Hernia repair is performed electively or emergently based on the patient status at the time. It is necessary to perform 'electively' to prevent strangulation which makes it emergent and can make the patient at higher risk for complication. She is a candidate for the surgery if she has not had stroke or mi in past 6 months (abnormal ekg) or unstable rhythm on ekg. The standard of care issue you raise - if he checked for perforation and missed it he is not negligent. He simply missed it . If he did not DOCUMENT that he checked for perforation, even if he always does it, then he did not check for perforation under the law. The law states that if it is not documented then it did not happen(even if you know you did it but forgot to write it down.) Reason for fever on post op day 1 - the first thing that comes to mind is infection - but commonly pt's with dehydration, breathing issue, slow movement of colon will also present with fever. It all depends on the doctor's interaction with the patient at the time - as to what he would have been thinking. I wouldn't necessarily say you had delay in diagnosis of the post op infection, because it takes some time to manifest itself before it can be discovered. As for the ct report - a few hours most likely did not change the outcome of the widespread peritonitis and sepsis. The only point of contention I see is if the first surgical report does not state he checked for perforation - you may have a case. Otherwise the rest of the issues were par for the course and would have transpired similarly over similar time frames for the most part.
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DrStephanie
