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Houserman v. Garrett12/10/2004
This medical-malpractice case involves the post-surgical retention within a patient's body of a surgical aid known as a Kerlix brand gauze pad. Jennifer Garrett, on June 30, 1995, underwent surgery to reverse a bilateral tubal ligation that had been performed years earlier. This reversal surgery, known as an isthmic-ampullary renanastomosis, is intended to surgically repair the fallopian tube after it has been cut or burned apart in a tubal ligation. The isthmic-ampullary renanastomosis procedure involves delicate microsurgery, made more difficult because the surgical site is located within the abdomen. Garrett's surgery was conducted by Dr. Virginia Houserman, who was assisted by her partner, Dr. Kathryn Honea.
Dr. Houserman and Dr. Honea practice medicine together as Honea & Houserman, P.C. Dr. Houserman and Dr. Honea are board-certified specialists in obstetrics and gynecology, and in the subspeciality of reproductive endocrinology. The surgery was performed at Brookwood Medical Center, which is operated by Brookwood Health Services, Inc. Assisting in the surgery were three nurses employed by Brookwood Health Services (Diana L. Tunney, Scott Thomas, and Carolyn Newsome). Dr. Houserman does not dispute that the Kerlix pad was placed under Garrett's uterus during surgery to elevate the uterus for better access and that this pad was not removed after the surgery was completed. It is undisputed that Nurse Tunney was responsible for counting the surgical sponges and surgical devices used in this procedure before and after the surgery and that she apparently did not include the Kerlix pad in her pre-surgery count and did not advise Dr. Houserman, before the surgical site was closed, that a pad or surgical device was unaccounted for. The evidence shows that Nurse Tunney may have lacked an understanding of how to record and keep track of the Kerlix pad and that she did not in fact include it in her count, which was verified three times before the surgical site was closed, in compliance with hospital policy. The evidence also shows that Nurse Tunney was not in the operating theater when the Kerlix pad was placed in Garrett's body and that she may not have been informed by the nursing staff that the Kerlix pad had been inserted.
The testimony in the case establishes that Dr. Houserman completed a three-part check before closing the surgical site: a visual inspection, a manual inspection (by feel), and a numerical count conducted by Nurse Tunney, the circulating nurse attending the surgeon. Manual inspection of the surgical site was complicated by the nature of the surgery and by the microscopic size of the fallopian tube. Testimony established that the reversal surgery is so delicate that a bump to the uterus or a shifting of the tissues could potentially undo the surgery, so the manual manipulation of tissues within the surgical cavity was constrained. By the same token, the visual examination of the surgical area was compromised in that the tissues could not be subjected to gross movement, and by the further fact that during the course of the surgery the site became covered with blood, bodily fluids, and other liquids, such as methylene blue dye, introduced into the site to prevent infection and cross-contamination.
It is undisputed that Garrett began experiencing significant discomfort and pain almost immediately after this surgery and that she visited Dr. Houserman several times seeking relief. Due, at least in part, to the fact that the Kerlix pad used by Dr. Houserman had no X-ray signature, none of the examinations conducted by Dr. Houserman subsequent to the surgery disclosed the presence of the pad. It was only when an abscess formed, with accumulated bodily fluids that were v
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