Unnecessary Pancreatectomy Lawsuit

This medical malpractice claim was filed in Baltimore City after doctors negligently removed a man's pancreas in an attempt to treat his unrelated abdominal pain. It was filed in Health Claims Arbitration on March 8, 2018, and it is the 111^th medical malpractice case filed in Maryland this year.

A man underwent a spinal fusion and discectomy at L5-S1. Eighteen months later, he began to develop significate pain on the left side of his abdomen. Before long, the pain, anorexia, and altered bowel habits prompted him to see a gastroenterologist. All of the gastroenterologist's diagnostic testing came back with normal results, so he referred the man to the GI Division at Johns Hopkins.

By the time of his first visit to Hopkins, the man's abdominal pain had worsened to the point where it made sleeping on his left side difficult. He also reported lower back pain that radiated into his left leg. The doctors suspected the man was suffering from chronic pancreatitis due to his longstanding history of heavy alcohol and tobacco use. The man underwent several pancreatic function tests, which showed no abnormalities. His endoscopic ultrasound indicated only four out of nine criteria for diagnosing mild pancreatitis. Importantly, the man reported abdominal pain in the lower right quadrant - a location that is not consistent with pancreatitis.

Over the next few days, the doctors at Hopkins continued to test the man for pancreatitis. The only irregularity they could find was a slightly low level of fatty tissue in the pancreas compared with the liver. Even though the evidence was only circumstantial, the man was told that he had chronic pancreatitis and was unlikely to recover. According to the doctors, his only option was to medically manage his pain.

Several months later, the man returned to Hopkins for a workup of his pancreas. Even though his liver, gallbladder, spleen, adrenal glands, kidneys, and pancreas all appeared to be normal, the man was classified as a good candidate for a total pancreatectomy with islet autotransplantation.

The man met with a general surgeon to discuss the removal of his pancreas. The surgeon explained that a pancreatectomy wasn't a guaranteed cure for the man's pain, but it was his best shot at relief. The surgeon also mentioned there was a one-third chance that the man's islets would not engraft into the liver, in which case he would become an insulin-dependent diabetic. In spite of the potential adverse outcomes, the man agreed to the surgery. He was never told about the significant possibility that he did not have pancreatitis at all and that his abdominal pain could be related to something else entirely. In fact, when the man asked if his pain could be a complication of his prior spinal surgery, he was repeatedly told "no."

Three years after his spinal surgery, the man underwent a total removal of his pancreas and gallbladder with islet transplantation. When his pancreas was analyzed at pathology after the procedure, there was no evidence of pancreatitis found in any of the pancreatic tissue. The man was never told about the pathology results, even though he continued to suffer from severe chronic pain. He also developed brittle insulin dependent diabetes and displayed clear evidence of diabetic nerve damage in his hands and feet only one year after the pancreatectomy.

Four years after his pancreatectomy, a total of seven years after his spinal surgery, the man saw a new gastroenterologist. The new doctor informed the man for the first time that his pancreas was likely removed for no good reason.

• Pancreatitis is the medical term for inflammation of the pancreas, which can occur when the normal flow of pancreatic fluid is obstructed. Between 60% and 90% of American pancreatitis patients have a history of chronic alcohol consumption.
• Endocrine cells in the pancreas, also called "islets of Langerhans," are responsible for producing hormones to help regulate blood sugar levels. When the pancreas is completely removed, doctors perform an islet autotransplantation in an attempt to preserve this regulatory function. During a total pancreatectomy, doctors will remove endocrine cells from the patient's pancreas, infuse them into the portal vein, and they will hopefully graft onto the liver. This way, the patient has a better chance of surviving without Type 3 diabetes. Unfortunately, the claimant's islet transplant didn't take. As a result, he suffers from a type of diabetes that is particularly difficult to control, even with insulin injections.
• Unbeknownst to the claimant, the Hopkins team had only performed thirteen pancreatectomies with islet autotransplantation at that time and were actively looking to gain patients and experience. The claimant was the 21st patient to undergo this procedure at Hopkins.
• The statement of claim briefly mentions that the claimant's abdominal pain may have been caused by adhesions which developed after his back surgery. Adhesions are scars that form inside the body as part of the normal healing process after a surgery. Scar tissue contains no nerve endings itself so it is typically unproblematic, but it can cause postoperative pain if it constricts the lumbar nerve root.

• Baltimore City

• The Johns Hopkins Hospital
• Johns Hopkins University d/b/a Johns Hopkins Medicine
• The Johns Hopkins Health System Corporation
• A gastroenterologist
• A general surgeon

• Johns Hopkins
• Penn State Hershey Medical Center

• Failing to properly understand and interpret the diagnostic procedures and tests performed to determine the nature of the claimant's medical status.
• Failing to ensure that the claimant actually had chronic pancreatitis before diagnosing him with chronic pancreatitis.
• Failing to recommend appropriate, conservative treatment for the claimant when preoperative testing did not reasonably support his classification as a good candidate for a total pancreatectomy.
• Failing to consider and rule out other possible causes of the claimant's abdominal pain, including adhesive disease from his prior spinal surgery.
• Failing to inform the claimant about his pathology reports.

• As a direct result of the defendants' negligence, the claimant suffered permanent and disabling injuries including the removal of his pancreas, brittle diabetes, neuropathies in his hands and feet, and continued severe abdominal pain.
• The man was never properly informed and educated about the risks of a pancreatectomy or the alternatives to a pancreatectomy.
• The claimant's wife also alleges that the claimant's injuries caused a disturbance to their marital relationship.

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