Oct. 30th, 1999

Deborah Krueger
Marinette, Wisconsin
Unnecessary Hysterectomy procedure performed on 6-11-97
Dr. Arnold M.D. Ob/Gyn   Marinette, WI

Please keep in mind that Deb did NOT have access to these reports until one and a half years AFTER her hysterectomy when she again presented to Dr. Arnold with “pelvic pain ” that was not resolved! He told her it was all in her head and she came to me to discuss her symptoms. We then secured all her medical and operative records in March of 1999…and discovered what your about to witness, malpractice in action!

We tried to secure and attorney to sue, but it is near impossible to sue a Dr. Arnold. We were able to have all her medical and hospital bills dropped!  And Dr. Arnold refused a consultation with Deb and Beverly Doucette, stating his insurance company instructed him never to allow Deb Krueger into his office again! 

Attached:
You will find a preoperative diagnostic report dated:
March 6, 1997 Pelvic Ultrasound:

Note: Deb presented with a history of complaints of “ pelvic pain”. 

No ovarian cyst’s observed on these films. 
The ultra sound showed the right adnexa (ovary) was adherent to the fundus ( main portion of the uterus.) Though adhesion tissue itself is not visible on any diagnostic test available today, it is possible to see organs that are abnormally situated within the body. Again, this same observation is repeated within this report!
Though he states he discussed this with Deb, he did not explain the possible roll “post surgical adhesions” might be playing in this attachment of the ovary to the uterus, though she has two prior c-section deliveries! 
In discussing the results of this report with Deb Krueger, Dr. Arnold used big words and made references of medical conditions she had no idea about, and said possible endometriosis as well. 

May 6, 1997 Pelvic Ultrasound:
 No ovarian cyst’s observed on these films. Same impressions were found as in the report of the Ultrasound of March 6, 1997, with the uterus now deviated to the right and also adhered to the pelvic sidewall, now it is suggestive of “dense adhesions.” Deb states that Dr. Arnold did not mention dense adhesion to her and that she never heard the words adhesions from him anytime during this medical intervention. He discussed a laporoscopic diagnostic, which was routine in a case like this.

May 5, 1997 Diagnostic Laporoscopy:
Preoperative diagnosis:  
Suspected  “cyst" of right ovary, yet no cysts were noted in the prior diagnostic Ultrasounds! 
Note no mention of suspected “ dense adhesions ”

Postoperative diagnosis:
Fluid is not reason for a hysterectomy, ever!  Papillary excrescences are normal, and benign, recent ovulation with stigma is what ovaries are supposed to do every month!

Procedure report: 
NO mention of visualizing “ dense adhesions,” yet something was adhering the right ovary and uterus to the pelvic sidewall in prior diagnostic ultrasounds! Endometriosis IS visible and diagnosable via a laporoscopic diagnostic procedure and with biopsy confirmation!

Post surgical pathology report:
Biopsies proved negative for abnormal pathology and endometrial implants! 
(NO endometriosis )

Emergency room visit on May 31-97
Deb presented with pelvic pain, nausea, dizziness, abdominal cramping following her diagnostic laporoscopy of May 5th 1997.
Seen by Dr. Darcy.  Pelvic ultrasound ordered:
Results of that diagnostic:
Fluid in pelvic cavity.  Suspected small hemorrhagic tissue in fluid, result of recent biopsy.
(Would be normal following the diagnostic procedure of 5/5/97) 
Small ovarian cysts on LEFT ovary..( Normal findings in an ovulating women.)
NOTE: Uterus IS normal in size! No mention of deviation to the right, or of right ovary adherent to the uterus! 
Endometrial strip ( lining ) IS normal, you cannot have endometriosis with a normal endometrial lining of the uterus! Impossible to have endometriosis AND a normal endometrial strip! Cannot have both at the same time! 

Deb states that Dr. Arnold told her and her husband that her pelivic pain was from endometriosis and she would need a hysterectomy to resolve her pain. No alternative for her chronic pain was offered to her. A hysterectomy was scheduled for June 11, 1997. 
Deb was 32 years old at this time and two children.

June 11, 1997 Hysterectomy procedure:
Preoperative diagnosis: Endometriosis, pelvic pain, dysmenorrhea ( heavy menstration )
Postoperative diagnosis: Endometriosis, pelvic pain, dysmenorrhea

Procedure: Hysterectomy with removal of right ovary and uterus.

NOTE: Fourth paragraph of operative report by Dr. Arnold: 
The uterine vessels were crossed clamped with bipolar cautery  (burned through ) and coagulated superior to the uterine artery because of bleeding…( thus the blood supply to the uterus was severed rendering this organ dead. )

Dr. Arnold then turned his scalpal to the urinary bladder as he had to spend 1.5 hours to free the uterus from the urinary bladder due to dense adhesions! You will note that these dense adhesions were from two prior c-section deliveries.

Note that bleeding was continuing in the pelvic cavity at the end of the surgery, and try to get an idea of why and how many dense adhesions that alone would cause Deb to form in the next few days and the suffering it would once again bring her!
Deb was expecting that this procedure would bring resolution to her pain and suffering…not that it would bring her even greater suffering in more ways then physical!
Though her husband had questioned him as to why that hysterectomy took so long, Dr. Arnold never once mentioned the incidence with the dense adhesions!

First page of discharge summary:
  First paragraph reads that the hysterectomy was performed due to “biopsy proven” endometriosis, and found during the diagnostic laporoscopy of 5/29/97!!   Both statements are not true at all! Blatant lies here.
Second paragraph Dr. Arnold states that because Deb is finished with her childbearing, the hysterectomy route would be taken. Note that there was no alternatives offered to resolving her chronic pelvic pain though he highly suspected post surgical adhesions to be the cause of the uterus deviation and right ovary being adherent to the uterus!!! 

Pathology:
1.) Uterus with “weakly secretory phase endometrium” which is a normal stage of ovulation in the ovary! In Deb’s case,  this stage was being caused by her being placed on hormone therapy, thus the “ exogenous hormonal therapy effect!”
2.) Inflamed cervix was also due to being on hormone therapy!! Nabothian cysts are found all the time in females,( they come and go spontaneously, some may require lancing, but that is few and far between,) Certainly not a cause for a hysterectomy!! 
3.) Fallopian tube “ adnexal cysts ” are again something that is found in women all the time, they come and go spontaneously.  Pathologist says that a micro section of the cysts must be done to rule out “ endometrial” tissue being present as no endo tissue is visable. (Tissue from the strip in the uterus)
4) Ovary (right) with follicle cysts, corpus luteum cyst (all normal in the ovary )and some bleeding from that biopsy of the ovary 5/29/97..(again to be expected from the biopsy)
5.) Dysplasia ( abnormal tissue findings ) and malignancy (cancer cells) are NOT observed on this specimen

Second page of discharge summary:
FINAL diagnosis:
1. Endometriosis of right fallopian tube and uterus (NEVER confirmed at all!! )
2. Corpus luteum cyst of right ovary (All part of the normal function of the ovaries)
3. Follicular cyst of right ovary  (A normal function of the ovary, produces estrogen)
4. Nabothian cyst of cervix (A cyst that is found in this area, comes and goes all the time in females!! 
Not one of these reasons show cause for a hysterectomy!! Not one of them at all!

Surgical pathology report:
Diagnosis following pathological study of specimens shows first the “ gross ” study of the specimens, (or visual inspection of the uterus and fallopian tube and right ovary.)
External inspection of the uterus shows fibrous adhesions on it.

Microscopic test results of the tissue: 
If a pathologist has to search microscopically for endometriosis in uterine tissue, fallopian tube and ovary tissue, then you can be assured that a surgeon definitely did NOT see endometriosis in a diagnostic procedure nor in that hysterectomy!! Impossible! And the microscopic results are inconclusive at that! (unable to determine if any endo tissue was in the cysts at all!)

1. Uterus with “weakly secretory phase endometrium” ( thinner endometrial strip in the uterus that was caused from hormone therapy! Normal when menstruating or on hormones! )
2. Inflammed cervix…(nothing new here)
3. Fallopian tube with adnexal small cysts “ suggesting “ endometriosis/endosalpingeosis  This cannot be determined by this specimen test,  a midro tissue lab test must be done on the tissue to determine IF endo was present in the cysts.
4. Right ovary, normal stage of cysts, hemorrage due to biopsy.

Following an adhesiolysis procedure in New York Columbia Presbyterian Medical Center with Dr. Harry Reich M.D. on April 20, 1999  Debbie remains productive and has not required any medical intervention for ARD or urinary tract problems!

Pelvic ultrasound January 12, 1999
Deborah Kreuger once again presents to Dr. Arnold with “ pelvic pain!”
( Gram negative rods mean bacteria without abnormal cells, no infection present!)

Her symptoms were NOT clearly defined, an ultrasound was performed.

Cysts were found on her left ovary, but no mention of surgery to remove that ovary due to cysts!!
She was tender over her right adnexa ( right pelvic area over where her right ovary would have been )
She was diffusely tender over her bladder…(where it took him 1.5 hours to cut through dense adhesions during the hysterectomy!) At no time did he mention that incidence of having to lyse the adhesions on her bladder for 1.5 hours to her either!

Sent her home without any pain medications, and told her to come back if she still had pain. When she did present to him again, he told her there was nothing more he could do for her, sent her to a urologist, no bladder infection nor bladder function problem, “ pain ” was her complaint!
Deb then started to see Dr. Bill Hultman at Bev Doucette’s insistence and was started on pain medication when all other diagnostic test ruled out any abnormal pathology as the cause of Deb’s pain and suffering!

In February of 1999, Deb secured her medical and operative reports and for the first time she was able to find the real reason for her chronic pelvic pain! The pain she was currently experiencing, was the exact pain she experienced prior to her hysterectomy in 1997! 
She confronted Dr. Arnold about “post surgical pelvic adhesions” saying she had discussed them with a friend and wanted to know if she had them when he performed that hysterectomy? He then told both Deborah and her husband that there was no such thing as pelvic adhesions. They then disclosed to him that they had secured and read Debs surgical reports and in fact, he had mentioned them in those reports, and that they now knew why that hysterectomy took 1.5 hours longer then it should have to complete…Dr. Arnold asked them to leave his office and find another Dr.! HE was angry!
I am sure he was!  It was later disclosed to Deb that Dr. Arnold was discussing her with another Dr. and was over heard to call her, "Another whining vagina he couldn’t please!!”

In her adhesiolysis under Dr. Reich at the Columbia Presbyterian Medical center, New York, Deborah was found to have massive dense adhesions on her urinary bladder attaching it to her pelvic sidewall!!
( video available of this surgery )
Deb remains between 50% - 75% pain and symptom free since that surgery, but continues to suffer with chronic pain and bladder spasms! 

Not to mention the heartache of having undergone an unnecessary hysterectomy at age 32 and being lied to by her surgeon. 
Update: January 2002:
Having been cued to the fact that the “Hospital Consent to Procedure and Operation” form states that all complications of the procedure must be fully explained to the patient prior to the procedure being completed on the patient, 99% of ARD sufferers we are aware of did NOT have post surgical adhesions discussed with them, nor had they ever heard the word adhesions and non were offered an alternative method of medical intervention prior to any of their respective surgeries, Deb included!