Wrong Diagnosis Leads to Unnecessary Surgery

A 62-year-old female patient presented to the ER with intermittent dull back pain for 2-3 weeks. She was previously seen at her primary care doctor, diagnosed with a UTI and sent home. The imaging results obtained in the emergency room suggested a possible aortic dissection and the patient was rushed to emergency surgery. Upon opening the abdominal cavity the doctor reported in his surgical note that there was a minimal tear and he performed a conservative repair. Shortly after the patient was discharged she received an anonymous note from a nurse stating that during the surgery, after opening the chest, the patient was found to have essentially a normal aorta without any dissection or aneurysm and despite the opinion of the OR team, the surgeon performed an extensive surgery and completely disregarded the patient’s safety in what presumably seemed as a way to overbill for his services.

Question(s) For Expert Witness

1. Is it a coincidence/suspicious that the incision was apparently made “directly upon the site of the very well localized intimal tear”?

2. Does the path report support that there was a dissection?

Expert Witness Response E-003939

If what this nurse wrote is true, than this could be a criminal case. I have had three or four people in my career, where we suspected AAD, but when we went in, it wasn't. I'd rather go in and make sure, than allow the tear to progress. It takes about two seconds to determine if there's a tear, and if not, the patient should be immediately closed. The only way to determine if this surgeon was correct or not would be to see the pre-op reports, and make sure the indications were appropriate to have gone into surgery in the first place.