Estrada v. Univ. of Toledo Med. Ctr.
2017 Ohio 821
| Ohio Ct. Cl. | 2017Background
- Rosemarie Becerra (62) underwent total hysterectomy with bilateral salpingo-oophorectomy on Sept. 20, 2010 for complex hyperplasia with atypia; Dr. John Geisler was primary surgeon.
- Intraoperative significant bleeding and a sclerotic-appearing liver were observed; liver biopsy later showed mild chronic hepatitis; autopsy diagnosed cirrhosis.
- Post-op course: acute tubular necrosis, prolonged ileus/no bowel movement, a firm right‑side abdominal mass, and CT on Sept. 23 showing large ventral hernia and ileus but no definitive obstruction or strangulation.
- On Sept. 25 she vomited in the x‑ray room, aspirated, suffered cardiac arrest (15–20 minutes), was resuscitated and taken to ICU.
- Sept. 26 Dr. Geisler performed exploratory laparotomy and resected necrotic bowel; patient was ultimately declared brain dead and died Sept. 27.
- Plaintiff sued for wrongful death/medical malpractice alleging failures to recognize and urgently treat wound dehiscence/evisceration/obstruction, to place an NG tube when vomiting began, and other deviations causing death.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether defendant breached standard of care by not performing immediate surgical exploration after Sept. 23 CT showing ventral hernia/dehiscence | CT actually showed wound dehiscence with protruding bowel; emergency surgery was required to prevent ischemia/necrosis | CT and clinical findings indicated a large ventral hernia/ileus without obstruction or strangulation; observation was within standard of care | No breach—observation rather than immediate surgery on Sept. 23 comported with standard of care |
| Whether failure to recognize/diagnose sepsis/necrotic bowel earlier breached standard of care | Confusion, increasing wound vacuum output, abdominal firmness and CT together indicated evolving necrosis/sepsis that should have been treated urgently | Vital signs, normal lactate/pH, decreasing WBC and other data supported alternative diagnosis (ileus or hepatic encephalopathy); no clear evidence of sepsis | No breach—clinical picture reasonably supported non‑surgical causes (hepatic encephalopathy/ileus) |
| Whether failure to place nasogastric tube when vomiting began caused the aspiration and death | NG tube should have been placed immediately; its absence permitted aspiration that led to cardiac arrest and death | Placement was discretionary; would likely be clamped for x‑ray and might not have prevented aspiration; not established as causative | No causation established; even if NG omission arguable, plaintiff failed to prove it more likely than not caused death |
| Whether Sept. 26 re‑operation was negligent or causally related to death | Second operation was pointless because patient showed signs of brain death beforehand and could not benefit | Surgeon reasonably sought to identify/treat ischemic bowel shortly after prolonged arrest; family requested intervention; surgery did not cause death | No causal relationship; surgery was not shown to be negligent and did not cause death |
Key Cases Cited
- Bruni v. Tatsumi, 46 Ohio St.2d 127 (Ohio 1976) (sets Ohio standard for physician malpractice — community standard of care).
- Reeves v. Healy, 192 Ohio App.3d 769 (10th Dist. 2011) (expert testimony required to establish standard of care and breach in medical malpractice action).