The high risks involved in heart surgery complicated by infection

G.S. lived with his wife and two children, in a climate as serene as many other families. Ups and downs, dark periods and others more cheerful, but always trying to make the most of the good things that life reserved for him. A good habit made better by the fact that serenity was almost an obligation for G. who suffered from heart and had to keep away from all those situations that could generate in him anguish and emotional tension.

Heart surgery is man's only chance to save his life

In fact, to say that Mr. G. simply suffered from the heart sounds like an understatement. He was suffering from a particular heart condition, called the sacciform aneurysm of the ascending aorta and also had severe coronary stenosis. It was framed into a not at all reassuring clinical condition since G. was hypertensive and diabetic and a long-term cigarettes smoker.

Just before 2012 Christmas, doctors summoned him for a long-planned intervention, necessary to allow him a normal life as much as possible. It is necessary to perform a open-heart surgery to insert a prosthesis into the aortes, replan some blood vessels and re-school the coronary artery.

Needless to say, the operation is risky and the mortality rate is high. Complications can be numerous: the heart may not be able to resume its normal heart rhythm on its own, the brain may suffer damage due to the lack of blood supply, blood clots may be released from the affected arteries.

Immediately after the surgery, G. is in fact affected by cerebral ischemia. Fortunately, this predictable neurological complication is promptly treated with medication and physiotherapy, and the patient seems to resume the path of convalescence.

However, an unpredictable and unexpected medical situation arises. A fistula is developing exactly where the thoracic aorta prosthesis was placed, near the esophagus, and it causes very severe back pain and a state of physical prostration that does not bode well. Fever increases and does not react to the administration of antibiotics.

Doctors suspect that the situation is to be blamed on an infection.

A long and troubled journey between departments

The infection generated by fistula does not regress with antibiotic therapy and unfortunately proceeding with a new operation would have meant a very high risk of death. Indeed, the debilitation of G. is high and he is more exposed than other patients also to the possibility of contracting other hospital infections.

In the same Hospital other cases of lethal infections

For G.'s family, these are hours of severe anxiety because they fear that their beloved has no favorable prognosis and in fact, four months after the surgery, G. dies from post-operative complications.

However, knowing that the death occurred as a result of an infection, there is a suspicion among family members that it may be due to poor sanitization of the hospital environment.

A little earlier, in the same hospital, two patients had died from a chimera mycobacterium infection contracted after using the same machine to which G had been connected.

Found in the instruments used in operating theatres, the bacterium has already caused other deaths among patients in other hospitals who have undergone open-heart cardiac surgery, causing damage to the respiratory level or to other organs, and it can cause a rather demanding pathology in itself.

Lawyer explains how to prove guilt

To support their desire to shed light on the cause of G.'s death, the family lawyer who listened to their doubts, decided to combine his experience with that of an expert who is able to confirm or deny the thesis of negligence.

In doubt between difficulties of intervention and postoperative management

It is never easy to ascertain without any doubt that the death of a patient within the walls of the hospital is to be blamed on the health facility. Especially when the patient has passed through more than one ward and is in already critical condition. In the case of infection, it is always possible that this will develop within the typical post-operative complications and only in some cases, and for some types of bacteria, it can be related to a liability.

In this case, given the particular pathology of G.S. and the difficulty of the intervention, whose technical success has never been denied, being able to obtain proof of responsibility is really complicated. A minimum of refreshment, even just moral, must have been to be able to sooth at least a little the pain of a young widow and her children.

Moreover, doctors seem rather confident in categorically denying the presence of mycobacterium chimera on Mr. G. and limiting the infection at the site of the aortic prosthesis by referring it to the bacterium streptococcus, which commonly grows in our oral cavity and cannot be classified as a nosocomial pathogen.

Though death could not be prevented, so much suffering was not necessary

The onset of a fistula at the place of implantation of a cardiac prosthesis is a wretched but possible eventuality, the prognosis of which can prove inausphasic in the most critical patients, regardless of the antibiotic treatment practiced. Therefore, the health professionals who handled the G.S. clinical affair cannot be seen as responsible.

This is the conclusion reached, uniformly, by both experts and judicial authority on the basis of the futility, for the purposes of survival, of a different pharmacological or surgical treatment, thus excluding any causal link  between the conduct of doctors and the death of the patient.

Family members would have no more than surrender in the face of the evidence, since both the Judge for preliminary investigations and the Court of First Instance declared that  G's  death could not have been prevented, given the extremely serious previous clinic situation and the sneaky silence in which the infection took place, manifesting itself only a week before death, when the organism was compromised.

However, the account of this suffering must have been so harsh that it even leveraged those who sanctioned the outcome of the judgment, which although contrary to what G.'s family had hoped, still showed that the loss of a relative during hospitalization is not an experience to be completely overlooked.

Although the request of G.'s family members was disregarded, and it was therefore reasonable to expect the order to pay the costs of the proceedings, the Judge decided to fully compensate the costs of the dispute precisely to not penalize beyond a family that, in a context of great suffering, has nevertheless seen its member lost at a young age.

Streptococcus even outside hospitals

Streptococcus is capable of causing nosocomial infections, or those infections that are not existing at the moment of hospitalization and manifest themselves after their incubation period, but it is certainly one of those that are most easily found outside the hospital environment.

For this reason it is classified as a "diner bacterium", that is, a bacterium that is normally found in the flora of the healthy population and that indeed has the function of protecting against the attack of pathogenic bacteria  preventing  their colonization.

However, if the host is particularly debilitated, then diner bacteria are also able to cause infection and if this is released during hospitalization, inevitably nosocomial infection will be classified even if the bacterium has been in the body for some time.