Covington, GA—A man whose outpatient gall bladder operation turned into over eight months of hospitalization and six years missed from work lost his Newton County Superior Court med mal case against the surgeon who performed the initial operation. William Ron Aiken and Sherri T. Aiken v. Newton Health System, Inc., and Steven Whitworth, MD (2011-SU-CV-2533-1)
According to testimony at the trial and other information, plaintiff Ron Aiken had his gall bladder removed by Dr. Whitworth as an outpatient procedure on January 28, 2009. The operation apparently went well, but after leaving the hospital that afternoon, Aiken began experiencing pain and felt weak. When his condition did not improve, his wife took him to the hospital the next morning. His blood pressure was low and a CT scan revealed the presence of a large amount of fluid in his abdomen. Dr. Whitworth was consulted and administered fluids and medications to raise Aiken’s blood pressure but did not operate that day.
By the next morning, January 30, Aiken’s condition had deteriorated, and his kidney function was deteriorating as well. Dr. Whitworth operated that morning and drained nearly a liter of blood and other fluid from Aiken’s abdomen. He also discovered that Aiken’s colon had become ischemic, and much of it had died. He removed a two-foot section of Aiken’s colon and reattached the remainder of his intestine. He also performed an ileostomy to allow Aiken’s intestine to heal.
Aiken’s medical problems were not over, however. Three months later, when Dr. Whitworth attempted to reverse the ileostomy and reconnect Aiken’s entire digestive tract, complications arose, resulting in a significant amount of waste leakage. Aiken remained hospitalized in various facilities for approximately eight months while he recovered, and he was unable to return to work until March, 2015.
In the opinion of Dr. John Porter, Aiken’s expert witness, Aiken was continuing to bleed at the time he was readmitted to the hospital on January 29, and the accumulating fluid in his abdomen caused pressure on the colon, reducing blood flow to the colon. Along with the loss of blood due to the internal bleeding and the medication Dr. Whitworth prescribed, the colon did not get enough blood and died. Dr. Porter believed that Dr. Whitworth should have operated on January 29 to remove the fluid, and, in that case, the resulting complications would not have occurred.
In his closing statement, Aiken’s attorney, James Carter, referred to Dr. Whitworth’s treatment of Aiken as “a case of too little, too late.” He noted that when Dr. Whitworth administered fluid to Aiken, his blood pressure increased temporarily but never normalized and later decreased again, indicating he was still bleeding. In addition, the CT scan at that time showed Aiken’s colon was still alive, so that surgery on January 29 would have saved the colon.
Carter also called the jury’s attention to the notes Dr. Whitworth made in April 2009, when Aiken was readmitted to the hospital to reattach his colon. In those notes, Dr. Whitworth wrote that after the gall bladder operation “the post-operative course was complicated by hypotension [low blood pressure] secondary to post-operative bleeding... This resulted in ischemic colitis requiring emergency surgery and colectomy [removal of the colon].”
Carter also called the jury’s attention to the fact that Dr. Porter praised Dr. Whitworth’s surgical techniques in the case and that he didn’t try to blame Dr. Whitworth for the initial bleeding. He suggested that a “hired gun” expert would more likely criticize every aspect of Dr. Whitworth’s treatment.
In regard to the defense suggestion that Dr. Porter was engaging in hindsight analysis, Carter noted that Dr. Porter only looked at the medical evidence that was available to Dr. Whitworth at the various times throughout the day on January 29 before formulating his own expert opinion as to what Dr. Whitworth should have done at that time, given only that knowledge. Carter continued, “We always have this situation where you talk about hindsight, is there hindsight in this case? Yes, there is hindsight, but it’s not hindsight on the part of Dr. Porter… The hindsight in this case is all the reasons that Dr. Whitworth … could come up with to justify not going in when all these things were going on.” To the contrary, what Dr. Porter was doing, in Carter’s opinion, was using foresight.
In his testimony, Dr. Whitworth defended his decision not to operate sooner by saying, “We don’t operate just to operate.” He believed that Aiken did in fact begin bleeding shortly after the operation, but that the bleeding stopped well before Aiken returned to the hospital the next day. If he had continued bleeding at the rate needed to lower his blood pressure, he would have died before being readmitted. In Dr. Whitworth’s view, the mere presence of blood in the abdomen is not a reason to operate. Based on Aiken’s blood counts and other tests, surgery was not required.
Dr. Whitworth also noted that post-operative bleeding after that type of surgery was common but that Aiken’s ischemic colon was an extremely rare occurrence, one that he had never had occur before or since in his practice. Further, when he did operate, he found nothing to indicate that the blood in Aiken’s abdomen was causing undue pressure on the colon. He did believe that the initial bleeding may well have been a factor in causing the colon to begin dying but that irreversible damage to the colon had occurred before the time that Aiken was readmitted.
In his closing statement, defense attorney Dan Huff noted “Reasonable doctors, when their patients are in a difficult situation do two things. Number one, they provide treatment for what they think is the most likely thing going on, and, number two, they monitor to make sure that if there’s a change, they can respond to it.” He pointed out that Aiken’s blood pressure had already started to go up before Dr. Whitworth administered fluids on January 29 and contended that the standard of care was for Dr. Whitworth to do exactly what he did, administer fluids and monitor Aiken’s condition.
As far as Dr. Porter’s contention that Aiken was continuing to bleed on January 29, Huff said, “I finally learned what you get for $900 an hour, for $900 an hour, you can get somebody to come in and say ‘low blood pressure means bleeding if you ignore everything else.’ … Every other factor that you would go into as a reasonable physician to look at, to see whether Mr. Aiken was continuing to bleed didn’t matter to him.” Huff noted that Aiken’s hemoglobin and hematocrit readings remained stable. Further, Aiken’s skin remained warm and dry, and his pulse and heart rate remained normal that day.
Huff also contended that, even if Dr. Whitworth had operated on January 29, the damage to the bowel had already been done by that time. Even if the bowel appeared normal, it was already dying and would have continued to die unless removed. The same process that caused bowel failure caused kidney failure as well, which was noted on January 29. Further, he noted, “What does your common sense tell you about, whether or not, if the stomach was really under pressure [due to continued bleeding], would just one part of the colon be ischemic? Wouldn’t the whole thing be ischemic? Wouldn’t that affect all of the blood supply if all of this was under pressure? … What does your common sense tell you … whether it would affect just one part of your colon, not a small part, but it wasn’t every part of it.”
After the jury returned its verdict in favor of the defense, Sharonda Barnes, one of the defense attorneys commented to CVN that the case was difficult because the plaintiff was sympathetic and well represented. She complimented the jury for its finding that Dr. Whitworth’s treatment met the standard of care. William Cromwell, one of Aiken’s attorneys, told CVN that the case was difficult because of a great defense lawyer, a difficult venue, and the fact that his client had recovered by the time of the trial.
CVN will have gavel-to-gavel coverage of this case as soon as it is available. Steve Silver can be reached at ssilver@cvn.com.
Related information:
Attorneys involved in the case include James Carter and William Cromwell of Atlanta's Carter Cromwell Law Group for plaintiffs and Dan Huff and Sharonda Barnes of Atlanta's Huff, Powell & Bailey for the defense.
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