Gallbladder cleansing Gallbladder surgery
What Doctors Didn’t Want Me to Know about Gall Bladder Surgery
by Elizabeth E. LaBozetta, editor, Mongoose News, Central Ohio Patient’s-rights Service. Originator of
The Support Network (for injury victims of laparoscopic cholecystectomy) 1562
Picard Road, Columbus, Ohio 43227-3296 (614) 235-0421
In the winter of 1990-91 laparoscopic cholecystectomy was introduced in Ohio.
The newspapers ran articles extolling the virtues of this new technology saying:
"Patients recover faster and return to work sooner, have smaller scars! The
one-day stay in the hospital saves money for health insurance companies!"
Prospective patients were given packages of information telling only good things
about this new procedure, both hand-made by the medical community itself and
also color brochures created by the laparoscopic equipment manufacturers.
The color brochures begin with a drawing of a woman bent over in agony and
finish with a picture of her after the new laparoscopic cholecystectomy smiling
and enjoying time with her family.
There were other articles being written by the medical community at this time
but these articles were not given out to prospective surgery patients: these
were articles written by doctors for doctors and appeared in all the major
medical trade journals; these articles, written by the top biliary specialists
in America, told a very different story of injury and death than the upbeat and
encouraging material created for and handed out to the prospective patients.
For example, the printed material I was given says "bile duct injury is a SLIGHT
risk" and if it occurs will be handled properly and promptly. I came to learn
the hardest way possible that neither statement was true.
And much too late I learned that at the same time my surgeon was handing out
this misleading printed material to prospective surgery patients he had
co-authored two articles about laparoscopic cholecystectomy that appeared in two
top medical journals and expressed concern about the true injury and death
rates.
This expression of concern about the very high injury and death rates associated
with this new procedure in its introduction phase was expressed by many surgeons
and is heavily reflected in the literature written by doctors for doctors from
the years 1991-1995.
Unfortunately the prospective surgery candidates were not given this "other"
information and allowed the opportunity for a true informed consent because if
they had been told the truth and allowed access to the same information
available to doctors nobody in their right mind would have exposed themselves to
such a dangerous thing.
A thing is either dangerous or it isn’t, people are being injured and killed or
they are not: both statements cannot be true. Yet my surgeon was handing out
material saying one thing to patients and writing the exact opposite to other
doctors.
The lying started before I ever entered his office for the first time.
In June of 1991 I woke up to a boring pain at the pit of my stomach. I’d been
having problems with indigestion at night. My husband had been ill several
months, had been hospitalized for a few weeks in the winter, and because I had
three children and a home to care for figured that the extra work and stress was
getting hold of me.
So when I woke up to that continuous pain I knew I’d better seek relief from my
family doctor pronto because with my husband so debilitated and struggling to
recover we could not afford two health problems going on at once.
My family doctor prescribed Tagamet, Librax, and Tylenol 3. The symptoms
subsided. I was fine for a while then things flared up again. One night in July
I started vomiting. I went to the emergency room at Grant Medical Center. I was
told I needed my gallbladder out and to "stop fooling around and just have it
done—the hospital has this easy new way of doing it, so what am I waiting for?"
I was given a referral to a surgeon before leaving. Months later when I was more
experienced I wondered at how the E.R. doctor arrived at his conclusion because
no definitive testing was performed: all I had was blood work and a short
examination.
I made an appointment to see the surgeon I was referred to and got shifted to
the newest member of that group since the surgeon whose name I was given was
leaving the state.
The nurse took a history and the surgeon came in and did a short examination,
set up a couple of tests, told me he was excited because Grant Medical Center
had just purchased new laser equipment---laser dissection was superior to
electrocautery, he told me, because it cuts and cauterizes at the same time and
reduces bleeding.
He actively discouraged the alternate treatments for gallstones: lithotripsy and
ursodiol dissolution, said "once a person makes gallstones they will always make
gallstones—surgery is better because it is permanent!"
He’d done plenty of these procedures, he assured me, and told me there were no
deaths and just one injury---a bile duct was nicked, no big deal, and it was
closed with one stitch. He said that if a bile duct is severed it’d be patched
with a piece of small bowel, and if nicked closed with a stitch. I was left with
the impression that everything would be taken care of and any potential problems
were easily fixable. It was not true.
What I wasn’t told is that a bile duct injury is a major disaster and is almost
irreparable in even the best of hands, requires prompt repair from a biliary
specialist at a specialty center equipped to handle such complicated tragedies.
Biliary repair is not for the novice: longevity, morbidity and mortality, is
determined by early proper repair by experienced hands.
I did not know that most injury victims would not be offered that biliary
specialist referral at a specialty center either: we’d be "patched", lied to,
and sent home to die wondering what happened to make us so sick.
There is a one-month window of opportunity to correctly repair a bile duct
injury and its resultant stricture before progressive and permanent liver damage
sets in. After that, cirrhosis and fibrosis comes and an infectious process that
is almost untreatable. This infectious process erodes heart, liver, joints,
spleen and kidneys. The symptoms are all over the body.
In 1991 I did not know the things I know now and had no way of knowing that the
testing my surgeon ordered, just ultrasound and chest x-ray, is not the
definitive testing for gallstones: ERCP and cholecystography are.
I did not know about infection possibilities and helicobacter pylori either. I
had stomach symptoms. Later I learned almost nobody really needs their
gallbladders out at all, that even if a person has gallstones there is nothing
wrong about choosing to repeat the non-invasive therapies as many times as
necessary.
I had the laparoscopic cholecystectomy August 9th, 1991. A resident physician
performed it without my knowledge or consent and the consent form I was given
makes no mention of a resident substitution for the licensed, credentialed,
already-practicing doctor I had chosen to do it. With this new procedure,
outcome is directly related to experience; I believed I was getting the man I
picked never suspecting that once on the table I’d be getting a trainee.
The doctor trainee severed the bile duct, patched it with a piece of small
bowel, and I was sent home to die, deliberately kept ignorant of what had
happened and left wondering why I was so sick, getting sicker.
The horror of those days is beyond words and when I remember all that I suffered
in 1991 to 1993 at the hands of my surgeon and his consultants. I have to wonder
how they are able to sleep at night: I went back to my surgeon for help when I
developed a septic complication and he ran me around to consultants who verbally
abused me, called me a "hypochondriac" even in the face of testing that showed
abnormal liver functions, heart problems, kidney problems---and none would help
me. I got lots of testing but no actual intervention. The doctors I’d see on my
own wouldn’t take me as a patient, would see me once or twice, maybe order some
further testing, then say I had to return to my surgeon for care, kept tossing
me back to him. They’d say: "I don’t want to get involved". Involved in what?
Nobody would tell me.
The medical bills stacked up and up for all that "care" I never actually got.
For the first time in my life collection agencies started to call me demanding
payment. I owed Grant Medical Center hundreds of dollars. With no job where was
the money to come from? My credit rating was ruined.
In June of 1992 my surgeon performed another surgery on me, said he was going in
to have a look around---and removed a portion of my small bowel without my
permission.
Later I learn he needed this piece of small bowel to reconstruct that patch made
when my bile duct was severed at the first surgery; that "quicky repair" failed
and necessitated another "quicky repair". This is the cheap repair that can be
sneaked in through a one-inch cut at the uppermost trocar site, saving money for
the insurer and limiting potential for the victim’s discovery of the malpractice
event.
I was cheated forever of a good repair by a specialist at a specialty center.
The damage done by a bad failed repair is irreversible and opportunity for best
outcome is gone.
The opportunity for free choice was removed also; I got what someone else wanted
me to have based on needs that were not mine.
The medical community, governmental bodies, and legal community tell me over and
over: "accidents happen; you should forgive and forget." I have no trouble
forgiving an accident—accidents do happen. But what happened to me and many
others like me was no accident: we were not given full information about this
new surgery, were misled about the true injury and death rate, were cheated of
the opportunity to give an actual informed consent, and were lied to about the
actual reparability of a bile duct injury and how often it really occurs in
inexperienced hands. We were promised prompt response if injury were to occur
and were misled to believe we’d be getting the surgeons we’d chosen from our
healthplan booklets when most everyone but the patients knew full well resident
physician substitution was the common practice once we were unconscious on the
operating table without out knowledge or consent, adding additional risks onto
an already risky procedure.
Tired of the run-around and getting no help, I decided to go to Canada to see if
I could get help there. I was told to research "bile duct injury" and "bacterial
endocarditis," given a referral to a Canadian surgeon and a liver specialist in
Ontario.
In February of 1993 I confronted my surgeon with some disturbing discrepancies
between my written records and what he had told me, confronted him with some
questions he didn’t want to answer on my x-ray films, and he dropped me as a
patient.
In June of 1993 I was very ill and asked a surgeon who’d successfully treated a
family member for a difficult cancer for a referral and this man told me: "If I
were in your situation this is the man I would get care from: he is the best
liver specialist I know" and gave me a referral to a gastroenterologist in New
York City. This gastroenterologist turned out to be all the other surgeon said
he was and had his partner perform a balloon dilatation of a biliary stricture.
I was told it would last for six months and I got two years off it. I was
grateful for the help; it bought me a little more time.
Later, I sought care in Ohio from a friend of the New York doctor who has a
practice at Ohio State University: this man was a top-drawer liver specialist
and did something few doctors are willing to do: he wrote me a letter and put
the truth down on paper. That letter was the best thing that happened to me
since 1991: I’d been mired in a fight for my life against people determined to
hide the truth at any cost to me. Finally here were two gastroenterologists in a
row standing up for me and doing the right thing. But I had found them on my
own.
In March of 1993 I placed an ad in our local newspaper hoping to find other
injury victims of laparoscopic cholecystectomy. Other victims responded in large
numbers, even people from other states responded to the ad. All of us had been
mistreated the same standardized ways, coast to coast. All of us were cheated on
informed consent. All of us were called "hypochondriacs" when we presented
afterwards with serious problems even in the face of abnormal test results. All
of us were told "you are the only one having problems like this after that new
surgery!" When we got the chance to talk and trade information, we found that
several of us had been referred to the same gastroenterologist’s group in town
and these doctors had told each of us they’d never seen anything like this
before. Each of us were told we were the only ones having problems! It was like
they had one script to read from and read it to each of these injury victims
word for word.
I have had quite an education about the medical, legal, governmental bodies, and
the media since I started a national support network for injury victims of
laparoscopic cholecystectomy. I have listed below some of the most revealing
articles written by the medical community itself. They explains everything and
should be available from medical libraries.
· JAMA May 24/31, 1995 Vol. 273, no. 20 pages 1581-1585
"Falling Cholecystectomy Thresholds Since The Introduction Of Laparoscopic
Cholecystectomy"
· *ARCHIVES OF SURGERY October 1990 Vol. 125, page 1245
"Laparoscopic Cholecystectomy: Threat or Opportunity?"
· *THE AMERICAN JOURNAL OF SURGERY March 1991 Vol. 161, page 408
" Laparoscopic Cholecystectomy: Gateway To The Future".
· *PRIMETIME LIVE December 16, 1993 Burrelle’s Transcript #328 "Too Good To Be
True?"
Before this happened I never imagined such misery and suffering was possible.
I never imagined the irresponsible and callous behavior of people we have placed
in positions of trust either.
I was used as a guinea pig without our knowledge or consent and left to suffer
the consequences and bear the enormous financial burden of the misbehavior and
misadventure of doctors. I am now 43 and have irreversible liver damage; the
domino effect to all organ systems from this injury will kill me eventually. I
have cirrhosis and the consequences of chronic untreatable infection that a bile
duct injury brings. I and others like me were sacrificed to build a very
lucrative laparoscopic surgery industry.
Because I have spoken out about what happened to me, I cannot get medical care
no matter where I go or what happens to me. I had to learn as much as I can and
treat myself.
Would I do things differently knowing silence and compliance is the "price of
admission" to medical care in a system that is built on secrecy? No. Sometimes
we have to stand up and do what is right no matter the consequences.
I made my choice when I decided to become a patient’s rights activist and leader
and will accept whatever comes: I made my decision and will have to live, then
die, with it.
Some things are just worth it.
Reprinted from:
www.a-r-m.org/gallblad.htm