Saturday, December 22, 2012

Two Medical Cases with Strange Outcomes

Two medical cases where things went wrong caught my eye in the news this week. The first is from the Bluegrass State. I heard about it a couple of years ago, and it made me recall my days of medical malpractice defense work. You learn a lot of medical terminology doing that type of work since you have to review a lot of medical records and depose doctors and other medical personnel. Luckily, I never ran into a case like this first one, even though I worked in Kentucky.

Plaintiff Seaton
A man with penile problems was scheduled to have a circumcision to alleviate pain in 2007. Phillip Seaton signed a waiver that stated the doctor could undertake other procedures if he thought they were necessary during surgery. He knew that he had squamous cell carcinoma, a type of skin cancer, in his penis but he did not know how serious it was. The surgery took place at Jewish Hospital in Shelby County, Kentucky.

Life saver? Dr. John Patterson (right) talks to his lawyer Clay Robinson during the trial at Shelby County Courthouse in Shelbyville, Kentucky
Dr. Patterson (right) and his attorney
During surgery, Doctor John Patterson discovered squamous cancer cells were much wider spread than previously thought. So the doctor amputated a portion of the man's penis. When he awoke, he was pretty upset. He and his wife sued the doctor and the hospital. The hospital settled with the man, but the doctor took it to trial. Patterson claimed he saved the life of his patient by taking immediate action during the surgery.

A jury found that the doctor did not overstep his bounds in going the extra mile to resolve Seaton's problem. Indeed, Seaton signed a waiver permitting the doctor to exercise discretion, so he did consent to the additional surgery in the waiver. A witness also signed the form. Only later was it revealed that Seaton could not read, a fact that he did not tell Dr. Patterson at the time he signed the waiver.

Seaton appealed the decision, and it was the Court of Appeals decision this week that brought the case back into the news. Two of the three appellate judges, both female, found in favor of the doctor and upheld the trial court's decision -- the doctor acted within the parameters of what was medically necessary and prudent and did not violate the medical discretion that is afforded to doctors. Will Seaton appeal to the Supreme Court of Kentucky? That remains to be seen. It has been five years since the surgery, and undoubtedly it will be difficult to find an attorney who will be willing to front the cost. His current attorney may be obliged to file the appeal. But certainly he will not be happy if he is required by the rules of professional responsibility to see the case through to the end.

The second medical malpractice case this week that caught my eye involves a stem cell treatment gone wrong on a California woman. The story was first reported in Scientific American, and this is how they reported on the incident that was the subject of this case.
 When cosmetic surgeon Allan Wu first heard the woman's complaint, he wondered if she was imagining things or making it up. A resident of Los Angeles in her late sixties, she explained that she could not open her right eye without considerable pain and that every time she forced it open, she heard a strange click—a sharp sound, like a tiny castanet snapping shut. After examining her in person at The Morrow Institute in Rancho Mirage, Calif., Wu could see that something was wrong: Her eyelid drooped stubbornly, and the area around her eye was somewhat swollen. Six and a half hours of surgery later, he and his colleagues had dug out small chunks of bone from the woman's eyelid and tissue surrounding her eye, which was scratched but largely intact. The clicks she heard were the bone fragments grinding against one another.
What was causing the clicking in the woman's eyelid? Bones. Yes, bones. A summary from another source explains:
Bone cell
 [T]he very scientific-sounding stem cell facial was administered by cosmetic surgeons who "removed abdominal fat cells with liposuction and isolated the adult stem cells within." Next, they injected those stem cells into the woman's face, which theoretically should stimulate the growth of new, youthful skin cells.

The catch? The stem cells in question can develop into bone, cartilage, fat, or other tissues. The doctors also injected the woman's face with a dermal filler during the procedure, one that contained calcium hydroxylapatite, a mineral that encourages those stem cells to develop into bone, not skin. That lovely combination is what doctors think caused the cells to turn into bone and result in this freakish "side-effect."

Stem cells, which essentially act like chameleons (for want of a better analogy) and take on the characteristics of the nearest tissue that they can replicate, grew into small bone fragments grew in her eyelid. That's what was clicking together in her eye. It just goes to show you that $20,000 cannot buy you happiness.

So, those are the two boner cases in one week that caught my eye because they caused the respective patients a great deal of pain, in one way or another. I just hope these two senior citizens (he is 66 and she is described as being in her late 60s) can find a way to live their late years in . . . fulfillment.



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