Bleeding Risk Not Revealed, Kaiser Patient Says

     PORTLAND, Ore. (CN) - When a 410-pound woman consulted a Kaiser obstetrician-gynecologist about the feasibility of becoming pregnant, the doctor recommended uterine surgery but did not warn her about the risk of complications due to her weight, the woman claims in court.
     Dr. Rachel Algenio told plaintiff Karen Carmocan about a fibroid tumor on her uterus in 2008, according to the complaint. Yet, "it was not until 2011 when Dr. Algenio advised Karen that the said growth would interfere with her ability to have children and because of such, Dr. Algenio recommended that Karen have surgery to remove the growth from her uterus. Dr. Algenio represented to Karen that if she had the tumor removed she should be able to give birth to a child," the complaint states.
     Carmocan initiated a discussion with Dr. Algenio about pre-surgical blood storage in case she needed a transfusion, according to the complaint. However, Dr. Algenio dissuaded her, saying it was not necessary because the procedure was "routine," the complaint continues.
     Carmocan lost a higher than usual amount of blood and she began to have complications in the days following the operation, the complaint says. The complications included nausea and vomiting, breathing difficulties, excessive coughing and an unusually high level of white blood cells, according to the complaint. "An elevated white blood cell count can be an indication of an infection in the body," the complaint says. She needed to use a walker to walk because the blood loss had made her anemic, the complaint continues. After another two days, Carmocan was given a transfusion, but the anemia symptoms continued, as well as the coughing and vomiting, according to the complaint.
     A day after she went home, Carmocan was back in the hospital because of her continuing problems, where she was diagnosed with pneumonia and sepsis, the complaint says.
     Carmocan blames Kaiser for the pneumonia and subsequent permanent lung damage, alleging it was caused by aspirated stomach contents from her untreated post-operative vomiting. She also claims excessive use of the antibiotic Vancomycin, given for the pneumonia, caused kidney failure and irreversible kidney damage. "Anemia played a significant role in the events that followed Karen's surgery," the complaint says, depriving her brain and other organs of red blood cells and oxygen for an extended period. Carmocan says Dr. Algenio breached the standard of care by causing the excessive blood loss, not anticipating anemia as a likely result and not replacing the lost blood sufficiently before sending her home.
     Carmocan says Kaiser should have anticipated and warned her about "the problems that can occur during and following surgery performed on a person weighing 400 pounds," including "the increased risk of intraoperative bleeding in a patient when the surgical field is deep below an abdominal wall that is several inches thick" as well as "the increased risk of post-operative pneumonia in a patient whose extremely large body reduces the ability to breathe deeply and move about in the bed."
     "Had Karen been advised by Dr. Algenio of the severity of risk of the procedure, especially the risks related to Karen's excessive weight, such as the increased risk of intraoperative bleeding," she would have decided not to pursue the surgery, she says.
     Karen Carmocan gave up an educational goal of becoming a family counselor so that she and her husband, Dan, could try to have a family of their own, according to the complaint. However, "defendant's staff has represented to Karen that if she were to now become pregnant she would need to be placed on kidney dialysis during the time of the pregnancy, and even if she were to be placed on kidney dialysis, Karen would still have little chance of being able to bear a child," she says.
     Karen and Dan Carmocan are suing in Multnomah County Circuit Court for $1.3 million.