Sometimes when a pregnant woman is in labor, a surgical procedure called a C-section is necessary. During this procedure, a doctor will make an incision in the lower abdomen, the abdominal muscles are separated and the uterus is opened to ultimately get the baby out.
While it is not common while performing this procedure, it is possible that a surgeon nicks or damages the bowel, which leads to serious post-operative complications. When this happens, prompt diagnosis is crucial, and emergency surgery is required to repair the hole.
If proper diagnosis and treatment fails to occur, this complication can lead to abdominal infection and ultimately sepsis. In other words, if proper diagnosis and treatment is delayed, this complication can lead to severe infection, multi-organ failure, and in the most extreme cases, death.
In this case, delays and failures caused these very complications, and while our client survived, the negligence of her physicians caused extensive and painful damage. The Townsley Law Firm won this case in a settlement and secured over $375,000 in favor of our client.
Table of Contents
What Happened: A Surgical Injury Left Untreated While Her Condition Collapsed
Day One: Labor, Delivery, and Post-Operative Care
Our client, a 30-year-old woman, was admitted to the hospital at 39 weeks gestation for the induction of her labor. After a cesarean section delivery of a healthy baby, she was placed on a patient-controlled analgesia pump, referred to as a PCA, for post-operative pain management.
Post-operative orders following her c-section included ambulation, discontinuation of her Foley catheter, and PCA use eight hours after surgery. These are standard recovery protocols following a cesarean delivery. What followed was a failure to execute those protocols with the clinical attentiveness they require.
When nursing staff performed a gastrointestinal assessment, they documented her bowel movement pattern as normal and regular. This assessment was inaccurate. It was not consistent with what was actually happening inside her body.
When she attempted her ambulation trial, she displayed a concerning pulse rate elevation. Tachycardia following a c-section is not a finding that can be dismissed or left undocumented and ignored. It must be timely communicated to the physician. The nursing staff did not report it.
Later that same day, a gastrointestinal assessment revealed an abnormal lack of flatus, meaning she was not passing gas. In a post-surgical abdominal patient, failure to pass flatus is a significant clinical sign. It can indicate that the bowel is not functioning normally, which in turn can indicate a serious underlying problem. This finding, combined with the earlier tachycardia, should have triggered immediate physician notification and evaluation.
Instead, the physician was not notified. Our client was left untreated.
Day Two: The Worsening Condition – Signs of Complications Amplify
The following day, the signs of a serious and worsening condition were no longer subtle. Nursing staff documented and reported all of the following:
- Abnormal vital signs
- Abnormal lung sounds
- Shortness of breath
- A tachycardic cardiovascular assessment
- Decreased appetite
- Weakness
The physician on call did not come to evaluate her. Instead, from a distance, he ordered a chest X-ray.
The chest X-ray revealed a large pneumoperitoneum, which is the presence of free air in the abdominal cavity. This finding is a recognized radiological emergency. Free air in the abdomen following abdominal surgery strongly indicates a potential bowel perforation, meaning that a hole has been created in the intestinal wall, allowing intestinal contents to leak into the sterile abdominal cavity. This is a life-threatening surgical emergency that requires immediate physician evaluation and urgent intervention.
The on-call physician then ordered a CT scan of the abdomen and chest. He still did not come to the hospital.
Our client’s documented condition at this point included decreased oxygen levels, worsening diaphoresis (profuse sweating, a sign of physiological distress), upper right-sided abdominal pain, back pain, neck pain, and an abdomen that was firm and tender to the touch.
Her condition continued to deteriorate. Her physician still did not come evaluate her.
Five Phone Calls and a Single Dose of a Diuretic
Nursing staff called the physician repeatedly as their patient’s condition worsened. They called five times. Five documented calls while a post-surgical patient showed progressive signs of intra-abdominal catastrophe.
On the fifth call, the physician ordered a one-time 40mg intravenous dose of Lasix. Lasix is a diuretic, a medication used to help the body eliminate fluid through urination. It is used in conditions like heart failure and fluid overload. It has no role in treating a suspected bowel perforation or intra-abdominal sepsis. Ordering a diuretic for a patient in this condition was not only clinically useless; it was a further delay of the intervention she urgently needed.
The Emergency Surgery
When the physician finally arrived at the hospital, laboratory results revealed significant bandemia, an elevation in immature white blood cells called band cells in the bloodstream. Bandemia is a recognized marker of serious bacterial infection and sepsis. Her abdomen had grown to twice its original size. She had still not had a bowel movement. An abdominal ultrasound was ordered.
She was taken for an emergency exploratory laparotomy, a surgical procedure in which the abdomen is opened and directly examined.
When her peritoneum was opened, surgeons found three liters of stool in her abdominal cavity and a puncture wound in her bowel. The bowel had been perforated during her c-section. For the days that followed her surgery, while nursing staff called and the physician failed to respond and evaluate her, the contents of her bowel were leaking into her abdomen.
She was diagnosed with sepsis, infection with Klebsiella pneumoniae bacteria, and leukocytosis with fever, a significant elevation in white blood cells indicating the body’s response to severe systemic infection.
What is the Standard of Care Required at Each Stage?
The failures in this case were not limited to a single decision. They accumulated across multiple days and multiple clinical decision points.
The nursing staff was required to:
- Accurately perform and document gastrointestinal assessments
- Report abnormal vital signs including the tachycardia observed during the ambulation trial
- Escalate concerns when a patient’s condition was visibly deteriorating
- Continue to escalate through the chain of command when a physician was not responding adequately to repeated calls.
The attending physician was required to:
- Evaluate the patient in person when nursing staff reported the findings documented on day two
- Respond appropriately to a chest X-ray showing a large pneumoperitoneum by presenting to the hospital and initiating emergency evaluation and intervention
- Order clinically appropriate treatment rather than a diuretic for a patient with documented signs of intra-abdominal catastrophe
- Respond to five nursing calls about a deteriorating post-surgical patient by doing more than issuing a telephone order for a medication with no relevance to her actual condition.
The Townsley Law Firm presented these failures to the defendant in this case. They agreed that the standard of care was not met and that the failures caused our client’s injuries, ultimately leading to a settlement decision.
Why a Physician’s Failure to Respond to Nursing Calls Can Be Malpractice
In Louisiana, the duty of care does not end when a physician writes post-operative orders and leaves the hospital. A physician who has a patient under their care remains responsible for responding appropriately when nursing staff document and report changes in that patient’s condition.
When a patient’s nurse calls once, much less five times to report worsening symptoms, abnormal vital signs, abnormal imaging, and a deteriorating clinical picture, and the physician responds only with a telephone order for a medication that has no application to the documented condition, that response can constitute a breach of the standard of care. The physician’s failure to present to the hospital and personally evaluate the patient is independently actionable as negligence when the circumstances clearly required it.
Louisiana law holds both the individual physician and the hospital accountable in these circumstances. The hospital has its own duty to ensure that its medical staff respond appropriately to nursing escalations and that patients under their care receive timely evaluation and treatment.
What Is a Bowel Perforation After a C-Section and How Does It Cause Sepsis?
A bowel perforation is a hole or tear in the wall of the intestine. During abdominal surgeries, including cesarean sections, adjacent structures can be inadvertently injured by surgical instruments. When the bowel is perforated and the injury is not immediately recognized and repaired, intestinal contents, including bacteria and stool, begin leaking into the abdominal cavity.
The abdominal cavity is sterile. When fecal matter and bacteria enter it, the body mounts an intense inflammatory response. This is called peritonitis. If peritonitis is not treated promptly through surgical repair and antibiotic therapy, the infection spreads into the bloodstream and the patient develops sepsis.
Sepsis is a systemic, life-threatening response to infection. Left untreated, it progresses to septic shock, multi-organ failure, and death. In a patient with three liters of stool in her abdomen and documented Klebsiella pneumoniae bacteria, the severity of the infection she was fighting, while her physician ordered a diuretic from a distance, cannot be overstated.
What Is Bandemia and Why Does It Matter in a Malpractice Case?
Bandemia refers to an elevated count of band cells, also called band neutrophils, in the bloodstream. Band cells are immature white blood cells. Their elevation in the blood indicates that the body is under significant infectious stress and is releasing immature immune cells because the demand for infection-fighting cells has outpaced the normal supply of mature ones.
In clinical practice, bandemia is a recognized warning sign of serious bacterial infection and early or developing sepsis. It is reported on a standard complete blood count (CBC) with differential, a routine lab test. When a post-surgical patient’s labs return with significant bandemia alongside tachycardia, abdominal distension, and a CT scan showing a pneumoperitoneum, the clinical picture is unambiguous. Immediate surgical evaluation and intervention are required.
In a medical malpractice case, the presence of documented bandemia in the laboratory results is powerful evidence. It establishes that the infection was measurable and visible in the data, and that a physician with access to those results was on notice that something serious was happening inside their patient.
