As reported on the front page of the Chicago Daily Law Bulletin, last week
a lawsuit on behalf of Steven Karr was dismissed pursuant to a $30 Million
Settlement. The case was handled by partners
Joseph A. Power, Jr. and
Joseph W. Balesteri of Chicago personal injury lawfirm Power, Rogers & Smith, L.L.P.
The case involved a botched nephrectomy, which caused permanent and catastrophic
injury to Steven Karr.
On July 15, 2011, Mr. Karr underwent surgery at Elmhurst
Hospital for what was supposed to be a simple kidney removal, due to the presence
of a tumor. The surgeon performing the nephrectomy was Defendant Khalid
Badwan, M.D., a urologic surgeon with specialty training in laparoscopic
techniques. Dr. Badwan requested that his partner, Scott Cinel, M.D.,
assist (as the first assistant urologist) in the laparoscopic approach
to remove the left kidney. Hours into the case, Dr. Cinel left the operative
suite to perform a vasectomy on one of his office patients.
Dr. Cinel’s departure from the operative suite was not described
within the medical records. Hospital Rules and Regulations from the Department
of Surgery required that an M.D./D.O. first assistant be present and scrubbed
for all major parts of a nephrectomy. Dr. Cinel’s role included
holding the camera utilized by the lead surgeon (Dr. Badwan) for visualization
and magnification of the relevant anatomy. While Dr. Cinel was out of
the procedure, the camera was being operated by a cardiovascular technician
brought into this urologic case.
After Dr. Cinel’s departure, Dr. Badwan encountered
bleeding from an unknown source and, instead of converting the surgery to an open
procedure, a GIA stapler was fired into the surgical field.
A GIA stapler has both a stapling application and a cutting component.
The stapler cutting mechanism follows a trigger pull between placed staples.
The standard of care does not permit stapler use on unknown anatomy. The
GIA stapler was left in place after firing to help identify the bleeding
source and physician assistance was sought from a neighboring operating
suite to help control bleeding and to assist with converting to an open
The remainder of the case was concluded by Dr. Badwan with assistance from
a general surgeon who had been operating in an adjacent operating room
(Dr. Stephen Mendak, who did not participate in the settlement, was coincidentally
operating in an adjacent suite). Dr. Badwan testified that he did not
cause the stapling injuries and that Dr. Mendak was the only other individual
who used a stapler during the case. Dr. Cinel did return to Mr. Karr’s
operative suite before closure to hold a retractor, according to his testimony.
After the surgery was complete, Steven Karr had pain in his lower extremities,
lacked pulses in his legs, and was unable to move his legs while in the
post-anesthesia care unit. Work-up was instituted looking for spinal cord
compression issues from a prolonged surgery via a neurosurgical consult
but the results were negative. Efforts were next made following an abnormal
arteriogram to determine if there had been clotting within the aorta as
the arteriogram revealed a possible obstruction (an area of darkness within
the aorta). Emergent consultation with an interventional radiologist included
efforts from above and below a dark aortic abnormality on the arteriogram
to pass and open an obstruction but the area was impassable. It was later
discovered (at Loyola) that his the darkness was aortic separation from
transection and the proximal and distal aorta was stapled. The decision
was made to transfer Steven Karr to Loyola University Medical Center for
Shortly after midnight on July 16, 2011, Dr. Richard Hershberger, a vascular
surgeon at Loyola, discovered that Steven Karr had experienced aortic
ligation, aortic transection, and right renal artery injuries to his healthy
kidney (on the right side) from a stapling device. These injuries were
unrecognized at the time they occurred by the operating physicians, prior
to closure at Elmhurst.
As a result of these physician-caused injuries, Mr. Karr is a paraplegic
and is on permanent dialysis. His dialysis regimen includes treatment
three times a week (about 4 hours a visit) with physical therapy sessions
on the other weekdays since 2011. Mr. Karr worked during the years that
followed his injuries once discharged from his acute hospital stays in 2011.
medical negligence lawsuit was filed on Karr's behalf in Cook County Circuit Court in 2011.
This case shows that "a procedure to remove a kidney, which has been
done for about 100 years, can still be injurious without appropriate safeguards,"
Balesteri said. "No medical literature exists to describe injuries
of this nature during a nephrectomy. You can't use a stapler on anatomy
you can't see even if the assistant surgeon has left the surgery," he said.
Karr plans to use the settlement proceeds to buy a home with wheelchair
accessible features and for future medical and therapy needs, including
dialysis, Balesteri said.