A 42-year-old male is scheduled for bilateral total ethmoidectomy. Preoperative CT shows mild to moderate ethmoid disease bilaterally. No polyps, but CT revealed a low-lying skull base. Endoscopic sinus surgery was performed. The procedure took 2-1/2 hours and the blood loss was significant (900 cc). Postoperatively, the patient had a CVA and altered sensorium. At pathology, he had both gray and white brain matter bilaterally. There was a brain hemorrhage; he also had an aneurysm that had to be fixed by neurosurgery. The patient survived but had permanent brain damage as a result of the injury.
Is this a case of negligence or just a bad outcome?
Dr. Stankiewicz: This was a very interesting case I participated in about 15 years ago. It changed my mind about what is defensible and what isn’t. Basically, the decision at trial was this was a low-lying skull base-it could have happened to anybody-and this was a bad outcome but not enough to prove negligence.
Ms. Foltz: It is absolutely true that a bad outcome is not enough to prove malpractice. But remember, there will always be someone out there, I guarantee you, who will testify against you and there is nothing you can do to guard against them. My suggestion is if you have an outcome that is not what you expected or desired, the best thing you can do to try and avoid a lawsuit down the road is to talk to the patient honestly and empathetically about what happened.