ERCP Bowel Perforation Lawsuit

Pauzer v. Johns Hopkins Hospital

This is a surgical error/sepsis misdiagnosis case filed against Johns Hopkins after complications following an ERCP. This case is the 416th medical malpractice case filed in Maryland in 2016, and was filed in Health Claims Arbitration on August 22, 2016.

Summary of Plaintiff's Allegations

A 61-year-old woman has an endoscopic retrograde cholangiopancreatography (ERCP) done by a gastroenterologist and a gastroenterology fellow at Johns Hopkins Hospital.

Postoperatively, she does not do well. She complains of abdominal pain, and is admitted to Johns Hopkins for concerns of post-ERCP pancreatitis. An abdominal x-ray reveals a possible small amount of free air, and this is discussed with her doctor the same day. The doctor does not request additional imaging studies. Pain medication is administered, but she is never examined by the doctors who performed the ERCP. Over the course of several days, the plaintiff's pain is rated between an 8-10/10. She is discharged with a prescription for pain control.

A registered nurse called her two days after discharged to ask her about her hospital stay. At this time, the woman tells her that she is confused about her medications and unable to remember her husband's phone number to call for help. She admits that she has been in a state of confusion since she returned home from the hospital. However, the RN on the phone does not recommend any treatment.

Another phone call is made the next day, by a different RN, to the plaintiff. This time, her husband answers, and reports that his wife is still confused and was still taking the pain medication four times a day due to abdominal pain and nausea. A follow-up appointment with her primary care physician is confirmed, for nine days later.

The next day, the woman is transported via ambulance to Schuylkill Medical Center due to a change in her mental status. At intake, she is noted to be sleepy, lethargic, nauseated, and with poor oral intake. She is transferred to Lehigh Valley Hospital the same day, where a CT scan and workup is consistent with sepsis, secondary to perforated duodenum with extensive retroperitoneal fluid collection. Extensive bowel reconstructive surgery is required.

Plaintiff alleges that this was a result of the negligence of the doctors during her initial ERCP at Johns Hopkins Hospital, and that she will continue to suffer pain and permanent injuries to her gastrointestinal system. Specifically, she had to have an exploratory laparotomy to correct the bowel perforation, drainage of retroperitoneal abscess, creation of a retrocolic retrogastric gastrojejunostomy, placement of a feeding tube, a PICC line for nine months, and she had to endure tube feedings until the tube was removed as she was unable to eat or drink for almost three months. She now has an enhanced risk of adhesions, abdominal pain, intestinal obstructions, and other digestive disorders as a result.

Additional Comments
  • The last ERCP verdict in Baltimore City was a Miller & Zois verdict April 2016. Our client was awarded $1.53 million for an unnecessary ERCP.
  • A bowel perforation is just what it sounds like. It is hole in the intestine.
  • Bowel perforations occurring an ERCP do not, by themselves, show that the surgeon fell below the applicable standard of care. However, bowel perforations are among the deadliest potential complications of an ERCP. A doctor needs to identify and resolve the perforated bowel. Like the case we recently tried, the key to the case is whether the doctor's care of the patient fell below the standard of care not to indentifying the problem either during or after surgery until it was too late for permanent injury.
Jurisdiction
  • Baltimore City
Defendants
  • Johns Hopkins Hospital
  • Johns Hopkins Health System Corporation
Hospitals Where Patient was Treated
  • Surgical Positioning Johns Hopkins Hospital
  • Schuylkill Medical Center
  • Lehigh Valley Hospital
Negligence
  • Failure to adequately train and/or permit the Fellow to provide substandard care without sufficient training, experience, and/or understanding
  • Failure to diagnose a bowel perforation prior to discharge
  • Failure to adequately respond to the comment of free air in the abdominal X-ray report
  • Failure to communicate between the doctor who performed the surgery and the GI team regarding continued pain; failure to seek GI and surgical consultations
  • Failure to do an adequate follow-up
  • Negligently discharging a patient without reasonable explanation as to cause of underlying pain and abnormal x-ray findings
  • Failure during the two post-discharge phone calls to properly advise the plaintiff
Specific Counts Pled
  • Negligence
  • Loss of Consortium - Husband
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