Inadvertent liver resection

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Beeftenderloin said:
Gyne surgeon I’m with brought this case up today. Cackling away as she shows various organs on screen “iS tHiS a SpLeEn, iS tHiS a SpLeEn?”

You know you ****ed up when gyne is dunking on you.
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Mention the ureters…
 
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CopaceticOne said:
Also, why a MRI of the pelvis when the apparent concern was an intraabdominal process? There is something very weird with this case.

Partial situs inversus?
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Situs inversus wouldn't put the liver or spleen in the pelvis, though. You're right, it's weird without more information. My only guess is that they were looking for free fluid in the pelvis to track the hemoperitoneum, which maybe weight limited usefulness of US and CT.
 
Explanation I saw on reddit:

illinihand 374 points 9 hours ago

So I sent this to an ER doc friend of mine and he said he had read the official notes on this thing. This is that he said. "It’s been a while, but I did read the actual case file on it and I believe it goes something like this.
The patient was set up to have his spleen removed, while in the operating room they discovered he had an undiagnosed aneurysm of his splenic artery, which is pretty rare. He also had a rare congenital deformity where a portion of his liver was duplicated on the left upper side near the spleen. Typically the liver is isolated to the right upper quadrant of the abdomen.
During the surgery, the aneurysm burst causing massive life-threatening bleeding into the abdomen. The surgeon was unable to see anything because of blood loss and the patient coded. They did massive transfusions of blood, and the surgeon blindly respected (resected?) the organ he grasped in his hand in the field of blood . This was the location of the spleen but ended up being the rare duplicated liver in the location of the spleen.
Any surgeon who can visualize the organs would immediately know the difference between a spleen and a liver they look vastly different. This was a rare case where the patient ended up dying during the surgery and if I recall may have resuscitated him enough that he briefly survived, but then lost pulses again and couldn’t be saved. The organ once reviewed by the pathologist was found to be liver, and the headline was turned into surgeon accidentally removes the wrong organ killing a man when in reality a man had a double rare condition and spontaneously started bleeding to death, and the surgeon couldn’t save him. In the process of a last ditch Hail Mary effort he ****ed up"
 
GassYous said:
Explanation I saw on reddit:

illinihand 374 points 9 hours ago

So I sent this to an ER doc friend of mine and he said he had read the official notes on this thing. This is that he said. "It’s been a while, but I did read the actual case file on it and I believe it goes something like this.
The patient was set up to have his spleen removed, while in the operating room they discovered he had an undiagnosed aneurysm of his splenic artery, which is pretty rare. He also had a rare congenital deformity where a portion of his liver was duplicated on the left upper side near the spleen. Typically the liver is isolated to the right upper quadrant of the abdomen.
During the surgery, the aneurysm burst causing massive life-threatening bleeding into the abdomen. The surgeon was unable to see anything because of blood loss and the patient coded. They did massive transfusions of blood, and the surgeon blindly respected (resected?) the organ he grasped in his hand in the field of blood . This was the location of the spleen but ended up being the rare duplicated liver in the location of the spleen.
Any surgeon who can visualize the organs would immediately know the difference between a spleen and a liver they look vastly different. This was a rare case where the patient ended up dying during the surgery and if I recall may have resuscitated him enough that he briefly survived, but then lost pulses again and couldn’t be saved. The organ once reviewed by the pathologist was found to be liver, and the headline was turned into surgeon accidentally removes the wrong organ killing a man when in reality a man had a double rare condition and spontaneously started bleeding to death, and the surgeon couldn’t save him. In the process of a last ditch Hail Mary effort he ****ed up"
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Now this adds up and makes much more sense.
 
GassYous said:
Explanation I saw on reddit:

illinihand 374 points 9 hours ago

So I sent this to an ER doc friend of mine and he said he had read the official notes on this thing. This is that he said. "It’s been a while, but I did read the actual case file on it and I believe it goes something like this.
The patient was set up to have his spleen removed, while in the operating room they discovered he had an undiagnosed aneurysm of his splenic artery, which is pretty rare. He also had a rare congenital deformity where a portion of his liver was duplicated on the left upper side near the spleen. Typically the liver is isolated to the right upper quadrant of the abdomen.
During the surgery, the aneurysm burst causing massive life-threatening bleeding into the abdomen. The surgeon was unable to see anything because of blood loss and the patient coded. They did massive transfusions of blood, and the surgeon blindly respected (resected?) the organ he grasped in his hand in the field of blood . This was the location of the spleen but ended up being the rare duplicated liver in the location of the spleen.
Any surgeon who can visualize the organs would immediately know the difference between a spleen and a liver they look vastly different. This was a rare case where the patient ended up dying during the surgery and if I recall may have resuscitated him enough that he briefly survived, but then lost pulses again and couldn’t be saved. The organ once reviewed by the pathologist was found to be liver, and the headline was turned into surgeon accidentally removes the wrong organ killing a man when in reality a man had a double rare condition and spontaneously started bleeding to death, and the surgeon couldn’t save him. In the process of a last ditch Hail Mary effort he ****ed up"
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The op note is posted online. Reads like a massive coverup. Surgeon opinions vary on what could have really happened.
 
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That path report is weird. The (presumably) tech who grossed the “spleen” outright called it liver in the gross description. Shouldn’t they have notified the surgeon at that point, even if just concerning for a mislabeled specimen? I would be pissed if someone knowingly processed the wrong person’s tissue.
 
The spleen was the size of a basketball if not bigger. The surgeon removed a basketball sized piece of liver, meaning there was still a basketball sized spleen in there somewhere.
 
The MR a/p and CT a/p would have clearly delineated the anatomy and whether or not a duplicated liver segment was present in the LUQ.

The patient and family didn't want surgery and refused for days. They wanted to go home. The first mistake here is goading a patient into surgery that the patient clearly doesn't want.

I would also be very surprised if this surgeon had ever done a lap/hand-assisted splenectomy before as an attending. It's not a common operation. The second mistake here is not knowing one's limitations when it comes to unusual pathology and not reviewing the imaging carefully before jumping in to an uncommon surgery.
 
GassYous said:
Explanation I saw on reddit:

illinihand 374 points 9 hours ago

So I sent this to an ER doc friend of mine and he said he had read the official notes on this thing. This is that he said. "It’s been a while, but I did read the actual case file on it and I believe it goes something like this.
The patient was set up to have his spleen removed, while in the operating room they discovered he had an undiagnosed aneurysm of his splenic artery, which is pretty rare. He also had a rare congenital deformity where a portion of his liver was duplicated on the left upper side near the spleen. Typically the liver is isolated to the right upper quadrant of the abdomen.
During the surgery, the aneurysm burst causing massive life-threatening bleeding into the abdomen. The surgeon was unable to see anything because of blood loss and the patient coded. They did massive transfusions of blood, and the surgeon blindly respected (resected?) the organ he grasped in his hand in the field of blood . This was the location of the spleen but ended up being the rare duplicated liver in the location of the spleen.
Any surgeon who can visualize the organs would immediately know the difference between a spleen and a liver they look vastly different. This was a rare case where the patient ended up dying during the surgery and if I recall may have resuscitated him enough that he briefly survived, but then lost pulses again and couldn’t be saved. The organ once reviewed by the pathologist was found to be liver, and the headline was turned into surgeon accidentally removes the wrong organ killing a man when in reality a man had a double rare condition and spontaneously started bleeding to death, and the surgeon couldn’t save him. In the process of a last ditch Hail Mary effort he ****ed up"
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If this is true, then the anatomically correct liver would have still been left in the patient. That would have clearly been found on autopsy.
 
Could pathology have helped this case? This looks weird it appears the spleen is on the opposite side lets get some tissue and make sure everything is right before committing to cutting”it” out?
 
1725656365111.jpeg

Luuuucyyyy!!! You got some exspleenin’ to do!!!
 
narcusprince said:
Could pathology have helped this case? This looks weird it appears the spleen is on the opposite side lets get some tissue and make sure everything is right before committing to cutting”it” out?
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You could do frozen section but it takes time and it sounds like the patient was crashing.
 
Maz777 said:
The MR a/p and CT a/p would have clearly delineated the anatomy and whether or not a duplicated liver segment was present in the LUQ.

The patient and family didn't want surgery and refused for days. They wanted to go home. The first mistake here is goading a patient into surgery that the patient clearly doesn't want.

I would also be very surprised if this surgeon had ever done a lap/hand-assisted splenectomy before as an attending. It's not a common operation. The second mistake here is not knowing one's limitations when it comes to unusual pathology and not reviewing the imaging carefully before jumping in to an uncommon surgery.
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Too many physicians make this mistake. Aggressively convincing a patient into care they don't want, sometimes out of a fear of liability if the patient leaves. I always tell my ornery ICU patients, "I'm not a warden". You're free to leave if you can mentally make that decision, just make sure you document the heck out of the discussions you've had.


I can't say I've ever heard of someone being named in suit for an adverse outcome after a patient left AMA (would love examples if anybody has them). I can definitely say I've heard of plenty where a disgruntled family sues after a bad outcome they were talked into.
 
It's very rare that you read about a malpractice case and have this many more questions than answers afterwards but this is one for me. From a rads, path, and perioperative perspective, none of this makes sense.

In rads, we see basically all surgical misadventures that don't die before inevitably getting imaged (even some that do...). I do not buy the idea that there was heterotaxy, especially right isomerism, that went unnoticed. The reddit ED doc explanation above is oversimplication and junk from an academic center perspective. A splenic artery aneurysm certainly isn't rare and a prominent left lobe isn't really rare either. And neither of those things would be a surprise during planning for a splenectomy.

Sounds like someone encountered brisk bleeding and was forced into blind hemostasis which unfortunately failed in a spectacular way. The events leading up to the surgery don't make sense either but I attribute that to media confusion.
 
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pgg said:
Sounds like a mixture of plaintiff attorney press release nonsense, and actual malpractice.

Maybe a lobe of a giant liver was peeking over by the spleen and the surgeon injured it. No way the liver was removed. It's a ridiculous story.
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It’s Pensacola area/FL panhandle. In laws live not far from the place of the story. Let’s just say that healthcare there is so bad (as it is in much of the South, outside big cities) that it’s almost hard to fully comprehend it until you’ve witnessed it. You’d think you weren’t even in America.

When I saw it was Pensacola/Destin area, let’s just say I was not the least bit surprised…
 
Neopolymath said:
It's very rare that you read about a malpractice case and have this many more questions than answers afterwards but this is one for me. From a rads, path, and perioperative perspective, none of this makes sense.

In rads, we see basically all surgical misadventures that don't die before inevitably getting imaged (even some that do...). I do not buy the idea that there was heterotaxy, especially right isomerism, that went unnoticed. The reddit ED doc explanation above is oversimplication and junk from an academic center perspective. A splenic artery aneurysm certainly isn't rare and a prominent left lobe isn't really rare either. And neither of those things would be a surprise during planning for a splenectomy.

Sounds like someone encountered brisk bleeding and was forced into blind hemostasis which unfortunately failed in a spectacular way. The events leading up to the surgery don't make sense either but I attribute that to media confusion.
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100% agree. Got in over their head, more bleeding than expected, cut out whatever looked like it was bleeding pericode, which turned out to be the liver.

It's not like you can dissect out the spleen post-mortem after they've called time of death.

The most bewildering part of all is the op report. Clearly covering their tracks to an extent...
 
As a surgeon, seeing the op note being detailed enough to describe taking down ligaments (which reads almost like copying the steps out of a surgical atlas) yet accidentally removing the liver is pretty incongruent. I legitimately can't see how you get this lost. Also, unless the patient failed conservative management or was unstable, you generally are trying to AVOID splenectomy and IR embolization usually is attempted first. The decision to go to the OR for splenic bleeding (without more information or ability to review full chart) is curious as a "gradual downtrend" of his Hgb in itself isn't an indication for surgery. Typically you go to surgery after transfusing 4-6 units and failing IR control. If the patient had a splenic artery aneurysm (not a rare finding and should be readily seen on CT), treatment is generally via IR and he should've known that was there going in.

Will also say that he clearly stapled across the liver hilum and not the splenic hilum. I felt the impending doom in my gut reading that he used a stapler. Oof. And if the whole liver was removed, that means massive holes in the IVC even if stapled at the hilum. If only the left lobe was removed as some are suggesting here, he should have realized what he was doing as that raw edge of liver would have been draining bile and pouring out blood and he would know he didn't remove the whole organ. Will also point out that there isn't a hilum to the liver on the left lobe. If he thought it was the spleen, it should've been very obvious at that point he was wrong. I also wouldn't think a duplicated liver lobe (which is attached to the rest of the liver and far less able to be mobilized than a spleen) would cause that much confusion, plus would have been noted on imaging.

This is all monday morning quarterbacking and speculation based on limited info and the assumption that this is even the true op report. I would be curious to see surgeon notes as well as the radiology reads on this patient. If the autopsy shows a total hepatectomy was performed (and was there any dissection of structures around the spleen? Was he ever operating on the right thing?) I can't think of any satisfactory explanation for this.
 
Smurfette said:
As a surgeon, seeing the op note being detailed enough to describe taking down ligaments (which reads almost like copying the steps out of a surgical atlas) yet accidentally removing the liver is pretty incongruent. I legitimately can't see how you get this lost. Also, unless the patient failed conservative management or was unstable, you generally are trying to AVOID splenectomy and IR embolization usually is attempted first. The decision to go to the OR for splenic bleeding (without more information or ability to review full chart) is curious as a "gradual downtrend" of his Hgb in itself isn't an indication for surgery. Typically you go to surgery after transfusing 4-6 units and failing IR control. If the patient had a splenic artery aneurysm (not a rare finding and should be readily seen on CT), treatment is generally via IR and he should've known that was there going in.

Will also say that he clearly stapled across the liver hilum and not the splenic hilum. I felt the impending doom in my gut reading that he used a stapler. Oof. And if the whole liver was removed, that means massive holes in the IVC even if stapled at the hilum. If only the left lobe was removed as some are suggesting here, he should have realized what he was doing as that raw edge of liver would have been draining bile and pouring out blood and he would know he didn't remove the whole organ. Will also point out that there isn't a hilum to the liver on the left lobe. If he thought it was the spleen, it should've been very obvious at that point he was wrong. I also wouldn't think a duplicated liver lobe (which is attached to the rest of the liver and far less able to be mobilized than a spleen) would cause that much confusion, plus would have been noted on imaging.

This is all monday morning quarterbacking and speculation based on limited info and the assumption that this is even the true op report. I would be curious to see surgeon notes as well as the radiology reads on this patient. If the autopsy shows a total hepatectomy was performed (and was there any dissection of structures around the spleen? Was he ever operating on the right thing?) I can't think of any satisfactory explanation for this.
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Yeah the lack of IR mentioned anywhere is puzzling.
 
This case is crazy not explainable with the info provided, and an example of why you don’t want to have complex cases done at a podunk hospital. I saw this in the .mil. No you can’t do your complicated surgery here because 1. You are probably less skilled than you think you are after not doing complex cases and 2. This is a crappy tiny podunk hospital with limited resources. You wouldn’t think a splenectomy would be complicated, but when your spleen is allegedly the size of a football, your liver is 2x normal size and you want to do a laparoscopic operation on a probably chubby 70yo, maybe that’s not the best choice. I think this guy had significant hepatomegaly and a splenic cyst, and there was some miscommunication about what was what. Perhaps from the radiologist and/or the superstar surgeon who didn’t bother to review the MRI, etc. Then he went in laparoscopic with faulty expectations, got sloppy and the SHTF. Then he started some damage control slashing things open , packing everywhere, and stapling everything off, including stuff like the IVC, and the patient had an unresuscitatable arrest. I want to read the autopsy.
 
dozitgetchahi said:
It’s Pensacola area/FL panhandle. In laws live not far from the place of the story. Let’s just say that healthcare there is so bad (as it is in much of the South, outside big cities) that it’s almost hard to fully comprehend it until you’ve witnessed it. You’d think you weren’t even in America.

When I saw it was Pensacola/Destin area, let’s just say I was not the least bit surprised…
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There’s a difference in Pensacola (which is NOT where this incident occurred) and Ft Walton/Destin (where it actually happened). Night and day.
 
jwk said:
There’s a difference in Pensacola (which is NOT where this incident occurred) and Ft Walton/Destin (where it actually happened). Night and day.
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Having been through the whole area pretty extensively, I would have to disagree with that statement. IMO, the only place in FL where the healthcare is good is South Florida. The rest is bad news.
 
nimbus said:
Florida department of health order.

So bad.

www.documentcloud.org

Thomas Shaknovsky Order

www.documentcloud.org www.documentcloud.org

View attachment 392816
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Open and shut case. Autopsy tells you all you need to you know. Had no idea what he was doing. A complete failure of surgical residency training system. It'll be interesting to see if he gets jail time. Medical license is gone forever.
 
Maz777 said:
Open and shut case. Autopsy tells you all you need to you know. Had no idea what he was doing. A complete failure of surgical residency training system. It'll be interesting to see if he gets jail time. Medical license is gone forever.
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Spent 5 years doing who knows what. At least Dr. Death was in a specialty with tiny structures and tiny operating windows.
 
CopaceticOne said:
@Smurfette - what are your thoughts after reading the suspension order? Just curious
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Wow, that was scathing for a board order. But justafiably so. I read it and mostly thought "yep, that sounds right" because there is just no way anyone remotely competent could remove a liver on accident. Basically everything that sounded fishy in the op report is accounted for in the order. And there was no actual indication for surgical intervention at all in this patient (what is with the VPMA also trying to talk patient into it?), which is what I had thought when I read the op note. As a general surgeon, I can't understand how he just "finds" the IVC and tries to staple it. He'd hit the portal vein and hilum first, causing massive bleeding, unless he detached the IVC above the liver. Is it incompetence or intentional? It is so hard to be this level of incompetent, this being intentional almost makes more sense. I would be interested in a timeline of how long he stayed lap, how long after conversion before transecting IVC, etc.

I bet he was trying to write his op note and was googling anatomy and came back in to look at the specimen when he realized he had it all wrong. Because there was zero other reason to need to look at that specimen at that point.

Maz777 said:
Open and shut case. Autopsy tells you all you need to you know. Had no idea what he was doing. A complete failure of surgical residency training system. It'll be interesting to see if he gets jail time. Medical license is gone forever.
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He should be charged and should get jail time. This is not a "**** happens" type of complication or any one bad decision leading down the rabbit hole. It was a series of bad and worse decisions, starting from recommending surgery in a patient who didn't need it and didn't even fail other alternatives first, to failure to recognize some of the most readily identifiable HUGE organs and blood vessels in the body (and recognizing even which side of the body the structures are on), to falsifying records and lying to the world about what happened. This level of incompetence is hard to achieve. If it's true incompetence and not intentional or due to impairment, it's a failure of every place that has ever employed him to stop him. References are needed for all physicians at hire. Who was giving him one and not disclosing competence concerns?
 
I can’t fathom the explanations for this: serious psychiatric issue, especially as this is not the first time the wrong organ was removed, or severe impairment. I wish I could watch the testimony. The spleen and all its attachments still intact, did he even touch it!

What are times has anyone has seen bringing up to a surgeon to stop? Surprised the Surg tech didn’t even mention something which probably would’ve alerted anesthesia. I’ve only had one, but it was an ortho trauma, massively transfusing, asked the ortho surgeon if he could get henostasis and pack it up for then to get stabilized, he’s just like ‘ yeah sure, it does seem like a lot of blood loss, that’s probably better for him.’

When I was a resident had a baller urology chief resident, super smart and super humble, look the surgeon in the eye and say if she was going to cut the ureter on this peds pt he was leaving and reporting her, that attending took over a year to get fired, had monthly serious complications, came from the ivy league

Had an old school partner in my previous group call his old school general surgeon friend on a Gyn case after 4 hours of puttering around, losing 3 liters of blood. That surgeon, who was awesome surgeon/dude, came in and ‘assisted’ removing the ovary in 30 minutes, my partner said he basically did the case
 
jwk said:
There’s a difference in Pensacola (which is NOT where this incident occurred) and Ft Walton/Destin (where it actually happened). Night and day.
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Don't forget Jacksonville
 
jwk said:
There’s a difference in Pensacola (which is NOT where this incident occurred) and Ft Walton/Destin (where it actually happened). Night and day.
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Ehhh not really.

It’s all basically South Georgia/East Alabama with a FloridaMan twist


PCola has had its own fair share of headlines in this forum 🙂

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Gulf Breeze plastic surgeon Ben Brown arrested, charged with death of wife, Hillary Brown

'Hillary gave the ultimate sacrifice so Ben Brown cannot hurt anyone else,' Hillary Brown's father said regarding her husband's arrest in her death.
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Smurfette said:
Wow, that was scathing for a board order. But justafiably so. I read it and mostly thought "yep, that sounds right" because there is just no way anyone remotely competent could remove a liver on accident. Basically everything that sounded fishy in the op report is accounted for in the order. And there was no actual indication for surgical intervention at all in this patient (what is with the VPMA also trying to talk patient into it?), which is what I had thought when I read the op note. As a general surgeon, I can't understand how he just "finds" the IVC and tries to staple it. He'd hit the portal vein and hilum first, causing massive bleeding, unless he detached the IVC above the liver. Is it incompetence or intentional? It is so hard to be this level of incompetent, this being intentional almost makes more sense. I would be interested in a timeline of how long he stayed lap, how long after conversion before transecting IVC, etc.

I bet he was trying to write his op note and was googling anatomy and came back in to look at the specimen when he realized he had it all wrong. Because there was zero other reason to need to look at that specimen at that point.



He should be charged and should get jail time. This is not a "**** happens" type of complication or any one bad decision leading down the rabbit hole. It was a series of bad and worse decisions, starting from recommending surgery in a patient who didn't need it and didn't even fail other alternatives first, to failure to recognize some of the most readily identifiable HUGE organs and blood vessels in the body (and recognizing even which side of the body the structures are on), to falsifying records and lying to the world about what happened. This level of incompetence is hard to achieve. If it's true incompetence and not intentional or due to impairment, it's a failure of every place that has ever employed him to stop him. References are needed for all physicians at hire. Who was giving him one and not disclosing competence concerns?
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What if he was intoxicated?
 
It’s every bit as bad as it was rumored to be. Nobody is that incompetent, I just don’t believe it. They were either impaired, intoxicated or it was intentional. The spleen was intact and untouched. The “aneurysm rupture” must have been the IVC. Could he have had some kind of right left mix up? That nobody noticed? Seems unlikely.
I’ve been in nasty traumas where blood is arcing out as fast as we can dump it in, CPR is happening, and yet somehow the surgeon manages to identify structures, clamp, pack, repair, etc. No large easily identifiable organs removed by accident during the emergencies either.
 
Damn, that worse than expected, at first some thought it was just a left hepatectomy, which is still terrible, but now we find out it was a total hepatectomy. Like I’m not a surgeon, but I can tell you what looks like a liver.
 
HemeOncHopeful19 said:
Ehhh not really.

It’s all basically South Georgia/East Alabama with a FloridaMan twist


PCola has had its own fair share of headlines in this forum 🙂

www.pnj.com

Gulf Breeze plastic surgeon Ben Brown arrested, charged with death of wife, Hillary Brown

'Hillary gave the ultimate sacrifice so Ben Brown cannot hurt anyone else,' Hillary Brown's father said regarding her husband's arrest in her death.
www.pnj.com
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Completely agree.

I used to work in rural Alabama. A very large proportion of healthcare I saw that wasn’t done at a tertiary medical center was questionable (and even some of what *was* done at tertiary care was sketchy, too). It was shocking to me, given that I didn’t train in the south and wasn’t at all used to these standards that were apparently really, really low.

It’s a different world down there. Almost every day I encountered docs who I thought probably should have lost their licenses (or, at the very least, should have had some hardcore board-mandated remediation)…but they happily kept working for many years, doing the same incompetent stuff over and over, and everyone just acted like it was all normal and a-ok. I couldn’t wrap my head around it. It’s very much a cultural thing.
 
Anyone of us could have been the anesthesiologist on this case. I’d like to think I’d stop it from happening due to no real apparent necessity, and none the less going at 5pm with skeletal crew, but I imagine this surgeon pressured the case to go as the patient was from out of town, “needed this surgery” and wanted to get it done asap. Who knows how many other cases the anesthesiologist was covering at the time, but scary to think we could be named and have to settle for policy limits. He/she was likely called in emergently for the code after the IVC was severed, and the only communication prior to that would have been “patient is stable but surgeon is mucking around”
 
psycho-matic said:
What if he was intoxicated?
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It's possible. Although I can't imagine what I would need to be on to fail to identify a liver, some sort of hallucinogen maybe, although I can't imagine being impaired to the point of not identifying a liver, but still being upright and able to open a belly, and having staff not immediately notice something is wrong with me. There was no comment in the report that staff thought he was impaired and no emergency order for rehab or AODA assessment. I also am curious if the pt still had a gallbladder. While there really is no mistaking the liver for a spleen, if the gallbladder was there, there is no equivalent structure on the spleen and what did he think that was?

Iso4ane said:
Damn, that worse than expected, at first some thought it was just a left hepatectomy, which is still terrible, but now we find out it was a total hepatectomy. Like I’m not a surgeon, but I can tell you what looks like a liver.
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A left hepatectomy didn't make sense to me as there really aren't attachments or vessels to the liver to take down on that side, but you do have to divide the liver in half and there is no question in that circumstance you are leaving part of the organ behind. The op note actually correlates even less with a left hepatectomy (IMO) than a splenectomy. I was not at all surprised there was no dissection of structures around the spleen on autopsy because if the liver was removed, all of the dissection would have been on the other side of the belly.

I noticed that the order is from the board of health, signed by the state surgeon general, and not the board of medicine. I'm guessing there will be further investigations and details coming out as the BOM does their process.
 
IRpremed said:
Anyone of us could have been the anesthesiologist on this case. I’d like to think I’d stop it from happening due to no real apparent necessity, and none the less going at 5pm with skeletal crew, but I imagine this surgeon pressured the case to go as the patient was from out of town, “needed this surgery” and wanted to get it done asap. Who knows how many other cases the anesthesiologist was covering at the time, but scary to think we could be named and have to settle for policy limits. He/she was likely called in emergently for the code after the IVC was severed, and the only communication prior to that would have been “patient is stable but surgeon is mucking around”
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few, if any, anesthesiologists would have noticed he was removing the wrong organ in time to have made a difference
 
ucladoc2b said:
Once that IVC is cut, it’s game over.
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Exactly. Once it’s cut literally nothing any of us could do to avoid the inevitable, yet still I feel like they will try to place some of the blame on the unfortunate anesthesiologist on that case.
 
Smurfette said:
Wow, that was scathing for a board order. But justafiably so. I read it and mostly thought "yep, that sounds right" because there is just no way anyone remotely competent could remove a liver on accident. Basically everything that sounded fishy in the op report is accounted for in the order. And there was no actual indication for surgical intervention at all in this patient (what is with the VPMA also trying to talk patient into it?), which is what I had thought when I read the op note. As a general surgeon, I can't understand how he just "finds" the IVC and tries to staple it. He'd hit the portal vein and hilum first, causing massive bleeding, unless he detached the IVC above the liver. Is it incompetence or intentional? It is so hard to be this level of incompetent, this being intentional almost makes more sense. I would be interested in a timeline of how long he stayed lap, how long after conversion before transecting IVC, etc.

I bet he was trying to write his op note and was googling anatomy and came back in to look at the specimen when he realized he had it all wrong. Because there was zero other reason to need to look at that specimen at that point.



He should be charged and should get jail time. This is not a "**** happens" type of complication or any one bad decision leading down the rabbit hole. It was a series of bad and worse decisions, starting from recommending surgery in a patient who didn't need it and didn't even fail other alternatives first, to failure to recognize some of the most readily identifiable HUGE organs and blood vessels in the body (and recognizing even which side of the body the structures are on), to falsifying records and lying to the world about what happened. This level of incompetence is hard to achieve. If it's true incompetence and not intentional or due to impairment, it's a failure of every place that has ever employed him to stop him. References are needed for all physicians at hire. Who was giving him one and not disclosing competence concerns?
Click to expand...
I'm guessing it's hard to find precedence for this. The plastic surgeon in Bonita got 3 years in jail but easier to prove a criminal act than just incompetence in that case, and it took 6 years for a sentence to come about.

They should honestly look long and hard at residency programs that allow people like this to graduate. He trained at Hackensack. His PD and Chair there should have some explaining to do.
 
Maz777 said:
I'm guessing it's hard to find precedence for this. The plastic surgeon in Bonita got 3 years in jail but easier to prove a criminal act than just incompetence in that case, and it took 6 years for a sentence to come about.

They should honestly look long and hard at residency programs that allow people like this to graduate. He trained at Hackensack. His PD and Chair there should have some explaining to do.
Click to expand...

Agree.

His major error is blindly cutting a random vessel. That’s what doomed the poor patient. Removal of the liver, while horrible, just made really bad to worse.

I’ve seen/heard of similar things (inadvertent aortic transections, trochars in the aorta, and others).
 
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