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The International Journal of Evidence & Proof ( IF 0.7 ) Pub Date : 2019-09-05 , DOI: 10.1177/1365712719874630
Michael Plaxton 1
Affiliation  

In the course of performing a laparoscopic hysterectomy on Lanette Mitchell, Dr Evan Shikora made an incision into Mitchell’s abdomen. He noticed that Mitchell’s colon “had been severely cut”, making it necessary to perform an emergency loop ileostomy. Mitchell’s bowel was repaired, but she needed to wear an external ileostomy pouch for a time. Mitchell sued Dr Shikora, alleging negligence. She argued that Dr Shikora’s conduct fell below the medical standard of care, inasmuch as he failed “to identify her colon before making an incision into her abdomen”. Importantly, though, she did not claim battery or lack of informed consent; i.e. she did not claim that she was unaware of the risks or complications associated with the medical procedure when she consented to it. At trial, the defendant adduced expert evidence about known risks and complications of laparoscopic hysterectomies; in particular, that “in making the initial incision, a physician often cannot see through the tissue”, making it impossible to know for certain whether he or she will perforate the colon even in the absence of surgical negligence. The risks of such perforation are therefore present even during a ”properly performed laparoscopic hysterectomy.” The jury found in favour of Dr Shikora. On appeal, a three-judge panel of the Pennsylvania Superior Court held that the expert evidence, adduced by the defendant, should have been excluded. That evidence, the Superior Court held, was irrelevant, misleading, and confusing:

中文翻译:

案例评论

在对 Lanette Mitchell 进行腹腔镜子宫切除术的过程中,Evan Shikora 医生在 Mitchell 的腹部做了一个切口。他注意到米切尔的结肠“被严重割伤”,因此有必要进行紧急回肠造口术。米切尔的肠道已经修复,但她需要戴上回肠造口外置袋一段时间。米切尔起诉 Shikora 博士,指控其疏忽大意。她辩称,Shikora 医生的行为低于医疗护理标准,因为他未能“在切开腹部之前识别出她的结肠”。但重要的是,她并没有声称殴打或缺乏知情同意。即,当她同意时,她并没有声称她不知道与医疗程序相关的风险或并发症。在审判中,被告提供了关于腹腔镜子宫切除术已知风险和并发症的专家证据;尤其是“在做最初的切口时,医生通常无法看到组织”,因此即使没有手术疏忽也无法确定他或她是否会穿孔结肠。因此,即使在“正确进行腹腔镜子宫切除术”期间也存在这种穿孔的风险。陪审团认为 Shikora 博士胜诉。在上诉时,宾夕法尼亚州高等法院的一个由三名法官组成的小组认为,被告提出的专家证据应该被排除在外。高等法院认为,该证据不相关、具有误导性且令人困惑:即使没有手术疏忽,也无法确定他或她是否会穿孔结肠。因此,即使在“正确进行腹腔镜子宫切除术”期间也存在这种穿孔的风险。陪审团认为 Shikora 博士胜诉。在上诉时,宾夕法尼亚州高等法院的一个由三名法官组成的小组认为,被告提出的专家证据应该被排除在外。高等法院认为,该证据不相关、具有误导性且令人困惑:即使没有手术疏忽,也无法确定他或她是否会穿孔结肠。因此,即使在“正确进行腹腔镜子宫切除术”期间也存在这种穿孔的风险。陪审团认为 Shikora 博士胜诉。在上诉时,宾夕法尼亚州高等法院的一个由三名法官组成的小组认为,被告提出的专家证据应该被排除在外。高等法院认为,该证据不相关、具有误导性且令人困惑:宾夕法尼亚州高等法院的一个由三名法官组成的小组认为,被告提出的专家证据应该被排除在外。高等法院认为,该证据不相关、具有误导性且令人困惑:宾夕法尼亚州高等法院的一个由三名法官组成的小组认为,被告提出的专家证据应该被排除在外。高等法院认为,该证据不相关、具有误导性且令人困惑:
更新日期:2019-09-05
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