Legal Battle Ensues Over Kidney Stone Amputations

When Lisa Strong, now 45, went to the emergency room in the early morning hours with back pain from a kidney stone she hardly imagined that she'd leave four months later as a quadruple amputee.

"I was on a respirator in the ICU and I don't remember the first 10 days," said Strong, of Davie, Fla. Her then-husband and two young children had waited anxiously for a diagnosis or any good news as Strong battled septic shock, lived through surgery and then survived multiple heart attacks.

She got a diagnosis, "but at that point they didn't know I would be losing my hands and feet," said Strong.

Over the next month Strong watched the black "line of demarcation" as doctors called it inch up her fingers and toes signaling just how much of her limbs she would lose.

"My hands were black, it was as if I stuck them in a fire. The line moved very slowly, and it was very painful burning," said Strong. "I thought if I exercised a lot I could get life back into my limbs."

That was in 2004. Five years later Strong's tale of miscommunication, missed opportunities and tragedy has taken another twist.

Broward County Circuit Judge Charles M. Greene has thrown out a jury's 2006 not-guilty verdict in Strong's malpractice suit against nurses and three doctors in charge of Strong's care. According to the National Center for State Courts, judges set aside less than one-half of 1 percent of jury verdicts in civil trials nationwide in 2005, the most recent year for which complete statistics are available.

Now the emergency room physician and the doctor who admitted her to the hospital must again explain exactly what happened during the 16 hours after Strong claims she said she had a kidney stone, and doctors diagnosed her with a kidney stone.

"I walked into the hospital and told the triage nurse I have a kidney stone, I have a history of kidney stones and that I was a 10 on the 1 to 10 pain scale," said Strong. "After I talked with the triage nurse I started throwing up … I don't remember a lot after I started throwing up."

How a Kidney Stone Turns Deadly

Lawyers agree on a rough timeline of events. Strong came into the hospital between midnight and 2 a.m., vomiting and with a fever and she told the nurse about her pain and her kidney stones.

By 4 a.m. the emergency room physician saw her and ordered an ultrasound. By 5, Strong had gone into septic shock -- the body's fighting attempt to keep the brain and vital organs alive.

Strong then bounced from an emergency room doctor's care, to the care of an off-site internist, to waiting for three hours more for a doctor's care, to a doctor who showed up late for a shift, to a surgeon's care and then into an exploratory abdominal surgery that did not diagnose the problem.

Finally, around 4:30 p.m. the next day, two doctors used a CT scan to diagnose Strong with a kidney stone that had been blocking her kidney and causing the deadly infection to circulate in the blood stream.

In the end, all agree Strong ended up waiting too long in the hospital for hours on vasopressors -- medicine that would save her life, but endanger her limbs the longer she went without a proper diagnosis.

A jury decided neither the nurses, nor the surgeon, nor the emergency room physician Dr. Laurentina Kocik, nor the internist Dr. Jason Strong, was to blame.

But Judge Charles Greene disagreed. In his order to overturn the jury's decision, he wrote, "While all defendants argued that Dr. Sharma (a doctor not sued in the case) was negligent and that her negligence caused injury to plaintiff, the jury heard evidence that both Dr. Kocik and Dr. Strong were negligent."

In those early morning hours, Dr. Kocik had stabilized Strong just before the end of her shift, and telephoned internist Dr. Strong, who was ending his shift off of hospital grounds around 6:30 a.m., lawyers for the two said.

"That's very normal, that it was over the phone," said Mark Rosen, attorney for Dr. Strong.

All lawyers agreed on that point. But what was said, assumed, or not said during that phone call has been a matter of intense debate.

Dr. Kocik claimed she said over the phone that she thought the patient likely had a kidney stone rather than a gall bladder problem, but Dr. Strong said he heard the patient likely had a gall bladder problem, not a kidney stone, according to Judge Charles Green's order on the plaintiff's motion for a new trial.

"Dr. Strong's theory was that for some reason, after 30 years experience, Dr. Kocik was dumb and didn't know how to talk on the telephone," said James Nosich, attorney for Dr. Kocik.

Woman Amputated After Kidney Stone Says She's Hopeful

Whatever was said, even more confusion ensued after the doctors hung up the phone -- each ended their shifts with no new doctor taking charge.

Green wrote "that no doctor was administering care to plaintiff because Dr. Kocik had gone off shift and left the hospital: Dr. Strong never came to the hospital; and Dr. Sharma arrived about three to four hours late for the start of her shift."

Nosich said the statue of limitations has passed for Strong to also sue Dr. Sharma, whose first name was not given by lawyers involved.

But as she waits for the possibility of the next trial, Strong said she hopes her trial will somehow help another person in the future.

"Hopefully, it's that this never happen to anybody again," said Strong. "I'm just hoping that some good will come out of all this."

Dr. Marie Savard, an ABC News medical contributor, said that while patients can't control everything, there are some key tactics that can be used to prevent delays and avoid an emergency room misdiagnosis.

"Never go it alone, identify what I call a health buddy somebody -- who's going to be that squeaky wheel," said Savard.

Savard said it's important for patients to realize that they are their own advocates in the healthcare system and one of the best things they can do is to take charge of their personal medical records.

"We often say 80 percent of the accuracy of your diagnosis comes from your past history," said Savard.

Unfortunately, Savard said most people don't have cradle-to-grave medical records, or any medical records that would be readily accessible to the emergency room staff. Savard said calling your family doctor and trying to involve him or her is a good first step in getting the right diagnosis. An alternative would be to bring a copy of some medical records with you.

"I always say, it's your health that's on the line. Mistakes are made. Doctors are human, at the end of the day this is not like a pilot, where you trust the pilot 100 percent of the time with your life," said Savard. "Her [Lisa Strong] insurance card got her in the door, it's your personal information and your advocate who you know that can save your life."
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No Benefit From Surgery for Metastatic Colon Cancer

Surgeons who plan to operate to remove the original tumors from patients with metastatic colon cancer might do well to put down their scalpels and rely on chemotherapy instead, according to a new study.

Researchers at Memorial Sloan-Kettering Cancer Center in New York reviewed more than 200 cases and found that more than 90 percent of patients had no complications that required surgical intervention.

Of those who did require surgery, only two had complications leading to unsuccessful procedures.

"In this era of modern chemotherapy, routine surgery to remove the primary tumor in patients with unresectable metastases is no longer supported by the data," Dr. Philip Paty told colleagues here at the American Society of Clinical Oncology meeting.

"In addition to being an unnecessary procedure that carries its own risks of morbidity and mortality, surgery delays the start of chemotherapy for several weeks, and in some cases may make the patient less fit for and less tolerant of chemotherapy," Paty said. "Unless there is an immediate need for surgery, patients should begin chemotherapy first."

About 147,000 Americans will be diagnosed with colorectal cancer this year, and almost 50,000 will die from the disease, according to the American Cancer Society.

These findings came from a retrospective analysis of 233 patients from a much smaller group who had metastatic colorectal cancer at diagnosis -- which means their cancers had spread beyond their original location.

The researchers wanted to find out whether a longstanding procedure -- removal of the primary tumor -- would matter once the cancer had spread.

All of the patients received a standard three-drug chemotherapy combination. In a subsequent follow-up, 217 patients (93 percent) had no complications that necessitated surgery for the primary tumor.

Of those, 55 eventually had elective surgery on the original tumor when surgeons removed lesions elsewhere, while eight others opted for it when surgeons implanted a hepatic-artery infusion-pump -- a device that pumps chemotherapy medications directly into the liver.

For Colon Cancer, Surgery May Not Be Best Option

Of those who actually required surgery for primary tumor obstruction or perforation, 14 had successful procedures, suggesting that the delay posed little risk to the patients.

For the entire group, operative mortality -- the rate of death within 30 days of the surgery or while the patient is still hospitalized -- was 0.8 percent.
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Top 6 Extreme Cosmetic Surgeries: Obsession with Breast Implants to Feline Looks

Many moms would love to be mistaken for their 20-something daughter's twin. But Janet Cunliffe went as far as Croatia and $14,700 to make sure it happened.

Just four hours of surgery on her eyes and nose, plus a couple of lip injections and a diet, and 50-year-old Janet says she's now regularly mistaken as the sister of her 27-year-old daughter, Jane Cunliffe, according to reporting by the Daily Mail.

"I envied Jane's crinkle-free eyes, full lips and luscious, long blonde hair," Janet told the Mail. "I was desperate to look more like my daughter, but knew no wrinkle creams could ever wind back the clock that far."

From foot binding, to piercings and heels, humans have always gone to great lengths to alter their appearance. But with the relatively low price of modern plastic surgery, people can, and do, go much further today.

One woman's quest for a bigger bosom hit the legal limit; at a gallon of silicone in each breast, any more would have broken Texas state law. Last fall a Korean woman's compulsion for silicone injections led her to try a homemade injection of cooking oil.

Experts say compulsive, severe and risky plastic surgery can belie an underlying psychological problem, but not always.

The following is a list of notable cosmetic procedures compiled by ABCNews.com, as well as reflection by reputable plastic surgeons and doctors on what the medical profession should do about patients seeking extreme plastic surgery.

Cunliffe was not the first woman to ever ask for another person's face. So-called "octomom" Nadya Sulemen reportedly wanted to look like actress Angelina Jolie.

But plastic surgeons say Cunliffe's request to look like a family member is very rare.

"Certainly it's not the usual day in my office," said Dr. Malcolm Roth, director of plastic surgery at Maimonides Medical Center in Brooklyn, N.Y.

"To say, 'you're 50 years old, I'm going to make you 20 years old' -- that's not reasonable," said Roth, who is also the vice president of the American Society of Plastic Surgeons.

However, Roth said in Cunliffe's case, the request to make her look like her daughter might be more reasonable than a request like Sulemen's to look like a total stranger.

"It's her daughter -- they have the same genes, probably a lot of the same facial structure and architecture," he said.

But just because something is possible doesn't mean Roth will always comply with a patient's request.

"Over half of the patients who come into my office for plastic surgery I would not operate on," said Roth, who listed both medical concerns and concern over the idealism of his patients as reasons he'd not operate.

Cunliffe's case might be a drastic request, but Roth said he'd be more wary of her choice to try medical tourism.

"We're seeing, unfortunately, a lot of people who are looking for good deals, going to medical tourism and then they come back with problems that cost them more than they would have paid in the first place," he said.

It would be hard to miss Sheyla Hershey if she were walking down the street. She has record-setting breasts after years of plastic surgery.

After over eight surgeries and a gallon of silicone, Hershey's breasts balloon to an astonishing 38KKK, protruding like beach balls from her petite frame. The surgery had to be done in Brazil because of U.S. restrictions on how much silicone can be injected into a person's body.

"I want to look better each day, every day," Hershey told Fox 26 in Houston, Texas. "Everybody's got a dream inside, you know? And it's good when you can make your dream come true."

Hershey, a singer, dancer, actress and model, has consciously undergone multiple procedures on her breasts as well as her nose, lips and buttocks over several years in order to aid her career.

While Hershey's dream might be realized for now, some experts say that the feeling may not last.

"At the moment, the person that says it's enhancing their [career] may believe that," said Dr. Alan Matarasso, a clinical professor of plastic surgery at the Albert Einstein College of Medicine in New York and a spokesperson for the American Society of Plastic Surgeons.

But Matarasso pointed out that overdone breast augmentation could leave a person a breast implant cripple for life, unable to go without implants because the alternative would be stretched out, flat breasts.

"They're not doing themselves any service," Matarassso said. "And most of what we do isn't reversible."

Jocelyn Wildenstein's famous plastic surgery might never be topped. Many women think it's sexy to dress up as cat woman, but this New York socialite decided she literally wanted to be a cat-woman.

When there's a will, and millions of dollars, there's a way. According to The Times of London, Wildenstein spent more than $3 million to transform her face into a feline visage.

Much press coverage mused about her sanity, and there are several documented psychological disturbances that could contribute to such severe plastic surgery.

But Arie Winograd, psychotherapist and director of the Los Angeles Body Dysmorphic Disorder and Body Image clinic, cautions the quick judgment of those who get multiple surgeries.

"There are so many factors -- just because someone gets a lot of surgeries doesn't mean its Body Dysmorphic Disorder (or another disorder)," said Winograd, who defined Body Dysmorphic Disorder (BDD) as a psychological disturbance in which people obsess about a body part or body parts and compulsively act on that obsession in a certain way -- either by checking mirrors constantly, hiding the feature, touching the body part or getting repeated surgeries.

"It's not the vain person or the narcissistic person who likes how they look. BDD is the antithesis," said Winograd. "We are referred a lot of people from all over the place, who we find out later might have other conditions."

The unfortunate case of Hang Mioku's silicon (and cooking oil injections) last fall showed the world the depths of a cosmetic procedure compulsion.

Mioku's first cosmetic procedure at age 28 seemed normal enough, but after 20 years of surgeries, injections and lifts, the Korean woman had disfigured herself and ran out of doctors who would help her in her quest for silicone injections.

Then, at home in her kitchen, Mioku reached for some cooking oil and a syringe, instead. The public took pity on Mioku and helped pay for surgeons to remove the foreign matter after the local media broadcast images of her swollen face, according to reporting by The Telegraph.

But however much material they reomoved, local doctors said she could never retrieve her original face.

Winograd couldn't comment on Mioku's individual case, but he has seen how a compulsion manifests itself into cosmetic surgeries.

"Cosmetic procedures are a compulsion, but just because someone has BDD doesn't mean they act on the compulsion of surgery versus something else," said Winograd. "But then, there's people who get procedures and keep getting procedures and they're never satisfied because BDD is a psychological problem within and they're trying to fix it by fixing the shell."

While it's lyrics might attempt to convey a more nuanced message, the title of Michael Jackson's song "Black And White" is a good summary of how many people who get multiple, extreme plastic surgeries see the world.

People with the combination of psychological problems who seek out these surgeries never have a "kind of a good day," said Leslie Seppinni, a psychotherapist in Beverly Hills, Calif.

"It's either, 'I look fabulous today,' or 'I need to put a mask on my face,'" she explained.

Seppinni said the self-hatred that comes on days when some people don't like how they look is part of a drive for flawlessness.

"One thing is that they're looking for absolute perfection, and it's very narcissistic," said Seppinni.

"If they could only fix how they look on the outside ... then life will be so much better for them," she said, and that creates a very all or nothing situation, where they either feel really good about themselves or that they are a complete disaster.

Stemming from a lack of balance in their emotional lives along with poor coping skills, Seppinni said, it often leads some people to imitate a single person who they view as ideal.

"Usually, they have a vision of someone they've conjured up who they believe is perfection. And they sculpt themselves toward that look," she said.

In the case of Octomom Nadya Suleman, that person was actress Angelina Jolie, Seppinni conjectured, noting Suleman's attempts to emulate her.

As for Jackson?

"In his case, for years he said ... Diana Ross was like his ideal vision. He wanted her look," mused Seppinni.

While some who get multiple plastic surgeries idealize someone else, reality TV star Brigitte Nielsensaid she gets them because she idealizes herself -- or a younger version of herself, anyhow.

"She's trying to get back to a place that she can't get back to," said Seppinni. "There's an emotional immaturity."

People who strive to look like former visions of themselves, or even like someone else, Seppinni explained, often reach a point where they stop maturing emotionally, so, over time, it becomes more and more out of sync with their chronological age.

"Once they start to get help, they have to make up emotionally for the time they [lost] when they weren't maturing emotionally," she said. "Playing catch-up is really painful."

A desire to appear on reality shows, Seppinni said, may also appeal to a frequent-surgery-seeker's narcissism.

But in addition to narcissism, the desire to have multiple plastic surgeries often ties in to borderline personality disorder, where sufferers have difficulty maintaining relationships, and body dysmorphic disorder, where a person becomes obsessed with a minor or imaginary flaw with their body.

"They have a real false sense of what they see in the mirror," said Seppinni.

"Many of them will tell you that when they look in the mirror, they won't look in the mirror unless it's from the neck down," she said, with the person only looking at the part of their body they need to.

"Even though, physically, they've changed [after surgery], they don't see the change, and that's why they continue to move forward with other surgery. They really have a distorted body image."

But the bigger issue, said Seppinni, is how narcissism and an addiction to drama that is common in reality television, affects viewers. It shows, she said, a lack of concern for the message to young women.

"That [a reality TV star] is a person where you have to ask what would you do if your life was productive? What would you replace the drama with?" said Seppinni.

Pamela Noon: Surgery That Never Ends

Pamela Noon looks like a woman 20 years her junior. But it took Noon, who is in her early 60s, over 20 year to complete the transformation -- and she says it's not over.

Noon has had over 26 cosmetic operations on her face and body, as well as over 80 maintenance procedures, such as botox injections. Some of the procedures she has undergone include liposuction, multiple face lifts, brow lifts and rhinoplasty.

"I think [cosmetic surgery] is fairly addictive, because if you do something that turns your life around a little bit, particularly the way you look, you automatically feel better about yourself and are on to yourself every time you see something you should attend to. I'm definitely a work in progress," Noon told the New Zealand Weekend Herald in 2003.

But plastic surgery experts say there could be underlying psychological forces driving people who go to extremes with plastic surgery procedures.

Matarasso pointed out that people who feel they need to constantly perfect themselves physically through surgery could be showing signs of obsessive compulsive disorder, a need for perfection, or an inability to deal with aging.

"No matter what, they're never happy," Matarasso said. "But if [plastic surgery] is minimized to the point of going shopping, they are no longer looking at it as medicine. ... This is real-life surgery with health, welfare and safety complications. You can't take this lightly."
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Robot Assistant as Good as Human in Some Surgery

Robots Already Used in Tens of Thousands of Procedures Each Year

ONDON (Reuters) - Using a robot to operate a camera in gall bladder operations is as safe as working with a human, British researchers said on Wednesday in an analysis that underscores the effectiveness of robot technology in surgery.

While robots may not be ready to take over, they offer vast potential to do things such as allowing doctors to perform emergency operations without having to wait for a human assistant, Kurinchi Gurusamy of the Royal Free Hospital in London and colleagues said in the Cochrane Review journal.

The researchers looked at key-hole, or laparoscopic, surgery in which an assistant operates a camera that acts as the surgeon's eyes during gall bladder removal. The surgery is quite common in the developing world where about 10 to 15 percent of people develop gallstones.

Robots are already used in tens of thousands of different procedures each year, and experts predict machines will increasingly take a bigger role in the operating room, boosting understaffed hospitals worldwide.

The review looked at different technologies, including Intuitive Surgical Inc's market-leading da Vinci system, and found no differences in deaths, the need to switch to more complicated surgery, total operating time, or length of stay in hospital.

To see how well robots performed the job in place of humans, Gurusamy and colleagues analyzed data from five studies involving 453 people. The results showed no appreciable difference in the number of gall bladders that broke during surgery.

Some critics question the cost-effectiveness of robots when other treatments, such as cancer drugs, are being rationed. But proponents note prices will inevitably fall as usage and competition increase, as happened with once-costly computers.
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