Surgery Mistakes - Lazaro Perez's Nightmare Story
Steve Murphy (Voiceover): You’ve probably heard of or know someone who’s had surgery go drastically wrong. We all hope that it won’t happen to us but really, how common are these frightening mistakes these days? According to the LA Times and Washington Post, a study in the “Archives of Surgery” reports that the problem may be “20 times more common” than previously thought and that “Prevention effort may be very inadequate.” The Joint Commission on accreditation of health and patient advocacy groups have tried to eliminate such mistakes by “having doctors review and verify the procedure beforehand.” When the Insider Exclusive investigated 4 separate databases including the “Federal National Practitioner Data Bank,” a repository of malpractice payments and disciplinary actions, “…their records clearly showed that surgery mistakes occur between 1,300 and 2,700 times a year…” in the United States. Wow! That’s a lot of unhappy and critically injured patients “…and injured by doctors!”
Today, the Insider Exclusive investigates the horrendous surgery, malpractice story of Lazaro Perez and how the Palm Springs General Hospital and Dr. Juan Julio Hernandez-Pombo totally botched a rather common surgery and nearly Lazaro. In fact, in order to save his life he had to be transferred to another hospital. In 2010, nearly 90% of all gallbladder surgeries are performed using a method known as laparoscopic surgery. Surgeons now consider “Laparoscopic Gallbladder Surgery to be “the gold standard when removal of the gallbladder is necessary.”
On the screen as you can see one of the most common techniques for performing this procedure is begun by making a small incision in the navel and inserting a needle into the abdominal cavity. The cavity is then inflated with carbon dioxide gas. This distension allows for easier viewing and creates a workspace for the surgery to be performed. The needle is then removed and a sharp, hollow, metal cylinder called a Trokar is inserted in the now inflated abdominal cavity. The laparoscope is equipped with a camera that allows a magnified view of the inside of the abdominal cavity to be projected onto the video monitors located on either side of the operating table. Once the laparoscope is in place the abdomen is examined to ensure no injuries resulted from the placement of the choker. Three additional Trokars are then placed into the abdomen through small incisions under direct observation through the laparoscope. It is through these ports that various surgical instruments are inserted for manipulation and dissection. The surgeon then watches the monitor and performs the operation by manipulating the inserted surgical instruments. In the typical procedure, the end of the gallbladder is pulled upward towards the diaphragm. This allows the cystic duct, the cystic artery, and the common bile duct to be seen. Once these structures have been clearly identified and dissected away from the surrounding tissue, the cystic duct is sealed with a clip placed near its junction with the gallbladder. The surgeon then places two more clips near the point where the cystic duct joins the common bile duct. The cystic duct is cut and separated between the clips. The cystic artery which provides the main blood supply to the gallbladder is then divided in the same way. In performing this procedure, the surgeon must be meticulous for the cardinal rule of all gall bladder surgeries is that no anatomic structures are clipped or cut until the surgeon is unequivocally certain that they have been properly identified.
Now surgeons can either do this the right way or the wrong way. And in Lazaro Perez’s case, Dr. Pombo did it the wrong way. The right way is when the gallbladder is finally removed; the surgeon identifies and cuts the right duct and avoids cutting or nicking the wrong ducts. These ducts are small and close together and when a doctor who lacks the proper training or skill improperly identifies the ducts…the results are cases like Lazaro Perez’s. The duct that should be cut is called the cystic duct. The most common mistake made in laparoscopic gallbladder surgery is cutting of the common bile duct instead of the cystic duct and that is what Dr. Pombo did exactly. And when that happens, it sends bile into the patient’s abdomen and, in effect, poisons the patient. Incompetent or negligent surgeons like Dr. Pombo who rushed to perform this money-making surgery pose a serious risk to patients and safe medicine.
“This year more than 1 million people in the United States will learn they gallstones…and approximately 75,000 will need surgery…and one of them could be YOU.”
“OUT of the 75,000 gallbladder surgeries this year…approximately 1 out of every 200 patients will likely develop a bile duct injury.” Compared to the traditional surgery, the most modern gallbladder surgery procedure can cause up to “ 10x as many bile duct injuries.” Lazaro Perez is just 1 of the 200 very unfortunate patients who through the hand of fate met up with Dr. Pombo who had only performed 1 or 2 laparoscopic gallbladder removals prior to the one he attempted on Lazaro. Plus “He had been previously sued in the Midwest,” by a patient for the same procedure which also went bad.
Today, the Insider Exclusive presents Surgery Mistakes- Lazaro Perez’s Nightmare story, and how his lawyers Stewart Greenberg and Mark Stone, partners at the law firm of Greenberg, Stone & Urbano, got justice for Lazaro Perez earning them the highest respect from citizens and lawyers alike as one of the best plaintiff lawyers in Florida and in the nation. They have seen many innocent and hardworking people suffer needless injury at the hands of incompetent and negligent doctors. And because of that they are driven to help people who have been harmed by the negligent actions of others. Their goal, not only to get justice for Lazaro Perez, but to make sure healthcare is safer and also to hold hospitals and their insurance companies much more accountable. Hi, I’m Steve Murphy and welcome to the Insider Exclusive live from Miami, FL at the law firm of Greenberg, Stone & Urbano.
ONSCREEN TEXT: Surgery Mistakes - The Lazaro Perez Story
Steve Murphy: It is my great pleasure to introduce Stewart Greenberg and Mark Stone to the show. Welcome to the show.
Stewart/Mark: Thank you, Steve.
Steve: One of the clients that you’re representing in the case that we’re going to be talking about today is Lazaro Perez. Tell us a little bit about what happened in this case.
Stewart: This was a tragic situation. Back in 2003, Lazaro had a pain in his stomach and he went to a local emergency room called Palm Springs Hospital in Hialeah, FL. They did some studies on him and they said that he had to have his gallbladder removed.
Steve: Which, I understand, a lot of people…have not gallstone surgery but a lot of people have gallstones every year which cause pain in the abdomen.
Stewart: Correct. And in his case actually, he really didn’t need to have it removed according to the experts that we hired in the case. But the surgeon that the hospital provided for him said that ‘…you need to have it removed,’ and that he was going to do it laparoscopically.
Steve: And this was the on-call surgeon at the time whose name was…?
Stewart: Dr. Juan Pombo Hernandez. They scheduled our client for surgery and he performed a laparoscopic procedure. The day after surgery they sent him home.
Steve: Which is typical in cases like this, right?
Stewart: Correct. But what happened in the few days after that is that all of a sudden he developed pain in his abdomen and jaundice. So when he went back into the emergency room, top the hospital, they realized that something was wrong. And normally what happens in a case like this is that the doctor makes a mistake and cuts the wrong duct when he removes the gallbladder. And this doctor cut the wrong duct and there was bile spewing into his stomach. And bile is very acidic so it was causing an irritation in his stomach. Instead of then sending him to a specialist who could resolve this issue by probably putting a drain in and draining out the bile letting the stomach and the organs cool down…this doctor decided to admit him to the hospital, do some tests, and without the qualifications to do so, operated on him a second time.
Steve: Now, he had the authorization from the hospital to do this, right?
Stewart: Yes he did, although, he really never had no experience doing this procedure.
Steve: I understand he only had…this was his second operation or something like that?
Stewart: The second operation of this type had ever done in his life.
Steve: And the other operation he had been sued by the client, right?
Stewart: That’s correct. It occurred in the Midwest. The second operation he did on our client did not go well and he did a third operation on him for 8 hours which didn’t go well.
Steve: Now normally in a hospital you got a patient…I mean the hospital administration has got be saying to themselves, if they have a review board, “wait a minute, we brought a patient in - it didn’t go well, we had another operation- that didn’t go well again, we had a third operation…” they’re kind of thinking liability here…aren’t they?
Stewart: You would think…
Steve: But in this case they weren’t.
Stewart: You know it’s hard to think what they were thinking. They allowed this doctor to maintain treating this patient doing what he wanted to do when they should’ve said get him over to the university teaching hospital as soon as possible.
Steve: What happens next?
Stewart: The family insists he’s dying. He’s in intensive care. He doesn’t know what’s going on. The doctor basically throws his hands up and says, “I don’t know what else to do.” They said well let’s get him over to the University of Miami’s Jackson Memorial Hospital. It takes them 7 days to transfer a critical patient.
Steve: Why is that?
Stewart: We don’t know.
Steve: This is Jackson Memorial…they have an emergency room, don’t they?
Stewart: They sure do.
Steve: Anybody can come into an emergency room, right?
Stewart: They can and Jackson is very good at accepting patients who have had problems elsewhere. When they finally get him over to Jackson and he’s looked at by the Jackson physicians, the Jackson doctor on call asked the family in what third-world country was he operated on?
Stewart: They couldn’t believe what they had seen and it took them 6 months and a number of procedures to finally make this man better than he was.
Steve: What is his condition today?
Stewart: He no longer has a Colostomy. Thank goodness.
Steve: He had that temporarily?
Stewart: He had that temporarily. But his condition is such that he is at risk for a blockage for the rest of his life. So in order to avoid that or to check on it he has to undergo tests once or twice a year under general anesthesia, and as a result, he may need to have a kidney transplant in the future.
Steve: How did he come to you to have you represent him?
Stewart: One of his family members came to us when he was so sick. After they had gotten him to Jackson and after they were working on him the family realized that they needed someone to fight for him.
Steve: And what was your legal strategy in this case?
Mark: We assemble all the medical records and retain an expert who will then review the medical records.
Steve: For the audience that’s watching us right now, when you say…you say it easily, “we assemble all the medical records,” assembling is the act of discovery…subpoenaing the records, asking for the records, right? Often times medical professionals don’t give it to you too readily, do they?
Mark: Well, you’re right. Fortunately, here in the state of Florida, they are under an affirmative obligation to turn over records once we request them pursuant to statute.
Steve: Or what will happen:
Mark: Ultimately, we will bring a lawsuit with the records or without the records. But under the current state of the law we are under the affirmative obligation to request records; they are under an affirmative obligation to produce them prior to litigation even being filed.
Steve: Now when he went to Jackson Memorial, I understand that he was there for awhile. They saved his life, didn’t they?
Stewart: Yes they did.
Steve: …and the cost just from Jackson Memorial was, $900,000?
Steve: Almost a million dollars…
Stewart: Almost a million dollars.
Steve: Okay, tell us the outcome of this case.
Stewart: After extensive discovery in the case and depositions, right before trial, we resolved the case where the defense, number 1, paid all of his outstanding medical bills and number 2, paid our client a total of approximately 2.6 million dollars.
Steve: We have and what we are going to show right now one of the depositions you did of Dr. Pombo where he admits doing it incorrectly. So, we’ll go to that right now.
Dr. Pombo: We separate the duodenum and then we go into the ligament of Treitz. About 20 cm into the ligament of Treitz we make a resection and we bring that loop in conjunction with the duodenum that we transected, so we have a total drain through the intestinal bowel….at that time we put the side of the duodenum into the, either the hepatic or common duct for drainage of bile.
Stewart: What are you answering doctor? I don’t understand…..
Dr. Pombo: It wasn’t the duodenum that was attached to the hepato, the hepato …the hepato biliary duct, it was the jejunum. Stewart: So what you told me a few minutes ago, the way you described it is different from the way you….
Dr. Pombo: It is incorrect the way I described it. There’s a short distance between the jejunum and duodenum .
Steve: As a result of this case, Dr. Pombo…was his license taken from him by the medical review board?
Stewart: No. It’s rare that the medical review board ever revokes a doctor’s license to practice medicine.
Steve: Why is that?
Stewart: I don’t have a good answer for you. Unlike the bar which we’re responsible to, medical doctors rarely lose their license unless they really commit a heinous crime. Most medical malpractice is committed by 2%-3% of the doctors yet these doctors still maintain their license to practice.
Steve: Now this case, I remember reading, it was a long hard battle. Finally, the hospital admitted responsibility, correct?
Steve: Why didn’t they do that in the beginning? …the reason I ask this question is that it may sound kind of foolish but the bottom line is that without lawyers like yourselves who are willing to go to battle for these people…most people would lose, wouldn’t they?
Stewart: Sure, but understand this, hospitals are businesses, they’re corporations. They’re in in for profit. And what they try to do is: number 1, they want to see if the lawyer has the guts to go forward, has the money to go ahead and invest in the case, and if the client has the guts to go forward because often times they’ll make offers and they’ll try to entice someone to settle a case for less than a hundred cents on the dollar because they know their economic conditions.
Steve: Did they make an offer in this case, in the beginning?
Stewart: Sure, they made many offers and we did not resolve this case until we felt our client got what we felt was a fair settlement offer.
Steve: And you settled the case… it’s public knowledge, is that correct?
Stewart: That’s correct.
Steve: …and would you mind saying how much you settled…?
Stewart: 2.6 million.
Steve: And what did they offer in the beginning, something like $100,000?
Stewart: It started about that, yes.
Steve: $100,000. You know as the audience watches this, they’re probably wondering, “well, why aren’t they doing the right thing?” Very rarely do they do the right thing, do they?
Stewart: …only when the gun is to their head and it’s cocked do they do the right thing, usually.
Steve: Today, we have Lazaro with us. We’re going to bring him on right now.
Steve: It is my great pleasure to introduce Lazaro Perez and his interpreter Vicente De La Vega. Welcome to the show.
Lazaro: Thank you.
Steve: This has been a horrendous experience for you, hasn’t it?
Steve: Take us back to that day when you had a pain in your stomach, in your abdomen and you went to the hospital…
Lazaro: Well, this was a very acute pain that I had and I didn’t know what the diagnosis was going to be but it was diagnosed as problems with the gallbladder and that was the operation.
Steve: After you had the first operation and it was a failure, what were your thoughts about the doctor?
Lazaro: I really wasn’t that aware that the first operation had been a failure. I was really told that I was full of gas and that I should wait.
Steve: You subsequently had 2 more operations for a total of 3 and you were in worst shape than when you first came into the hospital?
Lazaro: Definitely, even while I was in the hospital there are certain things that I don’t even remember about although my family has told me about them.
Steve: Eventually you were transferred to Jackson Memorial. They saved your life. When you look back on Dr. Pombo, the doctor that was the surgeon for you… what’s your opinion on him?
Lazaro: I think alt about the difficulties I had and he was a person who operated on my 3 times and he lied to me.
Steve: In this particular case, with your lawyers getting justice for you and getting a relatively good settlement, what is your opinion of your law firm?
Lazaro: To me, it’s the best. The understanding that this law firm offers… they treat you not as an attorney to a client but as a friend to a friend.
Steve: I am so glad that you had a resolution and some sort of justice here. I certainly hope that you can feel better every single day.
Lazaro: Thank you very much.
Steve: It’s my great pleasure to introduce Roxanna Gonzalez, Lazaro’s niece, as well as Stewart Greenberg again. Welcome to the show.
Stewart/Roxana: Thank you.
Steve: You lived this experience with Lazaro, didn’t you, your uncle?
Roxana Gonzales: Yes I did.
Steve: Tell us a little bit about what you’re familiar with going through this terrible ordeal.
Roxana: Well, my uncle was a very happy person. He would never get sick or anything and after this whole thing happened, he’s not the same person…he’s very sad most of time…he’s just not the same person after he went through…all this pain that he went through.
Steve: Do you remember seeing him in the hospital after the third operation?
Steve: What did he look like?
Roxana: He was dying. He wouldn’t speak. He was just in bed, dying.
Steve: Now when he was transferred over to Jackson Memorial, did anyone ever figure out why it took so long?
Stewart: Jackson said they don’t know and Palm Springs said Jackson claimed they had no beds.
Steve: As a result of getting out of Jackson Memorial and over the last, how long has it been... 2 years?
Stewart: No, it’s been 6 years.
Steve: 6 years… has he gradually improved?
Roxana: Yes, he has improved but it’s been very difficult for him.
Steve: Does he have someone to help him at home or what?
Roxana: He has a sister… his sister helps him.
Steve: Ok. If you could say one thing to the Palm Springs General Hospital in Hialeah, what would you say to them?
Roxana: I would say that they have destroyed a perfectly normal person. That’s what they did.
Steve: Well, I want to thank you very much for being on the program.
Roxana: Thank you very much.
Steve: What is medical malpractice?
Mark: Medical Malpractice is simply negligence committed by a medical care provider. In the state of Florida, as in most states, it’s basically…has the doctor, the surgeon, the hospital utilize reasonable care based upon the medical standards of the community.
Steve: Is it pretty easy to determine what the reasonable care definition is?
Mark: Sure. I think most medical providers will agree on what the ultimate standard of care is and at that point it’s simply determining whether or not the doctors’ or the hospitals’ actions have fallen below that standard of care.
Steve: How do you suspect medical malpractice negligence?
Stewart: Well we look at every case on its facts. We have to get the records. We have to have them reviewed by an expert and we rely on the expert to tell us whether or not somebody fell below the standard of care…meaning they either did something they shouldn’t have done or they failed to do something they should have done.
Steve: But it has to be pretty blatant, doesn’t it?
Stewart: Well Mark and I have a lot of experience. So we take a look at the facts of the case, we research it…if the results are poor, sometimes, unfortunately medicine is not an exact science, you get a bad result that happens because it’s no one’s fault. Other times there are faults that cause bad results and that’s what we look for.
Steve: Well I want to thank both of you for representing these people that need this kind of representation that don’t have the financial wherewithal and go to bat for them and I want to thank you both for being on the program.
Thanks for joining us. You can find more information about our guest and the issues at InsiderExclusive.com.
To schedule a Free Consultation with Greenberg, Stone & Urbano, call 305-595-2400 or 1-888-499-9700. You can also visit us at www.sgglaw.com.