Lawsuit: Child died after adenoids procedure; no consent for UIHC resident involvement

ENT Medical Services in Iowa City (Vanessa Miller/The Gazette)

IOWA CITY — The family of a 2-year-old who died last year after a routine procedure to place tubes in his ears and remove his adenoids is suing a physician with the Iowa City-based ENT Medical Services for negligence by — among other things — allowing a medical resident to participate in the surgery without the patient’s consent.

Louden Lofgren — which, according to social media posts from the Muscatine Republicans, is the grandson of state Sen. Mark Lofgren, R-Muscatine — underwent a tube placement in both ears and an adenoidectomy on April 2, 2021, at the Iowa City Ambulatory Surgery Center in Iowa City.

Thomas Simpson, an otolaryngologist with ENT Medical Services, performed the surgery, according to a lawsuit filed Feb. 15 by Louden’s mother, Margaret Lofgren, in Johnson County District Court.

Simpson was assisted by Ryan Smith, a fourth-year medical resident with University of Iowa Health Care, according to the lawsuit.

Toward the end of the surgery, “very brisk bleeding” began as additional adenoid tissue was removed, and gauze was used to try and control the bleeding amid attempts to cauterize.

“After the bleeding had ‘apparently’ resolved, as Louden was being woken up, the bleeding resumed with coughing, briskly filling the oral cavity,” according to the lawsuit, noting an IV was placed and labs were taken showing anemia and hemoglobin levels down to 6.5, well below the 12.5 mean.

Nurse documentation indicated the medical resident Smith “was at the head of the bed when the intraoperative bleeding began,” and Simpson was at the head of the bed two minutes later “to resume the operation,” according to the lawsuit.

“Dr. Simpson’s note reads as if he was the primary surgeon for the entirety of the procedure and does not identify who was operating on Louden when the hemorrhage began,” the lawsuit asserts.

After surgery

Louden was transferred that day to Mercy Iowa City, where he was admitted due to a rapid heart rate and low blood levels. There, he received a partial blood transfusion and two days later was discharged — although he continued to have a rapid heart rate.

“No repeat check of his hemoglobin was done after the transfusion,” according to the lawsuit. “While inpatient at Mercy Hospital Iowa City, Louden was supposedly followed by Dr. Simpson, though there are no notes or entries in his medical record by Dr. Simpson.”

Within 24 hours of discharge, Louden had to be rushed to the UI Hospitals and Clinics emergency department “with a notable history” of low hemoglobin and black stools, according to the lawsuit. He was described at that time as “listless” and “pale” and was admitted due to blood loss and dehydration.

While a UIHC inpatient, Louden received a blood transfusion and improved — remaining stable until he was discharged April 7, 2021, according to the lawsuit. Five days later, on April 12, Louden while eating dinner began to hemorrhage and went into cardiac arrest.

He was rushed to nearby Trinity Hospital in Muscatine and then transferred to UIHC.

“Drastic efforts to save him were unsuccessful and he passed away shortly thereafter,” according to the lawsuit, noting the source of the bleeding was the adenoid surgical site.

Accusations

The family is accusing Simpson and ENT of negligence, specifically:

Failing to properly monitor and follow-up with Louden, who suffered “significant and excessive intraoperative bleeding.”

Failing to order testing or imaging or follow-up investigation of the significant bleeding.

Failing to adequately document or communicate “history of significant and abnormal intraoperative bleeding and related findings to subsequent care providers.”

Failing to obtain a complete history before the surgical procedure.

Failing to obtain informed consent.

Allowing a medical resident to perform surgery without patient consent.

Failing to provide care according to medical and surgical standards.

“Defendant ENT Medical Services is vicariously liable for the negligence of its employees, physicians, physician assistants, nurses, aids, technicians, agents and others who may have been involved in the care of Louden Lofgren, including Thomas Simpson,” according to the lawsuit. “Louden Lofgren’s death was a direct result of the negligence of Defendant Thomas Simpson.”

Allegations denied

In an answer to the lawsuit, filed in District Court this month, attorneys representing Simpson and ENT denied accusations of negligence.

To the assertion the UIHC medical resident was at the head of the bed when Louden’s intraoperative bleeding began, the defendants asserted they have “insufficient information to admit or deny the allegations.”

ENT Medical Services has provided otolaryngology, head, neck, facial plastic, and reconstructive surgery since 1957, according to its website. Its hospital affiliations include Mercy, and it lists six staff doctors, including Simpson.

According to his bio on the ENT website, Simpson chairs the Iowa City Ambulatory Surgery Center board of directors.

He was president of the Iowa Academy of Otolaryngology from 2002 to 2005 and legislative representative for the Board of Governor for the American Academy of Otolaryngology-Head and Neck Surgery from 2000 to 2005, according to his bio.

Simpson graduated from the UI in 1984 and finished his medical degree at the UI in 1990. After a one-year general surgery internship at Gunderson Clinic/Lutheran Hospital in La Crosse, Wis., Simpson completed a four-year residency at the UI Department of Otolaryngology.

Simpson was certified by the American Board of Otolaryngology in 1996.

Vanessa Miller covers higher education for The Gazette.

Comments: (319) 339-3158; vanessa.miller@thegazette.com