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Plaintiff's Counsel: David M. Paris
Ohio State University Pays Family $1,000,000 In Thoratic Surgury Wrongful Death
David M. Paris represented the wife and son of Paul Balzer, who died during an operative procedure performed by Edmund Kassis, M.D., to remove a bronchial carcinoid tumor from the upper lobe of his left lung on February 26, 2010. Paul Balzer underwent a bronchoscopy followed by a sleeve re-section of the upper lobe of his left lung in order to remove a carcinoid tumor. This was an elective procedure and he had a very good prognosis because this was early stage and a low grade lesion with a survival rate at five years of 90 percent.
A sleeve lobectomy is a very challenging procedure. There are different techniques to remove an upper lobe. As between pneumonectomy, VATS lobectomy, and sleeve lobectomy, the latter is the most challenging. In fact, of the 300 – 400 annual thoracic surgeries performed by the defense expert, only 3-5 have been sleeve lobectomies and only 5-10 percent of Plaintiff’s expert’s annual lobectomies are sleeve lobectomies. During the procedure, the patient developed a massive bleed in his left main pulmonary artery which obstructed the operative field to such an extent that the patient exanguinated on the table.
The Plaintiff was critical of Dr. Kassis in three specific respects. Plaintiff alleged:
- Dr. Kassis had insufficient experience to perform this procedure unsupervised. The defense expert conceded that for a VATS lobectomy, a less challenging procedure, in order to achieve the level of “competent,” one must have performed 25 cases. And to achieve the level of “proficient,” one must have performed approximately 150 cases. Dr. Kassis had not yet performed that many procedures.
- Dr. Kassis failed to dissect the pulmonary artery to the bifurcation and position a clamp or loop for proximal control of this main vessel in the event that injury to vessels occurred in a distal location. In a sleeve resection, if the tumor is in close proximity to the lobar/apical branches, as it was here, proximal control of the main pulmonary artery is recommended. This is done because accidental injury/bleeds to a pulmonary vessel in a distal location is a foreseeable risk under these circumstances. This is the standard of care as explained by Dr. L. Penfield Faber, an authoritative author and expert on the subject of sleeve lobectomies. In fact, during the surgery, an injury did occur to the left pulmonary artery at its juncture with an apical/lobar branch which caused it to bleed. This bleed was initially controlled by Dr. Kassis with manual pressure and a clamp just proximal to the injury and then repaired with sutures.
- Dr. Kassis testified that he removed the clamp completely, rather than slowly. The standard of care is to release such a clamp slowly to ensure that the sutures withstand the change in pressures within the vessel. This led to an increase in arterial pressure and either a complete failure of the sutured repair or a propagation of a new tear in the vessel. From that moment forward, the surgical site became obscured with massive amounts of blood pumping through the left main pulmonary artery, making it impossible for Dr. Kassis to obtain proximal control at or near the bifurcation in order to stop the bleeding. As a result, the decedent, Paul Balzer, bled to death on the surgical table.
To compound the failure to enlist an experienced surgeon at the outset, Dr. Kassis encountered several unexpected anatomical anomalies in the patient which made the procedure even more challenging and technically complex. First, when he entered the chest cavity, he found that the patient had a left hemidiaphragm which was significantly elevated and occupied more than half of his thoracic cavity. This meant that a shorter distance existed between all the vessels and organs and they were more closely approximated than normal. In other words, there was less room in the operative field to work than expected. Second, the patient’s left upper lobe had collapsed and there was substantial inflammation which led to adhesions of the upper lobe to the chest wall. All of these technical challenges, Plaintiff alleged, should have led a reasonably prudent physician with Dr. Kassis’s limited experience to seek assistance.
The case was settled for a confidential amount through private mediation two weeks before trial.