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The Expert: Dr. Robert Caplan, a Seattle-based anesthesiologist, testifies that complications, including bleeding, were not caused by the bone cement.
Testifying for the defense in a Washington state medical malpractice trial, Dr. Robert Caplan, a Seattle-based anesthesiologist, speaks in response to the plaintiff’s claim that healthcare providers were negligent in their off-label use of bone cement during a patient’s back surgery, allegedly resulting in complications, including hemorrhage.
The expert begins by explaining that the extreme blood loss in this case was caused by surgical blood loss and a condition known as DIC, or disseminated intravascular coagulopathy. This latter condition occurs in many surgeries that are accompanied by substantial blood loss even when bone cement is not used. It results in the internal destruction of the blood cells as the body overreacts to the blood loss by using massive amounts of platelets and coagulation factors. This ultimately results in a huge internal blood loss when clots form in the small vessels throughout the body. Unabated hemorrhage follows, because all of the clotting factors have been used up by this process.
The bone cement was administered and the DIC occurred an hour-and-a-half later. Caplan states unequivocally that after this amount of time, it could not be the bone cement that caused the DIC. This process instead was initiated by the debris from the corpectomy procedure getting into the bloodstream. This would trigger abnormal clotting with subsequent consumption of all clotting factors and the resultant extreme surgical blood loss.
The doctor then explains how he determines a patient’s blood volume using a calculation based upon body weight, and elaborates upon the details of how much fluid volume was administered during the procedure, in order to counter the plaintiff’s claim that the patient had lost more than five times her blood volume. Walking the jury through his calculation, he concludes that the patient lost 2.2 times her original blood volume. This volume of loss, the expert says, is common with DIC and is far less than the previous calculation supplied by the plaintiff.
The anesthesiologist was convincing and helped lead to a defense verdict.
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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