Meridia can cause Heart Attack and Strokes

On January 21, 2010, the day that U. S. Regulators warned that Meridia (sibutramine) shouldn’t be given to patients with a history of heart problems, their counterparts in Europe said the popular diet drug should be banned. The European Medicines Agency said that sibutramine – sold in Europe under several names, including Reductil, Reduxade and Zelium – should be pulled from the market because of associated risks of stroke and heart attack.

The call for a European ban came after a study of 10,000 patients suggested it put them at a higher risk for heart disease. The study, Sibutramine Cardiovascular Morbidity/Mortality Outcomes in Overweight or Obese Subjects at Risk of a Cardiovascular Event (SCOUT), was begun in 2002, and involved patients who were 55 years of age or older, overweight or obese, and had a history of heart disease or type 2 diabetes plus one additional cardiovascular risk factor. Patients who recently had a heart attack or stroke, or had poorly controlled congestive heart failure were not included in the study.

Preliminary data from SCOUT showed that cardiovascular events were reported in 11.4% of patients using Meridia compared to 10% of patients using a placebo. According to the FDA Early Communication issued in November, this difference was higher than expected, suggesting that Meridia is associated with an increased cardiovascular risk in the study population.

Based on the SCOUT findings, the European Medicines Agency found that “the risks of these medicines are greater than their benefits.” Its decision will now get passed to the European Commission for review.

The U.S. Food & Drug Administration (FDA) announced that because of the SCOUT findings, Abbott Laboratories had agreed to add a new contraindication to the Meridia label that it not be used in patients with a history of heart disease, including:

• History of coronary artery disease (e.g., heart attack, angina)
• History of stroke or transient ischemic attack (TIA)
• History of heart arrhythmias
• History of congestive heart failure
• History of peripheral arterial disease
• Uncontrolled hypertension (e.g., > 145/90 mmHg)

Meridia is a drug that is typically prescribed to patients with a history of obesity or being overweight. This particular patient population is at a greater risk of cardiovascular events. If you or a family member has suffered a heart attack, stroke or cardiovascular event while on Meridia, please call an attorney with McGowan, Hood and Felder today at 877-327-3800 (toll free). We offer all potential clients a free consultation to assist them in determining their legal rights. Call us today to determine your rights in regard to Meridia.

To discuss your case and how we can help you, contact McGowan, Hood & Felder, LLC today.

Motorcycle Accident Injury Attorneys

McGowan, Hood & Felder, LLC has represented numerous clients in regard to personal injury and wrongful death lawsuits against people causing injury to a person on a motorcycle. These situations have led to catastrophic injuries for persons who were riding on the motor cycle, including drivers and passengers.

Every year, the number of bikers seriously injured or killed in motorcycle accidents increases. This tragic fact is due in large part to the inattention of other motorists to motorcycles on the roadway and the disregard of the rights and safety of bikers. As the saying goes, "Look twice and save a life." Our firm has handled and successfully resolved cases involving motorcycle accidents.

Because motorcycles are not enclosed like cars or trucks, most accidents result in the driver being thrown from the cycle. Common motorcycle injuries include spinal cord injuries, broken bones, brain damage, paralysis and even death. Individuals injured in motorcycle, scooter or moped accidents need serious legal representation. Our law firm is committed to providing clients with sound and aggressive legal representation.

The attorneys at McGowan, Hood & Felder, LLC frequently consult medical, engineering and liability experts to build our cases. The types of experts frequently used in a motorcycle accident case include an accident reconstruction expert, human factors expert and bio-mechanical expert. These cases can be expensive to prosecute and our firm is dedicated to ensuring that each motorcycle accident case at our firm receives the proper experts and legal representation.

Helmet Use And Effectiveness

South Carolina as a state does not require the use of a helmet when riding a motor cycle. The use of the helmet is a safety mechanism but many riders enjoy the freedom of riding without a helmet. Whether the rider is using a helmet or nor may foretell of the type of injuries that the driver or passenger on a motorcycle may incur.

The National Highway Traffic and safety Administration (“NHTSA”) estimates that helmets saved the lives of 1,316 motorcyclists in 2004. If all motorcyclists had worn helmets, an additional 671 lives could have been saved. Helmets are estimated to be 37 percent effective in preventing fatal injuries to motorcyclists. This means for every 100 motorcyclists killed in crashes while not wearing a helmet, 37 of them could have been saved had all 100 worn a helmet.

All motorcycle helmets sold in the United States are required to meet Federal Motor Vehicle Safety Standard 218, the performance standard which establishes the minimum level of protection helmets must afford each user. In 2004, 20 States, the District of Columbia, and Puerto Rico required helmet use by all motorcycle operators and passengers. In another 27 States, only persons under a specific age, usually 18 were required to wear helmets. Three States had no laws requiring helmet use.

Types of injuries

* Head injury - affects the face, skull, and/or brain. These injuries are much more likely to result from motorcycle crashes than car accidents. Head injury often occurs when the motorcyclist is thrown from the bike, and their head collides with a solid object (e.g., pavement). It is especially prevalent when the rider is not wearing a helmet. A Traumatic Brain Injury has the potential to permanently hinder your motor skill functions.

* Broken bones and internal injury - usually affects arms and legs, but essentially no bone is safe in a crash. Groin injuries caused by the sudden stoppage of the motorcycle colliding with a car or another stationary object. Fractures may need months to heal and could even result in permanent disability if the victim is young enough that their growth plates have yet to fuse together. Internal injuries or organ damage may not be evident until a physician conducts a thorough examination. These can be fatal if they are ignored.

* Spinal cord injury and paralysis - damage to the vertebrae and connecting tissue that limits or completely restricts mobility depending on the location and extent of the damage. Paraplegia means the victim has loss of movement below the waist, while quadriplegia is from the neck down.

The attorneys at our firm work closely with referring attorneys to bring a case to successful resolution. The attorneys in our firm who practice in the motorcycle injury arena are constantly updating their education and ability to litigate these types of cases. S. Randall Hood of McGowan, Hood & Felder has helped litigate many catastrophic injury cases. S. Randall Hood is available for consultation by email at rhood@mcgowanhood.com or telephone (Toll free 1-877-327-3800).

Please visit our website at mcgowanhood.com for comprehensive information on motorcycle accidents.

Very truly yours,

McGowan, Hood & Felder, LLC
S. Randall Hood, 1539 Healthcare Drive, Rock Hill, SC 29732

How to Make Money Turning Down “Bad House” Cases

McGowan, Hood & Felder, LLC has handled numerous actions involving “Bad House” Cases in South Carolina and outside the state. These cases involve faulty construction or faulty materials used in the construction of a home.

Attorneys with McGowan, Hood and Felder, LLC investigate “Bad House” cases on a frequent basis. There has been a lot of news in the past couple of months about Chinese wall board and other faulty construction materials which can contribute to legal problems and issues for contractors, subcontractors or home repair entities in regard to building or repair of a house. The purpose of this newsletter is to help educate some of you in which cases not to take in this area of law.

You’re sitting in the office on Friday afternoon waiting for that big case to come calling. Sure enough, the phone rings. The nice lady on the line says she paid her builder at closing, but he won’t come back and finish the job even though he promised he would; or a man complains of a terrible leaky roof, and mold to boot, and then states that his insurance company won’t pay for repairs to his house; or the guy who is angry because the floor slabs in his home have enormous cracks and so do all of his neighbors’ floors. Many of these cases on their face appear to have liability but may not be the type of case to pursue. It is financially cogent to refuse to accept many of these claims as cases in your practice. Nowhere is the old adage “I made more money on the cases I didn’t take” more true than in construction defect work. Here are six reasons why.

Clients.

A man’s home is his castle, right? You can put up with that dent in the fender of your car, especially if it’s on the passenger side. But the loose brick in your fireplace that you see every night when you settle back with a cool beverage? No way. Whether you live in an $80,000 tract home or an $800,000 beauty on the lake, your home must be perfect. Clients in building defect cases, especially “punchlist” complaints, are the same way. Even though the cost to hire someone to fix all those problems may not be much, most of us are stubborn enough that we will torture ourselves staring at that loose brick before we pay someone to do something that builder should have done. Make sure you aren’t looking at two or three thousand dollars worth of cosmetic touchups before you sign that guy up. Both of you will be angry at the end of the case.

Competence.

It is wise to know what you are doing both legally and substantively when you elect to take on a construction defect case. Leaky roofs are usually a lot more complicated than finding the hole, especially if someone calls a lawyer instead of a roofer. Soils and foundation problems will force you to learn about compaction, kips, and sheep’s foot tampers. None of it is rocket science, but it requires a little experience outside what most of us know.

Experts.

In a punchlist case you can probably find an expert who will work for free, because he either finished the job or wants to finish the job. Structural issues, mold damage, drainage, moisture intrusion cases? Get ready. If you have a case that includes PI claims secondary to mold exposure, multiply that by four or five to arrive at a figure you will spend on experts. Beware, there is no pain and suffering in contract cases, and typically no way to recover these types of damages.

Damages.

No matter how big of a problem your defendant may be, you probably aren’t going to have a gross negligence case on your hands. Nearly all construction disputes are contract claims. That means no punitive, no pain and suffering, and often no consequential damages. Even if you recover 100% of your client’s actual damages, there usually isn’t enough left to fix her house, after your fees and expert fees are paid. The result is an unhappy client.

Insurance.

One of the really complicated issues in construction “law” is insurance coverage. There is coverage out there, but you need to plead into and prove it. Like any other area of practice, know what you are doing.

Collectability.

You don’t need to worry about coverage in some cases. “Mass” builders like KB Homes, Ryland, or D.R. Horton are good for a judgment in any single house case—even in today’s business climate. Local builders are a completely different story. With few exceptions (e.g., Mungo and Shumaker), homebuilders are sole proprietors or LLC’s. They keep no cash. Often they structure their billing so all their profit is at the front end, so by the end of the job they have no incentive to finish that punchlist—or pay your judgment. Particularly in this economy, local builders are either failing or temporarily closing up shop. Make sure there is a pocket out there to reach into or you may be working for free.

You can make money suing builders. You have to be picky about cases you take in the defensive construction arena. The cases can be expensive to work up and some have little damages. It is within your purview to decide which cases are good and which cases are bad.

Dixon Robertson works for homeowners whose homes don’t work the way they should. From shoddy construction to defective building materials, he has represented hundreds of individuals and a class of 8000 homeowners to resolve their claims and win them relief for their building problems. He practiced solo for nearly thirteen years before joining McGowan, Hood & Felder last year.

The attorneys at our firm work closely with referring attorneys to bring a case to successful resolution. The attorneys in our firm who litigate complex cases are constantly updating their education and ability to litigate these types of cases. Dixon Robertson of McGowan, Hood & Felder has helped to litigate many cases that involve construction litigation. Dixon Robertson is available for consultation by email at DRobertson@mcgowanhood.com or telephone (Toll free 1-877-644-6400).

Please visit our website at mcgowanhood.com for comprehensive information on construction defect litigation.

Very truly yours,

McGowan, Hood & Felder, LLC

W. Dixon Robertson, 1517 Hampton Street, Columbia, SC 29201

Children who Suffer Injury during Pregnancy

McGowan, Hood & Felder, LLC has represented numerous clients in regard to personal injury and wrongful death lawsuits against physicians and hospitals alleging that the medical practitioners failed to follow proper medical practice in regard to the treatment afforded to a patient during pregnancy. These situations have led to catastrophic injuries for infants and their families who trusted their medical professional.

The epilepsy drug Depakote has been linked to an increased risk of mental retardation and birth injuries when taken during pregnancy. According to reports since 2006, the risk of Depakote birth defects could be significantly greater when compared to the risks associated with alternative medications prescribed as an anticonvulsant.

Approximately 24 million American women have taken anticonvulsant drugs for problems such as epilepsy, bipolar disorder and migraine headaches. The use of Depakote during pregnancy has been compared with other similar anticonvulsant drugs, including Tegretol, Lamictal and Dilantin. Several reports have indicated that the risks of mental retardation, birth defects and fetal deaths are greater when Depakote is used as opposed o other similar pharmaceutical drugs.

INCREASED RISK OF MENTAL I.Q. PROBLEMS

According to a report presented in 2007 at the annual meeting of the American Academy of Neurology in Boston, children who were exposed to Depakote during pregnancy were twice as likely to have I.Q. scores in the range of mental retardation, when compared with children exposed to other epilepsy drugs.

The study followed 185 children whose mothers took Depakote, Lamictal, Tegretol or Dilantan during their pregnancy. Researchers reported that I.Q. tests administered at 2 years old indicate that children exposed to Depakote scored 7 to 8 points lower on the I.Q. test than children exposed to one of the other epilepsy drugs during pregnancy.

PRIOR WARNINGS OF DEPAKOTE BIRTH DEFECTS

In October 2006, the warning label for Depakote was changed to indicate that the drug could result in birth defects when taken during pregnancy. The warning was updated after a study was published in the August 8, 2006 issue of Neurology regarding Depakote side effects. The study found that congenital malformations and fetal deaths were more likely when expectant women took Depakote as compared to one of the other epilepsy drugs. Approximately 20.3% of babies born after the mother took Depakote suffered serious adverse outcomes, compared with the other drugs which had significantly lower rates between 10.7% and 1%.

Given the findings of these recent studies, doctors should strongly consider other drugs before prescribing Depakote for pregnant women. Had the severe risk of Depakote birth defects been made known earlier, many children born with malformations or mental retardation could have avoided these disabilities if the mother was given a different anticonvulsant during pregnancy.

The types of injuries which can occur to a child who is exposed to Depakote during pregnancy can include, but is not limited to, mental retardation, cognitive injury, birth defects, or death. The types of experts we have utilized in these types of cases include teratologists, perinatologists, obstetricians, neonatologists, pediatric neurologists, pediatric neuroradiologists, geneticists, nurses, life care planners, vocational experts and economists. In addition to our retained experts, we have a highly skilled legal nurse on staff that assists our attorneys in the review of clients’ medical records and helps in the prosecution of these complex cases.

The attorneys at our firm work closely with referring attorneys to bring a case to successful resolution. The attorneys in our firm who practice in the medical negligence and pharmaceutical injury arena are constantly updating their education and ability to litigate cases involving injuries to children which occur during pregnancy. S. Randall Hood of McGowan, Hood & Felder has helped to litigate many birth injury and medical malpractice cases. S. Randall Hood is available for consultation by email at rhood@mcgowanhood.com or telephone (Toll free 1-877-327-3800).

Please visit our website at mcgowanhood.com for comprehensive information on birth injuries.

Very truly yours,

McGowan, Hood & Felder, LLC

S. Randall Hood, 1539 Healthcare Drive, Rock Hill, SC 29732

Knowledge Management for Solos and Small Firms

McGowan, Hood & Felder, LLC has handled numerous actions involving complex legal matters in South Carolina and outside the state. Attorneys with McGowan, Hood and Felder, LLC have represented clients involving construction litigation, catastrophic injury, business litigation, class action and multi district litigation.

What if you could spend a few moments thinking about drafting a complaint, and then, with a couple of keystrokes, find exactly the go-by you needed? What if your staff had time to “tag” every work product document with keywords? What if your computer silently, constantly, indexed your document files by keyword and by full text? And what if finding that elusive complaint were as easy as using Google? Chances are, you would be working for a large firm with unlimited resources.

What if you feel like you do not have the time to learn about expensive programs and acronyms like DM, KM, and CRM. So what if you can’t remember the file your law partner had that was just like the trip and fall you got in yesterday?

There is no reason why small law firms can’t enjoy the same organization and recall for their work product as the big firms. Whether you start using the tools you already own in a different way, install free or low-cost solutions, or invest in a dedicated program, you can retrieve exactly the information you need, quickly and efficiently. So what are you waiting for?
Face it. All we have to sell is time and knowledge. In theory, at least, the more knowledge we have the less time it should take us to get work done for our clients. Knowledge management, or KM, includes document management but it is more. Most law firms have some system for finding documents that are capable of repetition. Some attorneys file copies in a drawer and others have a “Forms” folder on their computer. Some forms folders are broken down by document type, or by subject matter. Filing in a drawer means walking to the file cabinet and thumbing through all the complaints until you find the one you’re looking for. Saving files to a computer file cabinet isn’t much different, except you get to stay in the chair. E-mailing to your partners, or posting to a listserv, is really convenient only for you.

Managing documents is important. But documents don’t capture knowledge, except in the limited sense of our work product. We need to save and retrieve what we know about other lawyers and expert witnesses. Which lawyer habitually hands up a memorandum when the motion hearing begins? How do we recall circuit judges’ preferences, like district judges’ that are posted on the Internet? Likewise, we need to remember techniques for trial and deposition. The stab in the dark on the defense engineer’s qualifications that hit the mark? It might keep him out altogether the next time around. The damages argument I read about, or saw in a CLE, or watched another lawyer make to the jury? How can I make sure to remember it for the next trial?

Finally, our most important asset is our goodwill with clients. We can take care of the little things, like spelling their names right and sending their mail to a new address right after we learn about it. What about other things? Who goes ballistic when we send lawsuit-related papers to the house where his ex-wife lives? Who was so grateful for the Christmas card that she wrote us a thank-you note? Managing our relationships with our clients is a very different subset of knowledge management, but it’s no less important than managing documents or judges’ preferences.
I’ll explore ways we can collect and retrieve—and share with our law partners and associates—all this information in future newsletters. Next time, we’ll look at a few simple ways to find that Word or Acrobat document from the case we tried four years ago.

Dixon Robertson works for homeowners whose homes don’t work the way they should. From shoddy construction to defective building materials, he has represented hundreds of individuals and a class of 8000 homeowners to resolve their claims and win them relief for their building problems. He practiced solo for nearly thirteen years before joining McGowan, Hood & Felder last year. When he isn’t working for clients, he studies the management side of a law practice, particularly how computers can make life easier for solo firms and small firms. You can reach Dixon in our Columbia office at (Toll free 1-877-644-6400).

The attorneys at our firm work closely with referring attorneys to bring a case to successful resolution. The attorneys in our firm who litigate complex cases are constantly updating their education and ability to litigate these types of cases. Dixon Robertson of McGowan, Hood & Felder has helped to litigate many cases that involve construction litigation. Dixon Robertson is available for consultation by email at DRobertson@mcgowanhood.com or telephone (Toll free 1-877-644-6400).

Please visit our website at mcgowanhood.com for comprehensive information on construction defect litigation.

Very truly yours,

McGowan, Hood & Felder, LLC

W. Dixon Robertson, 1517 Hampton Street, Columbia, SC 29201

Nursing Home Negligence

McGowan, Hood & Felder, LLC has represented numerous clients in regard to personal injury and wrongful death lawsuits against nursing home (and assisted living) facilities. Neglect, such as the types listed below, in a long-term healthcare setting can lead to painful injuries and death.

• Pressure Sores
Pressure sores or “bedsores” are caused by unrelieved pressure, typically on the bony areas of the body, e.g. tailbone, heels, elbows, etc. in bedridden patients resulting in damage to the underlying tissue. Most bedsores are preventable. A nursing home must develop and maintain a pressure ulcer prevention program.

Preventive measures include turning and repositioning schedules, pressure relief mattresses or pads, regular skin care and assessment, proper hygiene, proper toileting, adequate nutrition, and wound care. Failure of the care planners to properly assess and plan for prevention or treatment of bedsores, as well as failure of staff to provide the care and services required by the care plan, makes it very difficult for a long term care facility to defend a bedsore case on the grounds that the pressure ulcers were unavoidable.

• Nutrition and Weight Loss
Nutrition is an essential element of nursing home care. This includes proper nutritional assessment, care planning and intervention by the health care provider. Malnutrition often precedes the onset of pressure ulcers and, according to most experts, can impact the ability of pressure ulcers to heal. Often residents are chronically ill and require special assistance to ensure proper nutritional needs are being met. This requires the nursing home to have in place proper staffing in terms of numbers and qualifications.

Nutritional care, assessment and care planning is an interdisciplinary practice. Dieticians, speech therapists, and restorative nurses should be used to address particular conditions leaving certain patients at higher risk of weight loss or dehydration. Some residents will require a specialized diet, such as mechanically softened meals, pureed food, and food supplements. Certain residents require the use of feeding tubes. Whatever the resident’s particular situation, it is the duty of the long-term care facility to ensure that the interdisciplinary care team meets its responsibilities in ensuring nutritional needs are met.

• Medication Errors
One of the most common types of negligence in any health care setting, nursing homes included, is medication error. Errors can be the result of transcription error on physician’s orders, MAR’s (medication administration record), nurses’ notes or physician’s progress notes. Medication errors can also simply result from human error in administration of the drug or in failing to follow doctor’s orders. Often, medications are not given as the physician directs and this can ultimately be proved by a close review of the patient’s chart. For example, it is not uncommon to have a facility chart that medication has been administered despite a resident not even being in the facility at the time the medication is noted to have been given.

• Falls and Fall-Related Injuries
Falls are not uncommon in the nursing home setting. Nursing home residents typically carry a variety of risk factors for falls. These falls can result in loss of physical function and decreased quality of life. Assessments for residents at a high risk for falls are a federally mandated requirement. The assessment should lead to an individualized plan of care that will set forth preventive measures for that resident’s risk of falls (or wandering, etc.).

Prevention measures include frequent monitoring, toileting schedules, use of lowered beds, removable restraints (lap belts, lap “buddies”, etc.), electronic body and bed alarms, and even specialized equipment such as electronic tethering devices that sound an alarm when a resident leaves certain areas of the building or when passing through exits from a building.

Once a fall does occur, a facility must provide appropriate and timely assessment for the injury, and generate an incident report. If the injury is serious, there should be an investigation as to the incident’s cause. Severe injuries of unknown cause must be reported to DHEC.

• Choking/ Asphyxiation
Residents with special diets or neurological damages from strokes or other medical conditions are often at increased risk of choking, particularly at mealtime. Proper nutritional assessments should include an assessment of the risk of such injuries which are most often fatal if a patient aspirates food, chokes, or asphyxiates while unsupervised at mealtime. In addition to specialized diets, the need for restorative dietary aides to assist at mealtime must be addressed and each particular resident’s needs met in order to avoid injury or death.

• Burns/Scalds
Burn injuries are more common than one might expect in long care facilities. Often, burns involve residents who are smokers and accidently ignite themselves or burns from uncontrolled water temperatures in showers or whirlpool therapy. The uncontrolled water temperature can be due to nursing home staff errors, plumbing company negligence, product defects, or some combination thereof.

• Physical and Chemical Restraints
Each resident has certain rights including quality of care and quality of life. There are federal regulations in place to ensure that these rights are not compromised by the improper use of physical and/or chemical restraints in the nursing home setting. Often the over use of physical and chemical restraints actually has the resultant effect of more falls and fall related injuries.

The problems in nursing homes will not go away in the foreseeable future. As the baby boom generation ages, the demand for nursing home care continues to grow. Nearly 17,000 nursing homes in the United States currently care for 1.6 million residents, and that number is expected to quadruple to 6.6 million residents by 2050. These staggering numbers will dramatically increase the stressors on a system already crippled by staff shortages, poor working conditions, lack of supervision, and inadequate training.

Some of the attorneys at McGowan, Hood & Felder are well versed in how to decipher nursing home records and determine whether the standard of care is being met. We have an on-staff nurse who assists with an initial impression of whether a case has merit or not. Our lawyers have been litigating nursing home cases for many years. We aggressively litigate nursing home cases and strive to provide our clients with top tier representation.

The attorneys at our firm work closely with referring attorneys to bring a case to successful resolution. The attorneys at our firm who litigate nursing home cases are constantly updating their education and ability to resolve nursing home cases. John G. Felder, Jr. of McGowan, Hood & Felder is currently litigating nursing home cases and is available for consultation by email at jfelder@mcgowanhood.com or telephone (Toll free) 1-877-644-6400.

Please visit our website at www.mcgowanhood.com for comprehensive information on nursing home abuse and neglect.

Very truly yours,

McGowan, Hood & Felder, LLC

John G. Felder, Jr., 1517 Hampton Street, Columbia, SC 29201

Laparoscopic Cholecystectomy

McGowan, Hood & Felder, LLC has handled numerous actions involving Laparoscopic Cholecystectomies in South Carolina and North Carolina.

While “lap chole’s” are not part of the everyday lexicon, the procedure is very common and is simply the surgical removal of the gallbladder. The procedure can be done either laproscopically, where the surgeon makes several small incisions in the abdomen to allow the insertion of surgical instruments and a small video camera, or with an “open procedure” which is major abdominal surgery in which the surgeon removes the gallbladder through a 10 to 18 cm (4- to 7-inch) incision and requiring at least an overnight stay in the hospital.

One of the more common types of injuries resulting from a lap chole is when the surgeon mistakenly identifies the common bile duct for the cystic duct. In order for a surgeon to remove the diseased gallbladder normally he will clip the cystic duct and simply remove the gallbladder. However, before he can remove this organ he must first properly identify the different structures of the biliary tree. A surgeon will do this by removing connective tissue and other types of scarring around the area know as the Triangle of Calot. When sufficient tissue is removed an actual triangle will appear bound by the liver, cystic duct and the common hepatic duct.

When this triangle appears proper identification of the biliary tree is almost without fail. This dissection, however, usually takes about an hour to perform and some surgeons “think” they have identified the cystic duct but are mistaken. A common mistake occurs when the surgeon clips and transects what they believe to be the cystic duct when in fact they mistakenly clip and transect the common bile duct (aka common hepatic duct). It has been my experience that “short cut” mistakes often happen during procedures that are performed late in the day or after the surgeon has already performed a number of other procedures.

When the common bile duct is transected (cut) it cannot simply be sewn back together. Normally transfer to a skilled organ transplant surgeon is required to perform what is known as an hepaticojejunostomy, which is when the small bowel (jejunum) is cut and then connected to the liver (hepatic).

While the common bile duct is improperly transected in only about .4% of cases, there are almost 500,000 of these procedures performed each year in the United States. This number makes it likely that an attorney will see at least one of these cases during his or her career.
Has there been malpractice?

The issue in these cases is not so much if it was negligence to transect the common bile duct, but rather was the surgeon negligent in not positively identifying the cystic duct before he clipped anything. A surgeon should keep cutting away/dissecting until the Triangle of Calot can be positively identified. Clips are then placed on the cystic duct and it is transected. For a number of reasons mentioned above, surgeons will mistake the common bile duct for the cystic duct and proceed to clip and transect it.

The logic can be quite simple when presented in the proper light. If a surgeon positively identifies the cystic duct (which makes up one of the three sides of the Triangle of Calot) then the surgeon should never mistakenly cut the common bile duct. The common defenses are 1) there were so many physical abnormalities (the biliary tree has more differentiation than any other section of the human body), 2) there was too much scar tissue, 3) there was too much bleeding, etc., that the surgeon could not make a positive identification.

These above defenses can be overcome since a surgeon should always revert from laparoscopic to an open procedure when one of the problems above occurs. An “open procedure” provides a surgeon with a much improved field of vision when complications arise. If the injury to the common bile duct occurred during an open procedure, the case may have a stronger defense possibility.

The attorneys at our firm work closely with referring attorneys to bring a case to successful resolution. The attorneys in our firm who litigate Laparoscopic Cholecystectomy cases are constantly updating their education and ability to litigate these types of cases. Robert V. Phillips of McGowan, Hood & Felder has helped to litigate many cases that involve laparoscopic cholecystectomy claims. Robert Phillips is available for consultation by email at rphillips@mcgowanhood.com or telephone (Toll free 1-877-327-3800).

Please visit our website at mcgowanhood.com for comprehensive information on Laparoscopic Cholecystectomy.

Very truly yours,

McGowan, Hood & Felder, LLC Robert V. Phillips, 1539 Healthcare Drive, Rock Hill, SC 29732