Patient Suffered Permanent Nerve Damage Due To Botched Saphenous Vein Harvest

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The law firm of Lupetin & Unatin routinely helps Pennsylvania patients find answers to their questions about medical malpractice and catastrophic injuries and deaths that often result from medical negligence. Our medical malpractice lawyers are knowledgeable and experienced in handling a variety of medical malpractice lawsuits. In what will be an ongoing blog series, we will discuss the facts of medical malpractice lawsuits successfully resolved by Lupetin & Unatin.

Today’s case involves a gentleman in his 60s who suffered needless injury due to medical negligence during his preparation for a coronary bypass surgery. Every year, thousands of patients undergo Coronary artery bypass grafting (otherwise known as “CABG”). CABG is a type of surgery that improves blood flow to the heart. Surgeons use CABG to treat people who have severe coronary heart disease (CHD). CHD is a disease in which a waxy substance called plaque builds up inside the coronary arteries.

In 2011, our client was admitted to a local hospital to undergo a CABG procedure. In preparation, the doctors planned to perform an endoscopic vein harvest of the patient’s saphenous vein. The saphenous vein is a large vein that runs the length of the inside of our legs from groin to foot. For CABG procedures, thoracic surgeons use pieces of the saphenous vein to create the bypass or graft around the patient’s blocked coronary blood vessels. Here is a picture of the leg depicting the location of the saphenous vein and saphenous nerve:

On the date of surgery, the patient was placed under general anesthesia.  Thereafter, a physician’s assistant endoscopically attempted to remove from the patient’s leg the necessary saphenous vein.  The harvesting procedure began by the physician’s assistant making an incision just below the patient’s knee.  The physician’s assistant was then to dissect the subcutaneous tissue in the leg and locate the greater saphenous vein.

The physician’s assistant had been trained or was supposed to have been trained to be able to identify the difference between a vascular structure such as the saphenous vein and a nerve.  Thereafter, the physician’s assistant was supposed to introduce an endoscopic vein harvesting device into the patient’s leg.  This device would then allow the assistant to refer to a video monitor to watch the endoscopic procedure and show her guiding the device through the subcutaneous lawyer (below the skin) of the patient’s leg.  The assistant was then to dissect the patient’s vein from surrounding tissue, moving first from the knee to the groin and then back to the knee.  Next, the assistant was supposed to insufflate (expand with air) a tunnel around the vein and proceed up and down the leg once again, this time manipulating the vein to expose branches between the greater saphenous vein and the femoral vein.  Thereafter, the assistant was supposed to carefully ligate the branches of the saphenous vein with cauterization (using a tool to burn away tissues).  The harvesting procedure was then to be completed by the assistant ligating or cutting the end of the vein closest to the groin and then pulling the vein in its entirety through the initial incision just below the knee.  Here is a picture of what the CABG harvesting procedure looks like:

As is required by the Pennsylvania Board of Medicine, the physician’s assistant was required to perform this saphenous vein harvesting procedure under the direct supervision of the thoracic surgeon whom was ultimately going to perform the cabbage procedure.  It turned out, however, that in this hospital setting, the physician’s assistant, contrary to the rules of the Pennsylvania Board of Medicine, was routinely permitted to perform the vein harvesting independently and without direct supervision.  In the instant case, the physician’s assistant performed her harvesting work while the thoracic surgeon worked elsewhere preparing the patient for surgery.

Lawsuit discovery undertaken by the lawyers of Lupetin & Unatin, (that is the use of written questions as well as oral questions under oath) revealed that the surgeon expected the physician’s assistant to consult if there were any problems with the harvesting procedure.  In fact, the physician’s assistant confessed that she was having doubts when she first identified what she believed to be the patient’s saphenous vein.  Specifically, the physician’s assistant admitted that she was unable to identify the patient’s greater saphenous vein upon initial dissection.  Eventually, she located what she thought was a branch of the greater saphenous vein.  Resultantly, she placed the vein harvesting device on the branch of what she believed was the saphenous vein and dissected this structure from the incision all the way up to the patient’s groin.  Unfortunately for the patient, what the physician’s assistant mistakenly understood was a branch of the saphenous vein was not any type of vascular structure but instead the saphenous nerve.

Though unsure as to exactly what she was dissecting, the physician’s assistant persisted in her harvesting procedure.  Discovery also revealed that instead of consulting with the thoracic surgeon, she instead asked for the assistance of another physician’s assistant.  Regrettably, this additional physician’s assistant simply confirmed what the first assistant had already believed and agreed that the harvesting procedure should continue.

Regrettably for the patient, the physician’s assistant removed a large portion of the patient’s saphenous nerve instead of the intended and needed saphenous vein.  The physician’s assistant did not realize the error of her ways until she presented the patient’s nerve to the thoracic surgeon for use in the cabbage procedure.  Immediately, the surgeon realized that the patient’s nerve had been mistakenly removed instead of a vein.  Thereafter, the vein harvesting procedure was performed again – this time with proper oversight and the patient’s saphenous vein was removed for the CABG procedure without additional incident.  The CABG procedure went smoothly and the patient, from a coronary perspective, recovered well.

Regrettably, the patient was left with permanent and avoidable nerve injury in his leg as a result of the physician’s assistant failing to follow the standard procedure for vein harvesting.  The patient was only able to learn the complete and full details about what had happened to him after the lawyers at Lupetin & Unatin investigated the medical records and the medical personnel that performed the procedure. The lawyers at Lupetin & Unatin were able to not only provide the patient answers but through the use of experts and their own medical malpractice experience obtain a fair resolution for the patient and his family.  Though the patient was told shortly after his cabbage procedure what, generally, had occurred, he never would have known the details about how this happened and how it could be prevented in the future without the insight and assistance of the lawyers at Lupetin & Unatin.

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