Defense Verdict Obtained in Perforated Esophagus Case

Dustin J. Denning, with assistance from Jared T. Hiatt, successfully defended our client, a family practice physician, in a medical malpractice jury trial in which the plaintiff alleged that our client was negligent when performing an esophageal dilation during which the esophagus perforated, leading to a pneumothorax and pleural effusion that required transfer to another facility for the surgical repair of the perforated esophagus.  The plaintiff alleged at trial that our client deviated from the standard of care in (1) failing to obtain proper informed consent; (2) perforating the esophagus with the guidewire that was used during the dilation that involved the use of a Savary brand bougie dilator; (3) failing to recognize the perforation at the time it occurred; (4) failing to recognize signs and symptoms of perforation after the procedure was completed; (5) failing to order appropriate testing to look for the cause of plaintiff’s signs and symptoms; and (6) prematurely discharging plaintiff from the hospital. 

The plaintiff alleged that our client allowed the guidewire to migrate out of the stomach and into the esophagus, which caused the perforation and allowed for spillage of esophageal content into the pleural cavity.  Shortly after the procedure, the plaintiff began complaining of vague rib pain and shortness of breath.  The rib pain was in the same area where plaintiff had sustained rib fractures several months earlier that our client had treated.  Our client ordered a chest x-ray that was read as normal.  After a period of further monitoring, plaintiff’s pain complaints subsided, and she asked to go home to rest after meeting all discharge criteria.  Our client agreed and discharged her home.  Plaintiff returned to the hospital by ambulance about two hours after discharge complaining of significant pain and shortness of breath.  Our client promptly diagnosed the perforation and arranged for the patient’s transfer to another hospital for further treatment and repair of the perforation.  Plaintiff was hospitalized for nine days and appeared to have made a full recovery by the time of trial, though she continued to argue that she had pain in the area where chest tubes had been placed and a worsening of her mental health problems.  The plaintiff sought more than $300,000 at trial.

We defended the case by showing that for the perforation to have occurred the way plaintiff says it occurred, the tip of the guidewire would have migrated more than 12 inches out of the stomach.  Our client’s procedure team, consisting of two experienced nurses, testified at trial and explained their roles in safely performing the procedure which included watching for migration of the guidewire.  Our client also demonstrated to the jury how the procedure is performed, and we argued that it would have been nearly impossible for the guidewire to migrate 12-plus inches and not be seen by anyone.  Our expert witness, a general surgeon who performs esophageal dilations, testified that the likely cause of the perforation was the mechanical effect of stretching the stricture, which is a known complication that can occur absent negligence.  We also demonstrated that the plaintiff was informed of the risks of an esophageal dilation, including perforation, despite her claim that our client never explained this potential complication to her.  After a five-day jury trial, a Republic County, Kansas, jury agreed and returned a 12-0 verdict in favor of our client after deliberating about 25 minutes.