Tell your surgical providers about your medical conditions

A Court ruling says patient should have revealed her medical conditions. The surgical team was held not liable for her death of a stroke after a hip replacement.

A 71-year-old woman who died after suffering a post-operative stroke neglected to inform caregivers about her chronic vascular disease before undergoing elective hip-replacement surgery at a Mississippi hospital. Because the hospital and surgical team were unaware of the increased risks before the procedure, a state court of appeals has cleared them of wrongdoing.

Jean Triplett, then 71, had her hip replaced at River Region Health System in Vicksburg on Jan. 6, 2004. The surgery was completed without incident, and Ms. Triplett appeared to be on the road to recovery the morning after, showing “no signs or symptoms of distress,” according to court records. Later that morning, however, Ms. Triplett’s speech became slurred and her left-side extremities weakened. She suffered a stroke, and passed away 2 years later on Oct. 25, 2006.

After Ms. Triplett’s death, a legal battle over the exact cause of the stroke ensued between her family and River Region. The family claimed the surgery was to blame, while the hospital contended it was “embolic in nature,” a result of Ms. Triplett’s many years of smoking and underlying right-side stenosis.

In 1997, doctors had diagnosed Ms. Triplett with bilateral carotid stenosis and recommended she undergo bilateral carotid endarterectomy, which she refused. Two years later, when her health worsened, the lifelong smoker agreed to undergo a right carotid endarterectomy, but declined the same procedure on the left side of her neck, despite multiple warnings from cardiovascular surgeons that failing to undergo the surgery would leave her at increased risk for stroke.

Then in 2003, when the pain in her hip became too much, Ms. Triplett decided to undergo surgery to replace the degenerative joint. Before the surgery, she neglected to tell orthopedic surgeon William Porter Jr., MD, that she suffered from a severely occluded (blocked) stenotic internal carotid artery. In addition, she did not inform family practitioner Lamar McMillin, MD, of the condition during her pre-op physical. On the day of surgery, she also failed to alert anesthesiologist John Adams, MD, and nurse anesthetist Patty Stone, CRNA, that she was at heightened risk for stroke, even after the two alerted her that death was a risk of anesthesia. Read more.

The serious nature of anesthesia must be explained to all patients. There are no minor anesthetics: each can cause injury. Medical crises and complications may occur during or after surgery, without any link to the surgery. Heart attacks, strokes, or blood clots that travel to the lung can occur coincidentally. if the surgical team- anesthesiologist and surgeon- are unaware of risk factors, they cannot take the steps needed to minimize the risks. In these crisis situations, where unknown factors are at play, the providers can only react to events, working to sustain the patient’s airway, breathing, and circulation.

Tell your surgical team about any medical conditions you know of. A medical clearance may detect previously known conditions. Your healthcare providers want you in tip top condition before you undergo surgery.

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