Wynn v. Gilbert, C-060457 (6-8-2007)

2007 Ohio 2798
CourtOhio Court of Appeals
DecidedJune 8, 2007
DocketNo. C-060457.
StatusPublished
Cited by11 cases

This text of 2007 Ohio 2798 (Wynn v. Gilbert, C-060457 (6-8-2007)) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Wynn v. Gilbert, C-060457 (6-8-2007), 2007 Ohio 2798 (Ohio Ct. App. 2007).

Opinion

DECISION. *Page 2
{¶ 1} In this medical-malpractice case, defendant-appellant Carl Gilbert challenges the jury verdict and the award of prejudgment interest in favor of plaintiff-appellee Celeste Wynn. Wynn alleged that Dr. Gilbert had severed the wrong duct while removing her gallbladder, and that the reconstructive repair had been done in reverse peristaltic order, causing her excruciating post-operative pain.

{¶ 2} Dr. Gilbert's defense was denial, even in the face of overwhelming evidence that he had botched the operation. The jury saw through the masquerade. And this ostrich-like defense more than supported the trial court's award of prejudgment interest. We affirm the trial court's judgment in all respects.

I. The Mistake — and Consequences
{¶ 3} The removal surgery was initially planned as a micro-invasive laparoscopic procedure. But after cutting the wrong duct, Gilbert was forced to modify the operation to an open procedure so that he could repair his error and better identify Wynn's anatomy. Gilbert opened Wynn up, consulted fellow surgeons on how to proceed, removed the gallbladder, and then attempted a Roux-en-Y to reconstruct the errantly transected duct.

{¶ 4} After surgery and for the next six months, Wynn experienced excruciating pain, lost 46 pounds, and had little strength to care for either herself or her children. Gilbert was unable to determine the cause of Wynn's extreme pain, eventually hypothesizing that she was suffering from phantom pains or depression.

{¶ 5} Wynn sought another opinion from Dr. Jeffrey Matthews, Chairman of the Department of Surgery at the University of Cincinnati. During an exploratory *Page 3 surgery, Matthews discovered that the Roux-en-Y procedure had been done in reverse peristaltic order (counter to the main alimentary-tract progression). With the faulty reconstruction, food "traveled against the grain," towards the common bile duct and liver. Matthews reconnected Wynn's intestines from the reverse order to the proper orientation, and she recovered and sued.

II. Wynn's Background and Surgeries
{¶ 6} Wynn had the gallbladder-removal surgery in October 2001, and at the time she was in otherwise good health. She was a married 36-year-old hair stylist and mother of an 18-month-old son and a 9-year-old daughter.

{¶ 7} This case can be divided into three significant events: (1) the laparoscopic cholecystectomy ("gallbladder surgery"), (2) the resulting Roux-en-Y choledochojejunostomy (the "reconstructive repair"), and (3) Matthews's exploratory surgery ("exploratory surgery"). The negligent gallbladder surgery and resultant reconstructive repair were two separate procedures that occurred during the same surgery in October 2001. The exploratory surgery was completed in April 2002.

III. The Gallbladder Surgery
{¶ 8} A laparoscopic gallbladder surgery initially requires the surgeon to correctly identify the Triangle of Calot. The Triangle refers collectively to the cystic duct, the common bile duct, and the liver. Only after the Triangle has been visualized should the first cut be made; and only the cystic duct should be transected. Identification of all three sides of the Triangle is critical because in isolation the cystic duct and the common bile duct are nearly indistinguishable. But if the surgeon is able to see the liver and both the common bile duct and the cystic duct *Page 4 simultaneously, then the two ducts can be differentiated. Again, it is the cystic duct that should be transected and not the common bile duct.

{¶ 9} While attempting the minimally invasive laparoscopic procedure, Gilbert completely severed the common bile duct, necessitating a more invasive open procedure. At trial, Wynn argued that Gilbert had failed to identify the Triangle and that this conduct fell below the surgical standard of care. Gilbert countered that he had reasonably identified the cystic duct, but that in hindsight he had simply misidentified Gilbert's anatomy. That the wrong duct was transected is certain.

IV. The Reconstructive Repair and its Aftermath
{¶ 10} After cutting the wrong duct, Gilbert was forced to convert the surgery to an open procedure so that he could better identify Wynn's anatomy and perform the reconstructive repair of the wrongly severed common bile duct. Because the duct had been completely severed, Gilbert was required to perform a duct-to-duct surgical connection (anastomosis) between her lower intestine and her common bile duct. In this procedure, a transection is made at a random point of the lower intestine (jejunum). The lower (distal) end of the transection is connected (anastomosed) to the injured common bile duct, creating a defunctionalized limb. The upper (proximal) end of the transection is then remerged (anastomosed) downstream (to the defunctionalized limb), creating a Y. When the procedure is performed correctly, food and bile are propelled in one direction.

{¶ 11} A week after the surgery, Wynn was unable to walk without assistance, was very weak, and could not ingest enough food to maintain proper nutrition. These ailments were compounded with periods of 104° — 106° fever, dry skin, and pain. She *Page 5 also suffered from inflamed bile ducts and had a biliary anastomotic leak (biliary fluid leaking into her abdominal cavity at the point of the surgical connection).

{¶ 12} Wynn required 24-hour aid including assistance in dressing, bathing, rearing her children, and using the restroom. She could not work, and every time she attempted to eat, she would experience excruciating pain that "felt like food was cutting through her system." Wynn's sister described the aftermath of ingestion as agonizing to watch and hear: "[W]ithin minutes of ingesting anything * * * [an] awful gurgling sound [could be heard], and [Wynn] would start to rock and shake. It was agonizing to watch her attempt to eat, but we felt like we ha[d] to work with her to get her to eat just to stay alive." Wynn's mother similarly testified that, after Wynn would swallow, her stomach could be heard churning from across the room and that it sounded as if something in her intestine was twisted and moving in the wrong direction.

{¶ 13} These symptoms progressively eroded Wynn's health. She lost 27 pounds in two weeks, and 46 pounds total. For the pain, Wynn was prescribed Demerol, Dilaudid, Morphine, Percocet, Roxicet, and Vicodin over the next six months. At one point, Wynn's symptoms had become so insufferable that she posited that if the pain did not kill her, then she would likely die of starvation.

{¶ 14} Again Gilbert attributed Wynn's symptoms to phantom pain and depression. Gilbert acknowledged that he did not "really know what was causing the damn problem." Wynn, having had enough, sought a new physician.

V. The Exploratory Surgery
{¶ 15} Wynn made an appointment with Dr. Matthews, who eventually suggested an exploratory surgery to determine the cause of Wynn's symptoms. *Page 6

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Bluebook (online)
2007 Ohio 2798, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wynn-v-gilbert-c-060457-6-8-2007-ohioctapp-2007.