Law and Ethics for Medical Careers 3rd Edition

1
Law and Ethics for Medical Careers 3rd Edition

• Negligence (4)
• Standard of Care (4)

2
The Case

• A patient with Crohns disease underwent a total
  colectomy in 1976. During this procedure her
  entire colon, rectum, and six inches of her small
  intestine were removed.

3
The Case, continued

• Because of this, she was required to use a
  colostomy bag. Her surgeon at that time had
  created a Brooks stoma at the end of her small
  intestine which protrudes from skin level.

4
The Case, continued

• In 1983 the patient was diagnosed with an ovarian
  cyst and a gynecologist performed a hysterectomy.
  A partner of the gynecologist assisted with the
  surgery. The patient tolerated the procedure
  well and was discharged six days later.
• After being home for several days, the patient
  realized she had been unable to void since the
  surgery.

5
The Case, continued

• The gynecologist was out of town, so his partner
  assumed the patients care. It appeared that the
  patient had a bowel obstruction, so another
  surgery was scheduled.

6
The Case, continued

• During the operation, the surgeon soon discovered
  that the abdominal cavity was filled with partly
  bloody and partly yellowish fluid. The
  intestines were covered with a rind of tissue.
  Another partner was called in to assist.

7
The Case, continued

• Several obstructions were removed during the
  four-hour surgery. The Brooks stoma was totally
  obstructed and also had to be removed. Instead
  of replacing it with another Brooks stoma, the
  doctors replaced it with a flat stoma.

8
The Suit

• The patient recovered from the surgery, but sued
  both physicians that performed the surgery. She
  said that the flat stoma caused skin irritation,
  pain, and incontinence. She contended the
  Brooks stoma had allowed her to live a
  relatively normal life.

9
The Suit, continued

• The patient contended that both of these
  physicians were negligent in replacing the
  Brooks stoma with a flat stoma.

10
What Do You Think?

• Would res ipsa loquitur apply to this case? Why
  or why not?
• Who would be qualified to determine the standard
  of care in this case?
• Do you think an expert witness is necessary? Why
  or why not?

11
The Court

• The trial court found for the physicians, stating
  there was no deviation from standard of care.
• In its opinion, the physicians had exercised
  their best surgical judgment in completing the
  four-hour operation.

12
The Appeal

• An appeal court upheld the trial courts
  decision.
• According to the testimony, it was clear the
  bowel and abdomen were in poor condition. The
  decision not to endanger the patient by
  attempting a Brooks stoma, but rather to
  complete the four-hour operation did not deviate
  from the standard of care.

13
What Do You Think?

• Did the courts rule as you would have? Explain.
• Discuss the decision-making process involved with
  this surgical case. How do surgeons make these
  judgment calls?
• Do you agree with the judgment call in this case?
  Why or why not?
• Gamino v. Lakeside Hospital, 652 So 2d 36 (La.
  Ct. of App., Feb. 15, 1995).