Record $10 Million Verdict Reached After 80-Year-Old Man Dies From Aspiration
RICHARD PELLOCK had been suffering from nausea and vomiting after surgery for bladder cancer.

The family of an 80-year-old Wisconsin man who died after aspirating the contents of his stomach into his lungs during surgery has been awarded a record-breaking $10 million malpractice verdict, according to news reports.

Richard Pellock had developed complications after undergoing surgery for bladder cancer at UnityPoint Finley Hospital in Dubuque, Iowa, in January 2015. In the days that followed, he suffered from nausea, vomiting and other symptoms. Eventually, 6 days after the initial surgery, he underwent exploratory laparotomy surgery to try to rule out bowel injury or anastomotic leak.

According to a complaint filed by Mr. Pellock's widow and son, CRNA James Wieters didn't perform a pre-operative evaluation of Mr. Pellock before administering anesthesia for the second surgery. The family further contended that Mr. Wieters, urologist Alex Horchak, MD and general surgeon Jacob Wagner, MD, knew or should have known that Mr. Pellock has a full stomach when he was induced, and that every precaution should have been taken to avoid aspiration.

According to the complaint, the CRNA and physicians didn't use a nasogastric tube, didn't perform a rapid sequence induction of anesthesia and failed to respond properly after Mr. Pellock aspirated. He died later that morning, reportedly from severe bilateral aspiration pneumonia.

Joanne Pellock, his widow, had sought $25 million for past and future loss of spousal consortium. Mitchell Pellock, the victim's son, had asked for $15 million for past and future loss of parental consortium.

Mr. Wieters, Dr. Wagner, Dr. Horchak and the hospital all denied that negligence had played a role in Mr. Pellock's death, blaming pre-existing conditions and/or failures on the part of others.

After an amended complaint was filed, a jury last month found Mr. Wieters and Dubuque-based Mississippi Valley Anesthesiology, his former employer, negligent.

Lawyers for Mississippi Valley Anesthesiology have told KWWL-TV in Waterloo, Iowa, that they plan to appeal. Mr. Wieters has reportedly retired and could not be reached for comment. Dr. Wagner had no comment on the verdict and Dr. Horchak did not respond to a request for comment. "Because Finley (Hospital) was dismissed from this lawsuit, we have no further involvement in this case," a hospital spokesperson said in an e-mail. "Our thoughts are with Mr. Pellock's family as to this very difficult matter."

Jim Burger

Uncovered: The Holy Grail of Opioid Prescription Durations After Surgery
JUST RIGHT? Prescriptions should generally last between 4 and 15 days, depending on the type of surgery.

Researchers say they're getting closer to pinpointing a Goldilocks range for opioid prescriptions after surgery — the volume of painkillers that's neither too generous nor too sparse. For patients having general surgery, scripts should cover 4 to 9 days, they say; for those having women's health procedures, 4 to 13 days is appropriate; and for those undergoing musculoskeletal procedures, prescriptions should last for 6 to 15 days. The findings are published in JAMA Surgery.

The median prescription lengths were:

  • 4 days for appendectomy, cholecystectomy and hysterectomy;
  • 5 days for inguinal hernia repair, mastectomy, anterior cruciate ligament repair and rotator cuff repair;
  • and 7 days for discectomy.

Virtually everyone agrees: Current opioid prescribing habits often end up dispensing more pills than necessary, which can lead to complications and dependence. But if prescribers become too stingy, legitimate concerns about sufficient pain management persist (not to mention concerns about middle-of-the-night phone calls).

The researchers reached their conclusions by looking at median prescription lengths for more than 200,000 patients, as well as the specific surgeries they'd undergone, and identifying the likelihood that they'd refill their prescriptions. The higher numbers in the ranges are based on minimum durations associated with the lowest risk of refills.

"Although 7-day limits on initial opioid pain medication prescriptions are likely adequate in many settings and … sufficient for many common general surgery and gynecologic procedures," say the authors, "in the post-operative setting, particularly after many orthopedic and neurosurgical procedures, a 7-day limit may be inappropriately restrictive."

Jim Burger

Stage-4 Cancer Patient Awarded $1 Million for OB-GYN's Negligence
LAUREN RODGERS, MD A jury found that Dr. Rodgers neglected to discuss the pathologist's findings with her patient and did not offer follow-up treatment.

A verdict by a Maryland jury found that a gynecologist failed to share with her patient a pathologist's warnings that the uterine tumors she discovered during a hysterectomy were potentially malignant.

According to the complaint, Lauren Rodgers, MD, discovered uterine tumors during the 2011 hysterectomy she performed on Roslyn Baxter and sent samples to a pathologist — who described the findings as potentially malignant and recommended close clinical follow-up treatment. Dr. Rodgers, however, neglected to discuss the pathologist's findings with her patient and did not offer follow-up treatment, says the complaint.

Dr. Rodgers denied the claim, pointing to a note from a 2011 meeting that called for a discussion of the pathology findings, but Ms. Baxter maintained that the discussion was never had.

In 2014, Ms. Baxter underwent medical tests and was diagnosed with metastatic lung cancer that likely originated in the uterus, as the suit claims, and she currently has stage-4 sarcoma in her lungs. The jury awarded Ms. Baxter $1 million, but as per Maryland's cap on noneconomic damages, the award has been reduced to $695,000.

The award is considered noneconomic because Ms. Baxter was not granted the amount based on past, present or future medical expenses. Experts couldn't provide exact judgment on whether Ms. Baxter's condition would have been prevented or treated differently had Dr. Rodgers offered proper follow-up care, so instead, the award is based on pain, suffering or inconvenience as a result of negligence.

Representing Ms. Baxter in this suit, Michael P. Smith, JD, holds that he and his client are satisfied with the award amount, but he hasn't ruled out the possibility of further action or appeal from the defense. Dr. Rodgers and her attorney, Robert C. Maynard, JD, have 30 days to appeal the decision and try the case again. They also have 10 days to file a motion for a judgment notwithstanding verdict (JNOV) that would let a judge overrule the jury's verdict based on insufficient evidence provided throughout trial. As of now, Mr. Maynard has made no comment on his client's intentions going forward.

Joe Madsen

InstaPoll: Rate Your Level of OR Civility

How would you rate the level of civility in your ORs? Are your surgeons and nurses always pleasant to each other, or do the insults and expletives sometimes fly? Tell us in this week's InstaPoll.

Forty-two percent of the 325 respondents to last week's InstaPoll have rendered care to an ill passenger on an airplane. The results:

Have you ever helped a sick passenger on an airplane?

  • yes 42%
  • no 58%

Dan O'Connor

News & Notes
  • OR Excellence is Vegas Strong The staff of Outpatient Surgery and OR Excellence stand with the victims and the families impacted by the tragic shooting in Las Vegas. We want to assure you that the safety and security of our ORX attendees, vendors and staff are our greatest concerns. The Red Rock is more than 15 miles from the Las Vegas strip where this incident took place and officials believe no further threat is present. We're looking forward to hosting you next week for a very special ORX and supporting Las Vegas in its time of need.
  • AAAHC revises, clarifies standards for 2018 The Accreditation Association for Ambulatory Health Care (AAAHC) has revised and reformatted its standards "to better demonstrate their intended meaning," and simplified its self-assessment and survey processes. The revised standards will be implemented during surveys that begin on or after March 1, 2018. The 2018 Accreditation Handbook for Ambulatory Health Care is available for purchase.
  • Control pain and limit falls after hip surgery Femoral nerve blocks effectively control post-op pain in patients who undergo hip arthroscopies, but adding intra-articular anesthetic injections to the mix limits risk of post-op falls, according to a new study in the journal Arthroscopy. The findings were based on the results of 193 patients who underwent arthroscopic hip surgery performed by a single surgeon.