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Trombley v. Starr-Wood Cardiac Group6/16/2000
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A: I did not goof. I'm a very experienced surgeon. I do the right thing when I put something on the chart. I bypassed the ramus intermedius. I know the ramus intermedius as well as he does. And the bypass that he thought I did it, that artery, no surgeon in the world would even have considered that artery to be bypassed because it was a tiny, less than half-a-millimeter artery.
A: And if a vessel which is half a millimeter in diameter, if you open that vessel to put a bypass, number one, you would not be able to put a bypass, and secondly, you might even cause some more damage to the heart, and it may end up it bleeding and all kinds of complications.
So any surgeon with some experience would not even dare to open up a small vessel which is half a millimeter in diameter.
So, it's impossible, it's almost impossible, and this kind of negligence, I can't say it never happens, but if it happens, it's - - it's a shame.
Q: Now, you say it would have been impossible to bypass the second diagonal?
A: Right.
Q: And when you said before it can happen, you didn't mean that?
A: What I meant, that somebody would make a mistake, a gross mistake.
Q: And if you did that, it would be a gross mistake, wouldn't it?
A: If I did that, yes.
This testimony shows that if Dr. Ahmad had bypassed the wrong artery, it would have been a negligent act. The combination of Trombley's medical experts' testimony that the wrong artery was bypassed with Dr. Ahmad's testimony that such a mistake would be negligent establishes a triable issue of fact as to whether Dr. Ahmad made a negligent mistake.
Expert testimony also establishes a question of fact as to whether bypassing the wrong artery, if it occurred, was a proximate cause of Trombley's damages. Dr. Colman Ryan observed that Trombley would not have had her post-surgical symptoms and ischemia if the diagonal had been properly bypassed. Dr. Anastassiou observed that, as a result of the improper bypass, additional invasive procedures, such as the angioplasties, were needed to improve the patient's condition. He concluded that the failure to bypass the ramus intermedius resulted "in recurrence of anginal symptoms in this patient."
Because there was sufficient evidence to create genuine issues of material fact as to mistake, negligence, and causation with respect to Dr. Ahmad's conduct, summary judgment was incorrectly granted in his favor.
2. There are triable issues of fact with respect to Dr. Barmada's conduct.
During the surgery, Dr. Barmada had the role of first assistant to Dr. Ahmad. In that role, he was said to have stood approximately "one inch" from Dr. Ahmad and helped Dr. Ahmad with every step of the bypass process. He held open the arteries while Dr. Ahmad stitched the vein into place. Dr. Barmada testified that "there is no difference between [myself and Dr. Ahmad]. We just -- basically these jobs, we swapped around, you know, because we were all so very capable of doing these things."
The standard of care for a first assistant surgeon must be determined on the facts of each individual case. In this case, not only was Dr. Barmada an integral part of the surgical team and a full participant in the bypass procedure, but he also possessed the same level of skill and training as the lead surgeon, Dr. Ahmad. As a cardiac surgeon, Dr. Barmada was fully qualified to perform the bypass surgery. This fact, combined with his vital role on the surgical team, subjects him to the same standard of care as Dr. Ahmad.
The issue of the standard of care for an assista
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