The patient experienced physical discomfort following a breast reduction procedure in 2010
The Manitoba Court of King’s Bench has declared that the doctor who left behind a broken drain inside his patient during a breast reduction surgery breached the standard of care expected of a prudent and diligent doctor.
In Drain v. Ziesmann, 2023 MBKB 59, Melanie Drain sued Dr. Manfred Ziesmann for leaving a broken, knotted drain piece in her left breast after a breast reduction surgery in 2010. The Manitoba Court of King's Bench confirmed that Dr. Ziesmann left the drain during the surgery and ruled that he breached the standard of care expected from a prudent and diligent doctor. The court further found that Dr. Ziesmann’s negligence caused damages to Melanie.
Melanie saw Dr. Ziesmann in 2010 because her large breasts were causing her back and shoulders discomfort. She underwent breast reduction surgery, with drains inserted in her breasts to drain excess fluid. These drains remained in place for a few days post-surgery.
Melanie returned to Dr. Ziesmann’s office two days after the surgery to have the drains removed from her breasts. Melanie and her husband, James Drescher, testified that Dr. Ziesmann’s nurse tried to remove the drain in Melanie’s left breast by pulling it, but it gave resistance. Melanie cried out in pain. The nurse then called Dr. Ziesmann, who came in and tugged on the drain. He eventually pulled the drain out with a popping sound. When Melanie asked if the drain broke, Dr. Ziesmann allegedly replied, “Maybe.” Melanie said the end of the drain tube was jagged, and her breast was throbbing when she left Dr. Ziesmann’s office.
On the other hand, Dr. Ziesmann said there was no resistance that seemed out of the ordinary. He claimed he pulled on the drain only once, with one continuous pull, but did not tug or yank.
The Manitoba Court of King’s Bench raised concerns over Dr. Ziesmann’s testimony as an operative report is usually prepared in these circumstances, but there was none in this case. Accordingly, the court found that Dr. Ziesmann had nothing to rely on about a supposedly uncontroversial drain removal over a decade earlier.
Breach of the standard of care
An expert testified that it was not unusual for the drain to break, but if the doctor had difficulty removing the brain, they would discuss with the patient about pulling on the drain or returning to the operating room to remove it. The expert further said it was not up to the doctor to rip the drain out if it was unyielding. The expert said different patients respond differently to foreign objects inside them, so she would expect all surgeons to discuss the removal of a torn drain with their patients.
The court found that Dr. Ziesmann failed to discuss with Melanie about pulling harder or returning to the operating room for removal. The court emphasized that the decision should be that of the patient to make. The court said Dr. Ziesmann “yanked on the drain” despite Melanie’s increasing upset at the force used and the pain it was causing her. The court was also satisfied Dr. Ziesmann had to have realized there was a good possibility that Dr. Ziesmann had to have realized there was a good possibility that his yanking on the drain caused it to break, and yet he downplayed that possibility. The court concluded that Dr. Ziesmann did not meet the standard of care expected of a diligent doctor as he forcefully yanked the drain out, causing the patient pain and distress, without first discussing her options.
Causal link
Melanie testified that she was in much pain after the drain removal. She could not even wear a typical bra because of the pain. After the 2010 drain removal, she underwent wound treatment and scar revision. In 2016, she reported a lump to another doctor, who found a sore spot and palpable mass in her left breast. Melanie expressed concerns about a retained drain left in her breast from her original reduction surgery in 2010. The broken drain was finally removed in 2017.
Melanie testified that her symptoms changed dramatically once the broken drain was removed. Afterwards, she could dress properly without pain, and problems around intimacy with her husband were resolved. Her family physician also noted that after the broken drain was removed, there was a significant difference in her pain situation. Melanie’s pain improved significantly within two days after removing the broken drain.
These factors led the court to conclude that Dr. Ziesmann’s breach of the standard of care did, in fact, cause Melanie’s pain, which she experienced until the knotted drain was finally removed. Accordingly, the court found that Melanie had proven her case against Dr. Ziesmann.
