$4 million Verdict in Suit Arising From Complications From Laparoscopic Cholecystectomy

Prior to June 21, 2001, Plaintiff Christine Gallaher then 42, a kindergarten teacher, was experiencing intra-abdominal pain for which she sought treatment with her family doctor.  Mrs. Gallaher’s family doctor diagnosed her with gallbladder stones and referred her to Defendant, Dr. Ledesma, for treatment.  On June 21, 2001, Defendant Dr. Ledesma performed a laparoscopic cholecystectomy at Defendant, Northeastern Hospital.

Mrs. Gallaher’s post-operative course was immediately characterized by significant abdominal pain greater than would have been expected from a laparoscopic cholecystectomy.  Whereas minimal pain and discharge within 24 hours is normally expected after such a procedure, Mrs. Gallaher remained hospitalized after surgery until June 24, 2001.  Throughout the entire four days after surgery, Mrs. Gallaher complained of and was treated with pain control medication for persistent abdominal pain, nausea, vomiting, difficulty with bowel movements and temperature elevations.

In addition, on June 22, 2001, Mrs. Gallagher was noted to have a markedly elevated WBC (white blood count) of 16,600 with 20% bands.  This blood work indicated a high likelihood of significant infection, it was alleged.  Despite this clinical picture, no further diagnostic studies were done.  During this time, Dr. Ledesma, was Mrs. Gallaher’s attending physician.

On June 23, 2001, Dr. Ledesma wrote instructions on an order sheet to discharge the patient “if an enema provides good results.”  An enema was administered, but only fluid was returned.  After being notified of this fact, Dr. Ledesma ordered more Demerol for pain, as well as an oral laxative.

On June 24, 2001, Mrs. Gallaher was seen by Dr. Formica, who noted a low grade fever, and ordered respiratory treatment and a urinalysis.  Despite the fact that no discharge order was given on June 24, 2001, Mrs. Gallaher was discharged from the hospital by the nursing staff.

On July 9, 2001, Mrs. Gallaher was readmitted to Defendant, Northeastern Hospital, with fever, chills and abdominal pain.  She was found to have a bile leak, the source of which was not entirely clear.  A CT scan performed on June 11, 2001 indicated a marked amount of ascites, with several collections of gas and the possibility of abscess formation.  An infectious process that had begun during the June hospitalization had eventuated into a massive intra-abdominal infection.  On July 12, 2001, 600cc of pus was percutaneously drained from Mrs. Gallaher’s abdomen.  On that same day, Dr. Ledesma performed an exploratory laparatomy with drainage of fluid collections throughout the abdomen.

Mrs. Gallaher went on to suffer further infectious complications, including an obstruction of her right kidney which required placement of a nephrostomy tube.  She also suffered bacterial tubo-ovarian abscesses requiring a total abdominal hysterectomy and bilateral salpingo-oophorectomy, which were performed at the Hospital of the University of Pennsylvania on September 10, 2001.

According to plaintiff’s expert, Dr. Anthony Coletta, Mrs. Gallaher’s post-operative clinical picture was clearly one consistent with a potential complication of laparoscopic cholecystectomy that warranted further evaluation, including additional blood work (serial CBC’s and liver function tests) and an abdominal CT scan to rule out intra-abdominal complications.

Mrs. Gallaher’s persistent pain, low grade fever, markedly increased white blood count, increased bands and segs, lack of bowel function, and nausea and vomiting were all warning signs of complications, such as a post-operative bile leak, bowel injury or intra-abdominal infection.  Despite this picture, no appropriate diagnostic studies were performed to rule out why she was having these unusual symptoms.

Further, plaintiff alleged, Dr. Ledesma prematurely ordered the discharge of Mrs. Gallaher without appropriately investigating why she was having the symptoms she was.  As a result, the bile leak and evolving infectious process went unrecognized, causing a diffuse peritonitis which, in turn, required two major laparotomies and the loss of her female reproductive organs.

Mrs. Gallaher was allowed to leave the hospital not only without a proper discharge order, but under circumstances of persistent fever for which Dr. Fornica had requested further work-up and treatment.  The order to discharge of June 23, 2001 was based upon a successful enema being administered that day.  The enema was not successful.  Despite this, and despite the persistent fever and without a physician’s direct order, Mrs. Gallaher was discharged by the nursing staff.

The defense contended that Plaintiff’s original operation (laparoscopic cholecystectomy) was performed well within acceptable standards of medical care and treatment by Dr. Ledesma.  Moreover, the Plaintiff’s care at NEH was reasonable and appropriate, and within prevailing standards of care.

Secondly, the tubal-ovarian abscesses did not result from any complication of the laparoscopic cholecystectomy <P> Moreover, the tubal-ovarian abscesses were not caused by peritonitis, but rather the result of a mixture of aerobes and an aerobes almost always arises as an infection ascending from the female genital tract and are included in textbook discussions of pelvic inflammatory disease.

Finally, from a damage perspective, it was not necessary to undergo that TAH/BSO, as surgical options could have been explored rather than a TAH/BSO.  Hence, she may not have had to lose her uterus and ovaries.

Injury:  Pain and suffering, multiple and extended hospitalizations; additional  unnecessary surgeries, including a percutaneous nephrostomy, a total abdominal hysterectomy and a bilateral salpingoophorectomy; permanent disfigurement and scarring to her abdomen; loss of her female reproductive organs; premature menopause; and ongoing abdominal complaints such as bloating, difficulty eating, regular vomiting episodes and problems passing stools.

Result:  $4,003,200, consisting of $4 million in non-economic damages and $3,200 in lost wages.

Settlement Negotiations:  Demand:  $450,000.

Plaintiff’s Expert Witness:  Anthony Coletta, attending surgeon at Bryn Mawr Hospital and Associate Clinical Professor of Surgery at Drexel University School of Medicine.

Defendants’ Expert Witnesses:  Jay Goldberg, M.D., ob/gyn; Mark Pello, M.D., surgeon; Roger E. Nieman, M.D., infectious disease, Abington, PA.

Plaintiff’s Attorney:  Anthony J. Baratta, of Baratta, Russell & Baratta, Huntingdon Valley, PA

Defendant’s Attorneys:  Charles A. Fitzpatrick, III, and Anthony R. DeLuca, of Mylotte, David & Fitzpatrick, Broomall, PA.

Gallaher v. Temple East, Inc., June Term 2003 No. 00271 (Philadelphia Cty, Ct. of Common Pleas, Pa. Dec. 21, 2006)