Abdominal pain sends plaintiff to ER, surgeon removes appendix, fallopian tube and ovary. Defense verdict. Orange County.

Facts and Background

• Facts and Background:

  On September 7, 2018 plaintiff, age 24,  underwent a bilateral tubal fulguration surgery by Ana Sanchez, M.D..  Plaintiff then presented in the emergency room at Orange County Global Medical Center on September 20, 2018 with 8 out of 10 right lower-quadrant abdominal pain.  A CT scan of the abdomen and pelvis was suggestive of a perforated appendix, but counseled that an ovarian torsion could not be ruled out.  However, a pelvic ultrasound was then performed, ruling out ovarian torsion and favoring a perforated appendix as the cause of the patient’s symptoms.

  William Davis, M.D. was called in as a surgical consultant and advised the patient that she almost certainly had a perforated appendix, and obtained her consent to a laparoscopic appendectomy. Dr. Davis contended that he also told the patient that 10-15% of all female patients with suspected appendicitis turned out to have some other source for their pain, and in this case, the right fallopian tube and ovary would be a prime possibility.  That discussion was denied by the patient and not reflected anywhere in the medical record.

  Dr. Davis proceeded to perform the recommended laparoscopic appendectomy, removing an appendix that he evaluated to be completely intact and normal. He then turned his attention to the right deep pelvis, spending over an hour removing dense adhesions and then electing to remove the inflamed right fallopian tube and ovary in part due to his perception that the area was infected. He was not able to remove the right fallopian tube and ovary laparoscopically, so he converted the surgery to an open procedure, and successfully removed the right fallopian tube and ovary.

  The pathology report by the hospital pathologist indicated a perforated appendix as well as an inflamed right fallopian tube and ovary, but no infection.

• Plaintiff's Contentions:

  Plaintiff contended that it was below the standard of care for Dr. Davis to have removed the right fallopian tube and ovary without the consent of the patient, and that he should have stopped his surgery after removing the appendix in the procedure for which the patient had expressly consented.   It was further alleged that the right tube and ovary appeared exactly as it should have 13 days after a bilateral tubal fulguration, and that this would have been known if Dr. Davis had consulted a gynecologist.

  In any event, it was the position of plaintiff and expert witness Dr. Charles Dubin that there was no medical indication for the removal of the right fallopian tube and ovary, and that Dr. Davis did not have the consent of his patient to remove that tube and ovary. Plaintiff argued that she had suffered a violation of her right to make decisions regarding her own body, and that she never would have agreed to the removal of her right tube and ovary.  

• Defendant's Contentions:

  That the care rendered to this patient by William Davis, M.D. complied with the standard of care in all respects. That the indications for the procedure made it reasonable for Dr. Davis to proceed with a pre-operative diagnosis of perforated appendix. However, he insisted that he would have advised the patient before surgery that her pain could be due to other sources in the right lower-quadrant of the abdomen and pelvis, including the fallopian tube and ovary. When he discovered the appendix to appear normal, he had an obligation to search for the cause of the patient’s complaints.

  Once Dr. Davis discovered a right fallopian tube and ovary that appeared inflamed, he concluded that this was the cause of the right lower-quadrant abdominal pain and was justified in removing those structures without a gynecology consult.

  A review of the pathology slides did reveal that the appendix was normal internally and without perforation, but that it had suffered external damage from some inflammatory process, reflected by granulation tissue. The right ovary, however, revealed signs of thermal damage from the prior tubal fulguration and resulting necrosis from disruption of the blood supply.  Defendant argued that these findings in retrospect were supportive of the judgment call by Dr. Davis in surgery that the right fallopian tube and ovary were the true cause of the patient’s right lower-quadrant abdominal pain. This was viewed as a necessary surgery to preserve the health of the patient, obviating the need for express pre-operative consent from the patient.