Virginia Lawyers Weekly//April 24, 2017
Virginia Lawyers Weekly//April 24, 2017//
Ava Blackburn was 64-years-old when she was referred to Dr. Timothy Klepper for a colonoscopy after one episode of unexplained bleeding. Blackburn walked five miles a day and gardened at the time of the procedure. Klepper is a general surgeon and performed this colonoscopy at Buchanan General Hospital in Grundy.
The colonoscopy was generally uneventful. Blackburn was kept in the recovery room approximately 30 minutes and then moved to a day surgery discharge room where standing orders required she be kept a minimum of 30 minutes with vital signs and conditions monitored prior to discharge under a specific list of criteria — these did not include pain. While in this location, she was under the care of a registered nurse. The typical stay in this room is 30 to 45 minutes. Blackburn was there for more than three hours. The nurse notified Klepper of her symptoms three times during this period. On the first occasion she had nausea, vomiting and cramping in her abdomen. Klepper ordered 4 mg of Zofran. Nausea and vomiting subsided after Zofran but not the cramping pain. On the second occasion, Klepper was notified that her blood pressure had precipitously dropped to 90/55. No new orders were given. Blackburn continued to complain of pain and cramping in her abdomen. The nurse notified Klepper third time. No response is recorded by the nurse. Blackburn was discharged in a wheelchair approximately 25 minutes later. She described her pain at discharge 10+ and said the nurse told her she might have to come back to the emergency room.
Blackburn, still in pain, returned to another surgeon’s office the next afternoon after repeated calls to Klepper’s office went unanswered. She was hospitalized, plain film revealed perforation, she was treated with antibiotics for her septic condition and underwent surgery the following day. A diverticula had perforated and filled her peritoneum with toxins. Her colon was resected and she was given a colostomy which she had for approximately eight months before the second surgery to reverse the colostomy.
Plaintiff’s expert, James Mann, a gastroenterologist and professor at the University of Virginia, testified that Klepper breached the standard of care by failing to respond to the precipitous drop in blood pressure which reflected shock and was the probable time of perforation or initial leakage into the peritoneum. He said that Klepper could have complied with the standard of care in multiple ways including ordering a plain film to rule out a perforation, seeing the patient, asking another doctor to see the patient, ordering the nurse send her to the emergency room or referring her to another facility. He opined that among many conditions in a differential diagnosis of these symptoms, a perforated colon was the most deadly and must be ruled out first. Plaintiff argued that Klepper abandoned his patient and the court gave the duration of duty instruction over defendant’s objection.
Defendant’s expert Dr. Robert Ripley, a private practice general surgeon in Salem, testified that Klepper was not negligent and the precipitous drop in blood pressure with other symptoms required no attention other than monitoring because the patient could be having a reaction to the anesthetic and was more likely having a vasovagal reaction to the procedure.
Type of action: Medical Malpractice
Injuries alleged: Unrecognized perforation of colon: peritonitis, shock, sepsis, colon resection, colostomy, surgical reversal of colostomy, continuing bowel dysfunction, embarrassment, mental anguish, aggravation of anxiety and depression
Name of case: Ava Blackburn v. Timothy Klepper, M.D.
Court: Buchanan County Circuit Court
Case no.: CL04-274-00
Tried before: Jury
Name of judge: Hon. Patrick Johnson
Date resolved: March 23, 2017
Special damages: $57,500.00
Verdict or settlement: Verdict
Attorneys for plaintiff: Mary Lynn Tate, Abingdon
Attorneys for defendant: John L. Cooley, Roanoke
Plaintiff’s experts: James A. Mann, M.D., gastroenterology, University of Virginia
Insurance carrier: Princeton Insurance Company