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eye infection-comments

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  • Jurydoctor@aol.com
    My thoughts are that if you have not already sought the opinion of an expert, you should do so now before you spend more time and more of the attorney s
    Message 1 of 1 , Oct 6 7:33 AM
      My thoughts are that if you have not already sought the opinion of an
      expert, you should do so now before you spend more time and more of the attorney's
      money. My opinion is you are right, but if the plastics expert and
      infectious disease expert do not agree then the work is a mute point. You really
      need to know where the infection originated. You might try a microbiologist for
      an opinion on this type of infection. Good luck


      ________________________

      Why was she taking prednisone?


      oh yeah, that has bothered me, too. Does she have some kind of
      pre-existing
      autoimmune disorder? If so, that will put a big kabosh in the plaintiff's
      circumstantial case.
      _____________________________________
      reviewed your pictures. The pictures with all the penrose drains would
      look pretty bad to a jury. I am used to seeing that kind of thing all the
      time though.


      The pictures with the lesion below her eye and the bump on her forehead,
      don't look that great. With time and a chemical peel, she may regain some
      nice
      looking skin. I am assuming those are the "after" pictures.

      Did you guys investigate the ethylene oxide (gas) sterilizer? The
      Fiberoptic cord would have been sterilized using it.

      Maybe since they had been using the sonic cleaner on that scope, (which
      they
      should not have been doing, those scopes cost thousands of dollars) the
      integrity of it may have been compromised and it could be harboring bacteria
      in
      the cracks. Just another thought.




      ___________________________
      Questions
      > 1) Does the circumstantial evidence support a verdict against
      > Surgery
      > Center?


      This is a "weight of evidence" problem. There is no clear proof of
      medical misconduct, except for one major point - that the sterilization
      procedure used for the endoscope was not that recommended by the
      manufacturer.

      Of course one cannot know definitively if the endoscope still carried
      live mycobacteria, but the flawed sterilisation process makes it possible.

      Mycobacteria are particularly heat resistant by the way, so altering the
      procedure could indeed fail to completely remove them, and the follow up
      medication would indeed increase the chance of a fulminating infection.

      However that point was not presented in evidence so legally cannot be used.

      Though as I say, it's a matter of weight of evidence, that weight does
      fall on the plaintiff's side of the fulcrum.


      > 2) Which is more likely : Heidi was infected after surgery or
      during
      > surgery?


      Without knowing the habits of Heidi and her family it is impossible to
      know. She *might* have let unsterile water touch the wounds. Who is to
      know?

      The only *fact* we have is that the endoscope was not correctly
      sterilised. All else is pure speculation. Again on weight of evidential
      *fact*, and *only* fact, the probability must be that the infection
      occurred during surgery.


      > 3) If she is entitled to recover money for her injuries and
      damages,
      > what is the reasonable range that can be expected for her?


      I would say that given the only *facts* in the case, and the weight of
      probability, then answer is yes, she is entitled to some degree of
      compensation, but nothing like the amount she is demanding.

      When a person elects for non-essential surgery, they are in the process
      admitting to some degree of personal risk, albeit this is no escape
      route from an accusation that medical staff failed to provide due care.

      Nevertheless there has to be some degree of shared responsibility unless
      damning evidence of medical malpractice is forthcoming. here it is not,
      but the one fact apropos dopes weigh against the defense.

      Presumably the Surgery is insured, and there is some weight of evidence
      on the side of the plaintiff so in terms of a "least harm" principle, I
      would say yes, let the lady have some financial relief.

      It won't break the Surgery, and certainly not the insurance company but
      it would at least reduce the overall harm done, be it an act of god or
      an act of negligence.

      The absolute truth we can never know, but on the weight of evidence, I
      would be inclined to award Heidi $20,000 to help her out, and to remind
      the Surgery to in future always follow manufacturer's instructions
      regarding the use of surgical equipment.



      _______________________________________
      Why was she taking prednisone? With the combination of dry eyes and
      prednisone I am inclined to say she knew about a pre-existing auto-immune
      disorder
      that would have greatly compromised her immune system. If the physician
      performing the surgery also knew of this condition I question his ethics.
      This
      puts her in a high risk category for a number of reasons. If the patient
      witheld knowledge of an autoimmune disorder so that she could get the
      surgery I
      anticipate the defense will bring this up and it will be difficult for Dr.
      Heidi to win.

      Did her pre-surgery instructions clearly say something about not taking
      Motrin for x number of days before surgery? If it did then she probably
      can't
      hold the doctor responsible. I have yet to see surgery instructions that
      don't
      mention that. If she had no such instructions than I would absolutely say
      he is responsible for negligence and it doesn't matter where she was
      infected.
      It was that bleed that opened the door for all the other problems.
      I am just guessing, but as someone who has had many surgeries and suffered
      from autoimmune disorders it seems rather odd that this doctor would
      recommend
      a surgery that extensive to someone taking prednisone. I had difficulty
      finding a surgeon who would do tear duct surgery on me knowing I had an
      autoimmune disease that was the cause.


      I have a lot of personal experience prednsone and surgery
      ___________________________________
      This is a "weight of evidence" problem. There is no clear proof of
      medical misconduct, except for one major point - that the sterilisation
      procedure used for the endoscope was not that recommended by the
      manufacturer.

      Of course one cannot know definitively if the endoscope still carried
      live mycobacteria, but the flawed sterilisation process makes it possible.

      Mycobacteria are particularly heat resistant by the way, so altering the
      procedure could indeed fail to completely remove them, and the follow up
      medication would indeed increase the chance of a fulminating infection.

      However that point was not presented in evidence so legally cannot be used.

      Though as I say, it's a matter of weight of evidence, that weight does
      fall on the plaintiff's side of the fulcrum.


      > 2) Which is more likely : Heidi was infected after surgery or
      during
      > surgery?


      Without knowing the habits of Heidi and her family it is impossible to
      know. She *might* have let unsterile water touch the wounds. Who is to
      know?

      The only *fact* we have is that the endoscope was not correctly
      sterilised. All else is pure speculation. Again on weight of evidential
      *fact*, and *only* fact, the probability must be that the infection
      occurred during surgery.


      > 3) If she is entitled to recover money for her injuries and
      damages,
      > what is the reasonable range that can be expected for her?


      I would say that given the only *facts* in the case, and the weight of
      probability, then answer is yes, she is entitled to some degree of
      compensation, but nothing like the amount she is demanding.

      When a person elects for non-essential surgery, they are in the process
      admitting to some degree of personal risk, albeit this is no escape
      route from an accusation that medical staff failed to provide due care.

      Nevertheless there has to be some degree of shared responsibility unless
      damning evidence of medical malpractice is forthcoming. here it is not,
      but the one fact apropos dopes weigh against the defense.

      Presumably the Surgery is insured, and there is some weight of evidence
      on the side of the plaintiff so in terms of a "least harm" principle, I
      would say yes, let the lady have some financial relief.

      It won't break the Surgery, and certainly not the insurance company but
      it would at least reduce the overall harm done, be it an act of god or
      an act of negligence.

      The absolute truth we can never know, but on the weight of evidence, I
      would be inclined to award Heidi $20,000 to help her out, and to remind
      the Surgery to in future always follow manufacturer's instructions
      regarding the use of surgical equipment.

      ________________________________
      It appears you have a lot of smoke and mirrors here. I will try to make
      my
      response a lot briefer than your outline. I see a series of no-nos mostly
      stemming from the surgeon.

      For starters, the sterilization of the instruments has no bearing at all on


      whether the water was tap or distilled. Distilled is used to protect the
      integrity of the lens since tap water contains abrasive salts. The fact
      that
      the ink was gone is probably irrelevant if the written notes indicate that
      the
      proper temp was set. However, that is definitely an issue to be raised
      with
      the Joint Commission on Accreditation of Healthcare Organizations who will
      not be very happy little campers.

      Was the doctor aware that she had taken Motrin pre-op? If not, why not?
      He
      should have asked.

      Why did she, an MD and her husband, an MD, allow her to take the Motrin
      pre-op?

      What antibiotics were used prophylactically either pre or during surgery?
      Hopefully 1 gm Ancef or something similar which is the norm in most
      facilities.

      What did they clean her hair with post-op? The norm would be peroxide and
      distilled water. Did they use tap water?

      Implants are much more subjective to infections because of the introduction

      of foreign matter. This is a unique situation. However, I believe the
      plaintiff does have a hard row to hoe since both she and her husband have
      MD
      after
      their names and a jury is not going to be as sympathetic as it would be
      toward a normal lay person..

      Since the surgery lasted more than twice as long as it should have, I
      would
      bet that there was cross-contamination on the surgical tray between the
      chin
      and eyelid instruments. Regardless, because of the excessive bleeding, it

      would be my guess that they did not get all of the blood out of all of the
      pockets as well.

      There are many, many species of mycobacteria. Most are environmental
      organisms and are ubiquitous in that they are everywhere. However, they
      are only
      responsible for opportunistic infections which is almost non-occurring in
      immunocompetent individuals. The Prednisone, I believe, is as guilty and
      responsible as the contamination itself.

      They thrive in wet environments (bloody instruments/used gauzes, etc) and
      they have an insatiable appetite for oxygen. The longer the bloody
      surgical
      instruments are exposed to the environment, the more apt they are to
      become
      contaminated. No folks, medical facilities are not aseptic contrary to
      what one
      would think and that is why so many people contract infections in the
      hospital.

      1) Excessive bleeding
      2) Extended exposure due to lengthier procedure caused by the surgeonĀ“s
      error
      3) Prednisone as a steroid is KNOWN to delay wound healing AND suppress
      the
      immune system.
      4) No immediate post-op culture and sensitivity when prolonged swelling
      first realized.

      In closing I will say that I do not believe it was the endoscope.
      Although
      there might have been improper cleansing of the surgical incisions post-op
      coupled with a cross contamination of the actual surgical instruments, I

      believe it was a combination of many factors. However, the Prednisone was
      the
      biggest mistake in my opinion. Also, remember that even though the
      endoscope
      was sterilized, it still had instruments inserted in it during surgery.
      I
      would say that the liability is on the surgeon and that the bleeding was a
      very
      significant factor. Delayed surgery results in longer exposure to aerobic

      pathogens. Hello, it is a medical facility with sick people.

      I would suggest you back off the improperly sterilized endoscope and
      emphasize more on the cross-contamination due to the overall surgical
      procedure and
      the lack of ordinary care and treatment under the circumstances
      presented.

      ______________________________________
      I currently work in a surgery center. I am amazed to think that anyone
      could claim to know that an instrument used during surgery was the culprit
      causing infection unless it was cultured at the time of surgery. The
      infection
      could have happened during surgery or after. It also could have been
      caused by
      any instrument used at the time, or by bad technique by anyone on the
      surgical team. The sterilization process described was adequate and
      appropriate to
      me except that if there was no print out that the parameters for
      sterilization were met, the scrub nurse should have insisted the instrument
      in question
      be ran over before incision. Also, working around the eyes is not
      completely
      a sterile procedure always because one cannot prep the skin around the eyes
      where drainage from the eyes can cross contaminate the wound. Without
      knowing
      more about this case, I would say that treatment post-operatively with
      antibiotics was miss handled. Let me know if I can be of any help.

      _______________________________
      Here's my take-
      #1-Maybe she had an infection in the first part that
      the doctor placed the endoscope that stayed on the
      instrument so when it was placed in the other parts of
      her face, it got into that part as well.

      #2-Maybe even though the instrument was put in an
      autoclave, was the autoclave properly working?

      #3-When I used to sterilize instruments in an
      autoclave (although that was many years ago and don't
      know if procedure is same now), you would wrap the
      instrument in a special paper, tape it shut and put a
      date on the tape when the instrument was sterillized.

      #4-What if the instrument was properly sterilized and
      when it was taken out in the operating room, it became
      infected with an airborne disease.

      This case is a real tuffy but the likelihood overall
      of the fact that she became infected ONLY in the areas
      where the endoscope was used would more likely than
      not tell me thre was a problem with the instrument
      itself.

      _____________________________






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