Best Lawyers America, Super Lawyers, Multi-Million Dollar Advocates, American Trial Lawyer's Association

Gallbladder Surgery Medical Injuries | Removal Surgery Involves A Very Real Risk

Injuries Due to Errors During Gallbladder Surgery

Chances are you, or someone you know, have had their gallbladder surgically removed. This operation is called a cholecystectomy. Gallbladder disease affects 12% of adults, and each year more than 700,000 Americans have their gallbladders removed. This operation involves a surgical procedure that has become commonplace in the United States. Despite its popularity, the procedure presents significant risks, such as injury to nearby organs and structures, which could require additional surgery, inflate medical bills, and/or cause serious and permanent injuries.
The gallbladder is an organ located beneath the liver which collects and stores bile. The most common issue that gives rise to gallbladder removal surgery is the presence of gallstones inside of the gallbladder or bile duct. These “stones” are formed by a combination of cholesterol and bile salts. Gallstones can block bile flow, causing the gallbladder to swell, and resulting in sharp abdominal pain, vomiting, indigestion, and fever. If the gallstones are blocking the bile duct, the skin around the area can turn a shade of yellow.

In recent decades, with the introduction of the laparoscopic cholecystectomy (as opposed to an “open” surgical procedure, which requires a large incision, with a resulting scar), there has been an increase in “closed” gallbladder surgeries. The laparoscopic procedure involves four small incisions into the abdomen, allowing the surgeon to remove the gallbladder by using a fiber-optic camera to visualize the gallbladder and the structures that surround it. About 90% of cholecystectomies are laparoscopic. Since the incisions are much smaller than a traditional cholecystectomy, recovery time is much shorter, and postoperative pain is significantly decreased.

Like many surgical procedures, even those as popular as this one, gallbladder removal surgery involves a very real risk of complications including, but not limited to: bleeding; pneumonia; infection; blood clots; heart problems; bile leakage; and unintended injuries to nearby organs and structures, commonly the bile duct or small intestine. Despite laparoscopic cholecystectomies being the favored procedure, open cholecystectomies pose significantly less risk of injury to the bile duct.

You should contact your doctor if any of the following symptoms occur after gallbladder surgery:

  • You have a persistent fever, nausea, or vomiting;
  • Your pain is not relieved by the medications provided by your physician;
  • You have a persistent cough or shortness of breath;
  • You are experiencing drainage of pus from your incision(s);
  • You have increased redness around your incision(s); or
  • You have not been able to eat or drink.

The most common medical error reported during laparoscopic cholecystectomy is the cutting of either the common bile duct or the common hepatic duct. Because the procedure is performed using a fiber-optic camera, which projects a two dimensional image (not three dimensional) onto a monitor for the surgeon to see and use to guide his instruments, surgeons sometimes mis-identify the common bile or hepatic duct for the cystic duct. Also, the surgeon is deprived of using the sense of touch to identify the various structures during a laparoscopic cholecystectomy. The cystic duct needs to be cut in order for the gallbladder to be removed. However, the common bile duct is supposed to remain intact, and an injury to that structure could mean additional surgeries, increased risk of secondary biliary cirrhosis, and liver failure.

Surgeons may limit the risk of injury to the bile duct by performing a cholangiogram before, or during, the procedure. A cholangiogram allows the surgeon to see the structures and gallstones by inserting dye into the common bile duct, thereby reducing the risk of misidentification. Surgeons may also elect to perform an open cholecystectomy, which allows them to see each structure, and avoid the risk of injuring a nearby organ, duct, or vessel. A surgeon who fails to consider and/or undertake either option, and then injures a structure during the surgery, may be held legally responsible for a patient’s injuries.

Injury to a nearby structure or organ during gallbladder surgery may have resulted from a preventable medical error. An experienced malpractice attorney can assist the injured patient, and his/her loved ones, in obtaining compensation to offset the unexpected and unwanted costs of medical bills, lost wages, pain and suffering, and psychological issues associated with this medical injury. Surgeons, and other medical professionals, must act in a manner that meets the accepted standards of medical care. If a surgeon deviated from these standards, a medical malpractice attorney can hold that healthcare provider legally responsible.

Compensation for Birth Injuries Under Pennsylvania Law: What You’re Entitled To

For all parents, the birth of a child is cause for celebration. While no one expects childbirth to be particularly easy, parents do not anticipate complications during labor or injuries during childbirth. When newborn infants spend the precious first moments of their lives being resuscitated, followed by days in the Neonatal Intensive Care Unit of a hospital, the happy parents’ celebratory occasion turns into cause for concern, and the unanswered questions overshadow conversations with the medical professionals who must answer questions that parents hoped they would never have to ask.

The American Congress of Obstetricians and Gynecologists (ACOG), an anti-medical malpractice lobby, would have you believe that your newborn’s birth injury is not the result of prenatal asphyxia, but a medical malpractice attorney who knows how to investigate birth injuries, can help you to determine whether the acts or omissions of the physicians, nursing staff, and hospital fell below the standard of care causing serious and permanent complications to the baby and/or the mother.

If complications arose during your pregnancy or labor, and your child suffers from neurological and cognitive deficits, and/or motor skills impairments, your child’s injuries could be a result of medical malpractice. It is important for parents to contact a birth injury lawyer as soon as possible to discuss available legal options, and to begin a thorough factual investigation.

Birth Injuries:

Erb’s Palsy
A common birth injury is Erb’s Palsy– a nerve injury to the baby’s arms resulting from excessive pulling or stretching during delivery. The injury winds up disabling the child’s motor functions in the stretched arm or hand, which severely restricts the child’s functioning later in life.

Hypoxic Ischemic Encephalopathy
Another common birth injury caused by physician malpractice is hypoxic ischemic encephalopathy, caused by deprivation of oxygen to the newborn. This often results in Cerebral Palsy. Paul Lauricella and Slade McLaughlin recently won a $55 million birth injury verdict for a child who was born with hypoxic ischemic encephalopathy, against an obstetrician/gynecologist who elected not to perform an emergency cesarean section to deliver a baby, despite ominous signs of fetal distress during a prolonged labor and delivery.

Injuries to Mother:

Loss of Child Bearing Capacity
Mothers who deliver via C-Section are vulnerable to a host of surgical complications. For that reason, physicians tend to avoid caesarean section deliveries, but caesarean delivery may be necessary in some cases. Although it may not be malpractice for a physician to cut the uterus during delivery, it may fall below the standard of care if the physician fails to locate that cut and stop the blood loss.

If you, or a loved one, suffered unnecessarily during your pregnancy or childbirth, you should speak with a birth injury lawyer in our Philadelphia office.

What Can Be Recovered

Pennsylvania law allows the parents, or child, who suffered from a birth-related injury to receive compensation for medical malpractice.

A child who suffered a birth-related injury may be entitled to damages for:

  • Current and future medical expenses;
  • Loss of lifetime earning capacity;
  • Pain and suffering;
  • Loss of life’s pleasures; and
  • Humiliation, embarrassment, and disfigurement

These figures can be difficult to calculate, but a skilled medical malpractice attorney will consult with the appropriate vocational, economic, and life care planning experts to determine the proper amount of damages that are due.

A mother who suffered an injury during childbirth may be entitled to damages for:

  • Current and future medical expenses;
  • Loss of wages;
  • Pain and suffering;
  • Physical, emotional, and psychological injuries; and
  • Loss of life’s pleasures.

A skilled attorney will ensure that parents and the injured child receive the compensation that they are entitled to receive. Only a thorough factual and legal investigation conducted by a skilled attorney who consults with the right experts, and has experience handling birth injury cases, is capable of securing just compensation for his/her clients.

Slade McLaughlin and Paul Lauricella are among the best birth injury attorneys in Pennsylvania and New Jersey. Speak with an attorney at McLaughlin & Lauricella’s Philadelphia or New Jersey office about your birth-injury case today.

Jury Sides With Plaintiffs After Failed Cancer Diagnosis


REPRINT: Pennsylvania Law Weekly, June 5, 2012. A Bucks County jury has awarded $700,000 to a woman and her husband after they alleged doctors failed to timely diagnose her breast cancer and that one doctor, a gynecologist, altered her medical … Continue reading

Altered States (of medical records)

About a quarter of a century ago, when I was a young lawyer, I asked of my mentor, the late, great James Beasley, Sr., “What if the doctor alters the record before we receive it?” He replied, “We can only hope he does.” I quickly realized the significance of medical record alterations in malpractice cases.

Most people would be shocked to learn the frequency with which doctors and other health care professionals revise, rewrite, or purge records following the occurrence of an adverse event that is likely to result in a medical malpractice lawsuit.  Pennsylvania law specifically provides that record alteration constitutes “unprofessional conduct.”

Doctors are allowed to supplement their charts, provided that they clearly indicate that the entries are dated so as to reflect that they have been added after-the-fact.  But when a physician alters a chart without post-dating the entry, he or she commits “unprofessional conduct.”

In a medical malpractice action, identification of an alteration almost always destroys a defense, especially if the doctor lies about it.

Not infrequently, a physician with a guilty conscience will revisit a patient’s chart, add some self-serving revisionist account, and use the altered record as the centerpiece of the defense in a medical malpractice lawsuit.  Because juries tend to repose far too much faith in the accuracy of physicians’ records, the exposure of an alteration quite properly undermines the integrity of the record and of the doctor, as well.

And that’s a good thing.  A physician who alters a record (particularly a physician who lies about the alteration) makes three implicit declarations to a jury: (1) the doctor is not to be trusted, (2) the medical record is not reliable, and (3) the subject matter of the alteration was, in all likelihood, very important.  Each of these implied declarations can be properly considered by a jury in a malpractice case precisely because they flow naturally from the act itself.

Since my fateful discussion with my late mentor, I have made it a point to inspect the original medical record in all of my medical malpractice cases.  Most lawyers would be surprised at what they miss when they only examine photocopies. In one case, I discovered that “white-out” had been applied to the original record so as to obliterate notations which were harmful to the defendant.

It is also important to carefully inspect the records of other physicians who may have a copy of your chart.  A gynecologist who refers a patient to a breast surgeon for evaluation of a breast lump might also send the surgeon a copy of the chart.  If, afterwards, the gynecologist decides to alter the chart, the surgeon’s file will contain a pristine copy of the unaltered records.  Think this is a far-fetched scenario?  It’s not; it happened to one of my clients in a case involving the delayed diagnosis of breast cancer.

This scenario occurs in other contexts as well.  For instance, when a baby is transported to a neo-natal facility, the referring facility may provide the other facility with a copy of the patient’s then-existing hospital chart.  About 15 years ago, I litigated an obstetrical malpractice case in which the obstetrician had altered his notes. He was unaware that the neo-natal facility already had a copy of his note in its unaltered form.

The tri-colored carbon forms used by many physicians provide opportunities to discover alterations. I litigated an obstetrical malpractice case in which two of the three carbons were different than the original.  Each had found it’s way into a different doctor’s chart.

Today, carbon copies and handwritten notes are being replaced by electronic records.  These records are designed to leave an “audit trail” which can highlight amendments and revisions.  But irrespective of high tech audit trails, the old school investigatory rules still apply. Not infrequently, doctors will print and retain hard copies of electronic records. Any variance between any such record and its electronically-maintained counterpart demands investigation.

In my twenty nine years of practice, I have discovered a wide variety of alterations in a wide variety of cases.  My colleagues have often remarked about the frequency with which I discover these irregularities. I explain to them that the discovery of record alterations requires the patience to simply plod through hundreds of pages of documents, and a willingness to accept the likelihood that most of the investigations will prove fruitless.

While I have seen many different doctors alter their records in many different ways, there is one thing I have never seen: I have never seen a doctor win a case involving altered records.

Paul Lauricella (Google+)

Paul Lauricella

McLaughlin & Lauricella, P.A.