A former patient who developed a life-threatening infection after undergoing knee replacement surgery in 2023 is suing Kaiser Permanente San Diego, alleging that the medical complication occurred “as a result” of “sterilization lapses” at the provider’s Zion Medical Center in Grantville.
Michael G. Ryan, in a lawsuit filed in San Diego Superior Court this week, requests unspecified compensation for general negligence, noting that Zion suffered a widely publicized problem with black and brown particles showing up in trays holding sterilized surgical instruments.
This “unknown substance” so concerned employees, the lawsuit notes, that 70 banded together, publicly petitioning their employer to halt surgeries until trays were consistently clear of the mysterious substance.
Kaiser consistently said that the particles were harmless, inert material dislodged by a malfunctioning water heater that was not infectious.
That continues to be Kaiser’s stance two years later.
In a statement, the company said that while it has not yet been formally served with the suit, it cannot comment on the details of any specific patient’s care due to requirements that it “protect patient confidentiality and comply with state and federal privacy laws.”
“However, we want to assure our patients and the public that all surgical instruments used at Kaiser Permanente undergo a stringent, multi-tiered cleaning and sterilization process,” Kaiser’s statement said. “This includes decontamination, ultrasonic cleaning and washing, visual inspection, sterilization, and further visual inspection prior to use.
“We remain confident that no patients or providers were placed at risk at this time in 2023, and that our care was safe and appropriate.”
Problems first started, Kaiser said in 2023, in mid-May of that year with issues still popping up on June 6, though it was not clear when the problem was permanently resolved. Kaiser reported temporarily moving some sterilization operations to San Diego Medical Center in Kearny Mesa while repairs were underway.
Nelson’s legal complaint indicates that he had his right knee replaced on May 16, 2023, and was not notified of the sterilization situation.
“As a result of the sterilization lapses, Mr. Nelson developed a persistent infection of the surgical site, bacteremia, and sepsis,” the lawsuit states. “These conditions required an extensive course of treatment including multiple additional surgeries.”
The infection was so severe, the lawsuit states, that the original implanted prosthetic knee had to be removed in March, 2024, and a new permanent device implanted in September of that year. Two additional “sceptic episodes,” the lawsuit states, occurred in 2025.
But while the initial legal filing notes that Nelson’s surgery coincided with the sterilization saga at Zion, it contains no additional information on how he would prove at trial that the infection was caused by a poorly sterilized instrument. While rare, infection is a documented occurrence during total knee replacement procedures. A 2022 study that examined surgical site infections in more than 2.6 million Medicare patients estimates that about 2% of cases end up with infections. And a 2024 review of such infections notes that other factors beyond negligence, such as chronic disease and age, can increase the risk of post-surgical infection.
Requests for additional comment made to Brian Burchett, Nelson’s attorney, were not returned.