In 1985 a surgeon in Germany, Erich Muhe, removed a gallbladder using a laparoscope.
The first laparoscopic cholecystectomy in France was performed by Philippe Mouret in Lyon in 1987.
J. Barry McKernan and William B. Saye performed the first laparoscopic cholecystectomy (LC) in the United States on June 22, 1988 in Marietta, Georgia. Laparoscopic cholecystectomy was developed and popularized in the United States by Dr. Eddie Joe Reddick in 1989.
It was a natural outgrowth of laparoscopic surgery being done by gynecologists and arthroscopic surgery done by orthopaedic surgeons many years prior to 1989. As this minimally invasive surgery was being developed and applied to gall bladder surgery many instruments had to be developed and then modified to accommodate the needs specific to biliary tract surgery. In addition surgical methodology had to be modified as better techniques were developed to accomplish a safe, efficient cholecystectomy.
Early in the national experience with laparoscopic cholecystectomy it became apparent that some surgeons who were in the early phases of their training would misidentify the anatomy and inadvertently clip and divide the common bile duct thinking it to be the cystic duct. In many instances this would result in complete obstruction of the common bile duct which would require a second operation to correct. Often these injuries were not noted at the time of the initial procedure and therefore a delay in the diagnosis of the problem often resulted.
Other problems of much less consequence have also been identified to occur following laparoscopic cholecystecomy. This includes entering the gall bladder and spilling stones and bile into the peritoneal cavity, failure to diagnose stones in the common bile duct, cystic duct clips falling off leading to bile peritonitis, holes being poked in the cystic dust while doing x-rays of the biliary tree (cholangiography), holes poked into the intestine or mesentery by either the needle used to fill the peritoneum with CO2 (Verness needle) or one of the trocars used to introduce the ports.
Dr. Steven E. Lerner & Associates. LAPAROSCOPIC CHOLECYSTECTOMY. History:http://www.drlerner.com/articles/article12.html
The Unwritten History never told to the public: Medical negligence, assault and battery
Despite of the formal recognition and endorsement of ethical principles set forth in the Nuremberg Code and Declaration of Helsinki by Doctors, the institutionalized development of laparoscopic cholecystectomy through leaning on ‘test subjects’ breach ethical, moral and legal standards. This infringement breaching all basic human right were deemed acceptable outcomes in a surgeon’s quest for the entrepreneurial exploration of the procedure, so too were the resulting deaths and injuries that followed.
Human Rights violation in more detail
The International Human Rights law including the Universal Declaration of Human Rights (1948) proclaims the right for all human beings to live in conditions that enable them to enjoy good health and health care.
Article 5: No one shall be subjected to cruel, inhuman or degrading treatment
Article 8: everyone has the right to an effective remedy by the competent national tribunals for acts violating the fundamental rights granted him by the constitution or by law.
Article 25: Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, or other lack of livelihood in circumstances beyond his control.
The problem also associated with this procedures (carried out mainly to woman) often have brutal consequences for a woman’s physical and mental health. And likely in breach of The Convention on the Elimination of All Forms of Discrimination against Women (1979), the Convention against Torture, and other Cruel, Inhuman or Degrading Treatment or Punishment, prohibits the infliction of physical or mental pain or suffering on women
Nuremberg Code breached by laparoscopic cholecystectomy surgeons
Just like the Nuremberg trials defendants, we assume doctors never aspired to bring evil into medicine but rather they over-identified with an ideological providing healing through the sacrifice of innocent trusting patients’ lives. Lacking empathy they couldn’t fully appreciate the human consequences of their career-motivated decisions.
Leo Alexander, a Viennese-born American physician, had joined the U.S. Army Medical Corps in 1942. At the end of the war, Alexander was sent on a special mission under the Combined Intelligence Objectives Sub-Committee and charged by orders from Supreme Headquarters of Allied Expeditionary Forces to gather evidence for the Nuremberg trials. Two days before the opening of the Doctors’ Trial, Alexander gave a memorandum entitled “Ethical and Non-Ethical Experimentation on Human Beings,” in which he identified three ethical, legal, and scientific requirements for the conduct of human experimentation. The second point is key which focused on the duty of physicians as expressed in the Hippocratic Oath, which Alexander restated in research terms:
“the medical Hippocratic attitude prohibits an experiment if the foregone conclusion, probability or a priori reason to believe exists that death or disabling injury of the experimental subject will occur”
Source : FIFTY YEARS LATER: THE SIGNIFICANCE OF THE NUREMBERG CODE. EVELYNE SHUSTER, PH.D.
From the Nuremberg trails emerged principles, the Nuremberg Code, that guide us today. These include, as regards medical interventions,
The voluntary consent of the human subject is absolutely essential
Exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, over-reaching, or other ulterior form of constraint or coercion…
Should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him/her to make an understanding and enlightened decision.
The last one is key. For consent to be valid, the person, or patient, must know everything. Consent, in this context, is a corollary of autonomy, probably the stoutest pillar in the ethical framework that doctors refer to on a day to day basis. Tom Beauchamp and James Childress, working in Healy Hall, Georgetown University, Washington, wrote Principles Of Biomedical Ethics, containing the now familiar touchstones:
Autonomy: The right for an individual to make his or her own choice.
Beneficence: The principle of acting with the best interest of the other in mind.
Non-maleficence: The principle that “above all, do no harm,” as stated in the Hippocratic Oath.
Justice: A concept that emphasizes fairness and equality among individuals.
What Really Happed with laparoscopic cholecystectomy (A story by Elizabeth Eugenia (James) LaBozetta – Abridged an addition )
Surgeons have long considered gallbladder surgery to be a “bread-and-butter” operation.
In the late 1980s it was threatened by two non-surgical procedures to treat gallstones: lithotripsy and ursodiol dissolution. People were choosing the non-surgical solutions.
Short background on non surgical treatment of the day: “the usefulness of this bile acid, as a therapeutic tool, has been successively reconsidered not only for its dissolution capacity, but also for the anti-inflammatory effect. A long-term follow-up study on UDCA treatment showed a significant decrease in the incidence of gallstone disease complications. In particular, this study showed that ursodeoxycholic acid UDCA treatment in patients with symptomatic gallstones reduced the incidence of biliary pain and acute cholecystitis compared with no treatment over an 18-year period. Interestingly, this therapeutic effect was independent of gallstone dissolution suggesting that UDCA could achieve these effects by restoring the normal gallbladder environment which more recent studies, on gallstone disease, have clearly shown to be characterized by an inflammatory status”
Guarino, Michele Pier Luca et al. “Ursodeoxycholic Acid Therapy in Gallbladder Disease, a Story Not yet Completed.” World Journal of Gastroenterology?: WJG19.31 (2013): 5029–5034. PMC.
The laparoscopic method offered surgeons a viable way to regain patient interest in surgery. Laparoscopic equipment companies recognized an enormous financial opportunity.
The laparoscopic method offered only a COSMETIC advantage in the smaller scars, not a safety advantage. The one-day hospital stay was attractive to the health insurance companies.
Doctors, and other parties, bought stock in the equipment manufacturing companies thus creating personal interest in getting this new procedure established.
A whole surgical community had to be trained at once; surgeons were clamouring for it so as not to be left behind their peers.
Insurers and government bodies colluded with surgeons to breach human-rights and the laws pertaining to informed consent to allow this new procedure to be trained and established.
Communities set up temporary training centers in non-university hospitals to accommodate the large, initial training swarm.
This large initial training swarm required patients to train on in order for the surgeons to gain experience and get their credentialing.
There were not enough valid gallbladder cases to go around for all to train on. False diagnosis for gallbladder problems took place.
A targeted victim group was skimmed off for use in training: people disenfranchised in one way or another and toll damages too small to interest lawyers who accept medical malpractice cases based upon their formula for determining economic damages: the elderly retired, housewives, single over the age of 25 with no dependents, people on public assistance, prisoners, etc.
In the initial training frenzy of L.C. the greed-crazed ER doctors making the referrals wanted that “referral fee” so badly they were referring people for gallbladder surgery for things like a fall.
One woman I know fell and bruised her ribs, went to the ER and got referred for gallbladder surgery–when she had no symptoms whatsoever.
Several hospitals would pull this trick: they’d admit people from the ER for any reason at all then once admitted they’d tell them they “needed” their gallbladder out and told them if they refused to go through with it nobody would sign their release form–and if nobody signed their release form then they would have to leave “against medical advice” and therefore they would have to pay for the overnight stay out of their own pocket instead of their insurance paying for it–so why not just go ahead with the surgery instead so they wouldn’t get stuck for the huge bill run up on them?
This victim trusted blindly when the surgeon advised the results of a pre-op ultrasound, The patient never thought to ask to see it for them self. Patient was told it was positive for gallstones and was so bad it would be an emergency soon. It was a lie. Then months after the surgery the surgeon actually admitted it didn’t need to be done–and apologized”
The victim of medical fraud later discovered the hospital was one of the two temporary “special” training centers set up to train the local initial training swarm of surgeons and were grabbing up every warm body they could con onto the operating table to meet their training needs.
The weirdest story came from the sister of this patient, : she had her gallbladder removed 20 years prior by the old, open method. She went to an ER for something else and the ER doctor was so eager to gather referrals (and the fee) that he referred her for gallbladder surgery! If he had even done a basic check he would have seen her big scar.
The entrepreneurial exploitation
The medical syndicate sold the surgery to the public through media outlets.
Printed literature extolling the virtues and minimizing and/or omitting the risks, were given to prospective patients.
Printed literature promised a prompt, ethical response to injury. (with no intention whatsoever of actually keeping that promise: too expensive)
Printed literature lied about actual injury and death rate, said it was 1-2% when it was actually 80+ %. (This is called “Fraud in the Inducement” when a person is deceptively lured into danger)
A referral fee of $2,500. was awarded to any doctor who made a completed referral to the training center. The usual referral fee for a completed referral to a teaching hospital’s student training at that time was $100. The large referral fee ignited a “feeding frenzy” with the ER doctors and family practitioners. Lives were bought and sold at a frantic rate. This is also called “human trafficking, fraud, civil conspiracy, collusion is an agreement between two or more parties to deprive a third party of legal rights or deceive a third party to obtain an illegal objective”
Lives were bought and sold with the full knowledge most of these people would be permanently injured or killed outright in the student training mills. This is also called “intent to commit likely Grievous bodily harm”, serious physical injury inflicted on a person by the deliberate action of another and is a very sophisticated form of serial killing.
Lives were bought and sold with the full knowledge that no ethical/proper response would be offered if the injury manifested/collapsed after discharge from the hospital–as most did due to the one-day stay.
Lives were bought and sold with the full knowledge most, if not all, of those targeted for use in training did not need this surgery. This is called “depraved heart murder crime , wilful doing of a dangerous and reckless act with wanton indifference to the consequences and perils involved”
Sudden, enormous, increase in the number of cholecystectomies with the introduction of the laparoscopic method. Documented in DRG files and trade literature.
“Cholecystectomies increased 159% following the introduction of laparoscopic cholecystectomy”
“It seems that the use of laparoscopic cholecystectomy, a new technology touted as reducing health care costs, may result in an increased consumption of health care resources due to changes in the indications for gallbladder surgery “
Increase falsely spun off to “backlog” and “patient demand” when it was actually “trainee demand”.
Patients injuries and death rates covered up
Increase in number of cholecystectomies brought increase in deaths and permanent and progressive injuries. Injury rate manipulated artificially low by actively responding to just one class of injury victim: the cases that collapse before discharge from the hospital and cannot be masqueraded to other causes.
The health insurance companies sold policies that offered “quality care”, listed ONLY the already-trained, experienced, practicing physicians in their plan booklets with no mention of green trainee substitution in the operating room after the patient is anesthetized and cannot stop it. (bait-and-switch)
Green trainees make their worst mistakes in the first 25-50 of each laparoscopic gallbladder procedure they perform.
The government pays teaching hospitals $100,000.+ for each resident they train and have a contractual obligation to provide/procure “teaching material” for their students to practice on.
The health insurance companies wanted the cost-saving potential of the new laparoscopic gallbladder surgery.
The health insurance companies often owned the teaching hospitals where the new surgery was being trained and the injuries were being created. And concealed.
The teaching hospitals control the medical record.
The health insurers did not want the enormous cost of providing proper aftercare and necessary intervention to all the injury cases created by their green trainees.
Bile duct injury is one of the worst injuries that can happen in abdominal surgery and is virtually irreparable even in the best of hands.
There is a one-month window of opportunity for a proper-but-expensive biliary repair, by a specialist, before permanent and progressive liver damage sets in.
Once permanent and progressive liver damage is allowed to set in the process cannot be reversed and leads inexorably to liver failure and death. An infectious process sets in that damages kidneys, heart, spleen–continually seeded all over the body from the damaged liver by way of the blood stream.
Thousands of deaths and tens of thousands of injuries were created in this initial training frenzy.
If the health insurers responded ethically to each case created they’d all bankrupt quickly.
If the malpractice insurers responded ethically to each case they’d all bankrupt quicker.
True death and injury rate manipulated artificially low. To their mutual benefit, the vested entities colluded/conspired to present a unified front and would control presentation and care offerings this way: Only the cases that collapsed before discharge from the hospital would actually receive that ethical, prompt response promised to all in the printed pre-op propaganda–only because those cannot be concealed. These would be the only cases counted.
The rest would get a sociopathically inhumane “cover-up-and-disposal” program that would make war crimes (Nuremberg war trials) look like a tea party.
Those injured would be methodically funnelled to specific specialist referrals in the local community and to specific laboratories: those who can be trusted best to stick to the “cover-up and dispose-of” protocols.
The natural features of injury at gallbladder surgery, particularly bile duct injury, would be exploited (a new secondary income streams for doctors and hospitals). Nothing shows on the surface where others can see it until the disease is well advanced. Nobody else can “see” pain, systemic infection, damage to other major organ systems and such as is common with this progressive injury(s).
Bile duct injury is one of the biggest “dirty secrets” of modern medicine: it is 100% doctor-caused unless a person was shot or stabbed in just the right places.
Symptomatic relief only/no active intervention–until you get well on your own, or die–and you will get that only if you shut up, stop fighting us, and accept a benign diagnosis that the treatment matches.” The doctors would not offer any response to our increasing symptoms but a useless symptomatic relief.
A false diagnosis of “mental disturbance” would be made and referral given to selected psychiatrists and psychologists.
The persistent patients would be routinely prescribed “psych drugs” to calm them into acceptance of their increasing symptoms, deliberately left untreated, and the myriad abuses heaped upon them. Designed to discredit them to others.
No proper, expensive, corrective surgery by a specialist, early, when it would do the most good. To do so would require exposing the malpractice. (“destroyed opportunity”)
To discourage injury victims from seeking care for their increasing symptoms the medical syndicate has demonstrated a standardized pattern of vicious verbal abuse, false accusations, and psychological battery at every encounter to make seeking intervention so unpleasant those injured gain an aversion to it and learn to avoid it. This is applied early and heavily to make the most lasting impact.
Injured become extremely valuable commodities to the medical syndicate as “teaching material” to be exploited and used up in further student surgery training, drug and device testing–which we are expected to pay for.
If that did not accept the “offers” made to us we are coerced into compliance by removing pain control and made to “earn” it back by compliance.
We are funnelled to “special” doctors in the community who can be trusted best to keep to the “use-up-then-dispose-of” program.
A correct diagnosis(s) is withheld. The standard of care is criminally reversed. Proper aftercare is withheld. We spiral downward, deliberately untreated.
X-ray tampering to hide injury. Lab reports falsified.
Wrong drugs are prescribed to make us worse, faster. (combining NSAIDS & H2-Blockers, erythromycin and Seldane, etc.)
Invasive testing is improperly performed to accelerate our injury and its consequences. (ERCP during active cholangitis without IV antibiotic protection, etc.)
Mass medical bills skyrocket, personal assets were pirated / plundered by running us through a never-ending battery of expensive, painful, dangerous, unnecessary testing done solely to stonewall and deceive. If we don’t pay the enormous medical debt run up on us liens are clapped on our homes, retirement funds, and such. Aggressive collection agencies are set upon us; our credit is ruined. If we speak out against what is done to us we are punished.
If we persist after being ordered to stop we are sent to prison on trumped-up charges (drug charges usually), confined to a mental institution for an attitude adjustment, or the psychological abuses are so heavily applied that few can withstand it and fall into helpless/hopeless despair or commit suicide.
Why all this, even long after the regular Statute Of Limitations and Statute Of Repose has expired? Why continue?
“THERE IS AN ONGOING TREATMENT DOCTRINE WHICH DICTATES THAT IN MEDICAL MALPRACTICE THE STATUTE OF LIMITATIONS WOULD NOT BEGIN RUNNING OR WOULD BE TOLLED UNTIL THE CONTINUOUS TREATMENT FOR THE CONDITION CONCLUDES.”
If no treatment for the true condition is ever initiated or recorded then it can never become continuous or conclude. This is what is driving these standardized abuses.
You can now understand how the medical industry colludes to protect its members from laparoscopic gallbladder surgery injury victims? These attitudes towards post care treatment and patient rights are still current today.
Consequences to victims
Outcomes breached several Universal Declaration of Human Rights (1948) including:
Article 5, 8 and 25 – Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, or other lack of livelihood in circumstances beyond his control.
Compromised ability to work and earn a living.
When people cannot work they consequently cannot build Social Security credits in order to later qualify for receiving benefits.
Without a correct diagnosis on paper victims cannot collect on their purchased disability insurance policies or access the Social Security disability benefits they are entitled to.
Without a correct diagnosis victims cannot adequately/accurately determine which drugs and treatments are harmful to their particular situation and avoid them.
Damage to marriage, children, family, and other relationships.
Victims become a burden to others: financially, socially, and physically.
Victims cannot perform usual chores and have to hire help or ask others to take over.
L.C. injury victims are immediately blocked/closed blacklisted out from accessing medical care: doctors automatically reject accepting them as patients, say they “do not want to get involved”.
Questions needing answering by Doctors
If this surgery is the cure-all it is touted to be WHY, then, are so many people sick and dying afterward?
Why an elaborate cover-up if none is necessary?
Why is the long term health risks known as Post cholecystectomy syndrome also never disclosed to the patient during the informed consent process.
Short background on Postcholecystectomy syndrome explained as: “The incidence of postcholecystectomy syndrome has been reported to be as high as 40% in one study, and the onset of symptoms may range from 2 days to 25 years. There may also be gender-specific risk factors for developing symptoms after cholecystectomy. In one study, the incidence of recurrent symptoms among female patients was 43%, compared to 28% of male patients.”
Postcholecystectomy syndrome (PCS), S. Mohandas, L.M. Almond, Department of General Surgery, Worcestershire Royal Hospital, Worcester, UK
Finally are doctors above the law?
The United States chief prosecutor for the Nuremberg trials, Telford Taylor opening statement pointed out this was “no mere murder trial,” because the defendants were physicians who had sworn to “do no harm” and to abide by the Hippocratic Oath. “ the trial was a murder trial and murder had been identified as a crime against humanity”
Doctors own testimonies at the time exposing the medical evil – criminal intent
PrimeTime Live (transcript) Airdate: 12-16-1993 Too Good To Be True?
“But tonight ABCs Dr. Timothy Johnson is going to tell you something you probably haven’t heard about this technique that hasn’t made the headlines–until now.”
“But there is a darker side to this revolution: surgeons who were inadequately trained, instrument companies who hyped it to the public, and an estimated hundreds who died and thousands who were injured by complications that many believe might have been avoided.”
“The way it was presented was that this was a surgery that offered few complications”
“Suddenly surgeons were scrambling to learn this new technique.”
“I didn’t know how people were going to screw this up until some people screwed it up”
“But many patients never heard about the potential problems. They only hear about the benefits.”
“…how little they say the hospital told them about the risks.”
“They didn’t talk about any complications for this surgery.”
“…this brochure, which was offered by the hospital’s public relations department. It says nothing
“It’s an illusion created by the company. It is a public demand that has been artificially created. It
is a scheme to use the mass media. It is, in fact, advertising.”
“There were many who started performing surgery without acquiring adequate training and skills. The result was that there was an explosion of injuries to patients’ biliary systems as well as other parts of their bodies, and many patients were turned into biliary cripples requiring multiple operations and procedures in an effort to effect a repair – a result which was a medical disaster for the patient, who then became another victim of medical negligence”
Archives Of Surgery Vol. 127, August 1992, Page 921 Laparoscopic Cholecystectomy. The New ‘Gold Standard’?. Nathaniel J. Sopor MD, Paul T. Stockmann MD, Deanna L. Dunnegan RN, Stanley W. Ashley MD
“Laparoscopic cholecystectomy has rapidly been adopted by surgeons, but concerns remain about its safety…”
“Rumor has it that many common bile duct injuries occurring as a result of laparoscopic cholecystectomy have not been described in the literature. Indeed, in the last year, surgeons at our institution have been asked to manage more than 15 injuries to the common bile duct resulting from laparoscopic cholecystectomy.
The American Journal Of Surgery, Vol. 161, March 1991, Page 399. “Training, Credentialing, And Granting Of Clinical Privileges For Laparoscopic General Surgery”. By: Thomas L. Dent
“Rumors of a steep learning curve, common bile duct injuries, massive hemorrhage, and even deaths following laparoscopic surgery are rife”
PROOF: introduced laparoscopic over nonsurgical treatment was a money making scam
Complications after laparoscopic cholecystectomy. MD Harvey R. Bernard’Correspondence information about the author MD Harvey R. Bernard1, BA Thomas W. Hartman1 Albany, New York, USA PlumX Metrics DOI: https://doi.org/10.1016/S0002-9610(05)80956-0
“The frequency of cholecystectomy has increased sharply, by 21%, since the advent of laparoscopic cholecystectomy. The serious injury rate may be approximately 15 times that observed after an open cholecystectomy.”
“The New York State department Of Health was alerted to possible problems posed by the largescale introduction of the laparoscopic methodology to general surgery as a treatment for diseases of the gallbladder by Dr. Hiram Polk, Jr., the editor of The American Journal Of Surgery, in May 1990. There were several factor that indicated a danger. These included:
(1) the attractiveness of the method to patients who were informed by the news media of the considerable benefits of minimally invasive surgery without any indication of the possible complications;
(2) the attractiveness of the method to surgeons who saw a ‘bread-and-butter operation threatened by nonsurgical treatment;
(3) the strong influence of instrument manufacturers for whom rapid dissemination of the technology was just good business; and
(4) the absence of the safeguards inherent in traditional surgical education in the numerous abbreviated training courses by which practitioners were introduced to laparoscopic methods.
Claudia Steiner, MD, M.P.H., February 10 issue of The New England Journal Of Medicine.”
“The study is the first in Maryland to analyse the pattern of a procedure called laparoscopic
cholecystectomy, or ‘lap chole’. According to the researchers, the procedure met unprecedented acceptance shortly after its introduction in 1989, without having undergone the scrutiny of a prospective randomized clinical trial. “As a result, there were many concerns about safety, who got the procedure and when
MAKING FALSE DIGANOSIS FOR WARM BODY TRAINING AND GAIN
The Columbus Dispatch June 5, 1995, Health column, New York Times News Service
“Gallbladder Surgery Easier–And Too Common?” By: Jane E. Brody
“In the five years since the technique was introduced, it has prompted a sharp rise in the number of gallbladders removed, in some cases from patients who have no symptoms.”
“Some experts now wonder whether the glamour of the high-tech procedure and the promise of a rapid postoperative recovery are resulting in a lot of needless surgery. Patients, though, forget that every operation has risks, and that the expected benefits from the surgery should justify taking those risks. Such justification may be lacking in most patients with gallstones that cause few or no symptoms. As health care budgets shrink, it is likely that stricter criteria will be established for a cholecystectomy.
Pedersen B1, Ellebæk MB, Dorfelt A, Qvist N. Cholecystectomy for uncomplicated gallbladder stones does not follow evidence-based recommendations.Dan Med J 64/11 November 2017 Danish Medical JOURN
CONCLUSIONS: Our results may represent overtreatment and/or incorrect selection of patients suitable for surgery. More and larger prospective cohort studies are warranted to elucidate the indications for cholecystectomy in uncomplicated gallbladder stones.
INFORMED CONSENT FRAUD
May 1993. “Management Of Major Biliary Complications After Laparoscopic Cholecystectomy” By:G. Branum MD, C. Schmidt MD, J. Baillie Md, P. Suhocki MD, M. Baker MD, A. Davidoff. MD, S. Branch MD, R. Chari MD, G. Cucchiaro MD, E. Murray RN, T. Pappas MD, P. Cotton MD , W.C. Meyers MD.
Dr. E. Armistead Talman: “It is not enough for SAGES to state, and I quote, “New laparoscopic procedures require informed consent, the exercise of sound surgical judgement and documentation of results in an environment designed to meaningfully evaluate safety and efficacy.” This just does not address the assault that marketing and competitive pressures have unleashed. In many cases this means someone picks up the pieces after the fact as Dr. Meyers has so vividly demonstrated today.”
Dr. David Adams: “…this has led us to believe that bile duct injuries after laparoscopic choleystectomy are more common than previously recognized, a point, I think, that has been underscored by Dr. Meyers report today.”
Variations in Consenting Practice for Laparoscopic Cholecystectomy. AM Chen,* DR Leff,* J Simpson, SJD Chadwick, and PJ McDonald
CONCLUSIONS: More often than not, patients are not provided with consistent information to make an informed choice. We suggest that a preprinted consent form will provide a more uniform approach to consenting practice for laparoscopic cholecystectomy.
NON REPORTING OF INJURY BY SURGEONS
FORUM, Vol. 18, No. 4, Fall 1997. “Bile Duct Injuries During Laparoscopic Cholecystectomy”. By: Brendan J, Carroll MD, Matthias Birth MD, Edward H. Phillips MD
“However, selection bias, under-reporting, and lack of long-term follow-up under-estimate the incidence of injuries.”
“To date, litigation has been resolved in 30 of the 46 cases studies. 21 were settled with payments ranging from $30,000 – $1,300,000 (average $221,000). Five plaintiffs prevailed at trial with an average award of $214,000 (range $125,000-$240,000)”
“The high rate of biliary injury associated with laparoscopic cholecystectomy has been attributed to the “learning curve”. Other reports have noted an ongoing problem well past the learning period. Of the injuries in the studied cases, nine occurred after the surgeon’s 50th case and five after the 100th case (including ductal transections and excisions). Clearly, no surgeon is immune from the risk of bile duct injury and no case is “routine”.”
“Surgeons performing laparoscopic cholecystectomies may encounter problems while attempting to repair bile duct injuries because of inexperience with the repair procedure. Primary surgeons tried to avoid major duct reconstruction in the hope that repair over a T-tube would suffice and would be easier to explain than hepatico-jejunostomies. These patients with a failed initial attempt at end-to-end repair underwent an average of two subsequent percutaneous balloon dilatation and two re-operations prior to successful recovery. Several patients had injuries worsened by inappropriate attempts at primary repair.”
September 1992. Management Of Bile Duct Strictures, An Evolving Strategy. J. Michael Millis MD, Ronald K. Tompkins MD, Michale J. Zinner MD, William P. Longmire Jr. MD, Joel J. Roslyn MD
“Approximately one-fourth of all injuries resulting in bile duct stricture were noted at the time of operation. It is interesting to note that more than 40% of patients in both groups presented more than 30 days after the initial injury, and 15 patients presented more than 5 years after the initial injury.”
Bile Duct Injury : Author unknown
Accidental damage to a bile duct during cholecystectomy is one of the most serious and difficult problems in abdominal surgery. Unless successful reconstruction is achieved progressive liver damage and fibrosis will occur and lead inexorably to liver failure and death.
JAMA, Vol. 269, No. 8, February 24, 1993, Page 1021. NIH Consensus Conference “Gallstones And Laparoscopic Cholecystectomy”
Bias toward the reporting of more favourable results is well recognized.
This is suggested by the fact that many major medical centers that are reporting relatively low rates of bile duct injury from laparoscopic cholecystectomy are simultaneously seeing an increased number of patients referred from outside hospitals for the treatment of such injuries. Thus, the reported data most likely underestimate the complication rates for laparoscopic cholecystectomy more than for open cholecystectomy.
TRAINING – LEARNING
Examining Your Doctor (book) Pages 206, 207. By: Timothy B. McCall
A doctor needs to perform a procedure a minimum number of times to gain competence.
To learn the technique, most doctor take intensive one-or-two-day courses usually given in hotels. They hear lectures, watch demonstrations, practice on models, and finally try out the technique on digs or pigs. Approximately ten thousand surgeons have taken these courses since the late eighties. According to the New York Times, some doctors did their first cases on a human a few days after practicing on a pig. It’s perhaps not surprising then that early on there were reports about high rates of complications.
These doctors had a 22 percent rate of complications
INJURY TO MAIN BILE DUCT – MEDICAL MISADVENTURE
August 1990. “Iatrogenic Injury To The Bile Duct–Who, How, Where?”. By: A.R. Moossa MD FRCS, A. David Mayer MS FRCS, Bruce Stabile MD
“Bile duct injuries that are recognized and repaired immediately have the best prognosis.
However, surgeons omitted cholangiography in most of our patients, and thus compounded the injury by failing to recognize it. Injuries that are only identified postoperatively should be referred to a specialized center with major interest and experience in hepatobiliary surgery because a failed attempt at repair may seriously compromise the outcome of a high stricture.”
“Injuries to the main duct are nearly always the result of misadventure during operation and are therefore a serious reproach to the surgical profession. They cannot be regarded as just an ordinary risk…”
“ My observation is that the primary surgeon’s relationship with the patient and the relatives before and after the injury determines what happens more than anything else. If the relationship is good, there has not been a legal problem. If the surgeon just abandons the patient and usually transfers the responsibility to a gastroenterologist and/or radiologist, a series of further disasters and legal complications often ensues.”
PATIENT TESTIMONY OF FRAUD – MEDICAL ASSAULT – BATTERY – NEGLIGENCE
“I myself was railroaded through to gallbladder surgery even though I am a 25 year old male, because I had persistant heartburn. They did a CCK test and sonogram and just told me my test came up positive for GB problems. Then they took it out. I went through about three months of severe pain in the liver area—which I was told was in my head—and now my persistent heartburn problem is even worse. I can barely sit in a chair for any amount of time, and now it has been a year and a half. Lord knows what’s going on internally by now. Oh yeah, about two months later I requested the report written by the pathologist who inspected my gallbladder and my other test reports—he wrote my gallbladder was absolutely normal. My other tests reports said normal too. I am doing my utmost to keep my job while in all this pain but if things get worse for me I don’t see how I will be able to do it. But what do the doctors care about someone like me when they injure someone, Arkansas is notorious for favoring the moneyed.”
“I am a retired grade school teacher. I was outdoors working on a ladder when I fell off and hit my ribs against a tree stump. Because of the bruising I thought it was a good idea to go to the ER for an x-ray to make sure I had no broken ribs. The ER doctor ordered a chest x-ray and immediately started talking about having my gallbladder removed. He said it had to be done right away, that it was an emergency, and he admitted me to the hospital overnight for surgery the next morning. The surgeon who was contacted to perform the surgery came to my room to speak to me about it. I told him I had no digestive symptoms whatsoever, and never had any in my entire life, and I just couldn’t understand this rush to surgery. He told me the x-ray showed many gallstones and it had to come out right away. My family doctor surprised me with a visit to my room. I do not know how he found out I had been admitted for surgery the next morning because I didn’t think to contact him. His attitude was very different from the ER doctor and the surgeon: he told me not to go through with it no matter what they said to me, told me I was being railroaded and that gallbladder surgery is an elective procedure that could be performed at any time so there was no good reason why I could not go home and take the time to gather information about the gallbladder surgery. I told him I was very confused by the fast way this was sprung on me and the conflicting advice I was getting from the doctors. He said that was all the more reason not to jump into surgery right now and that I needed to go home and think about it first. He advised me to get out of that hospital as fast as I could manage it. Before he left my hospital room he ordered a huge supper for me, told the nurse to go get it and bring it to my room immediately, and said I was to eat every bite of it. When the surgeon returned later that evening and found out what my family doctor had done, he was furious: I was to fast before the surgery and because I had eaten a huge dinner he could not perform surgery as scheduled the next morning. I was preparing to leave when the surgeon and a nurse came into my room and talked to me some more about the gallbladder surgery. They said I would die if I did not go through with it. I don’t know why I agreed to it, maybe because I was frightened and confused, but I signed the -105- consent forms they’d brought in with them and agreed to the surgery they recommended. I didn’t have digestive symptoms before the surgery but now I have many digestive, and other, symptoms: nausea, pain, diarrhea, vomiting, dizziness. A friend of mine who is a nurse at the same hospital told me a plain chest x-ray can’t show gallstones. She also told me the surgeon who was called in to perform my surgery doesn’t do them himself but rather trains residents laparoscopic cholecystectomy in that hospital and residents do all these surgeries.”
In 1992 I had laparoscopic gallbladder surgery and was very sick afterward: jaundice, pain, fever, weak. My doctors tried to tell me I had cancer but I did not buy it. Finally I found out about bile duct injury and went to see a specialist over at OSU. He told me he would repair my bile duct but on the condition I would not sue my surgeon and with the understanding he would not be writing anything incriminating down on my operative report that I could turn around and use against my surgeon in court. I agreed to those terms and had the repair surgery. I am much better but not exactly the way I was before my gallbladder was removed. So, I guess it was worth it.”
“…I brought my x-ray film plates with me when I went to see the surgeon I was referred to by my GI doctor. You told me not to let them out of my sight but I wasn’t thinking clearly at the time so when the surgeon picked up the whole folder and carried it out of the room I did not even think for a second to stop him. You can guess what happened next: I never saw my x-ray films again. He came back in the room without my folder and I asked for him to go get them and give them back to me. He said “what films? I have no idea what you are talking about!” and that was that. All gone. My x-rays showed a device shaped like two doorknobs stuck together. I wanted to show him this thing and ask him what it could be and if that could be the source of my pain and other symptoms. Now I don’t have the films to show to anyone else and get the help I need.”
“I am an investigative reporter. After listening to your stories I walked over to a hospital near my home and asked the office staff to show me their standard admission form and standard procedure consent form. One staff member said he’d go get them for me to look at and to sit down and wait, he’d be right back. I waited and waited but he never returned, just left me sitting there and I had to leave empty-handed. What do you think they did not want me to see?”
“XXXXX contacted me in your behalf and asked me if I would tell you the exact dollar amount of the “referral fee” doctors get paid for each completed referral they make into the teaching hospital’s resident surgery training program. The usual referral fee is set at $100. For laparoscopic cholecystectomy, however, it was set at $2,500. in 1991 when you had your surgery. Emergency Room docs made out like bandits…your life was sold away for $2,500. Now you know why so many people were referred for surgery they did not need.”
M.S. MD (Cardiologist, Virginia)
My sister had her bile duct severed Oct 17 2006 .Thanks to the “They sent me home to die” letter you wrote, I was able to get my sister sent to a biliary specialist six hours away. It took almost a week to get her transferred to the other hospital . She was having same day surgery to have her gallbladder removed and it went wrong, the Dr. told us it was his first time making the mistake and even though he did not know what he was doing he tried to repair it. She spent almost a month at Vanderbilt Medical Center , it was the -151- worst thing I have ever seen, her intestines blocked, she had 2 tubes draining bile off her stomach and 1 down her nose pumping it out of her stomach, and she was still vomiting bile. The team of specialist she had were great, they got her well enough to come home. They said that she was to sick to try to do a repair surgery–they didn’t think she would live through it. And at the time every thing was flowing correctly on the CT scan. Since she has been home she has been back to the hospital 4 times, twice they kept her there. She is at the DR. every week for labs. Her symptoms now are vomiting, dark green watery bowel movements that she has no control over, fever, stomach pains and bloating . Her new Gastro Dr. told her last week that he could not find anything wrong with her and he would no longer be able to treat her as a patient.
We are now starting to believe they sent her home to die and she is only 33
Alyssa (Tennessee) (abridged)
“Last week I was at Johns Hopkins and they did give me an MRI of my gallbladder area and I noticed that it was written on the bottom of my script “2 years exp”. I suddenly remembered what you said in the past about the statute of limitations and the statute of repose and how the doctors comspire to sit on our cases and just do nothing on purpose until those two time-limits expire and how you said wait and see if they finally respond when it did expire depending on what state I lived in. You were SO right! I had begged for an MRI, just like everyone else I know with this problem, for two years and nobody would do it. Now all of a sudden I can have it done? They told me they did not see anything wrong but offered me more tests such as an ultrasound of my bile duct…just like you said they would: tests, tests, tests but no real care. I’m not sure if I am going to do the tests or not. It is three hours driving to the hospital and three hours back home. I am too sick to make that trip and getting sicker all the time. My original surgeon called me and asked what was going on with me, pretending like he really cares.”
“Upon the insistance of his family practice quack insisting the gallbladder be removed my uncle -153- had surgery yesterday to remove his gallbladder. The surgeon came out of the operating room and told us there was nothing wrong with his gallbladder and he did not have any gallstones but said now he’s got severe liver problems and accused my uncle of being a drunk–he is NOT a drinker and never was. I know this for a fact. I think the surgeon damaged his liver and is trying to pin blame on my uncle…” “Never mind, my uncle died. He had a bile leak and lived just three days after the surgery.”
“My brother had bowel cancer. But his doctors told him he needed his gallbladder taken out! The doctors KNEW he had bowel cancer BEFORE they told him he needed his gallbladder taken out but did not tell him that until AFTER the gallbladder surgery. They should have told him about the cancer FIRST! If he had been told about the cancer FIRST I am positive he would not have allowed them to take his gallbladder out. He came out of the surgery a total mess, all swollen in the abdomen and screaming in agony. They let him go like that a couple of days until he finally died from it–a terrible death. I believe they did him like this to let residents practice gallbladder surgery on him because he had cancer and they figured they’d just use him up for their own benefit.”
R.B. L. (New Jersey)
I just read through your story with tears rolling down my face, I am a victim too, I have 10 months left to try to find an attorney that might be able to help me pay for some of the medical expenses I have incurred before my statue of limitations expires. And the expenses I will have the rest of my life. I am 28 years old and a mother of 3, Doctor’s insisted I needed my gall bladder out, I didn’t know any better, was never told about any complications. In fact I was told that I would have more chances of being struck by lightning driving myself to the hospital to have the procedure than anything going wrong. Four days after the procedure and calling and trying to get somebody to see me and telling them something was wrong and just given more pain med’s, I went into shock in the middle of the night, I am assuming from pain and my husband had to call the EMT. I sat there ( hospital) for 2 days in horrible pain which until now you are the first person that knows that pain, letting bile leak out and burn everything it touched. I could go on -158- and tell you the 2 and a half years of hospital stays and “procedures” and being told that no surgeon will operate on me, and even some doctors telling me nothing “SHOULD” be wrong! Everyday of my life I suffer, my children suffer and my husband suffer, and I keep getting told that what happen to me was within the “standard of care”, but the truth being nobody wants to testify against the surgeon. My medications cost over $1000.00 every month, I am on enough pain med’s to kill a person a day just to be able to function. I have never been able to take my 2 year old son, who is almost three to the park by myself. Our whole life has been changed before it even got a chance to begin. I need help, I don’t know where to go or who to ask about what this “standard of care” even is, a stint saved my life, but if it wasn’t for my children and the love I feel for my husband I wouldn’t have wanted it to. I would really love to talk with you and maybe you might have some information that could help me or vise versa . My prayers are with you and yours, and like the pain that I feel I wish to you moments of peace and moments of being pain free.
“I had my gallbladder removed in 1993. I was fine for about five months then one day I was walking down the hall and was suddenly doubled over in agonizing pain on my right side under my ribs in the same area my gallbladder used to be. I was sent from doctor to doctor, all of whom did testing, but it all came back negative. To make a long story short, and tired of the doctors I was referred to telling me I was imagining things and them wasting money I couldn’t afford to lose, I finally went out of my area and found out I had gotten a bile duct injury at the gallbladder surgery and it was repaired by a difficult surgery with a very large scar. I was better for a short time after the repair but soon the pain returned—worse. I had been single for several years and had found the man of my dreams and gotten married two years before my gallbladder surgery. At my age I did not expect to find love again. We were happily married and building a nice life together when I was injured. My husband wanted things to return to normal and wanted to have the wife back he had enjoyed before my injury but when he understood I was never going to be normal again he left me. Oh, he stuck around about two years waiting and hoping but once the truth hit he told me: “I want a whole marriage” and divorced me. I asked one of my doctors to write him a note saying I was not physically capable of all the activities we enjoyed before I was injured but it made no impression on him and he left me anyhow. Back when I was single I bought disability insurance and had kept the premiums up after I was married. I could not receive -92- benefits when I needed them, however, because the surgeon who did the repair on my bile duct refused to put a diagnosis down on paper (he told me before the repair surgery he would not do it, said he didn’t want to get involved) that I could turn in and collect on my policy: the repair surgery itself was not proof enough for the insurance company; they insisted on the doctor’s report. Unable to work, I lost my job and home and now live off Welfare—I have no choice. I am a registered nurse.”
I had my gallbladder removed in 1998. I had a laparoscopic cholecystectomy done. He cut my bile duct in two. I have suffered a lot. I am still paying for that man’s mistake. I had three surgeries done in two and a half years. I have had a lot of tests and procedures. I have seen a lot of doctors. It’s getting old fast. It all started in 1998 when I had my gallbladder removed. I was not told of any risk involved. I thought everything would be fine. Wrong!! He had my gallbladder out and told me everything went well. The day after I started leaking bile thru my incisions. The nurses and the doctor told me that leaking bile thru my incisions was normal and that it was a good thing that I was. Finally after leaking bile for three days they came in and got me so they could do two tests on me. They were a HIDA scan and an ERCP. I was already put out from the ERCP so I didn’t know what was going on. I don’t even remember talking to my husband or my kids. My husband was at home at the time they were doing the tests but was called to the hospital to sign some papers. He had to sign for me to have an emergency surgery. My husband asked the doctor what was going on and all he told my husband “it’s broke and he’s going to fix it”. Which the surgery took six hours. I didn’t even know I was going to have another surgery. This surgery was three days after my gallbladder surgery. It took me a while to even realize I had a second surgery because I was so drugged up. I was in the hospital another four days after my second surgery then I was finally released. The doctor wouldn’t release me from the hospital until I had someone watch my two young kids. (I was in the hospital for eight days) Five days after being released I went back into the emergency room because I had a T-tube that was supposed to stay in me for nine months but the tube slipped in and was hurting. The surgeon who did the two surgeries was the doctor that they called in. We told them that we didn’t want that doctor to see me and they said “he’s the one who did my surgeries”. Finally what I thought was the end of my pain and suffering. It didn’t stop there. I went a year and a half after that not feeling good, feeling sick to my stomach, loss of appetite, my stomach would swell up. I even lost a little weight. Last July is when it all started up. I was having really bad stomach pains so bad I went to the emergency room. The pains were so bad I thought it was worse than my gallbladder attack. They gave me something to drink and sent me home. It didn’t help. All it did was make me throw up all night. The next day my mother called -94- the doctor’s nurse. She told my mom to get me back to the emergency room now and if they didn’t help me to call her back. They put me in the hospital. The gastroenterologist and the surgeon who saw me last year when I was really sick said “this is life-threatening”. I was so sick I had lost fifty pounds. I was in the hospital a few days then they transferred me to XXXX I stayed there a few days and they did some tests and they finally found my bile duct was closed off…there was an operative staple that the surgeon put in the wrong place. I didn’t even know he had done that. He shut my liver completely off. So the doctors in XXXX went in and ballooned it open and put a stent in to keep it open hoping it would work. They said I would know in two weeks if it worked or not. Two weeks came and I was sick again: fever, chills, nausea, jaundice, stomach would swell up real big. The doctor put me on an antibiotic and I would still run fevers. He said he wanted to see me in his office. He told me I needed a third operation that I didn’t want. My third surgery was done in 1999. I really thought the third surgery was going to work because I felt good and didn’t hurt. Five months passed and I started getting sick again just like before. I had a lot of doctors but none of them could figure out what was going on. My liver functions would come back good. The doctors said they couldn’t understand why I was running fevers when they couldn’t find any infection inside my body. All my tests kept coming back normal and then my first surgeon started telling me I am crazy and it was all in my head! The gastroenterologist said he doesn’t want to do anymore tests because he doesn’t want me to get an infection and make me sicker than I am so he is recommending a liver specialist in XXXX. Before it is all said and done I will probably be having a fourth surgery to get whatever is wrong fixed. This has been a nightmare. Don’t even have the words to describe all that I have been through. It has been very stressful, emotional, and frustrating. I know you probably know what it feels like. I really don’t know all of the damage that was done to me. It was really nice to come across somebody that has had the same thing happen to me because you are the first person I heard of that went through the same thing that I went through. I was twenty-two when all of this started. I will be twenty-five this month. I have been going through pain and suffering three years. I hope it will stop soon. I am married and have two children. It is really hard to take care of the kids when you are as sick as I have been. It has been hard on them too. I feel lousy all of the time. It is an everyday thing. My stomach is swollen and hurts. My right side where my liver is -95- has been hurting too. It has been the worst thing that has ever happened to me in my whole life. I am not only scarred on the outside but I am scarred on the inside too. It has affected me really bad. I will never be able to forget it. The pain and suffering that I went through will always be there no matter what. I agree with you I don’t see how the doctors who mess people up like this can sleep at night knowing what their mistakes have costed a person. They knew when they made their mistakes that the person is going to suffer a lot. I also agree with you almost everything I have came across about laparoscopic cholecystectomy don’t say anything about risks not less anything about a bile duct injury. I think people ought to be completely aware of the risk involved. It is their life they ought to know about the risk involved. They are the ones whose got to suffer the consequences. I had to write to you to let you know you aren’t the only one who has been injured. I am so glad to have seen your letters on the internet. God bless you!
“I was admitted to the ER in November for what I thought might be my appendix but turned out to be gall stones. A doctor came and told me I would have to have my gallbladder removed. I woke up 10 days later in the ICU. I was told there were complications in my surgery, a second doctor performed a laparoscopy I guess and managed to puncture both my intestine and my bile duct where the bile was allowed to leak into my abdominal cavity. The first doctor had to cut me -96- all the way open and clean me out twice. I was in the hospital for over three weeks and have a $100,000. dollar hospital bill.
“I was suffering with stomach pain when I ate certain foods. I went to the doctor he ordered an ultrasound to be done on my stomach and that was all. Based on what he thought he saw he said that I had a stone in my gallbladder. And that I needed to have it removed. Based on what he said I had the surgery. After the surgery they could not find anything wrong with my gallbladder at all. So now I don’t have a gallbladder and am still suffering from the same pain.”
“I had the exact same symptoms and my family doctor did stool labwork. It turned out I have parasites called entamoeba hartmanni and endolimax nana. They are harmless but cause gas, bloating, and stomach gurgling. Unfortunately my family doctor won’t give me the medication to kill them because they are not harmful. Apparently the medication will only work once so if you ever get the ones that do cause harm it won’t work. I don’t know what to believe but she gave me Propulsid for the symptoms but its not a cure. The doctor at the ER told me I needed to have my gallbladder removed about a week earlier. My family doctor said he is a liar with no conscience.”
Author : Elizabeth Eugenia LaBozetta
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