any harm had they
not undergone sur-
gery in the first
place. When a plain-
tiff prevails on an
operative contraindication claim, the remaining negligence claims
pale in comparison because any bad outcome — routine side effect,
known complication or even medical negligence — would not have
occurred if surgery was never performed.
In the OR, the plaintiff's expert testified that Dr. Rech breached the
standard of care by not providing perioperative antibiotics for Mr.
Standley's high-risk situation. Further arguments drew a causal link
between the omission of antibiotics and Mr. Standley's infection and
limb loss. Even if this had been the only successful claim, the plaintiff
still would have prevailed, but the plaintiff's counsel had another line
of attack when criticizing post-operative management.
Specifically, the plaintiff's expert argued that Dr. Rech also failed to
provide timely and compliant post-op care, and that the deprivation of
care aggravated the plaintiff's catastrophic infection. Combined with
the other breaches, this specific post-op breach of the standard of care
predictably led to a resounding plaintiff verdict.
This case highlights the need to proactively mitigate risk along the
entire continuum of surgical care. While technical competence is
often the focus of surgeons and administrators, pre-operative patient
selection and post-operative care are critical elements when address-
ing surgical risk.
OSM
Ms. Stremick (jerene@elitemedicalexperts.com) is the managing nurse case
strategist at Elite Medical Experts in Tucson, Ariz., where she and her physi-
cian-led team have consulted on more than 7,000 medicolegal matters. Her
clinical expertise is in orthopedics, trauma, critical care, ambulatory surgery
and dermatology.
J U N E 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 2 3
While technical competence is often
the focus of surgeons and administrators,
pre-operative patient selection and
post-operative care are critical elements
when addressing surgical risk.
