I have been representing victims of medical malpractice in California since the early 1990's, and I can tell you that some of the most devastating cases I see do not begin with exotic diagnoses or experimental treatments. They begin with what everyone (the patient, family, and even the surgical team) assumed would be a routine procedure.
I recently resolved a case in San Bernardino County that I wanted to write about, with the names and identifying details kept confidential. The story matters because the lessons are not unique to this family. They apply to anyone who walks into a hospital expecting to walk out a few days later in better shape than they came in.
A Routine Surgery That Was Anything But
The patient was a young mother in her late 30s, pregnant with her fourth child at nearly 29 weeks. She arrived at a Southern California hospital with chest pain, leg pain, and shortness of breath. After workup, the team diagnosed acute appendicitis, and the on-call general surgeon performed what he described in the operative report as a "difficult but uncomplicated" laparoscopic appendectomy.
He was wrong about both halves of that sentence.
A few days later, the pathologist examining the specimen reached a different conclusion. The tissue removed from the patient's abdomen was not an appendix at all. It was a portion of her colon (large intestine) with no appendix in it. The surgeon had cut and "stapled" the wrong organ, leaving the appendix in place and leaving a piece of bowel open inside her abdomen.
Over the next several days, the patient's symptoms got worse, not better. Her white blood cell count climbed. She developed fever, tachycardia, and severe abdominal pain. A second exploratory surgery was performed by a different general surgeon, who later testified he had not been told about the pathology finding before he opened her up. He found significant infection— described in his own note as "diffuse fibrinous exudate" with "foul-smelling murky fluid"—but he did not locate the open bowel, did not repair it, and assumed there was simply an abdominal infection without a clear source. The patient was discharged days later. By the way, after a long career, this was the last surgery performed by this surgeon.
She was readmitted to the hospital three days later, this time in a near-fatal condition. Imaging revealed a contained bowel perforation that had created a fistula into her uterus. Emergency surgery delivered her baby early, removed her uterus and an ovary, transected and then repaired her right external iliac artery, and injured her right ureter, all while doctors fought to save her life and the life of the infant.
The baby survived. The mother survived. But they did not walk away whole.
The Lasting Harm
The injuries from this chain of events are permanent. Among them:
- Loss of her uterus and an ovary
- A colostomy and ostomy bag she will lie with for the rest of her life
- Permanent nerve injury to the lumbosacral plexus, causing weakness in her right leg and requiring a walker or cane
- A ureteral stent that must be replaced every three to six months in a hospital setting
- A surgical wound that keeps reopening at the site where a retained sponge was eventually removed
- PTSD, anxiety, and depression layered on top of pre-existing conditions that have substantially worsened
She is in her late 30s. By her treating life care planner's calculation, she has roughly four more decades of medical care, nursing support, equipment, and medication needs ahead of her.
Where the Negligence Occurred
A case like this is not about one mistake. It is about a sequence of failures that one of any which, caught in time, could have prevented the next.
The first surgeon failed to identify the organ he was operating on
He removed bowel and called it an appendix. Then he closed the abdomen without recognizing that what he had taken out was not what he was supposed to take out. Did he even look at the tissue he removed?
The hospital's communication system failed
The pathology lab flagged the problem within days. But by the time the patient was back in the operating room for a second look, that critical information had not made its way to the surgeon standing over her. The surgeon told us in deposition that he could not even identify where the prior surgery had been performed on the bowel.
The second surgery failed to find and fix the open bowel
There was a foul-smelling fluid in the abdomen. There was a fecalith, meaning fecal materials had escaped somewhere. The CT had shown findings consistent with perforation. The signs were there. They were not pursued.
Discharge came too soon
White blood cell counts were still elevated. The infection had not been controlled. She went home, got worse, and almost did not come back.
For every patient reading this, the takeaway is not that hospitals are dangerous places. The takeaway is that medicine depends on communication, careful identification, and timely recognition of errors. When any of those break down, patients pay the price.
How California Law Treats Cases Like This
California's medical malpractice statute, MICRA, caps non-economic damages (that is, compensation for pain, suffering, disfigurement, and loss of enjoyment of life). For cases filed before January 1, 2023, those caps were horribly low. With a modification to the law in 2023, the non-economic damages increased and improved recoveries for victims of malpractice. We argued, and the defense ultimately had to take seriously, that two separate acts of negligence by two different surgeons created two separate caps under Civil Code § 3333.2.
The economic side of the case—past and future medical expenses, lost earning capacity, the lien held by Medi-Cal—was sustainability larger than the non-economic side. A treating life care planner projected lifetime medical and supportive costs in the mid-seven figures. The defense retained its own life care planner who, predictably, projected dramatically lower annual costs (roughly $28,000 per year in his model) by recommending less attendant care, fewer services, and different assumptions about future needs.
This is what mediation does well. Both sides put their numbers on the table. A neutral mediator helps the parties see where reasonable people can disagree, where the evidence is strong, and where the risk of trial cuts both ways. After a full day of mediation, the case resolved for a confidential seven figure result.
What I Want Patients and Families to Take From This
A few practical lessons:
- Ask for your pathology report. When tissue comes out of your body, a pathologist looks at it. You have a right to know what they saw.
- If something does not feel right after surgery, push. Rising fevers, worsening pain, no bowel function, these are not things to "wait out". They are reasons to demand imaging and answers. Do not let the medical providers tell you what you are feeling is normal when you know it is not normal.
- Document everything. Names of doctors, times of conversations, what you were told and by whom. In a malpractice case, this is gold.
- Talk to a lawyer early. California has a strict statute of limitations for medical negligence claims. Waiting too long can end your case before it begins.
Not every surgery that resulted in a bad outcome is malpractice. But what if a doctor did act negligently? You need to know if your outcome was an unfortunate outcome, or caused by preventable negligence. If you or a loved one has been through something similar—a surgery that did not go the way it was supposed to, complications that nobody can quite explain, a hospital that will not return your calls—please reach out. A confidential, no-obligation conversation costs nothing and may answer questions that have been keeping you up at night.
