Ohio Appellate Court Affirms Defense Verdict In Laparoscopic Cholecystectomy Malpractice Case

The Ohio Court of Appeals Ninth Judicial District (“Ohio Appellate Court”) in its Decision and Journal Entry dated February 20, 2019 upheld the defense verdict reached by a Ohio medical malpractice jury, concluding “that the jury’s verdict was not against the manifest weight of the evidence.”

The Ohio medical malpractice plaintiff had undergone a laparoscopic cholecystectomy (gallbladder removal surgery) performed by the defendant surgeon during which a bile duct injury occurred that the plaintiff alleged was due to medical negligence. The Ohio medical malpractice jury concluded that the defendant surgeon was not negligent in performing the laparoscopic cholecystectomy, and the plaintiff filed an appeal. On appeal, the plaintiff alleged that the jury’s verdict was against the weight of the evidence.

Critical View of Safety

The Critical View of Safety was developed to avoid the duct injuries that were occurring during the time period that laparoscopic surgery developed. During open procedures, which involve larger incisions, doctors could more easily see and touch the various structures, whereas with laparoscopic surgery, multiple smaller incisions are used and the doctors view the surgical field through a telescope.

In achieving a Critical View of Safety, an area known as Calot’s Triangle is dissected. The borders of the triangle are made up of the cystic duct, the bottom of the liver where the gallbladder is attached, and the common bile duct. The cystic artery runs through the area of the triangle. The area of the triangle contains fatty tissue that must be cleared away so that the surgeon can locate the cystic duct and the cystic artery, which are the two structures that enter the gallbladder and are clipped and then ligated during a cholecystectomy. The goal is to clearly define the cystic duct and cystic artery so that no other structures are clipped or cut during the surgery. If a structure in addition to the cystic duct and artery is seen, it is not safe to proceed. If that happens, a cholangiogram is performed to better discern the anatomy or convert to an open procedure.

One of the plaintiff’s medical experts testified during trial that the defendant surgeon violated the standard of care by clipping the right hepatic duct and that the breach caused the plaintiff’s complications. The expert testified that if the Critical View of Safety had been undertaken, the right hepatic duct or anything else would never have been damaged, even if the plaintiff had an aberrant ductal anatomy, as alleged by the defendant and his expert.

Another expert who testfied on behalf of the plaintiff noted that the defendant failed to discuss obtaining a Critical View of Safety in his operative report. In addition, the expert testified that the presence of the duct injury further suggested that the Critical View of Safety was not obtained.

The defendant surgeon testified that he obtained the Critical View of Safety during the plaintiff’s laparoscopic cholecystectomy, and that he believed that the plaintiff had an aberrant branch of the right hepatic duct that was very close to the cystic artery and that when he clipped the cystic artery, the branch of the right hepatic duct was hidden behind it and was inadvertently clipped as well. The defendant thought that the duct was somehow close to, behind, or stuck to the cystic artery. The defendant testified that, if that was what had happened, he was not negligent.

The defendant’s expert testified at trial that the defendant met the standard of care in performing the plaintiff’s laparoscopic cholecystectomy and the defendant’s expert did not find fault in the defendant failing to mention the Critical View of Safety in the operative report because the defendant described the operative report as a summary which does not require going into all of the details. The defendant’s expert further testified that obtaining the Critical View of Safety would not always reveal an aberrant ductal anatomy in a patient, and that the plaintiff had an unusual anatomy of her ductal structures that was a contributing factor to the injury of her duct.

The Ohio Appellate Court held: “[w]hile there was evidence from which the jury could have found in [the plaintiff’s] favor, there was also evidence to support the verdict … it is well settled that ‘the trier of fact is in the best position to determine the credibility of witnesses and evaluate their testimony accordingly’ … [g]iven all of the foregoing, we can only conclude that the jury’s verdict was not against the manifest weight of the evidence.”

Source Dyer v. Dalton, 2019-Ohio-602.

If you or a loved one may have been injured as a result of medical negligence in Ohio, you should promptly find a Ohio medical malpractice lawyer who may investigate your medical malpractice claim for you and represent you or your loved one in a Ohio medical malpractice case, if appropriate.

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This entry was posted on Monday, March 4th, 2019 at 5:28 am. Both comments and pings are currently closed.

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