Friday, February 16, 2007

Team Weis' Hired Hand Testifies

An expert witness was brought in Thursday to testify on behalf of Charlie Weis in the Notre Dame coach's malpractice trial against Massachusetts General Hospital doctors Charles Ferguson and Richard Hodin.

San Diego surgeon Alan Wittgrove, right, who said he has performed 3,500 operations like the gastric bypass procedure that Weis underwent, testified for over three hours. Wittgrove criticized Ferguson, who performed the surgery, and Hodin, whom Ferguson entrusted with Weis' post-operative care, for continuing to administer the blood-thinning drug Heparin while Weis was hemorrhaging before a second surgery was performed to stop the bleeding.

Wittgrove didn't stop there, blaming the partial paralysis in Weis' feet on Massachusetts General's apparent failure to monitor his thiamine levels. "It's well-known that if you don't give adequate thiamine, [nerve damage] can ensue."

Defense attorney William Dailey then took his shots at Wittgrove, getting the surgeon to acknowledged that he charges $7,500 a day for testimony. Dailey's attack on Wittgrove's credibility continued, with Dailey getting the surgeon to acknowledge that in a previous case with similar circumstances — in that case, the patient died — Wittgrove testified the doctor gave appropriate care.

Judge Charles Spurlock called attorneys on both sides to the bench four times for conversations as the questioning became mildly contentious.

On Friday, New England quarterback Tom Brady will testify on Weis' behalf.

To help us put Day 3 in perspective, we bring in our expert for the trial, Gary Gaffney, M.D., University of Iowa Hospitals and Clinics and founder of the site Steroid Nation.

"Was it obvious Weis was suffering from internal bleeding during the immediate post-op period as Wittgrove seemed to indicate? Apparently not. Weis was comfortable at first, then became distressed. The Massachusetts General doctors ordered a CT scan, which did not reveal internal bleeding on Saturday, the day after the surgery. Further, the doctors were concerned about pulmonary (lung) embolism (blood clot), which is fatal.

"Heparin, which Wittgrove criticized, treats blood clots. Concern about pulmonary embolism is likely the reason that Massachusetts General doctors continued the blood-thinning medicine.

"Wittgrove's assertion that thiamine deficiency is 'well-known' to cause leg pain in bypass patients is interesting for two reasons:

"—It takes time for thiamine to become low (weeks to months) because the malabsorption caused by surgery depletes the body of thiamine;

"—If Weis had followed normal procedure — a long period of counseling before surgery — perhaps he could have increased his stores of thiamine before surgery.

"Weis' condition deteriorated into Saturday night. Something must have happened that night to exacerbate Weis' distress. We know Weis pulled his trachea breathing tube out. By Sunday, nurse Jennifer Wilson notified doctors of her suspicion of internal bleeding. After a barium swallow revealed the internal bleeding, Weis underwent emergency surgery that was followed by infection, shock and a two-week coma.

"It's clear that Weis' post-operative course produced a serious threat to his life. Did Massachusetts General physicians neglect their professional duty or provide substandard care?

"As for Wittgrove performing 3,500 of the same operation Weis underwent, that is up for debate. While it is true Wittgrove 'pioneered laproscopic gastric bypass', it appears Weis underwent Roux-en-Y bypass, which requires a large incision, different from the Wittgrove procedure."

Previous coverage:
Day 2: Weis testifies
Day 1: Opening statements
Preview: A legal perspective
To bypass registration, go to Bug Me Not. Thanks to Hester Graphics for their help.


Anonymous said...

you should do more research yourself before stating some of the things you have stated about Dr Alan Wittgrove.

Anonymous said...

Wittgrove is either a liar or has no idea what he is talking about. You don't get thiamine deficiency related neuropathy after 2 days (especially in someone as well-nourished as Charlie Weis appeared to be).

Anonymous said...

Your expert for the trial, Gary Gaffney, M.D., was either misquoted or misinformed pertaining to the comment that the laparoscopic procedure performed by Dr. Wittgrove is different than the Roux-en-Y procedure that Weiss had. Any surgeon knows that a Roux-en-Y gastric bypass can be done "open" or "laparoscopically." If you have done 3,500 of either, you are an expert in the basic anatomy and potential complications pertaining to either approach.

Anonymous said...

Yes, it appears true that the internal procedure used on the laparoscopic approach is Roux-en-Y; we meant the external approach is different.

We acknowledged that we did not have medical records to look at, and thus didn't know the exact procedure. We tried to be fair in the comments, especially since we did not have access to the medical records, nor the testimony transcript.

If 'any surgeon' knows the anatomy and the complications of the procedure, why did the defense team fly in Dr. Wittgrove at great expense?

If it is 'obvious to any surgeon' on that point, is it 'obvious':
1. That Weis' surgeons should have known he was bleeding? (point of contention)
2. That thiamine deficiency was the cause of the lower extremity neuropathy in the case? (point of contention)

Again, we tried to present a fair commentary on the trial, without examination of the medical record.