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Gevorgyan v. Mihranian

Dr. Robert Cole Details Treatment of Hospital Patient in California Med Mal Trial

The Expert: Dr. Robert Cole, a California-based surgical expert, concludes that the patient’s infection did not stem from a lap-band procedure and that the defendant in the case did not meet the appropriate standard of care.

The Verdict: A mistrial, following a declaration that the jury was deadlocked.

By Dr. Gary F. Gansar, MD, FACS
Senior Physician Medical Director, AMFS

During a 2017 Los Angeles County medical malpractice trial, California-based general surgery expert, Dr. Robert Cole, testifies about the infection-related death that occurred following routine gallbladder surgery on a well-known Armenian folk singer. He specifically spotlights one defendant as having failed to meet the standard of care in this case.

There had been speculation during the trial that the infection may have been related to a lap- band placed five years earlier, and whether this foreign body was subsequently seeded with bacteria. Using a CT scan performed at the time of the patient’s successive hospital admission for infection following her cholecystectomy, the surgical expert justifies his statement that, “the lap-band was absolutely not the source of the infection.” A lap-band is a laparoscopically placed, silicone, inflatable, and adjustable band that is positioned around the top of the stomach where it joins the esophagus. Depending upon how much the band is filled, the upper stomach is compressed, allowing a morbidly obese patient to eat less food.

The expert points to the relevant slices of the scan demonstrating tiny bubbles and debris within the gallbladder fossa as well as inflammatory fluid surrounding the liver, as a strong indication that this is the likely location source of infection. Using this same scan, the expert points out that there are no air bubbles, fluid, or any other signs of infection around the lap -band. This lack of evidence of infection around the lap-band was confirmed at autopsy.

Cole explains that 5 years after placement of the lap-band would be very unusual for it to become infected. Once it has been placed, the body works over the next few months to “epithelialize” the foreign body and incorporate it into the natural body. This process, once established, makes bacterial seeding much more difficult and in fact unlikely this far removed from its placement.

Having established that the lap-band could not be blamed for the fatal infection, the surgeon speaks to the standard of care of the defendant physician’s assistant in this case. He stresses that the PA was “intimately involved in this patient’s care” by taking the jury through several important decisions that the PA made as well as specific orders made by this PA. One of these involved his handling of a significant complaint of chest pain that the patient expressed. There was a suspicion of a possible heart attack. Around midnight tests were performed and blood work obtained. These results were reported directly back to this PA. His supervising physician, who was also a defendant in this case, was not notified when this happened and discharge the following morning was not delayed.  Cole feels that a cardiologist should have been consulted, antibiotics continued, and further evaluation performed prior to discharge. Neglecting this constellation of problems that should have held up the patient’s discharge that following morning represented a breach in the standard for a PA responsible for this discharge.

The jury remained deadlocked and evenly split, so a mistrial was declared.

About the Author Dr. Gary F. Gansar, MD, FACS

Gary Gansar, MD, is residency-trained in general surgery. He served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Touro Infirmary and Mercy Hospital in New Orleans, LA. Dr. Gansar was Board Certified in general surgery while in active practice. He joined AMFS in 2015 as a Physician Medical Director.

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