Guillen v. Martin
| Decision Date | 15 December 1958 |
| Parties | Aurora GUILLEN and Natividad Guillen, Plaintiffs and Respondents, v. J. Needham MARTIN et al., Defendant and Appellant. Civ. 5763. |
| Court | California Court of Appeals Court of Appeals |
Swing & Swing, San Bernardino, for appellant.
Collins & McKenna, Los Angeles, for respondents.
Plaintiff-respondent Aurora Guillen (hereinafter called plaintiff) on July 2, 1954, consulted defendant-appellant Dr. J. Needham Martin (hereinafter called defendant) with an abdominal complaint that ultimately led to a diagnosis of cholelithiasis and a cholecystectomy, or surgery for removal of the gall bladder, on August 6, 1954. Defendant performed the surgery with the assistance of other doctors and nurses.
This was the plaintiff's first abdominal surgery in the area of the biliary ducts. The biliary duct system is composed of the right and left hepatic ducts which attach to and come directly out of the liver, to join together in the common hepatic duct which proceeds for about four centimeters to where it is joined by the cystic duct which connects with the gall bladder. The cystic duct itself is about four centimeters in length. From the point where the cystic duct joins the common hepatic duct the name 'common bile duct' is applied until it reaches its ultimate destination about eight centimeters away at the duodenum, which is that portion of the digestive tract attached directly to the stomach. The function of the bile thus carried into the duodenum from the liver and the gall bladder is primarily to aid in the digestive functions. When the gall bladder becomes diseased it is sometimes found necessary to remove it. This is done by severing the cystic duct, removing the gall bladder, and suturing the end of the cut duct which is closest to its juncture with the common hepatic duct, so that the cystic duct becomes permanently sealed off and entirely inoperative. If the common duct or common hepatic duct should be severed and both of the severed ends ligated, the end closest to the duodenum will gradually atrophy and contract through disuse. The ligation of the end closest to the liver will cause the liverproduced bile to back up into the liver itself, causing the liver to swell and gradually disseminate its bile into the bloodstream with resulting severe jaundice and ultimate death unless the back pressure is relieved. If the ligation in this portion of the common bile duct slips off, the liver continuing to function will discharge its bile directly into the peritoneal cavity causing severe inflammation of those organs that it reaches, with resulting peritonitis and ultimate death unless prompt action is taken to correct the situation. In a cholecystectomy the operating surgeon is aware of all these things and knows that one of his primary needs is to expose and identify the cystic duct, the gall bladder, and the common hepatic and common duct, and to closely guard against severance of the common hepatic duct or the common bile duct. All of these things were also well known to defendant, and he testified that he did take such precautions.
After the operation plaintiff continued to suffer pain, developed fever, inability to retain food, abdominal distention, and absence of natural bowel movement during the entire stay in the hospital until she was discharged. On August 15, she was discharged from the hospital but continued to suffer, complained to defendant, was readmitted to the hospital, and was treated for bile peritonitis due to leakage of bile into the peritoneum. Defendant called in a consulting physician and performed another surgery of an exploratory character (laparotomy), but due to plaintiff's poor physical condition did not expose the biliary tract (area around the liver and bile ducts), but did institute drainage; large amounts of bile-like fluid were drawn from the abdominal tract. Her condition worsened to the critical stage and on September 10, at her own request, she was removed to another hospital and employed another doctor (Wetrich).
Doctor Wetrich also removed substantial amounts of bile-like fluid from the abdominal tract, instituted further drainage, and after a month-long body building process to sufficiently strengthen her that she could again endure a major operation, opened the biliary tract to view and ultimately discovered that the common bile duct had been severed and at least partly ligated; that bile was leaking from it into the peritoneal cavity; that one catgut tie was lying loose and unattached near the severed end of the common bile duct closest to the liver, which catgut tie was involved or imbedded in scar tissue. It was found that the common hepatic duct had been severed about two centimeters away from the juncture of the right and left hepatic ducts; that portion of the common hepatic duct where the cystic duct joins was missing; the severed end of the common hepatic duct was then joined to the severed end of the common bile duct (an anastomosis). This operation was performed about October 13, 1954. A drainage tube was inserted and remained sticking out of her abdomen until May of 1955, during all of which time she suffered some pain, discomfort and inconvenience, but gradually recovered.
Thereafter, an action for damages was brought by plaintiff against de...
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