Negligent Post-Operative Care

Post-operative care refers to medical monitoring and care a patient receives following a surgical procedure. The primary objective of post-operative care is to ensure the patient heals and recovers properly, monitor for post-operative complications (e.g., infection), and treat any complications that arise. Our malpractice lawyers see cases on a monthly basis where the claim is the failure of the doctors and nurses to properly monitor the patient after a procedure that results in injury or death.

Many complications can arise after surgery. The complications a patient may suffer following a surgery can be individualized. So treatment for postoperative complications differs and is based upon, among other things, the patient’s age, overall health, medical history, extent of the disease, type of surgery performed, and individual tolerance for specific medications, procedures, or therapies.

If you or a loved one has suffered an injury as a result of a postoperative complication and you think a doctor or a nurse is to blame, contact the lawyers at Miller & Zois for help. We can review your medical records and help you determine whether or not medical malpractice may have occurred. Call us today at 800-553-8082 or request an online consultation.

Common Post-Operative Complications

Shock is a dangerous postoperative complication that results from a severe reduction of blood flow throughout the body. This reduced blood flow deprives your cells and organs of the oxygen and nutrients they need to function properly and can cause serious organ damage. In many cases shock is associated with a reduction in blood pressure that can be caused by a number of things. Patients who go into shock require immediate treatment or else the condition can get worse very quickly. Proper treatment depends on the cause and can include stopping blood loss, maintaining an open airway, intravenous fluids or blood transfusions, oxygen therapy, medication, and emergency surgery.

Hemorrhages are also a common postoperative complication. A hemorrhage simply means bleeding. In severe cases involving a hemorrhage, blood loss can occur rapidly from the site of surgery and can lead to shock. Treatments to stop a hemorrhage can include intravenous fluids and blood transfusions and, when necessary, returning the patient to surgery to stop the bleeding.

Wound infections are another common postoperative complication and occur when bacteria enter the site of surgery. Infections can delay the surgical site from healing, and they can also spread to nearby organs or tissue, or in serious cases to distant areas through the bloodstream. To properly treat wound infections, treatments include antibiotic treatment and draining of any abscesses. More serious infections may require additional surgery.

Deep vein thrombosis is also a very serious postoperative complication and is the formation of blood clots within deep-lying veins, usually in the leg or pelvis. If a large blood clot breaks free, it can travel to the lungs and block a pulmonary artery. This is called a pulmonary embolism and can be fatal.

Surgery and immobility following surgery can increase the risk of deep vein thrombosis. Treatment depends on the extent and location of the blood clot and can include anticoagulants, which prevent additional clotting, thrombolytic medications, which break clots down, and, in serious cases, procedures or surgery.

Pulmonary complications can also occur following surgery. These can include atelectasis, pneumonia, aspiration, respiratory failure, and pulmonary embolism. Problems may develop because of anesthesia, pain that makes deep breathing difficult, immobility, inhaling food or fluids, infection, or an underlying lung condition. Common symptoms include shortness of breath, low oxygen levels, wheezing, chest pain, fever, rapid breathing, and a cough.

Urinary retention is also common and can include either temporary urine retention or a total inability to urinate and empty the bladder. This is generally caused by anesthesia, medications, pain, or the type of surgery performed and can be treated by using a catheter until the patient regains control of their bladder.

Lastly, reactions to anesthesia are rare but are possible. These reactions can range from relatively minor nausea, dizziness, or confusion to serious breathing, cardiovascular, or allergic reactions.

Warning Signs After Surgery That Doctors Should Not Ignore

Not every symptom after surgery means that something has gone wrong. Pain, swelling, fatigue, and other problems can be part of a normal recovery.

But there are warning signs that doctors and nurses need to take seriously, particularly when several occur together or the patient is getting worse instead of better.

• Increasing or severe pain that is not responding to treatment
• Falling blood pressure
• Rapid heart rate
• Fever or chills
• Shortness of breath or falling oxygen levels
• Chest pain
• Increasing abdominal pain or distention
• Persistent nausea or vomiting
• Decreased urine output
• Confusion, lethargy, or other changes in mental status
• Dropping hemoglobin or hematocrit
• Increasing white blood cell count or other abnormal laboratory results
• Redness, drainage, swelling, or worsening pain around a surgical wound
• Leg swelling or pain that may suggest a blood clot
• Loss of a pulse, unusual coolness, numbness, or discoloration in an arm or leg

The point is not that every one of these symptoms means the patient needs emergency surgery. But postoperative patients can deteriorate quickly. Someone has to recognize when the recovery is no longer following the expected course and figure out why.

Postoperative Malpractice

A physician or surgeon caring for a patient who has just undergone surgery is responsible, like any other physician or surgeon, to exercise the degree of care and skill that a physician/surgeon should use given the circumstances. Postoperative malpractice occurs when a physician or surgeon fails to identify or properly treat postoperative complications that cause the patient to suffer an injury. Nurses and hospitals are also frequently involved in post-operative malpractice cases, since they are more directly involved in post-operative monitoring of patients.

A postoperative complication by itself does not mean there was medical malpractice. Complications can happen even when the surgery and follow-up care are appropriate.

Often, the malpractice claim is not that the complication happened. It is that doctors and nurses failed to recognize it and treat it before it caused a much more serious injury.

Did the patient’s blood pressure keep dropping without anyone figuring out why? Did a nurse see worsening vital signs and fail to call the surgeon? Was the patient complaining of increasing abdominal pain while everyone continued to assume it was normal postoperative pain? Did the doctors know there had been a possible bowel injury but fail to investigate it? Was a patient with signs of a blood clot discharged home?

These are the questions that often drive postoperative malpractice lawsuits.

Common Postoperative Malpractice Claims

Some of the most common postoperative malpractice cases our lawyers see involve:

• Failure to Diagnose Internal Bleeding: A patient’s blood pressure drops, heart rate rises, or hemoglobin falls after surgery, but doctors and nurses fail to recognize that the patient is hemorrhaging.
• Failure to Diagnose a Bowel or Organ Injury: A bowel, bladder, blood vessel, or other organ is injured during surgery and the injury is not recognized until infection, peritonitis, sepsis, or organ failure develops.
• Failure to Diagnose or Treat an Infection: A patient develops increasing pain, fever, drainage, redness, or other signs of infection, but treatment is delayed until the infection becomes much more serious.
• Failure to Diagnose Sepsis: Doctors and nurses dismiss worsening vital signs and laboratory results as part of the normal postoperative course while the patient is actually developing sepsis or septic shock.
• Failure to Prevent or Diagnose DVT or Pulmonary Embolism: A high-risk patient does not receive appropriate clot prevention or signs of a DVT or pulmonary embolism are missed.
• Failure to Recognize Vascular Compromise: A patient’s arm or leg becomes cool, painful, numb, discolored, or loses a pulse after surgery and the loss of blood flow is not treated quickly enough.
• Respiratory Monitoring Errors: A patient develops low oxygen levels or trouble breathing after surgery, but the airway is not protected or respiratory deterioration is not treated quickly enough.
• Premature Discharge: A patient is sent home despite symptoms, abnormal vital signs, abnormal laboratory results, or other evidence that the patient is not medically ready for discharge.
• Failure to Respond to Nursing Concerns: Nurses recognize that the patient is deteriorating but the physician does not come to the bedside, does not order appropriate testing, or does not escalate care.

One theme runs through many of these cases. The surgery may be over, but the doctor’s responsibility to the patient is not.

Postoperative Infection Malpractice Lawsuits

A postoperative infection does not automatically mean medical malpractice. Infections can occur even when doctors provide appropriate care.  More practically, even when a negligently caused infection occurs, it is usually impossible to prove.

Malpractice cases do arise from what happens after the infection begins because, too often, health care providers sleep on infections.  An incision that becomes increasingly red, swollen, painful, warm, or starts draining is a warning sign of a surgical site infection. Fever, chills, an increasing heart rate, low blood pressure, confusion, and worsening lab results can indicate the infection is spreading, and we have to do all we can to prevent that.

But to do that, doctors and nurses have to recognize these changes and respond quickly. Depending on the situation, that can mean examining the wound, ordering blood work or imaging, obtaining cultures, starting antibiotics, draining an abscess, or taking the patient back to surgery.

We see this issue after many different types of surgery. An infection after an appendectomy, bowel surgery, joint replacement, plastic surgery, or abdominal surgery may become a malpractice case if doctors fail to recognize and treat the problem before the patient suffers a much more serious injury.

Again, the fact that the incision became infected is usually not enough by itself. Stronger postoperative infection malpractice cases involve evidence that the infection gave doctors and nurses warning signs, and the medical team failed to act.

Postoperative Malpractice Verdicts and Settlements

Summarized below are verdicts and reported settlements from medical malpractice cases involving postoperative complications and errors. These case descriptions are provided for informational purposes only.

You cannot determine the settlement value of your postoperative malpractice case by looking at another verdict. But these cases do give you some idea of the types of postoperative mistakes that lead to serious malpractice claims.

• Anonymous v. Anonymous (New York) $2.5 Million Verdict: A woman began experiencing serious breathing problems several hours after elective surgery while recovering in the post-anesthesia care unit. The plaintiffs alleged that the treating physician failed to timely secure her airway despite signs of acute respiratory distress. She suffered respiratory and cardiac arrest, sustained catastrophic brain damage from lack of oxygen, and died several days later. The jury awarded the family $2.5 million.
• Anonymous v. Anonymous $4.25 Million Settlement: A patient underwent orthopedic surgery after suffering a tibial plateau fracture. The procedure itself was completed without complication, but the patient remained tachycardic after surgery and later developed low blood pressure, rapid breathing, and low oxygen levels. The patient suffered cardiac arrest and died from a massive pulmonary embolism. The family’s experts alleged that the worsening postoperative vital signs should have triggered physician notification and evaluation for a blood clot. The wrongful death case settled for $4.25 million.
• McCrae v. The Centers for Advanced Orthopedics, LLC, et al. (Maryland) $1.975 Million Verdict: Gerald McCrae developed an infection following a total hip replacement. His orthopedic surgeon performed repeated washout procedures while leaving the infected prosthetic hip in place. The infection continued to worsen and McCrae developed septic shock, organ failure, strokes, and permanent physical and cognitive injuries. The plaintiffs argued that the infected hardware should have been removed much earlier. A Baltimore County jury awarded $1.975 million, with the final judgment reduced by Maryland’s cap on noneconomic damages.
• Kunda v. Premier Surgical Pavilion and Lexington Plastic Surgeons (Maryland) $35 Million Verdict: Faith Kunda underwent liposuction and a Brazilian butt lift. She developed a postoperative infection that the plaintiffs alleged was missed at two follow-up visits despite her complaints that she felt feverish and unwell. She later went into septic shock and was diagnosed with necrotizing fasciitis. Kunda spent more than three months in the hospital, underwent numerous debridement procedures and skin grafts, and was left with catastrophic scarring and permanent injuries. A Prince George’s County jury awarded approximately $35 million, although Maryland’s cap substantially reduced the noneconomic portion of the verdict.
• Karavas v. University of Maryland Medical Center Defendants (Maryland) $8.3 Million Verdict: Zesis Karavas, a 53-year-old man, underwent surgery at the University of Maryland Medical Center to remove a kidney. His colon was perforated during the procedure, but the injury was not recognized before the surgery ended. After surgery, he developed serious complications and exploratory surgery the following day revealed the bowel injury. He ultimately died. A Baltimore City jury awarded his family $8.3 million, subject to Maryland’s cap on noneconomic damages.
• Minor v. Hospital (Washington) $6 Million Settlement: A 7-year-old female plaintiff goes to hospital after fracturing her arm. She undergoes orthopedic surgery involving the use of pins to surgically repair the bone fractures. Surgery is successful, but during the post-operative recovery period she begins to display signs and symptoms of severe vascular compromise and compartment syndrome, including loss of radial pulse, cool fingers, blue discoloration in her fingers, and paresthesia in the arm. Despite signs of a potential emergency situation plaintiff is promptly discharged from the hospital later that afternoon. Things get worse through the night and the next day plaintiff is back at hospital with complaints of severe pain. They increase her pain meds and send her home. Several days later she was diagnosed with compartment syndrome resulting in Volkmann’s contracture (a permanent hand deformity). Her left arm is permanently deformed and paralyzed. She sues the hospital for negligent post-operative care and discharging her despite clear signs of complications. The case settles for $6 million.
• Muehleisen v. Monarch Med Spa (Maryland) $340,638 Settlement: A plaintiff underwent a standard plastic surgery procedure but developed a large abdominal abscess after the procedure that was improperly treated. It resulted in a non-healing wound and required multiple hospitalizations and additional surgeries to fix it. The plaintiff brought this medical malpractice action against the defendant, alleging negligence in her postoperative care that resulted in her complications. The case did not go to trial and parties settled for $340,638. The plaintiff also settled with the surgeon (but we do not know the amount).
• Kurchner v. Harbison and Temple Hospital (Pennsylvania) $2.5 Million Verdict: A 74-year-old woman goes into the hospital for a standard laparoscopic surgical repair of an incisional hernia. The surgery seemed to have went well, however, her surgeon failed to perform a post-operative re-examination of the plaintiff at the end of the surgery to ensure there were no leaks of her bowel. Four days later the surgeon learned that there was a bowel laceration that had occurred during the surgery and her bowels were leaking substantially, however, it was too late as peritonitis and sepsis had already set in and she tragically passed away. Had an examination been performed postoperatively, the bowel laceration would have been revealed. Her family brought this wrongful death and survival action alleging medical malpractice, claiming the surgeon breached the standard of care by failing to perform a postoperative examination. The case went to trial where the jury found for the plaintiff and awarded a verdict of $2.5 million; $1.5 million for the wrongful death claim and $1 million for the survival claim.
• Ivy v. Memphis Obstetrics & Gynecological (Tennessee) $4.35 Million Verdict: A plaintiff had a laparoscopic endometrial ablation performed by the defendant, however, the defendant failed to check her bowel for lacerations or holes after the procedure and she suffered a perforation of her bowel, which is basically a hole that can result in bowel leakage and cause serious complications. When the defendant found the perforation she had already developed peritonitis and sepsis, but luckily they were able to save her despite requiring a ventilator and numerous surgeries to repair the damage. The plaintiff brought this medical malpractice action alleging the defendant breached the standard of care in his postoperative care of her as well as failing to inform her of preexisting conditions she had that made the risks of complications more likely for her if she underwent the procedure. The case went to trial where the jury returned a verdict for the plaintiff of $4.35 million.

How Much Is a Postoperative Malpractice Case Worth?

There is no meaningful average settlement amount for a postoperative malpractice lawsuit.

These cases can range from relatively modest claims to multimillion-dollar cases because “postoperative malpractice” describes the mistake, not the injury. If you get past whether malpractice caused an injury, the question becomes what those injuries were.

A patient who needs an extra week of antibiotics because an infection was diagnosed late has a very different case from a patient who develops septic shock, loses a limb, suffers brain damage, requires a permanent colostomy, or dies.

The strength of the negligence case also matters. Was the patient’s deterioration subtle, or did the chart show hours of falling blood pressure, rising heart rate, fever, abnormal laboratory results, and increasing pain while no one responded? Did nurses repeatedly call the surgeon? Was the patient discharged despite obvious warning signs?

Timing is often everything in these cases. Plaintiffs usually have to prove not only that the doctors or nurses made a mistake, but that acting earlier probably would have changed the outcome.

Future medical care, lost income, disability, pain and suffering, and the patient’s age and health before the malpractice can all have a major impact on settlement value. In Maryland, the statutory cap on noneconomic damages also affects the amount ultimately recoverable.

The verdicts and settlements above are useful examples. They are not a formula for what another postoperative malpractice case is worth.

Miller & Zois Can Help With Your Postoperative Malpractice Case

If you or a loved one has suffered an injury as a result of a postoperative complication and/or error and you think the physician may have made a mistake, contact the lawyers at Miller & Zois for help. We can review your medical records and help you determine whether or not medical malpractice may have occurred. Call us today at 800-553-8082 or request an online consultation.