified radical hysterectomoy was the only procedure to assure that all cancer would be removed. She agreed to the surgery.
Following surgery, she was given an anticoagulant. Later, her blood pressure dropped, and she was given more anticoagulant. She was hemorrhaging internally. She underwent emergency surgery to repair the damage. She endured several more surgeries until she died four months later.
Decedent’s family alleges that the initial cancer surgery was not warranted and that it was performed negligently. Further, the defendant surgeon failed to uphold the standard of care in the follow-up surgeries to repair the damage, they claim.
Question(s) For Expert Witness
- 1. Should the initial surgery have been performed?
- 2. What breaches to the standard of care occurred, and by whom?
Expert Witness Response
There was no basis or indication for anyone to conclude that the decedent had adenocarcinoma in situ or cancer of her cervix. There is no documentation in the materials I reviewed that a cone biopsy was ever performed on her.
Following surgery, decedent did not meet criteria for anticoagulant prophylaxis of deep vein thrombosis, and administration of a second injection was absolutely contraindicated in a patient with ongoing massive hemorrhage.
In the follow-up surgery, the defendant found the dead large bowel and appropriately resected it. He inappropriately did an anastomosis of small bowel to large bowel in the setting of peritonitis and liver failure. The loop of bowel should have been brought up as an ostomy as the chance that this anastomosis would heal was remote. A colorectal surgeon was not consulted and did not participate in that surgery. The anastomosis did not heal and she subsequently needed reoperation where the leaking anastomosis was found. He also prolonged the operation by resecting a portion of the ureter even though it did not have evidence of leaking. He should have simply placed a stent; instead he opened the bladder and re-implanted the ureter. This also did not heal and later needed drainage tubes placed directly into the kidneys.
It is my opinion that the defendant surgeon acted beneath accepted standards of care, and thus acted negligently by telling the decedent that she had cervical cancer and advising a radical hysterectomy. Such a surgery has a much higher risk of bleeding, infection, bowel injury and urinary tract injury than a simple cervical excisional procedure. The applicable standard of care is clear that a radical hysterectomy is not indicated without a clear diagnosis of invasive cancer. The surgeon and two other doctors also failed to appropriately manage the decedent’s post-operative care by prescribing an anticoagulant, failing to timely recognize that she had hemorrhaged almost half of her total blood volume into her pelvic area, failing to timely treat her hemorrhagic shock by promptly replacing lost blood volume, failing to timely stop and reverse the effects of the anticoagulant, failing to timely perform an exploratory laparotomy, and failing to call in a colorectal surgeon to consult.
The hospital and its nursing staff also acted beneath applicable standards of care by failing to timely determine decedent’s blood pressure and vital signs and to document them every four hours, failing to timely transfuse her with packed red blood cells after the order to transfuse was given.
These failures contributed as a cause of her death. It is my opinion, that the acts and omissions on the part of the surgeon were 100% of the cause of her injuries and death.
The expert is board-certified in gynecological oncology and obstetrics and specializes in pelvic reconstruction.