Deposition of Gastroenterologist in Medical Malpractice Case
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- čas přidán 17. 02. 2020
- This is the videotaped deposition of Dr. Mark D. Noar, a gastroenterologist and owner of a medical practice called GI Microsurgery Institute, P.A., with offices in Bel Air and Towson. Dr. Noar was the primary defendant in this case. The case ended with a $1.5 million verdict.
Facts
Our client was initially referred to Dr. Noar by her primary care physician because a blood test revealed elevated lipase and CA19-9 levels and an abdominal ultrasound showed a “possible indistinct pancreatic head mass.” The elevated markers are non-specific for pancreatic cancer.
The doctor correctly ordered radiology tests to evaluate our biliary system and her pancreases. A CT and MRI did not reveal any mass in the pancreases.
A mass can cause pressure on the pancreatic duct resulting in a stricture and then can cause an enlargement of the duct up to the point of the stricture. Once a defined stricture is located, the gastroenterologist can check for cancer by brushing the stricture, via an ERCP, in an attempt to scrape cells off of the wall of the pancreatic duct, provided the patient’s clinical presentation warrants such an invasive procedure. There must be a stricture to brush. Because there was no stricture in this case, the ERCP brushing was unwarranted and a breach of the standard of care.
Many months later, the doctor recommended an endoscopic ultrasound (EUS) The EUS is a much more sensitive test to locate a mass/stricture than an MRI, ultrasound, or CT scan. The EUS did not detect any cancer, tumor, or mass.
Here is where the problem begins. At the conclusion of the test, the doctor handed our client an EUS photo image of her pancreases with the word “tumor” and “mass” on the image.
The doctor recommended our client undergo an ERCP as soon as possible to locate a tumor that was not detected by the EUS. He was ostensibly looking for a tumor between 0-3mm in size. He claims that he was brushing a stricture near the end of the pancreatic duct, where the duct emptied into the intestines at the ampulla, to find evidence of an otherwise invisible tumor.
The doctor also failed to inform Mrs. Saffer of the alternative treatment options available to her, which is a failure to obtain her informed consent. The other treatment options would be to wait 90 days and repeat the MRI and/or EUS and blood work.
Why not just get the ERCP to be safe? Because the risk of pancreatitis is a known risk of an ERCP procedure, the benefits must be carefully weighed against the potential harm. The benefits in this case, the possibility of finding a tumor not detected by all other forms of non-invasive reliable studies, including an EUS, were clearly outweighed by the potential for harm.
During the ERCP, Dr. Noar punctured our client's pancreatic duct. She had four subsequent admissions at St. Joseph’s Hospital for medical care caused by the unnecessary ERCP.
This doctor is no longer practicing medicine:
www.mbp.state.md.us/BPQAPP/or...
Somewhere else I’m sure there’s a doctor being sued for not performing the same procedure and the patient had cancer that wasn’t found.
The lawyers are doing their job but they lack medical knowledge and why we choose to further investigate suspicious lesions that could potentially kill a patient. The patient could have died from pancreatic cancer. One of the deadliest. I feel sorry for this doctor. He tried his best. The patient had informed consent. She chose to investigate further.
His license was suspended in 2018 by Maryland State Board. The Consent Order is pretty eye opening regarding this guys character.
Sharp and fair minded attorney.
That’s terrible that I wind up in the persons body that shouldn’t of happened negligence should not be tolerated
She must have had very good insurance for him to keep her case open and keep ordering tests.
Great Job Rod!
Yes, i also think Rodney did a great job. Can't say the same for Justin!
The patient should have been thoroughly informed in the office, with discussion of risk /benefit, prior to treatment decision.
ERCP has many risk factors, pancreatitis being one. Those who have pancreatitis are familiar. Sometimes, as with my 9 year old grandson, one can choose to 'wait and see' after all other scans and interventions do not find a structural causation and remedy. Patients often do not have a choice due to their severe progressive pathology. Most try to locate a practitioner who has done numerous of these procedures (this MD has preformed thousands?), yet there is no ERCP without complicated risk.
These lawyers can make any doctor or practitioners look like they did something wrong regardless of the truth. That is what they have learned to do because of the financial ramifications in these cases.
yes they’re slime and a large part of rising medical costs everyone is CYA
With medical errors being the 3rd leading cause of death in this country…. I’m thankful for them. Did you not read that this man no longer is practicing medicine? Thank God for that
@@tinaadams2281 Medical errors are not the 3rd leading cause of death in this country. Where did you get this? Provide a reference to support this statement. Just because that physician doesn’t practice anymore doesn’t mean he did anything wrong. Many of us are close to leaving medicine as it is because it isn’t a great career anymore. Lawyers are a big reason for this. He did make an error during surgery however there are risks such as this that come with any surgery. My point is a good lawyer can win a case against any doctor wether they truly did anything wrong or not.
@@4EyedFox I'm also in medicine and while I question his judgment of manipulating a pancreatic duct of a 70 year old woman I wouldn't call it malpractice because I'm sure the paperwork they signed consenting mentioned the risk of slicing right into it. People forget that part sometimes. Just like this doctor forgot the most basic rule of surgery and thats never under any circumstances ever fuck with the pancreas. However he never misdiagnosed her. He never refused to test her. He never blew the nurses off when they call him 15 times in one night. He just made a mistake so like yourself I have a hard time finding malpractice.
@@4EyedFox Is Johns Hopkins credible? www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us
I was diagnosed with a cyst or a meniscus neoplasm on my pancreas in 2018...it was 8mm in diameter...recently they took another look and now it's 13mm but the VA doctor won't do any invasive surgery until it gets bigger
Any suggestions?
Oh gosh Jason, please go to an oncologist for a 2nd opinion! ANY growth of a ‘mass’, especially one as large as yours, warrants immediate imaging & further testing!!! I mean holy crap! Not to scare you, but I’m concerned about your post! The reason for an oncologist? I HIGHLY suspect cancer, and 2 - They can typically get insurance to pay for diagnostic testing/procedures without pre-authorization or other procedures they would require you to have done first. A wonderful GI suspected my father-in-love had a very suspicious mass on his pancreas. It was found during a CT for another problem. He did a biopsy and it came back normal. Without even having the biopsy results yet, he told me to have Dad see a surgeon. Dad’s mass wasn’t even 3mm. So please go to an oncologist, even if you need to go outside of the VA. God bless you and may the mass be benign.
@@allergiesrusdb I will thank you
mucinous cystic neoplasm you may mean?
Are they alleging the surgery was unnecessary or did something go wrong? Im only like 10 mins in.
I'm guessing from the questions and answers here that the jury didn't say this Doc did anything wrong in the procedure, since what happened was a known risk. I'm guessing this case was won because it sounds like there was not enough reason to reasonably do it in the first place? Maybe an informed consent case? If that's true, then I wonder just exactly what was or wasn't in that Doc's brochure that was given to her, read to her, etc.
Thank you for the detailed description. Did the doctor lose his right to practice and his license as a result of this case? Or did he have prior malpractice cases??
It was not due to this case actually. He agreed to give up his license in response to a number of other serious complaints to the medical board that were not related to this particular case.
@@Millerandzois Well that didn't last long. He's still performing Stretta operations which also includes an endoscopy.
@@Millerandzois Not in NJ.
He's actually an excellent doctor. I don't think people can judge his decisions and understand the nuances without the medical knowledge and specialised knowledge of his field.
Was this recorded on VHS?
Yes, recorded w a potato
Again, you would be amazed at the cost of recording these depositions. The quality is not what it should be, I agree.
What was the independent expert opinion in this case?
I guess it's a bad idea to have Stretta done with this doctor?
This physician is pretty sharp!
Not as sharp as his scalpel though when he cut clear through her pancreatic duct during surgery. He must of been absent the day they taught doctors the most valuable rule in medicine. Whatever you do make sure you never fuck with the pancreas.
Not in my book.
He fucking better be.
The public would be shocked by how many truly incompetent physicians there are out there practicing and continue to practice. Yet, they trust them because they carry the almighty MD title at the end of their name. I'm still puzzled to this day why we still use a signed informed consent. It doesn't matter because even if any bad outcome occurs that was addressed in the consent, a lawsuit is still likely to occur. No doubt a result of malpractice costs and medical care costs are due as the result of potential litigation. Double edged sword.
Thank you for the excellent explanation of the testing and diagnosis. This seems like an error (or two), though: "The doctor correctly ordered radiology tests to evaluate our biliary system and her pancreases. A CT and MRI did not reveal any mass in the pancreases." Additionally, throughout, you make references the "the pancreases" (plural).
I'm curious as how you're able to put up these videos without the consent of the deposed? Why would any of them let you?
It’s public records
I like this surgeon’s affect, he is calm and is knowledgeable but it’s his poor vision that has hindered him.( Surprised he choose Intra- ocular implants plus contact lens. [ He retired from his practice after this lawsuit]. Malpractice insurance goes super expensive.
Why does he wear his white hospital coat!! He’s off duty? Who’s he trying to impress?
100% correct. But it is a common practice l
Mr. MaGoo operating...
He was a very rude man. As far as being a doctor he was fairly ok, but he treated staff poorly. I could not function well while working with him at all. His temper was unbelievable. Myself along with a few other’s didn’t have a choice but to leave that workplace.
I have a feeling he might be a good doctor if he could see.
Oh damn
With few exceptions, the comments demonstrate exactly why you don't want your case argued in front of a jury. Most states require that litigants try to reach a fair and equitable settlement before going to trial. This means mediation is the real battlefield. A well prepared settlement video can knock the other side out of their intransigence. I've even seen defense attorneys and insurance reps actually start crying as one of my videos was presented. That's a very, very good sign for the plaintiff.
One thing is even more important to me. Lawsuits are not just about somebody making money or not paying it out. The whole concept of civil litigation is to benefit society as a whole, not just punish wrongdoers. My greatest successes have occured when the defendants actually asked for copies of the settlement video to use in loss prevention training. You sleep really well after one of those.
BTW, the deposition videographer did a fine job with this deposition. The read-on was clear and concise and I even liked the lighting. It wasn't just flat, even from both sides but it was not overly dramatic or unfairly affecting the deposition.
Jesus Christ, this is my gastro. Should I be worried?
You should because he surrendered his medical license......
@@chgsf03 So that means now he is not allowed to operate as a physician in any State..?
VRD Yes, he cant practice in a clinical setting, but he can hired in non-clinical jobs.
@@chgsf03 What did he do? Wrong?
There is only one pancreas (not pancreases).
Aren't you smart. Smart Ass.
@@md21656 Dickey? Nice nickname!
Im a M.D. Thank God not in the U.S.!!
Yes, now you can maim and kill people all you like with no repercussions.
Explain yourself doctor, or will that cost me a $20 copay?
No doubt eh
@@terryinraleigh shit happens all the time in medical practice not every time is it gonna come.out perfect that's why a surgery is explained that you can possibly die from anyone type of surgery depending on the person's reaction to everything that being said jts there job to do there best to weigh out these causes and explain it all to the client. But it can happen with anything. Just like a work place death witch happens everyday and doesn't get sued like this half the time. He was doing his job and it didn't work out perfectly as with any job doesn't always happen
I bet if people had the type of money to pay for a lawyer for all there time and hours most people would sue for things that happen cause everyone in there life has a close call or something you could probably sue over, its all for money 💰 but it ruins peoples lives
This being said I'm not saying he shouldn't have to pay for the next surgerys that's needed after for causing the need for them in the first place and what ever else goes with it hospital stay mess blah blah cause he should.
My opinion
Thats why I'm glad Canada has its health care
This doctor did the best he could. He should sue the person that sued him.
Looks like this doctor has poor vision. A magnifying glass would have been less obvious.(This highly skilled gi- specialist retired his license to practice). He is well- versed in his field. Patient being 70 was a high risk for pancreatic cancer. ( Saffer had a forgetful about receiving pre- op instructions/. Alzheimer’s perhaps?)
Those images are tiny on the paper. They appear to be 1.5x1.5 inch images of an endoscope image which fills a TV screen in the endoscopy suite and some structures appear small even at full size. My vision is excellent and I would also have to hold those images close and squint.
Shouldn't he have been able surmise this.
Drs. 7 times, same incident plus one serious . I worked w/ this procedure- the view is already magnified to its normal anatomy size. ( This excellent had vision deficits- experienced but poor visualization). I like his affect, he truly seems dedicated. It’s damned age that grabs us n throws into problems .
Was this Dr convicted of malpractice in this particular case?He seems to know the stuff he’s talking about.
Yes.
He was not convicted of anything. He lost a medical malpractice lawsuit. The responding lawyer knows this very well.
@@Millerandzois Ooh my God,then it’s impossible to practice.
@@stevewhite3424 Forgive my ignorance, I am no attorney,is there a difference between “ convicted of malpractice” and “ lost a malpractice lawsuit”.Where I live its a bit different,malpractice is handled via a)Medical and Dental Council,which has an Investigating committee,which will investigate first by calling the patient and the plaintiff to hearing and after looking at the case they then decide if there’s a malpractice case or not,if they are of the opinion that the practitioner has a case then they refer to a different committe called the disciplinary committee which will summon the practitioner alone without the patient and then he’s supposed to justify his action/s,this committe will be made of practitioners of the same specialty as the defendant practitioner ie plastic surgeons for plastic surgery malpractice,cardiologists for cardiology malpractice etc.If this committee concludes that there was malpractice,they convict the practitioner and send a report to the court for determination of the settlement.On top of that,the committee also imposes it’s on sentence on the practitioner depending on the gravity of the case ranging from cancellation of license to practice for life,retraining at University hospital,working under the supervision of another practitioner,suspension of license for a certain period whilst undergoing reevaluation/retraining to a fine.
b)If the plaintiff doesn’t want this route,they approach the courts directly but the court will send the case to the Council and the same process happens,so it amounts to the same thing,because no practitioner is willing to spend several hours testifying in court as an expert witness because they are not paid for that and end up losing income being away from their practices.So plaintiffs prefer the route of going via the Council because they don’t have to pay an attorney,however if they want to engage one they still can and the attorney is allowed to follow proceedings of the committees but cannot cross examine the defendant practitioner.
If the practitioner is convicted and is not happy about the conviction and and any other sanctions imposed by the Council,they can appeal to the courts but it’s a waste of time because the courts will still refer the case back to the Council,but it will be a very bad decision or I’ll advice because the Council will feel like you’re wasting their time as you already had an opportunity to defend yourself and may end up imposing an even harsher sentence against you on appeal,it’s not perfect but I think it keeps health costs down.
What’s happening in the US is really a great disservice to the public because a lot of money is wasted paying insurance by practitioners,who in actual fact don’t pay it but simply transfer it to the patients,secondly a lot of money is wasted on unnecessary investigations because practitioners are practising defensive medicine,where virtually every test,every scan,every X-ray is done without having any major improvement in treatment outcomes.
The end result is a lot people can’t afford healthcare,end up going to other countries to seek attention where it’s cheaper,maybe I am wrong but that’s my humble opinion.
@@seanbrendangarrette7644 here in the US, we love to sue, hence the number of lawyers in this country.
Why is he wearing a lab coat?
'merica lol
Somewhat misleading information by this law firm to aggrandize their success in this case. They actually failed to prove he violated the standard of care. The verdict may have been 1.5million but was later reduced. Transparency is key if you want to be trusted.
I think it was reduced to $1.1 million. I don't recall the exact figure but we have written about the reduction in this case in many places online. But that is from a cap on damages specific to Maryland. So the better marker of case value is the $1.5 million.
My goodness, if there is a more transparent law firm in the country, I want to find that firm.
Wow he seems like an incredibly diligent doctor who did everything correctly
It’s all about money. That’s why doctors do all these tests. It’s called cover your ass
"Anesthesia person".....
You mean, nurse anesthetist?
Oh give me a fucking break. I don't want to be mean but honestly at this point most of the midlevels should deserve to be called in this or similar ways considering the absolute bullshit mess they're causing with independent practice and the sort.
Nowadays, you can have either an anesthesiologist or nurse anesthetist do the anesthesia….so i dont blame him for his choice of words
Dr. ScalpedHead wearing is white jacket as a symbol of power and authority....Whatever!!!!
Satanic death cult. Origination of allopathy, it was regarded as BLACK MAGIC, DARE I SAY...SORCERY!! EVERYTHING ALWAYS COMES TO LIGHT.