Doctor breached standard of care by ripping drain from Manitoba woman's breast after surgery: judge

A Manitoba woman has won a lawsuit against a doctor whoa judge found ripped a drain from her breast after surgery, then tried to downplay the chance it broke leaving a piece stuck inside her for more thansix years.

Two days after the woman hadreduction surgery to help alleviate back and shoulder pain in August 2010, she came back to Dr. Manfred Ziesmann's office to get two drains in her breasts removed.

While a nurse was able to get the right one out, the attempt to remove the left one caused the woman to cry out in pain, a March 23Manitoba Court of King's Bench decision said.

The patient said the nurse then got Ziesmann, who "came in and tugged on the drain, then pulled harder, and pulled the drain out with a popping sound," Justice Brenda Keyser wrote.

The woman said her left breast was throbbing and the end of the drain tube was jagged, the court document says. When she asked whether the drain had broken, the doctor replied, "maybe," according to the decision.

The woman's account matched that of her husband, who accompanied her for the procedure and said his wife became "more upset and frantic" with each attempt to remove the drain, the judgment said.

After bringing his shaken wife back to their car, the husband came back alone to ask whether the drain had broken.He said the doctor told him it was unlikely but possible, and that any drain fragment would easily be found with an ultrasound though he did not offer to provide one, according to the decision.

Lawyers for Ziesmann and the woman did not respond to requests for comment.

Doctor denies he yanked drain

Ziesmann said he was able to get the drain out with one continuous pull not by tugging or yanking on it and that there was no resistance that seemed unusual. He said after the removal, he looked at the end of the drain and saw nothing concerning, the judgment said.

On cross-examination, Ziesmann said he didn't recall the woman's emotional state or whether he used multiple pulls to remove the drain.

While he also said either the woman or her husband expressed concern about the drain breaking, that testimony was different from what he said while being deposed, when he didn't recall the woman's husband being there.

Results from an urgent ultrasound ordered by the woman's family doctor the next day came back negative for the drain, though the judgment noted the ultrasound report itself didn't specifically show the technician "was alerted to the fact that this was the reason for the ultrasound."

The drain piece wasn't found until an MRI done in 2016, after the woman complained about a sore spot in her breast. The drain was removed in January 2017.

Though several procedures the woman had between 2010 and 2016 didn't pick up the drain, the judge said she was satisfied it wasfrom the 2010 procedure because of concerns raised about it at the time and the factthe woman didn't have any other operations where a drain could have been left behind.

Credibility concerns

Keyser said she had "no hesitancywhatsoever" accepting the version of events presented by the woman and her husband, noting their concern about the drain removal was verified by the woman's family doctor, whom she went to see the day after.

The judge also said she had "concerns over the credibility of Dr. Ziesmann's testimony," particularly since there was no operative report prepared.

The only documentfound that was linked to the procedure was "a curious chart note" that contained a misspelling of the woman'sname and was written in a different font than the rest of herfile.

That note indicates it was made by the nurse who helped with the procedure, though there's nothing in it to show Ziesmann was the one who removed the drain or indicatingwhether there was any conversation between the nurse and doctor about that.

When asked why none of those details were charted, the nurse "started mumbling some disjointed explanation,"the judgment said.

"It appeared as though she was trying not to undermine Dr. Ziesmann's position. She seemed extremely uncomfortable about being on the witness stand and under oath," wrote Keyser.

The judgment found Ziesmann breached the standard of care expected of a diligent doctorand"tried to downplay the possibility that the drain had broken and did not himself offer followup to confirm whether the drain had broken, even though he likely believed it had."

It said the woman was in so much pain after the drain removal that she couldn't even wear a typical bra, but that once the broken drain was removed in 2017 "her symptoms changed dramatically" within two days.

"All of this leads me to the inescapable conclusion that the breach of standard of care by Dr. Ziesmann did in fact cause the pain" the woman experienced, the judge said.