Bleeding Risk Not Revealed, Kaiser Patient Says
5-23-2013 14:06:00

     PORTLAND, Ore. (CN) - When a 410-pound woman consulted a Kaiser obstetrician-gynecologist about 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 a complaint filed in Multnomah County Circuit Court.
     Dr. Rachel Algenio recommended surgery to remove a fibroid tumor from Karen Carmocan’s uterus, "represent[ing] to Karen that if she had the tumor removed she should be able to give birth to a child," the complaint states. But complications from the surgery left little chance of her having children.
     Although Dr. Algenio discovered the tumor in 2008, when Carmocan went to her to try to become pregnant, the doctor did not remove it until 2011, at which time it was 5.5 inches across, the size of a 5-month-old fetus, according to the complaint.
     Also, the complaint says that, although Carmocan had a 1-in-4 chance of needing a transfusion during surgery, because of the procedure being performed, and Carmocan had asked about storing her own blood prior to surgery, Dr. Algenio dissuaded her, saying it was not necessary because the procedure was "routine."
     Carmocan lost a higher than usual amount of blood during the surgery - three times the average - the complaint continues. In the days following the operation, she also had nausea, vomiting, breathing difficulties, excessive coughing, difficulty walking, an unusually high level of white blood cells, indicating infection, and anemia, according to the complaint.
     While Carmocan had "severe" anemia after the operation, as indicated by a hemoglobin count of 6.1 grams/dL, for which she had a transfusion, she was discharged from the hospital with a hemoglobin count that had dropped to 5.6 grams/dL, 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.
     In her complaint, Carmocan blames Kaiser for the pneumonia and subsequent permanent lung damage, alleging it was caused by her post-operative vomiting. She also claims the antibiotic Vancomycin, given for the pneumonia, caused irreversible kidney damage, leaving her little chance of bearing a child.
     Dr. Algenio and Kaiser should have anticipated and warned Carmocan about "the increased risk of intraoperative bleeding in a patient when the surgical field is deep below an abdominal wall that is several inches thick" and "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," according to the complaint.
     "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 so she and her husband, Dan, could try to have a family, according to the complaint. However, Kaiser staff have told her 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 so, “would still have little chance of being able to bear a child," according to the complaint.
     Karen and Dan Carmocan are suing in Multnomah County Circuit Court for $1.3 million. 1305-06731