Opinion ID: 1872831
Heading Depth: 1
Heading Rank: 3

Heading: dr smith's version of events

Text: In all significant instances, Dr. Smith's version of events is very different from that of Lana Fox. Dr. Smith explained that when Mrs. Fox first came to see him she complained of abdominal pain and excessive bleeding during menstrual periods. According to Dr. Smith, he and Mrs. Fox did discuss her IUD on this first visit on January 8, 1986. Dr. Smith testified that they discussed the IUD on January 8th, and he recommended removal of the IUD. Additionally, Dr. Smith, testifying from Lana Fox's medical records, explained that Mrs. Fox's chart indicated that he also discussed the IUD with Mrs. Fox during the pre-op office visit on February 25, 1986. This is a sharp contrast from the testimony of Mrs. Fox wherein she claims that the first time that Dr. Smith ever mentioned the IUD removal was in the operating room only seconds before she was put to sleep. In the excerpt which follows, Dr. Smith is testifying and reading from his office chart on Lana Fox for the entries made on February 25, 1986: A. Surgery, appendectomy. Medicines presently taking, none. Last menstrual period, two, three, eighty-six. Full discussion with patient, quote, `Don't want IUD removed. She is aware of recent Searle lawsuits and advised for  from Searle, but does not  BY MR. SMITH: Excuse me, I have no  A.  But wishes not to remove IUD, but use your own judgment,' quote. As indicated by the testimony quoted above, Dr. Smith alleged that the IUD was discussed with Mrs. Fox in both office visits prior to surgery. Mrs. Fox allegedly informed Dr. Smith that she did not want the IUD removed even though she was aware of consumer lawsuits against Searle Company, the manufacturer. On February 25, 1986, following Mrs. Fox's office visit, Dr. Smith dictated a physical examination report to the hospital via telephone. Regarding the IUD, the report stated, She has a CU-7 present. Does not want it removed. The contrasts between Dr. Smith's and Mrs. Fox's story sharpen. Dr. Smith further testified that he came to Mrs. Fox's room prior to surgery, a fact which Mr. and Mrs. Fox adamantly deny. According to Dr. Smith, when he arrived at the hospital, he received word that Mrs. Fox had refused to sign her consent form, and he went to visit her. The testimony which follows describes Dr. Smith's version of what transpired in Lana Fox's room prior to surgery: Q. Well tell me again what  what the discussion was with Mrs. Fox in her room on February twenty-seventh? A. To the effect that we're going to do a laparoscope. `I know you don't want your IUD out.' `No, I don't want my IUD out, but if I think it's a problem or find any difficulty, well certainly you ought to take it out.' ...       Q. Was there any discussion there in the room about `Take it out if you think it's necessary,' or anything like that? A. Yeah, that's what I was just saying. If you  `I don't want it out, doctor Smith.' `I understand, Mrs. Fox, you don't want it out, but if we find that that's a major problem it ought to come out.' Total agreement. As a result of this conversation with Mrs. Fox on the morning of surgery, Dr. Smith made the following handwritten note on her physical examination report:  On rounds this am 2-27-86 pt has decided to have old cu 7 removed and consider another one /s/ pns. Dr. Smith testified that his understanding with Mrs. Fox was that even though she did not want the IUD removed, she left the decision to remove to his professional judgment. Dr. Smith also described a meeting with Lana Fox in the holding area of the operating room just prior to surgery: A.  there was a RN there in surgery said that Mrs. Fox wanted to see me again, and I went in there ... And she was asking  I think she goes through a list of what's going to be done and she said, `A laparoscope and anything else  Well if my IUD needs to come out we're going to take it out, but I don't want to take it out; I mean that was the general gist of the  so we were going to do a laparoscope and whatever was necessary. Q. But she did tell you there also that if the IUD needs to come out  A. That's correct. Q.  It could? A. That's correct. Dr. Smith described the laparoscopy. An incision is made just below the navel, and CO2 gas is then injected into the incision. The gas fills the belly and lifts the internal organs. An optic tube is then inserted which allows viewing of the internal organs. This allows the surgeon to examine the internal organs in the pelvic area such as the ovaries, fallopian tubes, etc. Other internal organs such as the bowels and gallbladder are also examined. Dr. Smith testified that the procedure revealed that Mrs. Fox had mild endometriosis. Dr. Smith explained that as he was placing the laparoscopy instruments in place, he observed that the IUD was extruding from the cervix and was in poor condition. A. Part  Again an IUD is part plastic and part copper; that copper is tightly wound; this was beginning to unwind and you don't know the extent or what's missing. The plastic appeared somewhat calcified, eroded; The plastic part itself did not appear separated into many piece  any pieces, the copper did, but because of the condition of the plastic and the copper which are, use the word fragmented, torn up, unwound, in pieces, and then coated heavily with a lot of tissue reaction which any foreign object in the uterus is just going to have a lot of blood and  and fibrous tissue or hard tissue around it. Since the copper part of the device was beginning to unwind, Dr. Smith explained that it was necessary to probe (curettage) the uterus to determine if any foreign particles remained in the body. Dr. Smith explained that he did not perform a true D & C but that the term D & C appeared on Lana Fox's records so that the procedure would be understood by the insurance company for billing purposes. Q. The circulator says that you did do a D and C. Now where is the difference? A. Well the difference  There's a tremendous amount of difference in how you might code something out for insurance purposes and how it is more clearly understood by everyone and the actual procedure. As you know, in  with  with medical insurance and I suppose with any kind of insurance you've got ways that they can look at a procedure and say this or that was or wasn't done and get an understanding. Now when you dilate the cervix  the cervix is the opening to the uterus; Does anybody not understand what I'm talking about? Now the term D and C means you dilate or make wider the cervix; we didn't do a dilatation. A curettage means you scrape. Now if you want to say that you take an instrument and search the uterus briefly for any remaining fragments of whatever kind of tissue, yes, that's what we did. When you realize that that should be done, you take a small instrument called a Novac Curette, which is a very thin, almost pencil  a little bigger than a pencil lead, and you insert it into the uterus, so technically no dilatation was ever done, no curettage; a search for any portions of tissue or fragments of IUD in this particular case was made.       In my handwriting what I imply to the circulator and I think everyone understands this, if you instrument the uterus you've got a code that is easily understood. `Doctor Smith, what should we code out?' `Make it simple, we can put down D and C, removal of IUD.' `We didn't dilate the cervix, Doctor Smith; we didn't curette the cerv  the uterus.' I realize that, but for coding, technical purposes I think it's easier to put that as a D and C and laparoscope, and I'm sure that's what I said... . Dr. Smith testified that he removed the IUD in the exercise of good medical judgment. According to Dr. Smith, it would have been poor medical judgment to have left the IUD in place. In addition to the poor condition of the IUD, Dr. Smith was aware that the CU-7 had been the subject of consumer lawsuits against the manufacturer, Searle Company. Additionally, Dr. Smith knew that this particular IUD had been in place for years beyond the manufacturer's recommendation. Finally, Dr. Smith described the health hazards which could have resulted if he had left the IUD in place and not removed it. Well the possibilities are several; She was already having a health hazard, number one, from her infection and pain and prolonged bleeding. The possibilities are the longer it's left in the more infection, the more chance of pelvic abscesses or pus in the belly, the more chances of having to have a hysterectomy, the more chances of obstructing your bowel, and having to have part of your bowel resected, the more chance of losing your ovaries, the more chance of being infertile, the more chances of dying if it gets into the wrong place, the more chances and not at all to be humorous, but there have been numerous cases of where the male has torn his penis from a partially extruded IUD; That's another hazard when one is into the vaginal canal.