As part of its new partnership with American Medical Forensic Specialists, Dr. Gary Gansar analyzes testimony from Dr. Hugo Cheng, whose opinion played a key role in a $6 million verdict for the family of a hospital patient who died while being treated for a bowel obstruction. The full analysis can be found at the AMFS site. You can watch extended video, along with the analysis, on CVN Essentials.
The testimony of Dr. Hugo Cheng was pivotal in obtaining a $6 million verdict for the family of a woman who died following complications from a bowel obstruction. Scoggins v. Smith, et al., 15A56505E4.
Ann Scoggins, 72, suffered a fatal heart attack in 2014 during a bout of vomiting while being treated by internal medicine specialist Dr. Daniel Moldoveanu for a bowel obstruction at Athens (Georgia) Regional Hospital.
Doctors believed Scoggins’ obstruction was caused by prescription pain meds following a knee replacement surgery days earlier. In the DeKalb Sounty Georgia State Court trial, her family claim Moldoveanu did not properly treat the obstruction when she was readmitted to Athens Regional complaining of symptoms relating to the obstruction.
Cheng, an internal medicine specialist from the University of California at San Francisco, took defendant Moldoveanu to task as he explained how standard investigations and treatments were omitted while the patient was instead given an oral laxative and enema, omissions which ultimately contributed to her vomiting, aspiration, and cardiac arrest.
In this video clip, Cheng explains the need to place a nasogastric tube into the patient’s stomach as soon as X-rays demonstrated an actual or functional blockage of gastrointestinal emptying. He explains that, under these circumstances, when there is the possibility of a bowel obstruction, draining the stomach and bowel secretions of air and liquid is key to alleviating the patient’s abdominal discomfort. More importantly, however, it would have prevented the vomiting and massive aspiration of that vomitus into the lungs that ultimately occurred.
Cheng memorably describes the fluid typically drained by nasogastric tube suctioning in such cases and notes that the appearance of the drainage can better inform a patient’s treatment. Cheng warns that when “what comes out is looking like stool,” that is “a huge red flag” that would have completely changed the course of treatment, by confirming a bowel obstruction of long standing rather than bowel sluggishness from prescription narcotic use.
Cheng explains nasogastric tubes are very commonly used, despite patient resistance to them and their discomfort during placement. He says, in his experience, a careful explanation of the tube’s importance and purpose usually convinces patients to accept it, and if not, then the patient is accepting the risk of aspiration by not draining their stomach of the caustic fluids. Still, he emphasizes the importance of the conversation with the reluctant patient.
Speaking directly to causation, Cheng explains that, even with the nasogastric tube, Scoggins may still have vomited, but the amount of emesis would have been far less than she actually did vomit because the stomach would have been emptied by the nasogastric tube. “She would not have aspirated to the degree and severity that she had, that led to her cardiac arrest and eventual death,” Cheng says.
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While jurors cleared another doctor who had cared for Scoggins before her admission to Athens Regional, it took the jury only three hours to find Moldoveanu negligent and grant the plaintiff a seven-figure award.
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Gary Gansar, MD, is residency trained and Board Certified in General Surgery. He previously served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Mercy Hospital and Touro Infirmary in New Orleans, LA. Dr. Gansar also served as Clinical Instructor and Professor of Surgery at Tulane University. He received his MD and served as Chief Resident at Tulane University Medical School. Dr. Gansar joined AMFS as a consulting medical expert in 2011 and has served as Medical Director since Nov. 2015. In this capacity, Dr. Gansar provides consultation, review and guidance to attorney clients.