This case involves a morbidly obese middle-aged male who passed away after undergoing a gastric bypass surgery. At the time of the incident in question, the Plaintiff went to his doctor to have an EKG in preparation for a scheduled gastric bypass surgery. The EKG found evidence of a hereditary heart defect which could prove dangerous in a surgical setting. The patient had another EKG performed at the hospital prior to the procedure that again noted the condition: long QT waves. Nevertheless, the patient underwent a bypass procedure and was discharged from the hospital with a follow-up examination scheduled the following week. During the next few days the patient had complaints of heart palpitations and called the surgeons office. He was told by the surgeon’s office that they would see him later that week at his scheduled appointment. The Plaintiff passed away sometime during that evening and the cause of death was determined to be cardiac in nature.
Question(s) For Expert Witness
- 1. Should the man have undergone the bypass surgery given his history of a long QT wave syndrome?
- 2. Should the surgeons office have told the man to go to the emergency room due to his palpitations?
- 3. What is the standard practice for healthcare providers when a patient with long QT syndrome has symptoms of heart palpations following a major surgery?
Expert Witness Response E-004704
There are several places where I have concerns about this case that make it worth review because on first evaluation this was a preventable death. With those EKG findings he should not have had any elective surgery until the issue was evaluated by a cardiologist. When the patient had a new complaint following surgery she should have been seen and evaluated or instructed to go to the emergency room. The standard of care is that patient with a long QT who have new symptoms need an evaluation because they are at risk for an arrhythmia and sudden death. First, if the primary care doctor was responsible for an evaluation and or clearance for surgery and had an H&P, he fell below the standard in care by not getting a cardiology work up for the prolonged QT. If the PCP had privileges at the hospital that the operation took place, then he is responsible for that content of the medical record. If the PCP does not have privileges then the surgeon has to validate the PCP. Second, the anesthesiologist should not have put the patient to sleep with these findings. Finally, when a patient calls with a new complaint after a gastric bypass, the patient should have been evaluated or sent to the emergency room. If the patient’s symptoms were not discussed with the doctor and it was given by anyone employed by the surgeon, he is still responsible.
This double board certified surgeon specializes in surgical critical care and is the director of bariatric surgery at her university as well as an Associate Professor of Surgery. She is a member of such prestigious professional societies as the American College of Surgeons and the Society of Laparoendoscopic Surgeons. In addition to her clinical appointments she also serves as an associate professor of surgery at a university medical center. She has published multiple peer-reviewed articles in several medical journals such as the World Journal of Gastrointestinal Surgery and the Journal of Robotic Surgery. In addition to her journal articles, this highly qualified surgeon has authored a book chapter gastric bypass surgery in an obesity management textbook. She lectures widely on laparoscopic surgery, gastric bypass surgery and the treatment of obese patients.