Hi, I need some perspective on medical malpractice. Mom's PEG tube popped out Saturday night. We took her into the ER Sunday morning; in the process of replacing the tube the doctor perforated her stomach and/or intestine. She went home in a lot of pain and the next morning went into shock. She died a little more than 48 hours after Sunday's tube replacement.

I contacted a lawyer who is a medical doctor and he said it was not malpractice because the injury was a reasonable medical practice and the standard of care was followed.

I am hoping someone on this board has experience or thoughts about this.

I have a signature with Mom's info, but I don't see it popping up. Here is her info:

Trish, CG to Mom age 84. Mom dx with SCC of jaw Stage 4 in 7/10. Had complete mandibulectomy on 2/16/11. Came home 8/2011, dependent on PEG tube.

Trish, Im very sorry for the sudden loss of your mother. You must be devastated. Poor thing went thru so much. May the memories of happier times help to ease your pain.



As to the post and your concerns, I am unable to give you any info about what is or isnt malpractice. Not sure if anyone here would be able to help with that as we arent medical professionals. Im very sorry to read of what she went thru. It always makes me very sad to hear of anyone passing away or having any pain or discomfort.

Trisha, I'm sorry for your loss. Speaking in general terms, the test for malpractice is if the doctor performed the steps at a standard to be expected from a professional with the same qualifications (ie. a specialist is held to a higher standard than a gp).

If you want to pursue this, seek a second opinion from another malpractice lawyer, a local bar association should be able to give names. You will likely need the details of the procedure and risks for an informed opinion.

Take some time to grieve your loss before deciding what you want to do.

Best wishes,

Hi there yes I am not a law suit person myself, but placement of tubes is supposed to be done with an ultrasound of some sort. Replacing a tube shouldn't cause pain, if she was sent home in pain and it wasnt checked - I'd be asking questions. So sorry for your loss.

I must disagree, Cheryl. As someone who frequently has their feeding tube replaced, I can say with certainty it can cause considerable pain. I have had this done only once without any anesthesia or lidocaine and was in agony. Of course everyone is different but this is something that would cause most people some pain or discomfort.

As far as a lawsuit goes, I am not able to comment on that at all. I am simply addressing Cheryl's comment that replacing it wouldnt cause pain. From what I have learned replacing a button type feeding tube is the most simple of procedures and usually does not cause any pain or discomfort.

I'm sorry for your loss. I agree you should grieve and then get maybe a second opinion from a doctor and a lawyer. My prayers go out to you and your family during this time.

Sorry... Just clarify - Christine, I do want to ask - as I had the tube inserted only one time and it was fine - they used anesthetic, and I was watched post op for several hours, then sent home being told that the area AROUND the insertion site would be tender, or sore for 24 - 48 hrs. But any "pain" other than that would have been abnormal. The actual act of putting it in of course is very painful as they are going through layers of skin and your abdomen etc... (hence the anaesthetic) But so when you leave the hospital Christine do you still have pain (other than at the stoma site?) despite having had a feeding tube for several years now?

My response was - focused on two things - 1) she's a long time peg user, has likely had it changed before and knows what's normal, and 2) there's a difference between normal pain at the insertion site, and the pain someone would have if their stomach has been perforated. Location, intensity etc... If I was wrong please forgive me. Someone new to having a tube in place would just have pain and not know the difference, but being a long time peg user (over a year) pain outside the insertion process - would have been unusual.

hugs. Again I am sorry for your loss. It is a normal procedure - and a replacement is fairly simple compared to the initial placement. There are supposed to be protocols place to spot an error, at the time of insertion. I would seek a second option on the law suit.

Cheryl, sending a PM. Dont want to hijack Trish's thread.

Hi,
I am so very sorry for your loss. I can't imagine how shocking this has to be. I pray that somehow you can find a bit of peace to be able to mourn her passing. I know you are looking for legal help, but try to get past the painful loss first maybe? You have time for the legal stuff.
As a caregiver, I sincerely hope you are not in any way blaming yourself for this. Just a thought as I know how hard on ourselves we can be. We can't control the works of others, only the love and care we give.
I pray that the happy memories will help you through the future.
Blessings,
Kathy

I am so very sorry for your loss and will hold you in my prayers. I, too, lost my mother just before Christmas from sepsis that developed after surgery, and there was a lawsuit that was settled out of court, without an admission of liability, as is the outcome of most such suits.

Regarding "perforation of stomach or intestine": as a general rule perforation of either would be unlikely in the course of inserting a PEG tube, and if that is what occurred then malpractice or negligence may have occurred. One has to make an incision into the stomach wall to insert the PEG tube into the stomach, and it may be that the doctor cut too far into the stomach (e.g. perforated the far side of the stomach from where the PEG was inserted), nicked an artery without realizing it, or otherwise had an accident as part of the procedure. Whether it is negligence or malpractice will depend on factors such as: 1) did the doctor assess for and recognize the problem, and 2) did he respond appropriately (according to generally accepted standards of practice) to treat the problem and prevent your mother's death (if possible; not all deaths from complications can be prevented, e.g. persons whose general health is very poor to begin with may die from minor complications that most others would survive).

A perforation of the intestine would be very serious as the intestine contains fecal material and high levels of bacteria. If the intestine is perforated the fecal material and bacteria leak into the abdomen and can cause potentially fatal peritonitis (infection of the abdomen, essentially). This is a true medical emergency, and a person with an intestinal perforation should not have been sent home. It concerns me that your mother was sent home rather than held for observation, esp. if the doctor thought something may have gone wrong during the procedure.

I do not know if you were told of the perforation at the time of the PEG insertion or not until after her death. If the doctor thought there was a problem at the time and still sent your mother home, that is concerning. The safest course of action would be to obtain the opinion of a second attorney. Unless the attorney himself is a medical expert, he should have a medical expert review all pertinent records, from those related to the PEG tube procedure to any autopsy that may have been done. There may be a charge to do this, for the expert's time, the copies of the records, etc. I wonder if your first attorney really looked thoroughly at all the records, or if he went more on your reports or the reports of the doctor who did the procedure. If would seem unlikely that he could have done a thorough case review given how little time has passed since your mother's death.

What happened, when it happened, whether it is a reasonable possible complication (i.e. one that can occur even when the doctor is performing at his best and according to standards of practice, which in essence means "the way doctors are expected to practice, the state of the art") or was something that likely would not have occurred unless the doctor did something wrong (was not performing according to usual standards of practice, following expected procedures, taking reasonable care, etc), whether the doctor properly checked for any signs of complications, what he did if any signs of complications were present (was it what he should have done, was it done in a timely and thorough manner, etc) all factor in to decisions about whether or not negligence or malpractice may have occurred.

Dealing with such issues while in the midst of grief is very difficult. It does not have to be handled right away--it can usually be delayed, unless the deadline for liability suits is nearing. In our case my dad pursued the lawsuit, believing that he had to do it for my mother, and it took about two years to run its course. One has to consider whether the circumstances of the loved one's illness and death, the expense, and the likelihood of success are such that a lawsuit should be pursued, and that may not be an easy decision, esp. at an already difficult time. It gets even more complicated, as settlements treat the lost loved one as an asset, like a car that someone wrecked. For example, the loss of an elderly person who did not work may result in a smaller settlement because that person would not have lived much longer regardless, and the premature death did not result in the loss of wages. I remember in my mother's case the discussion of her being a housewife, of the impact her loss had on the family (not emotionally, but as loss of companionship) and a dollar figure being determined based on these variables. It was very difficult to go through emotionally. In the end the settlement was for what to us was a significant amount of money, though probably less so to attorney used to the big settlements we read about in the papers (and far less than any family would think its mother was "worth" in an economic sense).

I have been where you are, and wish you well. Please take care of yourself also at this difficult time, and good luck in whatever action you decide to take next.