Medical Verdicts

Did delayed cesarean delivery cause child’s brain damage?

SEVERAL HOURS AFTER A WOMAN ARRIVED at a hospital in labor, the fetal heart rate dropped to 60 beats/min. The on-call ObGyn performed a cesarean delivery 90 minutes later. The child has permanent neurologic disabilities, receives nourishment through a gastric tube, and will require full-time assistance for life.

PATIENT’S CLAIM The 90-minute delay in performing cesarean delivery caused brain damage. A compressed umbilical cord reduced the oxygen supply, compromised the fetal heart rate, and led to brain damage. There were delays in notifying the physician, assembling the surgical team, and taking the mother to the operating room. The ObGyn failed to inform the mother she could have an expedited cesarean section under local anesthesia.

DEFENDANTS’ DEFENSE The ObGyn claimed that a placental infection caused the child’s brain damage. The hospital claimed that the physician was called immediately, the surgical team was gathered as quickly as possible, and cesarean delivery was performed in a timely manner.

VERDICT An $8.5 million New Jersey settlement was reached, including $6 million for the child and $2.5 million for the parents.

PPH untreated—blood could not be found

AT AGE 36, A WOMAN GAVE BIRTH to her first child by cesarean delivery. She developed postpartum hemorrhage, but surgery was not performed because physicians believed the hospital did not have enough matched blood for a transfusion. The woman died.

It was later determined that the hospital did have the appropriate blood in its refrigerator. The estate reached a confidential settlement with the delivering physician, leaving only the hospital as defendant at trial.

ESTATE’S CLAIM The hospital failed to maintain an adequate stock of blood, failed to follow policy in procuring emergency blood, and failed to provide blood in a timely manner.

In discovery, the estate learned that a janitor had been sent to procure blood, despite hospital policy requiring that emergency blood be delivered by law enforcement. An order to type and screen the patient’s blood was given before cesarean delivery, but was not carried out for hours. The woman was type A-negative, which the hospital did not stock. The hospital did have A-positive and O-positive blood, which could have been used, but the physicians were not told it was available.

HOSPITAL’S DEFENSE The physician should have performed surgery. Blood was not needed for the procedure that would have saved the woman’s life. Her death was due to peripartum cardiomyopathy.

VERDICT A $4,623,924 Minnesota verdict was returned.

Were non-stress tests interpreted accurately?

A MOTHER BEGAN TO EXPERIENCE irregular contractions and decreased fetal movement at 38 weeks’ gestation. Her ObGyn sent her to the emergency department for a non-stress test and fetal ultrasonography. The tests were interpreted as normal, and she was discharged.

When she saw her ObGyn the next day, he repeated the non-stress test, and found the results to be reassuring and reactive.

Two days later, the ObGyn was unable to find a fetal heartbeat. He sent the woman to the hospital, where a diagnosis of intrauterine fetal demise at term was made. After attempts to induce labor were unsuccessful, a cesarean delivery was performed, and a 10-lb, 8-oz stillborn baby was delivered. The pathologist was unable to define a cause of death at autopsy.

PATIENT’S CLAIM The physician was negligent in failing to properly interpret the non-stress tests. Because of the mother’s symptoms, additional testing should have been performed that would have revealed fetal compromise, and led to delivery of a healthy baby.

PHYSICIAN’S DEFENSE The treatment provided was appropriate. The non-stress tests were properly interpreted.

VERDICT An Illinois defense verdict was returned.

Child’s arm paralyzed despite mother’s expressed concern

WHEN PREGNANT A SECOND TIME, a woman reported to Dr. A, a member of an ObGyn group, that she had a history of gestational diabetes, and that her first child had been large but had been delivered vaginally. At 28 weeks’ gestation, screening was negative for gestational diabetes. Two prenatal sonograms, performed at 35 and 37 weeks’ gestation, showed a large fetus.

The woman went into labor at 39 weeks. Dr. B, an associate of Dr. A, encountered shoulder dystocia, but freed the shoulder and completed the vaginal delivery. The baby had Apgar scores of 2, 3, and 7. He was given a diagnosis of separation of four of five nerve roots in his shoulder and has complete paralysis of the right arm, from biceps to fingers.

PATIENT'S CLAIM Knowing the mother’s history, the ObGyns were negligent in not diagnosing gestational diabetes. A cesarean delivery should have been performed because the fetus was known to be large; in fact, the mother requested cesarean delivery during labor—because she could tell the baby was larger than her first child—but the request was refused. Proper maneuvers were not used when shoulder dystocia occurred.

PHYSICIANS’ DEFENSE The prenatal charts were not sent to the hospital, so the results of the sonograms were unavailable. The fetus experienced intermittent hypoxia during delivery, resulting in a “floppy baby” more susceptible to injury during normal maneuvers. Shoulder dystocia was treated properly.

VERDICT A $1.6 million Ohio verdict was returned against the ObGyn group.

Midwife “pulled too hard”; child injured

A NURSE MIDWIFE ENCOUNTERED shoulder dystocia. Without calling for her back-up physician, she delivered the child. The baby suffers from a moderate brachial plexus injury.

PLAINTIFF’S CLAIM The midwife should have called in the physician when shoulder dystocia was encountered. The midwife pulled too hard on the child’s head, causing the injury.

DEFENDANT’S DEFENSE The midwife properly treated shoulder dystocia.

VERDICT A $950,000 North Carolina verdict was returned.

Would earlier cancer diagnosis have changed prognosis?

AFTER LAPAROSCOPIC ADHESIOLYSIS failed to resolve severe abdominal pain, a 52-year-old woman underwent removal of her ovaries and fallopian tubes in 2005. A pathologist reported that the tissue was a benign serous papillary tumor with psammoma bodies. Two years later, the woman’s abdominal pain returned, and, over the next 8 months, her primary physician sent her for several magnetic resonance imaging scans that revealed little change in the lower pelvis.

A diagnostic laparoscopy in 2008 found low-grade IIIC primary peritoneal carcinoma thought to have originated from her ovaries and fallopian tubes. The surgeon testified that there was cancer everywhere in the woman’s peritoneal cavity. After comparing pathology slides from the two procedures, the surgeon believed the tissue was virtually identical, and that the patient had been misdiagnosed in 2005.

PATIENT’S CLAIM The pathologist was at fault for not diagnosing cancer or borderline cancer in 2005. Had it been diagnosed then, the patient’s chances of survival would have been increased by almost 70%.

PHYSICIAN’S DEFENSE According to a gynecologic pathology expert who reviewed both tissue samples, the 2005 diagnosis was reasonable. An earlier diagnosis would not have changed the woman’s prognosis.

VERDICT A Washington defense verdict was returned.

Skull fracture and brain hemorrhage in infant

AFTER 11 HOURS OF LABOR, a mother developed fever. The fetal heart rate fluctuated until the baby was delivered 3 hours later. When the cervix was fully dilated, the mother’s pushing failed to result in fetal descent, and a cesarean delivery was performed. The child suffered seizures shortly after birth; magnetic resonance imaging and computed tomography scans revealed a linear skull fracture with subarachnoid hemorrhage. The discharge summary for the baby indicated hypotonia, birth depression, and acidosis.

PATIENT’S CLAIM During prenatal treatment, the ObGyn suggested the mother might require cesarean delivery because of her small stature (height, <5 ft). The injuries to the baby could have been avoided; when an arrest of labor occurred soon after the mother’s arrival at the hospital, a cesarean delivery should have been performed.

PHYSICIAN’S DEFENSE An arrest of labor did not occur; treatment provided was proper and timely

VERDICT A New York defense verdict was returned.

Did delayed cesarean delivery cause child’s brain damage?

SEVERAL HOURS AFTER A WOMAN ARRIVED at a hospital in labor, the fetal heart rate dropped to 60 beats/min. The on-call ObGyn performed a cesarean delivery 90 minutes later. The child has permanent neurologic disabilities, receives nourishment through a gastric tube, and will require full-time assistance for life.

PATIENT’S CLAIM The 90-minute delay in performing cesarean delivery caused brain damage. A compressed umbilical cord reduced the oxygen supply, compromised the fetal heart rate, and led to brain damage. There were delays in notifying the physician, assembling the surgical team, and taking the mother to the operating room. The ObGyn failed to inform the mother she could have an expedited cesarean section under local anesthesia.

DEFENDANTS’ DEFENSE The ObGyn claimed that a placental infection caused the child’s brain damage. The hospital claimed that the physician was called immediately, the surgical team was gathered as quickly as possible, and cesarean delivery was performed in a timely manner.

VERDICT An $8.5 million New Jersey settlement was reached, including $6 million for the child and $2.5 million for the parents.

PPH untreated—blood could not be found

AT AGE 36, A WOMAN GAVE BIRTH to her first child by cesarean delivery. She developed postpartum hemorrhage, but surgery was not performed because physicians believed the hospital did not have enough matched blood for a transfusion. The woman died.

It was later determined that the hospital did have the appropriate blood in its refrigerator. The estate reached a confidential settlement with the delivering physician, leaving only the hospital as defendant at trial.

ESTATE’S CLAIM The hospital failed to maintain an adequate stock of blood, failed to follow policy in procuring emergency blood, and failed to provide blood in a timely manner.

In discovery, the estate learned that a janitor had been sent to procure blood, despite hospital policy requiring that emergency blood be delivered by law enforcement. An order to type and screen the patient’s blood was given before cesarean delivery, but was not carried out for hours. The woman was type A-negative, which the hospital did not stock. The hospital did have A-positive and O-positive blood, which could have been used, but the physicians were not told it was available.

HOSPITAL’S DEFENSE The physician should have performed surgery. Blood was not needed for the procedure that would have saved the woman’s life. Her death was due to peripartum cardiomyopathy.

VERDICT A $4,623,924 Minnesota verdict was returned.

Were non-stress tests interpreted accurately?

A MOTHER BEGAN TO EXPERIENCE irregular contractions and decreased fetal movement at 38 weeks’ gestation. Her ObGyn sent her to the emergency department for a non-stress test and fetal ultrasonography. The tests were interpreted as normal, and she was discharged.

When she saw her ObGyn the next day, he repeated the non-stress test, and found the results to be reassuring and reactive.

Two days later, the ObGyn was unable to find a fetal heartbeat. He sent the woman to the hospital, where a diagnosis of intrauterine fetal demise at term was made. After attempts to induce labor were unsuccessful, a cesarean delivery was performed, and a 10-lb, 8-oz stillborn baby was delivered. The pathologist was unable to define a cause of death at autopsy.

PATIENT’S CLAIM The physician was negligent in failing to properly interpret the non-stress tests. Because of the mother’s symptoms, additional testing should have been performed that would have revealed fetal compromise, and led to delivery of a healthy baby.

PHYSICIAN’S DEFENSE The treatment provided was appropriate. The non-stress tests were properly interpreted.

VERDICT An Illinois defense verdict was returned.

Child’s arm paralyzed despite mother’s expressed concern

WHEN PREGNANT A SECOND TIME, a woman reported to Dr. A, a member of an ObGyn group, that she had a history of gestational diabetes, and that her first child had been large but had been delivered vaginally. At 28 weeks’ gestation, screening was negative for gestational diabetes. Two prenatal sonograms, performed at 35 and 37 weeks’ gestation, showed a large fetus.

The woman went into labor at 39 weeks. Dr. B, an associate of Dr. A, encountered shoulder dystocia, but freed the shoulder and completed the vaginal delivery. The baby had Apgar scores of 2, 3, and 7. He was given a diagnosis of separation of four of five nerve roots in his shoulder and has complete paralysis of the right arm, from biceps to fingers.

PATIENT'S CLAIM Knowing the mother’s history, the ObGyns were negligent in not diagnosing gestational diabetes. A cesarean delivery should have been performed because the fetus was known to be large; in fact, the mother requested cesarean delivery during labor—because she could tell the baby was larger than her first child—but the request was refused. Proper maneuvers were not used when shoulder dystocia occurred.

PHYSICIANS’ DEFENSE The prenatal charts were not sent to the hospital, so the results of the sonograms were unavailable. The fetus experienced intermittent hypoxia during delivery, resulting in a “floppy baby” more susceptible to injury during normal maneuvers. Shoulder dystocia was treated properly.

VERDICT A $1.6 million Ohio verdict was returned against the ObGyn group.

Midwife “pulled too hard”; child injured

A NURSE MIDWIFE ENCOUNTERED shoulder dystocia. Without calling for her back-up physician, she delivered the child. The baby suffers from a moderate brachial plexus injury.

PLAINTIFF’S CLAIM The midwife should have called in the physician when shoulder dystocia was encountered. The midwife pulled too hard on the child’s head, causing the injury.

DEFENDANT’S DEFENSE The midwife properly treated shoulder dystocia.

VERDICT A $950,000 North Carolina verdict was returned.

Would earlier cancer diagnosis have changed prognosis?

AFTER LAPAROSCOPIC ADHESIOLYSIS failed to resolve severe abdominal pain, a 52-year-old woman underwent removal of her ovaries and fallopian tubes in 2005. A pathologist reported that the tissue was a benign serous papillary tumor with psammoma bodies. Two years later, the woman’s abdominal pain returned, and, over the next 8 months, her primary physician sent her for several magnetic resonance imaging scans that revealed little change in the lower pelvis.

A diagnostic laparoscopy in 2008 found low-grade IIIC primary peritoneal carcinoma thought to have originated from her ovaries and fallopian tubes. The surgeon testified that there was cancer everywhere in the woman’s peritoneal cavity. After comparing pathology slides from the two procedures, the surgeon believed the tissue was virtually identical, and that the patient had been misdiagnosed in 2005.

PATIENT’S CLAIM The pathologist was at fault for not diagnosing cancer or borderline cancer in 2005. Had it been diagnosed then, the patient’s chances of survival would have been increased by almost 70%.

PHYSICIAN’S DEFENSE According to a gynecologic pathology expert who reviewed both tissue samples, the 2005 diagnosis was reasonable. An earlier diagnosis would not have changed the woman’s prognosis.

VERDICT A Washington defense verdict was returned.

Skull fracture and brain hemorrhage in infant

AFTER 11 HOURS OF LABOR, a mother developed fever. The fetal heart rate fluctuated until the baby was delivered 3 hours later. When the cervix was fully dilated, the mother’s pushing failed to result in fetal descent, and a cesarean delivery was performed. The child suffered seizures shortly after birth; magnetic resonance imaging and computed tomography scans revealed a linear skull fracture with subarachnoid hemorrhage. The discharge summary for the baby indicated hypotonia, birth depression, and acidosis.

PATIENT’S CLAIM During prenatal treatment, the ObGyn suggested the mother might require cesarean delivery because of her small stature (height, <5 ft). The injuries to the baby could have been avoided; when an arrest of labor occurred soon after the mother’s arrival at the hospital, a cesarean delivery should have been performed.

PHYSICIAN’S DEFENSE An arrest of labor did not occur; treatment provided was proper and timely

VERDICT A New York defense verdict was returned.

Did delayed cesarean delivery cause child’s brain damage?

SEVERAL HOURS AFTER A WOMAN ARRIVED at a hospital in labor, the fetal heart rate dropped to 60 beats/min. The on-call ObGyn performed a cesarean delivery 90 minutes later. The child has permanent neurologic disabilities, receives nourishment through a gastric tube, and will require full-time assistance for life.

PATIENT’S CLAIM The 90-minute delay in performing cesarean delivery caused brain damage. A compressed umbilical cord reduced the oxygen supply, compromised the fetal heart rate, and led to brain damage. There were delays in notifying the physician, assembling the surgical team, and taking the mother to the operating room. The ObGyn failed to inform the mother she could have an expedited cesarean section under local anesthesia.

DEFENDANTS’ DEFENSE The ObGyn claimed that a placental infection caused the child’s brain damage. The hospital claimed that the physician was called immediately, the surgical team was gathered as quickly as possible, and cesarean delivery was performed in a timely manner.

VERDICT An $8.5 million New Jersey settlement was reached, including $6 million for the child and $2.5 million for the parents.

PPH untreated—blood could not be found

AT AGE 36, A WOMAN GAVE BIRTH to her first child by cesarean delivery. She developed postpartum hemorrhage, but surgery was not performed because physicians believed the hospital did not have enough matched blood for a transfusion. The woman died.

It was later determined that the hospital did have the appropriate blood in its refrigerator. The estate reached a confidential settlement with the delivering physician, leaving only the hospital as defendant at trial.

ESTATE’S CLAIM The hospital failed to maintain an adequate stock of blood, failed to follow policy in procuring emergency blood, and failed to provide blood in a timely manner.

In discovery, the estate learned that a janitor had been sent to procure blood, despite hospital policy requiring that emergency blood be delivered by law enforcement. An order to type and screen the patient’s blood was given before cesarean delivery, but was not carried out for hours. The woman was type A-negative, which the hospital did not stock. The hospital did have A-positive and O-positive blood, which could have been used, but the physicians were not told it was available.

HOSPITAL’S DEFENSE The physician should have performed surgery. Blood was not needed for the procedure that would have saved the woman’s life. Her death was due to peripartum cardiomyopathy.

VERDICT A $4,623,924 Minnesota verdict was returned.

Were non-stress tests interpreted accurately?

A MOTHER BEGAN TO EXPERIENCE irregular contractions and decreased fetal movement at 38 weeks’ gestation. Her ObGyn sent her to the emergency department for a non-stress test and fetal ultrasonography. The tests were interpreted as normal, and she was discharged.

When she saw her ObGyn the next day, he repeated the non-stress test, and found the results to be reassuring and reactive.

Two days later, the ObGyn was unable to find a fetal heartbeat. He sent the woman to the hospital, where a diagnosis of intrauterine fetal demise at term was made. After attempts to induce labor were unsuccessful, a cesarean delivery was performed, and a 10-lb, 8-oz stillborn baby was delivered. The pathologist was unable to define a cause of death at autopsy.

PATIENT’S CLAIM The physician was negligent in failing to properly interpret the non-stress tests. Because of the mother’s symptoms, additional testing should have been performed that would have revealed fetal compromise, and led to delivery of a healthy baby.

PHYSICIAN’S DEFENSE The treatment provided was appropriate. The non-stress tests were properly interpreted.

VERDICT An Illinois defense verdict was returned.

Child’s arm paralyzed despite mother’s expressed concern

WHEN PREGNANT A SECOND TIME, a woman reported to Dr. A, a member of an ObGyn group, that she had a history of gestational diabetes, and that her first child had been large but had been delivered vaginally. At 28 weeks’ gestation, screening was negative for gestational diabetes. Two prenatal sonograms, performed at 35 and 37 weeks’ gestation, showed a large fetus.

The woman went into labor at 39 weeks. Dr. B, an associate of Dr. A, encountered shoulder dystocia, but freed the shoulder and completed the vaginal delivery. The baby had Apgar scores of 2, 3, and 7. He was given a diagnosis of separation of four of five nerve roots in his shoulder and has complete paralysis of the right arm, from biceps to fingers.

PATIENT'S CLAIM Knowing the mother’s history, the ObGyns were negligent in not diagnosing gestational diabetes. A cesarean delivery should have been performed because the fetus was known to be large; in fact, the mother requested cesarean delivery during labor—because she could tell the baby was larger than her first child—but the request was refused. Proper maneuvers were not used when shoulder dystocia occurred.

PHYSICIANS’ DEFENSE The prenatal charts were not sent to the hospital, so the results of the sonograms were unavailable. The fetus experienced intermittent hypoxia during delivery, resulting in a “floppy baby” more susceptible to injury during normal maneuvers. Shoulder dystocia was treated properly.

VERDICT A $1.6 million Ohio verdict was returned against the ObGyn group.

Midwife “pulled too hard”; child injured

A NURSE MIDWIFE ENCOUNTERED shoulder dystocia. Without calling for her back-up physician, she delivered the child. The baby suffers from a moderate brachial plexus injury.

PLAINTIFF’S CLAIM The midwife should have called in the physician when shoulder dystocia was encountered. The midwife pulled too hard on the child’s head, causing the injury.

DEFENDANT’S DEFENSE The midwife properly treated shoulder dystocia.

VERDICT A $950,000 North Carolina verdict was returned.

Would earlier cancer diagnosis have changed prognosis?

AFTER LAPAROSCOPIC ADHESIOLYSIS failed to resolve severe abdominal pain, a 52-year-old woman underwent removal of her ovaries and fallopian tubes in 2005. A pathologist reported that the tissue was a benign serous papillary tumor with psammoma bodies. Two years later, the woman’s abdominal pain returned, and, over the next 8 months, her primary physician sent her for several magnetic resonance imaging scans that revealed little change in the lower pelvis.

A diagnostic laparoscopy in 2008 found low-grade IIIC primary peritoneal carcinoma thought to have originated from her ovaries and fallopian tubes. The surgeon testified that there was cancer everywhere in the woman’s peritoneal cavity. After comparing pathology slides from the two procedures, the surgeon believed the tissue was virtually identical, and that the patient had been misdiagnosed in 2005.

PATIENT’S CLAIM The pathologist was at fault for not diagnosing cancer or borderline cancer in 2005. Had it been diagnosed then, the patient’s chances of survival would have been increased by almost 70%.

PHYSICIAN’S DEFENSE According to a gynecologic pathology expert who reviewed both tissue samples, the 2005 diagnosis was reasonable. An earlier diagnosis would not have changed the woman’s prognosis.

VERDICT A Washington defense verdict was returned.

Skull fracture and brain hemorrhage in infant

AFTER 11 HOURS OF LABOR, a mother developed fever. The fetal heart rate fluctuated until the baby was delivered 3 hours later. When the cervix was fully dilated, the mother’s pushing failed to result in fetal descent, and a cesarean delivery was performed. The child suffered seizures shortly after birth; magnetic resonance imaging and computed tomography scans revealed a linear skull fracture with subarachnoid hemorrhage. The discharge summary for the baby indicated hypotonia, birth depression, and acidosis.

PATIENT’S CLAIM During prenatal treatment, the ObGyn suggested the mother might require cesarean delivery because of her small stature (height, <5 ft). The injuries to the baby could have been avoided; when an arrest of labor occurred soon after the mother’s arrival at the hospital, a cesarean delivery should have been performed.

PHYSICIAN’S DEFENSE An arrest of labor did not occur; treatment provided was proper and timely

VERDICT A New York defense verdict was returned.

Breast infection misdiagnosed

A SWOLLEN, TENDER AREA DEVELOPED on a mother’s right breast 3 weeks after giving birth. She called her ObGyn to report that pus was oozing from the nipple. He prescribed an antibiotic for what he presumed to be a clogged milk duct, and told her to continue to breastfeed. The infection worsened, until milk ceased to flow and the breast was red, painful, and warm.

At an office visit 2 weeks after the phone call, the ObGyn prescribed a new antibiotic, and told the mother to let the right breast milk dry up. Within 24 hours, pus breached the skin several centimeters above the nipple. The patient went to the emergency department, where 100 cc of pus was surgically removed. The infection was diagnosed as methicillin-resistant Staphylococcus aureus (MRSA). The patient was found to also have a MRSA infection in her left breast, but that infection was able to be treated by needle drainage. The ObGyn reported that he believed that the MRSA infection had developed shortly after the office visit.

PATIENT’S CLAIM The ObGyn was negligent in not diagnosing the infection earlier. MRSA infection could not have developed as quickly as the physician said; it probably started when pus began oozing from the nipple 3 weeks after childbirth.

PHYSICIAN’S DEFENSE The initial infection was in a clogged milk duct. Staphylococcal infection is rare in nursing mothers.

VERDICT A $200,000 Missouri verdict was returned.

Postpartum bleeding; then hysterectomy and chronic pain

TWELVE DAYS AFTER GIVING BIRTH to her third child, a 30-year-old woman went to the emergency department with heavy vaginal bleeding. An ObGyn, using ultrasonography, found pieces of placental tissue still attached to the uterine wall. He performed suction dilatation and curettage and prescribed medication to help the uterus contract. When the bleeding did not slow or stop, he consulted his partner.

During exploratory surgery, they found several sources of hemorrhage, including diffuse uterine bleeding. After trying to control the bleeding, they performed an abdominal hysterectomy; the woman had already lost one-half of her total blood volume.

PATIENT’S CLAIM The ObGyns were negligent in performing the hysterectomy. In addition to being unable to have more children, she also now suffers from chronic pain syndrome.

PHYSICIANS’ DEFENSE They did what was needed to save the patient’s life.

VERDICT An Illinois defense verdict was returned.

Drug blamed for osteonecrosis of jaw

AFTER TAKING ALENDRONATE SODIUM (Fosamax) for osteoporosis for several years, a woman was found to have osteonecrosis of the jaw.

PATIENT’S CLAIM The gynecologist was negligent in prescribing alendronate sodium, which reduced the blood flow to her jawbone, leading to osteonecrosis.

PHYSICIAN’S DEFENSE The patient had a history of jaw problems. Her condition could have been caused by her use of steroids for pain resulting from an automobile accident.

VERDICT A New Jersey defense verdict was returned.

Sponge found during laparotomy

A WOMAN UNDERWENT a hysterectomy in September. She returned to her gynecologist in December with abdominal pain; a diagnosis of appendicitis was made. During emergency laparotomy, a surgical sponge was found in the abdominal cavity. A third surgery was performed because she developed an abdominal infection that required bowel resection.

PATIENT’S CLAIM The gynecologist was at fault for leaving the sponge in her abdomen during hysterectomy. The surgical nurses were at fault for reporting a complete sponge count.

DEFENDANTS’ DEFENSE The gynecologist maintained that he relied on the surgical nurses’ sponge count, and that he had been told it was correct.

VERDICT The hospital settled before trial. A Florida defense verdict was returned for the physician.

Dye not used after 2nd bladder repair; fistula develops

AFTER COMPLAINING OF PAIN, excessive menstrual bleeding, and anemia, a woman underwent a hysterectomy.

During surgery, her gynecologist injured, then repaired, the bladder. Indigo carmine dye test was performed; when dye indicated a second, smaller hole, the gynecologist repaired it with a figure-of-8 stitch. The dye test was not performed after the second repair.

The patient underwent repair of a vesicovaginal fistula 2 months later.

PATIENT’S CLAIM The gynecologist was negligent in using the figure-of-8 stitch in the bladder, and in failing to perform a second dye test that would have indicated an additional leak.

PHYSICIAN’S DEFENSE The figure-of-8 stitch was an appropriate technique to close the second hole. Performing another dye test would have stretched the bladder, weakening the sutures. A fistula is a known complication of a hysterectomy.

VERDICT A Missouri defense verdict was returned.

Should IUGR have been found “incidentally”?

SEVEN MONTHS’ PREGNANT, an obese woman was admitted to the hospital with hypertension. Dr. A, a hospital-employed ObGyn, discharged her after 3 days.

The woman returned to the hospital 1 month later, but refused to see Dr. A. Another ObGyn (Dr. B) was unable to find a fetal heartbeat, diagnosed fetal death, and performed a cesarean delivery. Fetal death was blamed on intrauterine growth restriction (IUGR). The parents requested an autopsy.

PATIENT’S CLAIM Dr. A should have diagnosed IUGR with ultrasonography when the woman was first hospitalized. The autopsy was not performed.

DEFENDANTS’ DEFENSE The hospital claimed Dr. A acted properly in not ordering the sonogram, based on the patient’s complaints and symptoms. The hospital also denied there was any duty to perform an autopsy; the cause of death had been determined.

VERDICT A California defense verdict was returned.

Should conservative care trump surgery?

A 38-YEAR-OLD WOMAN WAS REFERRED to a specialty clinic for management of severe urinary stress incontinence and pelvic prolapse. A gynecologic surgeon performed mesh repair of the prolapse, and cystocele repair with bilateral sacrospinous ligament fixation and a prepubic transvaginal sling.

After surgery, the patient suffered increasing pain and fever. Diagnostic laparoscopy failed to find a suspected bowel perforation. An intravenous pyelogram revealed a left ureteral injury; the patient was transferred to another hospital for stent placement. The woman later developed a vesicovaginal fistula, with mesh erosion into the bladder.

PATIENT’S CLAIM Conservative treatment should have been offered first. Too many procedures were performed during one operation, increasing the risk of complications.

PHYSICIAN’S DEFENSE The patient declined conservative treatment. Her severe symptoms required multiple procedures within one operation. The complications that she developed were known risks of the procedures.

VERDICT A California defense verdict was returned.

Mother dies right after birth of twins

BECAUSE OF HER HISTORY of previous obstetrical complications and two cesarean deliveries, a 29-year-old woman, pregnant with twins, was under the care of a high-risk obstetrics clinic at a university hospital.

The patient was hospitalized for 6 days because of preterm contractions, then seen several times in the clinic. Her family testified that she was told to be on bed rest, and that she had complied.

Three weeks after discharge, she delivered twins by cesarean. As delivery was completed, she became unresponsive. Resuscitation attempts failed. An autopsy revealed a massive saddle pulmonary embolus. It had likely broken off from a deep vein thrombosis (DVT) in the legs or pelvis.

ESTATE’S CLAIM When bed rest was recommended, she should have been started on DVT prophylaxis.

DEFENDANTS’ DEFENSE The ObGyn and hospital claimed that no restrictions were placed on the woman’s activity following discharge from the hospital for preterm labor. Standard of care requires DVT prophylaxis for patients with a prior history of clots or thrombophilia; the decedent had neither of those conditions. Heparin was not indicated because it would increase the risk of bleeding and cause anesthesia risks. Mechanical prophylaxes such as TED hose and sequential compression devices have not been proved effective in preventing pulmonary embolism or death.

VERDICT An Illinois defense verdict was returned.

Breast infection misdiagnosed

A SWOLLEN, TENDER AREA DEVELOPED on a mother’s right breast 3 weeks after giving birth. She called her ObGyn to report that pus was oozing from the nipple. He prescribed an antibiotic for what he presumed to be a clogged milk duct, and told her to continue to breastfeed. The infection worsened, until milk ceased to flow and the breast was red, painful, and warm.

At an office visit 2 weeks after the phone call, the ObGyn prescribed a new antibiotic, and told the mother to let the right breast milk dry up. Within 24 hours, pus breached the skin several centimeters above the nipple. The patient went to the emergency department, where 100 cc of pus was surgically removed. The infection was diagnosed as methicillin-resistant Staphylococcus aureus (MRSA). The patient was found to also have a MRSA infection in her left breast, but that infection was able to be treated by needle drainage. The ObGyn reported that he believed that the MRSA infection had developed shortly after the office visit.

PATIENT’S CLAIM The ObGyn was negligent in not diagnosing the infection earlier. MRSA infection could not have developed as quickly as the physician said; it probably started when pus began oozing from the nipple 3 weeks after childbirth.

PHYSICIAN’S DEFENSE The initial infection was in a clogged milk duct. Staphylococcal infection is rare in nursing mothers.

VERDICT A $200,000 Missouri verdict was returned.

Postpartum bleeding; then hysterectomy and chronic pain

TWELVE DAYS AFTER GIVING BIRTH to her third child, a 30-year-old woman went to the emergency department with heavy vaginal bleeding. An ObGyn, using ultrasonography, found pieces of placental tissue still attached to the uterine wall. He performed suction dilatation and curettage and prescribed medication to help the uterus contract. When the bleeding did not slow or stop, he consulted his partner.

During exploratory surgery, they found several sources of hemorrhage, including diffuse uterine bleeding. After trying to control the bleeding, they performed an abdominal hysterectomy; the woman had already lost one-half of her total blood volume.

PATIENT’S CLAIM The ObGyns were negligent in performing the hysterectomy. In addition to being unable to have more children, she also now suffers from chronic pain syndrome.

PHYSICIANS’ DEFENSE They did what was needed to save the patient’s life.

VERDICT An Illinois defense verdict was returned.

Drug blamed for osteonecrosis of jaw

AFTER TAKING ALENDRONATE SODIUM (Fosamax) for osteoporosis for several years, a woman was found to have osteonecrosis of the jaw.

PATIENT’S CLAIM The gynecologist was negligent in prescribing alendronate sodium, which reduced the blood flow to her jawbone, leading to osteonecrosis.

PHYSICIAN’S DEFENSE The patient had a history of jaw problems. Her condition could have been caused by her use of steroids for pain resulting from an automobile accident.

VERDICT A New Jersey defense verdict was returned.

Sponge found during laparotomy

A WOMAN UNDERWENT a hysterectomy in September. She returned to her gynecologist in December with abdominal pain; a diagnosis of appendicitis was made. During emergency laparotomy, a surgical sponge was found in the abdominal cavity. A third surgery was performed because she developed an abdominal infection that required bowel resection.

PATIENT’S CLAIM The gynecologist was at fault for leaving the sponge in her abdomen during hysterectomy. The surgical nurses were at fault for reporting a complete sponge count.

DEFENDANTS’ DEFENSE The gynecologist maintained that he relied on the surgical nurses’ sponge count, and that he had been told it was correct.

VERDICT The hospital settled before trial. A Florida defense verdict was returned for the physician.

Dye not used after 2nd bladder repair; fistula develops

AFTER COMPLAINING OF PAIN, excessive menstrual bleeding, and anemia, a woman underwent a hysterectomy.

During surgery, her gynecologist injured, then repaired, the bladder. Indigo carmine dye test was performed; when dye indicated a second, smaller hole, the gynecologist repaired it with a figure-of-8 stitch. The dye test was not performed after the second repair.

The patient underwent repair of a vesicovaginal fistula 2 months later.

PATIENT’S CLAIM The gynecologist was negligent in using the figure-of-8 stitch in the bladder, and in failing to perform a second dye test that would have indicated an additional leak.

PHYSICIAN’S DEFENSE The figure-of-8 stitch was an appropriate technique to close the second hole. Performing another dye test would have stretched the bladder, weakening the sutures. A fistula is a known complication of a hysterectomy.

VERDICT A Missouri defense verdict was returned.

Should IUGR have been found “incidentally”?

SEVEN MONTHS’ PREGNANT, an obese woman was admitted to the hospital with hypertension. Dr. A, a hospital-employed ObGyn, discharged her after 3 days.

The woman returned to the hospital 1 month later, but refused to see Dr. A. Another ObGyn (Dr. B) was unable to find a fetal heartbeat, diagnosed fetal death, and performed a cesarean delivery. Fetal death was blamed on intrauterine growth restriction (IUGR). The parents requested an autopsy.

PATIENT’S CLAIM Dr. A should have diagnosed IUGR with ultrasonography when the woman was first hospitalized. The autopsy was not performed.

DEFENDANTS’ DEFENSE The hospital claimed Dr. A acted properly in not ordering the sonogram, based on the patient’s complaints and symptoms. The hospital also denied there was any duty to perform an autopsy; the cause of death had been determined.

VERDICT A California defense verdict was returned.

Should conservative care trump surgery?

A 38-YEAR-OLD WOMAN WAS REFERRED to a specialty clinic for management of severe urinary stress incontinence and pelvic prolapse. A gynecologic surgeon performed mesh repair of the prolapse, and cystocele repair with bilateral sacrospinous ligament fixation and a prepubic transvaginal sling.

After surgery, the patient suffered increasing pain and fever. Diagnostic laparoscopy failed to find a suspected bowel perforation. An intravenous pyelogram revealed a left ureteral injury; the patient was transferred to another hospital for stent placement. The woman later developed a vesicovaginal fistula, with mesh erosion into the bladder.

PATIENT’S CLAIM Conservative treatment should have been offered first. Too many procedures were performed during one operation, increasing the risk of complications.

PHYSICIAN’S DEFENSE The patient declined conservative treatment. Her severe symptoms required multiple procedures within one operation. The complications that she developed were known risks of the procedures.

VERDICT A California defense verdict was returned.

Mother dies right after birth of twins

BECAUSE OF HER HISTORY of previous obstetrical complications and two cesarean deliveries, a 29-year-old woman, pregnant with twins, was under the care of a high-risk obstetrics clinic at a university hospital.

The patient was hospitalized for 6 days because of preterm contractions, then seen several times in the clinic. Her family testified that she was told to be on bed rest, and that she had complied.

Three weeks after discharge, she delivered twins by cesarean. As delivery was completed, she became unresponsive. Resuscitation attempts failed. An autopsy revealed a massive saddle pulmonary embolus. It had likely broken off from a deep vein thrombosis (DVT) in the legs or pelvis.

ESTATE’S CLAIM When bed rest was recommended, she should have been started on DVT prophylaxis.

DEFENDANTS’ DEFENSE The ObGyn and hospital claimed that no restrictions were placed on the woman’s activity following discharge from the hospital for preterm labor. Standard of care requires DVT prophylaxis for patients with a prior history of clots or thrombophilia; the decedent had neither of those conditions. Heparin was not indicated because it would increase the risk of bleeding and cause anesthesia risks. Mechanical prophylaxes such as TED hose and sequential compression devices have not been proved effective in preventing pulmonary embolism or death.

VERDICT An Illinois defense verdict was returned.

Breast infection misdiagnosed

A SWOLLEN, TENDER AREA DEVELOPED on a mother’s right breast 3 weeks after giving birth. She called her ObGyn to report that pus was oozing from the nipple. He prescribed an antibiotic for what he presumed to be a clogged milk duct, and told her to continue to breastfeed. The infection worsened, until milk ceased to flow and the breast was red, painful, and warm.

At an office visit 2 weeks after the phone call, the ObGyn prescribed a new antibiotic, and told the mother to let the right breast milk dry up. Within 24 hours, pus breached the skin several centimeters above the nipple. The patient went to the emergency department, where 100 cc of pus was surgically removed. The infection was diagnosed as methicillin-resistant Staphylococcus aureus (MRSA). The patient was found to also have a MRSA infection in her left breast, but that infection was able to be treated by needle drainage. The ObGyn reported that he believed that the MRSA infection had developed shortly after the office visit.

PATIENT’S CLAIM The ObGyn was negligent in not diagnosing the infection earlier. MRSA infection could not have developed as quickly as the physician said; it probably started when pus began oozing from the nipple 3 weeks after childbirth.

PHYSICIAN’S DEFENSE The initial infection was in a clogged milk duct. Staphylococcal infection is rare in nursing mothers.

VERDICT A $200,000 Missouri verdict was returned.

Postpartum bleeding; then hysterectomy and chronic pain

TWELVE DAYS AFTER GIVING BIRTH to her third child, a 30-year-old woman went to the emergency department with heavy vaginal bleeding. An ObGyn, using ultrasonography, found pieces of placental tissue still attached to the uterine wall. He performed suction dilatation and curettage and prescribed medication to help the uterus contract. When the bleeding did not slow or stop, he consulted his partner.

During exploratory surgery, they found several sources of hemorrhage, including diffuse uterine bleeding. After trying to control the bleeding, they performed an abdominal hysterectomy; the woman had already lost one-half of her total blood volume.

PATIENT’S CLAIM The ObGyns were negligent in performing the hysterectomy. In addition to being unable to have more children, she also now suffers from chronic pain syndrome.

PHYSICIANS’ DEFENSE They did what was needed to save the patient’s life.

VERDICT An Illinois defense verdict was returned.

Drug blamed for osteonecrosis of jaw

AFTER TAKING ALENDRONATE SODIUM (Fosamax) for osteoporosis for several years, a woman was found to have osteonecrosis of the jaw.

PATIENT’S CLAIM The gynecologist was negligent in prescribing alendronate sodium, which reduced the blood flow to her jawbone, leading to osteonecrosis.

PHYSICIAN’S DEFENSE The patient had a history of jaw problems. Her condition could have been caused by her use of steroids for pain resulting from an automobile accident.

VERDICT A New Jersey defense verdict was returned.

Sponge found during laparotomy

A WOMAN UNDERWENT a hysterectomy in September. She returned to her gynecologist in December with abdominal pain; a diagnosis of appendicitis was made. During emergency laparotomy, a surgical sponge was found in the abdominal cavity. A third surgery was performed because she developed an abdominal infection that required bowel resection.

PATIENT’S CLAIM The gynecologist was at fault for leaving the sponge in her abdomen during hysterectomy. The surgical nurses were at fault for reporting a complete sponge count.

DEFENDANTS’ DEFENSE The gynecologist maintained that he relied on the surgical nurses’ sponge count, and that he had been told it was correct.

VERDICT The hospital settled before trial. A Florida defense verdict was returned for the physician.

Dye not used after 2nd bladder repair; fistula develops

AFTER COMPLAINING OF PAIN, excessive menstrual bleeding, and anemia, a woman underwent a hysterectomy.

During surgery, her gynecologist injured, then repaired, the bladder. Indigo carmine dye test was performed; when dye indicated a second, smaller hole, the gynecologist repaired it with a figure-of-8 stitch. The dye test was not performed after the second repair.

The patient underwent repair of a vesicovaginal fistula 2 months later.

PATIENT’S CLAIM The gynecologist was negligent in using the figure-of-8 stitch in the bladder, and in failing to perform a second dye test that would have indicated an additional leak.

PHYSICIAN’S DEFENSE The figure-of-8 stitch was an appropriate technique to close the second hole. Performing another dye test would have stretched the bladder, weakening the sutures. A fistula is a known complication of a hysterectomy.

VERDICT A Missouri defense verdict was returned.

Should IUGR have been found “incidentally”?

SEVEN MONTHS’ PREGNANT, an obese woman was admitted to the hospital with hypertension. Dr. A, a hospital-employed ObGyn, discharged her after 3 days.

The woman returned to the hospital 1 month later, but refused to see Dr. A. Another ObGyn (Dr. B) was unable to find a fetal heartbeat, diagnosed fetal death, and performed a cesarean delivery. Fetal death was blamed on intrauterine growth restriction (IUGR). The parents requested an autopsy.

PATIENT’S CLAIM Dr. A should have diagnosed IUGR with ultrasonography when the woman was first hospitalized. The autopsy was not performed.

DEFENDANTS’ DEFENSE The hospital claimed Dr. A acted properly in not ordering the sonogram, based on the patient’s complaints and symptoms. The hospital also denied there was any duty to perform an autopsy; the cause of death had been determined.

VERDICT A California defense verdict was returned.

Should conservative care trump surgery?

A 38-YEAR-OLD WOMAN WAS REFERRED to a specialty clinic for management of severe urinary stress incontinence and pelvic prolapse. A gynecologic surgeon performed mesh repair of the prolapse, and cystocele repair with bilateral sacrospinous ligament fixation and a prepubic transvaginal sling.

After surgery, the patient suffered increasing pain and fever. Diagnostic laparoscopy failed to find a suspected bowel perforation. An intravenous pyelogram revealed a left ureteral injury; the patient was transferred to another hospital for stent placement. The woman later developed a vesicovaginal fistula, with mesh erosion into the bladder.

PATIENT’S CLAIM Conservative treatment should have been offered first. Too many procedures were performed during one operation, increasing the risk of complications.

PHYSICIAN’S DEFENSE The patient declined conservative treatment. Her severe symptoms required multiple procedures within one operation. The complications that she developed were known risks of the procedures.

VERDICT A California defense verdict was returned.

Mother dies right after birth of twins

BECAUSE OF HER HISTORY of previous obstetrical complications and two cesarean deliveries, a 29-year-old woman, pregnant with twins, was under the care of a high-risk obstetrics clinic at a university hospital.

The patient was hospitalized for 6 days because of preterm contractions, then seen several times in the clinic. Her family testified that she was told to be on bed rest, and that she had complied.

Three weeks after discharge, she delivered twins by cesarean. As delivery was completed, she became unresponsive. Resuscitation attempts failed. An autopsy revealed a massive saddle pulmonary embolus. It had likely broken off from a deep vein thrombosis (DVT) in the legs or pelvis.

ESTATE’S CLAIM When bed rest was recommended, she should have been started on DVT prophylaxis.

DEFENDANTS’ DEFENSE The ObGyn and hospital claimed that no restrictions were placed on the woman’s activity following discharge from the hospital for preterm labor. Standard of care requires DVT prophylaxis for patients with a prior history of clots or thrombophilia; the decedent had neither of those conditions. Heparin was not indicated because it would increase the risk of bleeding and cause anesthesia risks. Mechanical prophylaxes such as TED hose and sequential compression devices have not been proved effective in preventing pulmonary embolism or death.

VERDICT An Illinois defense verdict was returned.

Blocked intestine after cesarean—
a nonsurgical cause?

A 34-YEAR-OLD WOMAN GAVE BIRTH to a healthy baby by cesarean delivery. Several weeks later, the mother reported abdominal pain, distention, and nausea. Her ObGyn suspected it was related to a somatic disorder.

Two months after delivery, the mother came to the emergency department with increasingly severe symptoms. One month later, at another hospital, physicians diagnosed a bowel obstruction. During emergency surgery, a lap sponge was found within the lumen of the patient’s small intestine.

PATIENT’S CLAIM The ObGyn left the lap sponge in her abdomen during cesarean delivery.

PHYSICIAN’S DEFENSE The sponge count from the cesarean delivery was correct. The ObGyn suggested that the patient had swallowed the sponge, because it was found within the lumen of the intestine, not in free space. The surgeon who removed the sponge agreed with the ObGyn, and recommended a psychiatric consult.

VERDICT A Louisiana defense verdict was returned.

Did vacuum extraction cause developmental delays?

SUCCESSFUL DELIVERY was performed using vacuum extraction. Later, mild balance and coordination issues, cognitive deficits, and speech delay were diagnosed in the child.

PATIENT’S CLAIM Use of the vacuum extractor was unnecessary; the instrument caused a subdural bleed that resulted in the child’s developmental delays.

PHYSICIAN’S DEFENSE Vacuum extraction was necessary because the baby was not progressing down the birth canal and was beginning to show signs of distress. Vacuum extraction did not cause the child’s injuries.

VERDICT A confidential South Carolina settlement was reached during jury deliberations.

Suture fails to dissolve; fistula develops

A WOMAN UNDERWENT SURGERY for uterine fibroids, during which injury to the bladder was repaired with a single suture.

A few weeks later, she developed abdominal pain, blood in her urine, and urinary incontinence. It was determined that the suture had not dissolved, and caused obstruction of the right ureter and kidney. A vesicovaginal fistula developed when the stitch migrated through the anterior wall of the vagina.

PATIENT’S CLAIM The gynecologist was at fault for injuring the bladder during surgery, and repairing it with a nondissolving suture.

PHYSICIAN’S DEFENSE Injury to the bladder and ureters is a known risk of the procedure. The correct type of suture was used; it was supposed to dissolve. The gynecologist tested the bladder and ureters using Indigo carmine-based dye before closing.

Over time, as the suture failed to dissolve, scar tissue occluded the ureter. Subsequent surgery returned the patient to baseline health.

VERDICT A Pennsylvania defense verdict was returned.

Baby stillborn. Vasa previa missed?

ULTRASONOGRAPHY REVEALED that the patient probably had a vasa previa. Her ObGyn referred her to an OB specialist, who ordered a second scan, which ruled out vasa previa. A month later, the patient was taken to the hospital with vaginal bleeding. It was determined that she was in labor, and her ObGyn performed a cesarean delivery. The baby was stillborn.

PATIENT’S CLAIM Both ObGyns failed to diagnose a vasa previa, which caused the stillbirth. Proper diagnosis would have allowed for cesarean delivery before labor began, resulting in a successful birth.

PHYSICIANS’ DEFENSE The pregnancy was properly managed. Vasa previa had been ruled out by ultrasonography. Placental abruption or a fetal-maternal hemorrhage was responsible for the stillbirth.

VERDICT A Kentucky defense verdict was returned.

Delay in delivery, then uterine infection, then hysterectomy

A 29-YEAR-OLD WOMAN was 34 weeks’ pregnant with her third child when she suspected that her water broke, and went to the hospital. Testing revealed the membranes had ruptured, but the ObGyn elected to delay delivery.

Amniotic fluid continued to leak for 5 days when suddenly the woman’s temperature spiked. A healthy baby was delivered by cesarean section 24 hours later.

After delivery, an intrauterine infection was diagnosed in the mother. She was transferred to another hospital, where she underwent a hysterectomy.

PATIENT’S CLAIM The ObGyn was negligent in failing to deliver the child when membranes initially broke. Leaking amniotic fluid contributed to the uterine infection.

PHYSICIAN’S DEFENSE It was appropriate to allow the pregnancy to continue because the fetus was premature. Infection could have occurred regardless of when delivery was performed.

VERDICT A $25,000 Mississippi verdict was returned.

What caused this child’s brain damage?

DURING PROLONGED DELIVERY, the physician assistant and residents in charge of labor and delivery noted meconiumstained amniotic fluid discharge. When advised, the mother’s ObGyn directed the hospital staff to perform amnioinfusion. The child was born vaginally several hours later and determined to have suffered brain damage.

The child cannot swallow and receives nutrition through a feeding tube. She cannot speak, is confined to a wheelchair, and has the cognitive function of an 18-month old.

PATIENT’S CLAIM The child suffered a hypoxic event caused by meconium aspiration, resulting in encephalopathy and cerebral palsy. The finding of stained amniotic fluid should have prompted the ObGyn to perform an emergency cesarean delivery.

PHYSICIAN’S DEFENSE Electronic fetal monitoring never indicated fetal distress. Amnioinfusion cleared the amniotic fluid, making a cesarean delivery unnecessary. The child’s condition resulted from preexisting neurological problems and/or a genetic condition that also caused microcephaly, a heart defect, and polydactylism.

VERDICT A New York defense verdict was returned.

Bowel is perforated: “Now I can’t conceive”

A WOMAN WAS GIVEN A DIAGNOSIS of endometriosis. During laparoscopic surgery to treat the condition, the gynecologist used a unipolar laparoscopic coagulator wand.

Eighteen days later, the patient went to the emergency department with severe lower abdominal pain. Peritonitis, caused by bowel perforation, was diagnosed, and she underwent surgery. A portion of bowel was removed. A colostomy was created, which was later reversed.

She developed adhesions from the peritonitis and required additional surgeries that, she alleged, caused subsequent fertility treatments to be unsuccessful.

PATIENT’S CLAIM The coagulator wand perforated the bowel. The gynecologist was negligent in his use of the wand; the wand manufacturer and the electrosurgical generator manufacturer were negligent in the equipment’s design; and the hospital was negligent in its maintenance of the equipment.

DEFENDANTS’ DEFENSE The instrument manufacturer denied any design defect and argued that the injury was not a burn but was caused by the coagulator wand making contact with another surgical instrument. The physician, generator manufacturer, and hospital denied negligence.

VERDICT The claim against the gynecologist was dismissed by summary judgment. The hospital and the generator manufacturer settled for an undisclosed amount. A $2.2 million California verdict was reached against the wand manufacturer.

Child has spina bifida despite evaluation

ULTRASONOGRAPHY RESULTS indicated normal fetal growth during a woman’s pregnancy. However, the child was born with spina bifida and required back and brain surgery shortly after birth. She wears ankle and foot orthotics and is incontinent.

PATIENT’S CLAIM The ObGyn failed to perform a prenatal alpha-fetoprotein test. The radiologist misinterpreted the sonogram.

PHYSICIANS’ DEFENSE The ObGyn believes that most spina bifida conditions are detectable by ultrasonography, and the radiologist’s report did not indicate spina bifida.

VERDICT The radiologist settled for $1 million before the trial. A $2.5 million New Jersey verdict was returned against the ObGyn.

Blocked intestine after cesarean—
a nonsurgical cause?

A 34-YEAR-OLD WOMAN GAVE BIRTH to a healthy baby by cesarean delivery. Several weeks later, the mother reported abdominal pain, distention, and nausea. Her ObGyn suspected it was related to a somatic disorder.

Two months after delivery, the mother came to the emergency department with increasingly severe symptoms. One month later, at another hospital, physicians diagnosed a bowel obstruction. During emergency surgery, a lap sponge was found within the lumen of the patient’s small intestine.

PATIENT’S CLAIM The ObGyn left the lap sponge in her abdomen during cesarean delivery.

PHYSICIAN’S DEFENSE The sponge count from the cesarean delivery was correct. The ObGyn suggested that the patient had swallowed the sponge, because it was found within the lumen of the intestine, not in free space. The surgeon who removed the sponge agreed with the ObGyn, and recommended a psychiatric consult.

VERDICT A Louisiana defense verdict was returned.

Did vacuum extraction cause developmental delays?

SUCCESSFUL DELIVERY was performed using vacuum extraction. Later, mild balance and coordination issues, cognitive deficits, and speech delay were diagnosed in the child.

PATIENT’S CLAIM Use of the vacuum extractor was unnecessary; the instrument caused a subdural bleed that resulted in the child’s developmental delays.

PHYSICIAN’S DEFENSE Vacuum extraction was necessary because the baby was not progressing down the birth canal and was beginning to show signs of distress. Vacuum extraction did not cause the child’s injuries.

VERDICT A confidential South Carolina settlement was reached during jury deliberations.

Suture fails to dissolve; fistula develops

A WOMAN UNDERWENT SURGERY for uterine fibroids, during which injury to the bladder was repaired with a single suture.

A few weeks later, she developed abdominal pain, blood in her urine, and urinary incontinence. It was determined that the suture had not dissolved, and caused obstruction of the right ureter and kidney. A vesicovaginal fistula developed when the stitch migrated through the anterior wall of the vagina.

PATIENT’S CLAIM The gynecologist was at fault for injuring the bladder during surgery, and repairing it with a nondissolving suture.

PHYSICIAN’S DEFENSE Injury to the bladder and ureters is a known risk of the procedure. The correct type of suture was used; it was supposed to dissolve. The gynecologist tested the bladder and ureters using Indigo carmine-based dye before closing.

Over time, as the suture failed to dissolve, scar tissue occluded the ureter. Subsequent surgery returned the patient to baseline health.

VERDICT A Pennsylvania defense verdict was returned.

Baby stillborn. Vasa previa missed?

ULTRASONOGRAPHY REVEALED that the patient probably had a vasa previa. Her ObGyn referred her to an OB specialist, who ordered a second scan, which ruled out vasa previa. A month later, the patient was taken to the hospital with vaginal bleeding. It was determined that she was in labor, and her ObGyn performed a cesarean delivery. The baby was stillborn.

PATIENT’S CLAIM Both ObGyns failed to diagnose a vasa previa, which caused the stillbirth. Proper diagnosis would have allowed for cesarean delivery before labor began, resulting in a successful birth.

PHYSICIANS’ DEFENSE The pregnancy was properly managed. Vasa previa had been ruled out by ultrasonography. Placental abruption or a fetal-maternal hemorrhage was responsible for the stillbirth.

VERDICT A Kentucky defense verdict was returned.

Delay in delivery, then uterine infection, then hysterectomy

A 29-YEAR-OLD WOMAN was 34 weeks’ pregnant with her third child when she suspected that her water broke, and went to the hospital. Testing revealed the membranes had ruptured, but the ObGyn elected to delay delivery.

Amniotic fluid continued to leak for 5 days when suddenly the woman’s temperature spiked. A healthy baby was delivered by cesarean section 24 hours later.

After delivery, an intrauterine infection was diagnosed in the mother. She was transferred to another hospital, where she underwent a hysterectomy.

PATIENT’S CLAIM The ObGyn was negligent in failing to deliver the child when membranes initially broke. Leaking amniotic fluid contributed to the uterine infection.

PHYSICIAN’S DEFENSE It was appropriate to allow the pregnancy to continue because the fetus was premature. Infection could have occurred regardless of when delivery was performed.

VERDICT A $25,000 Mississippi verdict was returned.

What caused this child’s brain damage?

DURING PROLONGED DELIVERY, the physician assistant and residents in charge of labor and delivery noted meconiumstained amniotic fluid discharge. When advised, the mother’s ObGyn directed the hospital staff to perform amnioinfusion. The child was born vaginally several hours later and determined to have suffered brain damage.

The child cannot swallow and receives nutrition through a feeding tube. She cannot speak, is confined to a wheelchair, and has the cognitive function of an 18-month old.

PATIENT’S CLAIM The child suffered a hypoxic event caused by meconium aspiration, resulting in encephalopathy and cerebral palsy. The finding of stained amniotic fluid should have prompted the ObGyn to perform an emergency cesarean delivery.

PHYSICIAN’S DEFENSE Electronic fetal monitoring never indicated fetal distress. Amnioinfusion cleared the amniotic fluid, making a cesarean delivery unnecessary. The child’s condition resulted from preexisting neurological problems and/or a genetic condition that also caused microcephaly, a heart defect, and polydactylism.

VERDICT A New York defense verdict was returned.

Bowel is perforated: “Now I can’t conceive”

A WOMAN WAS GIVEN A DIAGNOSIS of endometriosis. During laparoscopic surgery to treat the condition, the gynecologist used a unipolar laparoscopic coagulator wand.

Eighteen days later, the patient went to the emergency department with severe lower abdominal pain. Peritonitis, caused by bowel perforation, was diagnosed, and she underwent surgery. A portion of bowel was removed. A colostomy was created, which was later reversed.

She developed adhesions from the peritonitis and required additional surgeries that, she alleged, caused subsequent fertility treatments to be unsuccessful.

PATIENT’S CLAIM The coagulator wand perforated the bowel. The gynecologist was negligent in his use of the wand; the wand manufacturer and the electrosurgical generator manufacturer were negligent in the equipment’s design; and the hospital was negligent in its maintenance of the equipment.

DEFENDANTS’ DEFENSE The instrument manufacturer denied any design defect and argued that the injury was not a burn but was caused by the coagulator wand making contact with another surgical instrument. The physician, generator manufacturer, and hospital denied negligence.

VERDICT The claim against the gynecologist was dismissed by summary judgment. The hospital and the generator manufacturer settled for an undisclosed amount. A $2.2 million California verdict was reached against the wand manufacturer.

Child has spina bifida despite evaluation

ULTRASONOGRAPHY RESULTS indicated normal fetal growth during a woman’s pregnancy. However, the child was born with spina bifida and required back and brain surgery shortly after birth. She wears ankle and foot orthotics and is incontinent.

PATIENT’S CLAIM The ObGyn failed to perform a prenatal alpha-fetoprotein test. The radiologist misinterpreted the sonogram.

PHYSICIANS’ DEFENSE The ObGyn believes that most spina bifida conditions are detectable by ultrasonography, and the radiologist’s report did not indicate spina bifida.

VERDICT The radiologist settled for $1 million before the trial. A $2.5 million New Jersey verdict was returned against the ObGyn.

Blocked intestine after cesarean—
a nonsurgical cause?

A 34-YEAR-OLD WOMAN GAVE BIRTH to a healthy baby by cesarean delivery. Several weeks later, the mother reported abdominal pain, distention, and nausea. Her ObGyn suspected it was related to a somatic disorder.

Two months after delivery, the mother came to the emergency department with increasingly severe symptoms. One month later, at another hospital, physicians diagnosed a bowel obstruction. During emergency surgery, a lap sponge was found within the lumen of the patient’s small intestine.

PATIENT’S CLAIM The ObGyn left the lap sponge in her abdomen during cesarean delivery.

PHYSICIAN’S DEFENSE The sponge count from the cesarean delivery was correct. The ObGyn suggested that the patient had swallowed the sponge, because it was found within the lumen of the intestine, not in free space. The surgeon who removed the sponge agreed with the ObGyn, and recommended a psychiatric consult.

VERDICT A Louisiana defense verdict was returned.

Did vacuum extraction cause developmental delays?

SUCCESSFUL DELIVERY was performed using vacuum extraction. Later, mild balance and coordination issues, cognitive deficits, and speech delay were diagnosed in the child.

PATIENT’S CLAIM Use of the vacuum extractor was unnecessary; the instrument caused a subdural bleed that resulted in the child’s developmental delays.

PHYSICIAN’S DEFENSE Vacuum extraction was necessary because the baby was not progressing down the birth canal and was beginning to show signs of distress. Vacuum extraction did not cause the child’s injuries.

VERDICT A confidential South Carolina settlement was reached during jury deliberations.

Suture fails to dissolve; fistula develops

A WOMAN UNDERWENT SURGERY for uterine fibroids, during which injury to the bladder was repaired with a single suture.

A few weeks later, she developed abdominal pain, blood in her urine, and urinary incontinence. It was determined that the suture had not dissolved, and caused obstruction of the right ureter and kidney. A vesicovaginal fistula developed when the stitch migrated through the anterior wall of the vagina.

PATIENT’S CLAIM The gynecologist was at fault for injuring the bladder during surgery, and repairing it with a nondissolving suture.

PHYSICIAN’S DEFENSE Injury to the bladder and ureters is a known risk of the procedure. The correct type of suture was used; it was supposed to dissolve. The gynecologist tested the bladder and ureters using Indigo carmine-based dye before closing.

Over time, as the suture failed to dissolve, scar tissue occluded the ureter. Subsequent surgery returned the patient to baseline health.

VERDICT A Pennsylvania defense verdict was returned.

Baby stillborn. Vasa previa missed?

ULTRASONOGRAPHY REVEALED that the patient probably had a vasa previa. Her ObGyn referred her to an OB specialist, who ordered a second scan, which ruled out vasa previa. A month later, the patient was taken to the hospital with vaginal bleeding. It was determined that she was in labor, and her ObGyn performed a cesarean delivery. The baby was stillborn.

PATIENT’S CLAIM Both ObGyns failed to diagnose a vasa previa, which caused the stillbirth. Proper diagnosis would have allowed for cesarean delivery before labor began, resulting in a successful birth.

PHYSICIANS’ DEFENSE The pregnancy was properly managed. Vasa previa had been ruled out by ultrasonography. Placental abruption or a fetal-maternal hemorrhage was responsible for the stillbirth.

VERDICT A Kentucky defense verdict was returned.

Delay in delivery, then uterine infection, then hysterectomy

A 29-YEAR-OLD WOMAN was 34 weeks’ pregnant with her third child when she suspected that her water broke, and went to the hospital. Testing revealed the membranes had ruptured, but the ObGyn elected to delay delivery.

Amniotic fluid continued to leak for 5 days when suddenly the woman’s temperature spiked. A healthy baby was delivered by cesarean section 24 hours later.

After delivery, an intrauterine infection was diagnosed in the mother. She was transferred to another hospital, where she underwent a hysterectomy.

PATIENT’S CLAIM The ObGyn was negligent in failing to deliver the child when membranes initially broke. Leaking amniotic fluid contributed to the uterine infection.

PHYSICIAN’S DEFENSE It was appropriate to allow the pregnancy to continue because the fetus was premature. Infection could have occurred regardless of when delivery was performed.

VERDICT A $25,000 Mississippi verdict was returned.

What caused this child’s brain damage?

DURING PROLONGED DELIVERY, the physician assistant and residents in charge of labor and delivery noted meconiumstained amniotic fluid discharge. When advised, the mother’s ObGyn directed the hospital staff to perform amnioinfusion. The child was born vaginally several hours later and determined to have suffered brain damage.

The child cannot swallow and receives nutrition through a feeding tube. She cannot speak, is confined to a wheelchair, and has the cognitive function of an 18-month old.

PATIENT’S CLAIM The child suffered a hypoxic event caused by meconium aspiration, resulting in encephalopathy and cerebral palsy. The finding of stained amniotic fluid should have prompted the ObGyn to perform an emergency cesarean delivery.

PHYSICIAN’S DEFENSE Electronic fetal monitoring never indicated fetal distress. Amnioinfusion cleared the amniotic fluid, making a cesarean delivery unnecessary. The child’s condition resulted from preexisting neurological problems and/or a genetic condition that also caused microcephaly, a heart defect, and polydactylism.

VERDICT A New York defense verdict was returned.

Bowel is perforated: “Now I can’t conceive”

A WOMAN WAS GIVEN A DIAGNOSIS of endometriosis. During laparoscopic surgery to treat the condition, the gynecologist used a unipolar laparoscopic coagulator wand.

Eighteen days later, the patient went to the emergency department with severe lower abdominal pain. Peritonitis, caused by bowel perforation, was diagnosed, and she underwent surgery. A portion of bowel was removed. A colostomy was created, which was later reversed.

She developed adhesions from the peritonitis and required additional surgeries that, she alleged, caused subsequent fertility treatments to be unsuccessful.

PATIENT’S CLAIM The coagulator wand perforated the bowel. The gynecologist was negligent in his use of the wand; the wand manufacturer and the electrosurgical generator manufacturer were negligent in the equipment’s design; and the hospital was negligent in its maintenance of the equipment.

DEFENDANTS’ DEFENSE The instrument manufacturer denied any design defect and argued that the injury was not a burn but was caused by the coagulator wand making contact with another surgical instrument. The physician, generator manufacturer, and hospital denied negligence.

VERDICT The claim against the gynecologist was dismissed by summary judgment. The hospital and the generator manufacturer settled for an undisclosed amount. A $2.2 million California verdict was reached against the wand manufacturer.

Child has spina bifida despite evaluation

ULTRASONOGRAPHY RESULTS indicated normal fetal growth during a woman’s pregnancy. However, the child was born with spina bifida and required back and brain surgery shortly after birth. She wears ankle and foot orthotics and is incontinent.

PATIENT’S CLAIM The ObGyn failed to perform a prenatal alpha-fetoprotein test. The radiologist misinterpreted the sonogram.

PHYSICIANS’ DEFENSE The ObGyn believes that most spina bifida conditions are detectable by ultrasonography, and the radiologist’s report did not indicate spina bifida.

VERDICT The radiologist settled for $1 million before the trial. A $2.5 million New Jersey verdict was returned against the ObGyn.

No tests ordered, despite baby’s yellowing skin

Many studies suggest that our ability to judge bilirubin levels on the basis of skin color is rather limited.

A 5-DAY-OLD INFANT’S YELLOW COMPLEXION led his worried mother to take him to a family practice. The physician assistant (PA) who examined the child noted yellowing of his face and chest. When the baby’s doctor arrived at the office unexpectedly, the PA consulted with her. The mother was given standard infant care instructions; no orders for diagnostic testing were issued.

Two days later the baby’s skin became yellower and he appeared lethargic. His mother brought him to a clinic, where she was told to take him to the hospital immediately. Testing at the hospital revealed an elevated bilirubin level. The infant developed kernicterus and suffered brain damage, resulting in developmental delays and cerebral palsy.

PLAINTIFF’S CLAIM The physician was negligent in failing to test and treat the infant promptly. The mother claimed that the physician had treated her older son for jaundice, as well. The mother also claimed that the physician noted the infant’s skin color but did nothing.

THE DEFENSE The infant’s sclera were white and he was alert and active when examined. The mother didn’t follow the instructions given to her.

VERDICT $6.25 million Delaware verdict.

COMMENT Many studies suggest that our ability to judge bilirubin levels on the basis of skin color is rather limited. It’s hard to imagine not doing a simple test in this situation.

Amputation blamed on tardy Dx of compartment syndrome

PAIN IN HER RIGHT LEG AND KNEE prompted a woman in her 60s to go to the emergency department (ED). She couldn’t remember any specific event or trauma that might have triggered the pain. Her history included deep vein thrombosis, pulmonary embolism, diabetes, hypertension, placement of a Green-field filter, and right knee replacement. She was taking warfarin; her international normalized ratio (INR) in the ED was 5.0. A physician diagnosed joint effusion and sent the patient home on pain killers.

Two days later, the patient returned to the ED complaining of numbness in her leg and excruciating pain in her right calf. She was seen by a different physician, who ordered a surgical consultation. Evaluation revealed a lack of sensation in her right foot, a dorsalis pedis pulse undetectable by Doppler ultrasound, and inability to dorsiflex or plantarflex the right foot.

Compartment syndrome was diagnosed and an emergent fasciotomy performed. The patient suffered extensive muscle and tissue death and became septic, necessitating an above-knee amputation. While recuperating and waiting for a prosthesis, the patient fell from her wheelchair, fracturing her dominant arm and shoulder in several places.

PLAINTIFF’S CLAIM No information about the plaintiff‘s claim is available.

THE DEFENSE No information about the defense is available.

VERDICT $890,000 Virginia settlement.

COMMENT When the diagnosis is ambiguous, close follow-up and reevaluation is key to avoiding a hefty settlement.

Abnormal labs go unnoted, patient goes into septic shock

A 52-YEAR-OLD WOMAN went to the ED because of vomiting and weakness. Her fingers and toes were blue; she was tachycardic and hypotensive. A pacemaker/defibrillator had been implanted 3 weeks earlier. The woman’s history included cardiomyopathy, eczema, renal failure, and lumbar fusion requiring maintenance narcotic medication. When initial blood tests showed hypokalemia, she was given potassium and general fluid resuscitation.

The ED physician also ordered a complete blood count, which automatically included differential and band counts. The patient’s bands were high and her platelets low, but these results weren’t noted.

The patient improved after receiving fluids; her longtime physician admitted her to the hospital with a diagnosis of hypokalemia and narcotic withdrawal. He ordered repeat blood work for the following morning.

That evening, another doctor, who was covering for the patient’s physician, received calls from nurses reporting that the patient was complaining of increased pain in her extremities. He diagnosed Raynaud’s syndrome and ordered medication. The patient’s physician also diagnosed Raynaud’s syndrome when he saw her the next morning; he noted that she was improving and ordered her diet to resume. The results from the second CBC, performed that morning, weren’t noted in the patient’s chart.

The covering doctor was on duty again in the evening and again received calls reporting that the patient was in pain. The following morning the patient went into septic shock. She was diagnosed with a staph infection and transferred to the ICU, where she died of sepsis and multi-organ failure a few days later.

PLAINTIFF’S CLAIM The doctors and nurses were negligent in failing to note the abnormal band and platelet counts for 44 hours. The physicians should have recognized signs and symptoms of infection and administered antibiotics. The hospital should have reported the laboratory results and findings of infection to the physicians.

THE DEFENSE The patient’s physician maintained that the patient’s signs and symptoms weren’t consistent with infection. He didn’t order a differential blood test and wasn’t aware that the hospital performed it automatically. He claimed that the results weren’t available to him on the first 2 days; the hospital and nurses claimed that the results were available.

The covering doctor argued that he was only the on-call physician, never actually saw the patient, and had no duty to follow up on the blood tests. The hospital maintained that the nurses had no duty to look at the laboratory results unless requested to do so and that the physicians hadn’t asked them to do so.

VERDICT $500,000 Illinois verdict against the patient’s physician; high/low agreement of $3 million/$150,000 between plaintiff and hospital ($150,000 to be set off from the verdict against the physician).

COMMENT If a test is ordered, review it promptly. Ignorance is unlikely to be an adequate defense in a malpractice allegation.

Infection, then rapid death

HIGH FEVER, DIARRHEA, LETHARGY, SPREADING RASH, and other symptoms in a 16-month-old boy led to an ED visit. The child died about 3 hours later from meningococcemia and sepsis caused by Neisseria meningitidis (Waterhouse-Friderichsen syndrome).

PLAINTIFFS’ CLAIM The ED physician failed to properly monitor and treat the child’s deteriorating condition from meningococcemia and septic shock.

THE DEFENSE The child received proper treatment, but his condition was too far advanced to prevent his death.

VERDICT Illinois defense verdict.

COMMENT Urgent evaluation and treatment—even today—can be imperative to help prevent the sequelae of meningococcemia.

No tests ordered, despite baby’s yellowing skin

Many studies suggest that our ability to judge bilirubin levels on the basis of skin color is rather limited.

A 5-DAY-OLD INFANT’S YELLOW COMPLEXION led his worried mother to take him to a family practice. The physician assistant (PA) who examined the child noted yellowing of his face and chest. When the baby’s doctor arrived at the office unexpectedly, the PA consulted with her. The mother was given standard infant care instructions; no orders for diagnostic testing were issued.

Two days later the baby’s skin became yellower and he appeared lethargic. His mother brought him to a clinic, where she was told to take him to the hospital immediately. Testing at the hospital revealed an elevated bilirubin level. The infant developed kernicterus and suffered brain damage, resulting in developmental delays and cerebral palsy.

PLAINTIFF’S CLAIM The physician was negligent in failing to test and treat the infant promptly. The mother claimed that the physician had treated her older son for jaundice, as well. The mother also claimed that the physician noted the infant’s skin color but did nothing.

THE DEFENSE The infant’s sclera were white and he was alert and active when examined. The mother didn’t follow the instructions given to her.

VERDICT $6.25 million Delaware verdict.

COMMENT Many studies suggest that our ability to judge bilirubin levels on the basis of skin color is rather limited. It’s hard to imagine not doing a simple test in this situation.

Amputation blamed on tardy Dx of compartment syndrome

PAIN IN HER RIGHT LEG AND KNEE prompted a woman in her 60s to go to the emergency department (ED). She couldn’t remember any specific event or trauma that might have triggered the pain. Her history included deep vein thrombosis, pulmonary embolism, diabetes, hypertension, placement of a Green-field filter, and right knee replacement. She was taking warfarin; her international normalized ratio (INR) in the ED was 5.0. A physician diagnosed joint effusion and sent the patient home on pain killers.

Two days later, the patient returned to the ED complaining of numbness in her leg and excruciating pain in her right calf. She was seen by a different physician, who ordered a surgical consultation. Evaluation revealed a lack of sensation in her right foot, a dorsalis pedis pulse undetectable by Doppler ultrasound, and inability to dorsiflex or plantarflex the right foot.

Compartment syndrome was diagnosed and an emergent fasciotomy performed. The patient suffered extensive muscle and tissue death and became septic, necessitating an above-knee amputation. While recuperating and waiting for a prosthesis, the patient fell from her wheelchair, fracturing her dominant arm and shoulder in several places.

PLAINTIFF’S CLAIM No information about the plaintiff‘s claim is available.

THE DEFENSE No information about the defense is available.

VERDICT $890,000 Virginia settlement.

COMMENT When the diagnosis is ambiguous, close follow-up and reevaluation is key to avoiding a hefty settlement.

Abnormal labs go unnoted, patient goes into septic shock

A 52-YEAR-OLD WOMAN went to the ED because of vomiting and weakness. Her fingers and toes were blue; she was tachycardic and hypotensive. A pacemaker/defibrillator had been implanted 3 weeks earlier. The woman’s history included cardiomyopathy, eczema, renal failure, and lumbar fusion requiring maintenance narcotic medication. When initial blood tests showed hypokalemia, she was given potassium and general fluid resuscitation.

The ED physician also ordered a complete blood count, which automatically included differential and band counts. The patient’s bands were high and her platelets low, but these results weren’t noted.

The patient improved after receiving fluids; her longtime physician admitted her to the hospital with a diagnosis of hypokalemia and narcotic withdrawal. He ordered repeat blood work for the following morning.

That evening, another doctor, who was covering for the patient’s physician, received calls from nurses reporting that the patient was complaining of increased pain in her extremities. He diagnosed Raynaud’s syndrome and ordered medication. The patient’s physician also diagnosed Raynaud’s syndrome when he saw her the next morning; he noted that she was improving and ordered her diet to resume. The results from the second CBC, performed that morning, weren’t noted in the patient’s chart.

The covering doctor was on duty again in the evening and again received calls reporting that the patient was in pain. The following morning the patient went into septic shock. She was diagnosed with a staph infection and transferred to the ICU, where she died of sepsis and multi-organ failure a few days later.

PLAINTIFF’S CLAIM The doctors and nurses were negligent in failing to note the abnormal band and platelet counts for 44 hours. The physicians should have recognized signs and symptoms of infection and administered antibiotics. The hospital should have reported the laboratory results and findings of infection to the physicians.

THE DEFENSE The patient’s physician maintained that the patient’s signs and symptoms weren’t consistent with infection. He didn’t order a differential blood test and wasn’t aware that the hospital performed it automatically. He claimed that the results weren’t available to him on the first 2 days; the hospital and nurses claimed that the results were available.

The covering doctor argued that he was only the on-call physician, never actually saw the patient, and had no duty to follow up on the blood tests. The hospital maintained that the nurses had no duty to look at the laboratory results unless requested to do so and that the physicians hadn’t asked them to do so.

VERDICT $500,000 Illinois verdict against the patient’s physician; high/low agreement of $3 million/$150,000 between plaintiff and hospital ($150,000 to be set off from the verdict against the physician).

COMMENT If a test is ordered, review it promptly. Ignorance is unlikely to be an adequate defense in a malpractice allegation.

Infection, then rapid death

HIGH FEVER, DIARRHEA, LETHARGY, SPREADING RASH, and other symptoms in a 16-month-old boy led to an ED visit. The child died about 3 hours later from meningococcemia and sepsis caused by Neisseria meningitidis (Waterhouse-Friderichsen syndrome).

PLAINTIFFS’ CLAIM The ED physician failed to properly monitor and treat the child’s deteriorating condition from meningococcemia and septic shock.

THE DEFENSE The child received proper treatment, but his condition was too far advanced to prevent his death.

VERDICT Illinois defense verdict.

COMMENT Urgent evaluation and treatment—even today—can be imperative to help prevent the sequelae of meningococcemia.

No tests ordered, despite baby’s yellowing skin

Many studies suggest that our ability to judge bilirubin levels on the basis of skin color is rather limited.

A 5-DAY-OLD INFANT’S YELLOW COMPLEXION led his worried mother to take him to a family practice. The physician assistant (PA) who examined the child noted yellowing of his face and chest. When the baby’s doctor arrived at the office unexpectedly, the PA consulted with her. The mother was given standard infant care instructions; no orders for diagnostic testing were issued.

Two days later the baby’s skin became yellower and he appeared lethargic. His mother brought him to a clinic, where she was told to take him to the hospital immediately. Testing at the hospital revealed an elevated bilirubin level. The infant developed kernicterus and suffered brain damage, resulting in developmental delays and cerebral palsy.

PLAINTIFF’S CLAIM The physician was negligent in failing to test and treat the infant promptly. The mother claimed that the physician had treated her older son for jaundice, as well. The mother also claimed that the physician noted the infant’s skin color but did nothing.

THE DEFENSE The infant’s sclera were white and he was alert and active when examined. The mother didn’t follow the instructions given to her.

VERDICT $6.25 million Delaware verdict.

COMMENT Many studies suggest that our ability to judge bilirubin levels on the basis of skin color is rather limited. It’s hard to imagine not doing a simple test in this situation.

Amputation blamed on tardy Dx of compartment syndrome

PAIN IN HER RIGHT LEG AND KNEE prompted a woman in her 60s to go to the emergency department (ED). She couldn’t remember any specific event or trauma that might have triggered the pain. Her history included deep vein thrombosis, pulmonary embolism, diabetes, hypertension, placement of a Green-field filter, and right knee replacement. She was taking warfarin; her international normalized ratio (INR) in the ED was 5.0. A physician diagnosed joint effusion and sent the patient home on pain killers.

Two days later, the patient returned to the ED complaining of numbness in her leg and excruciating pain in her right calf. She was seen by a different physician, who ordered a surgical consultation. Evaluation revealed a lack of sensation in her right foot, a dorsalis pedis pulse undetectable by Doppler ultrasound, and inability to dorsiflex or plantarflex the right foot.

Compartment syndrome was diagnosed and an emergent fasciotomy performed. The patient suffered extensive muscle and tissue death and became septic, necessitating an above-knee amputation. While recuperating and waiting for a prosthesis, the patient fell from her wheelchair, fracturing her dominant arm and shoulder in several places.

PLAINTIFF’S CLAIM No information about the plaintiff‘s claim is available.

THE DEFENSE No information about the defense is available.

VERDICT $890,000 Virginia settlement.

COMMENT When the diagnosis is ambiguous, close follow-up and reevaluation is key to avoiding a hefty settlement.

Abnormal labs go unnoted, patient goes into septic shock

A 52-YEAR-OLD WOMAN went to the ED because of vomiting and weakness. Her fingers and toes were blue; she was tachycardic and hypotensive. A pacemaker/defibrillator had been implanted 3 weeks earlier. The woman’s history included cardiomyopathy, eczema, renal failure, and lumbar fusion requiring maintenance narcotic medication. When initial blood tests showed hypokalemia, she was given potassium and general fluid resuscitation.

The ED physician also ordered a complete blood count, which automatically included differential and band counts. The patient’s bands were high and her platelets low, but these results weren’t noted.

The patient improved after receiving fluids; her longtime physician admitted her to the hospital with a diagnosis of hypokalemia and narcotic withdrawal. He ordered repeat blood work for the following morning.

That evening, another doctor, who was covering for the patient’s physician, received calls from nurses reporting that the patient was complaining of increased pain in her extremities. He diagnosed Raynaud’s syndrome and ordered medication. The patient’s physician also diagnosed Raynaud’s syndrome when he saw her the next morning; he noted that she was improving and ordered her diet to resume. The results from the second CBC, performed that morning, weren’t noted in the patient’s chart.

The covering doctor was on duty again in the evening and again received calls reporting that the patient was in pain. The following morning the patient went into septic shock. She was diagnosed with a staph infection and transferred to the ICU, where she died of sepsis and multi-organ failure a few days later.

PLAINTIFF’S CLAIM The doctors and nurses were negligent in failing to note the abnormal band and platelet counts for 44 hours. The physicians should have recognized signs and symptoms of infection and administered antibiotics. The hospital should have reported the laboratory results and findings of infection to the physicians.

THE DEFENSE The patient’s physician maintained that the patient’s signs and symptoms weren’t consistent with infection. He didn’t order a differential blood test and wasn’t aware that the hospital performed it automatically. He claimed that the results weren’t available to him on the first 2 days; the hospital and nurses claimed that the results were available.

The covering doctor argued that he was only the on-call physician, never actually saw the patient, and had no duty to follow up on the blood tests. The hospital maintained that the nurses had no duty to look at the laboratory results unless requested to do so and that the physicians hadn’t asked them to do so.

VERDICT $500,000 Illinois verdict against the patient’s physician; high/low agreement of $3 million/$150,000 between plaintiff and hospital ($150,000 to be set off from the verdict against the physician).

COMMENT If a test is ordered, review it promptly. Ignorance is unlikely to be an adequate defense in a malpractice allegation.

Infection, then rapid death

HIGH FEVER, DIARRHEA, LETHARGY, SPREADING RASH, and other symptoms in a 16-month-old boy led to an ED visit. The child died about 3 hours later from meningococcemia and sepsis caused by Neisseria meningitidis (Waterhouse-Friderichsen syndrome).

PLAINTIFFS’ CLAIM The ED physician failed to properly monitor and treat the child’s deteriorating condition from meningococcemia and septic shock.

THE DEFENSE The child received proper treatment, but his condition was too far advanced to prevent his death.

VERDICT Illinois defense verdict.

COMMENT Urgent evaluation and treatment—even today—can be imperative to help prevent the sequelae of meningococcemia.

PATIENT’S CLAIM The ED physician should have remained with the patient until she was in the ICU; promethazine was contraindicated and led to cardiopulmonary arrest; the ED physician failed to intubate the patient in a timely manner.

DEFENDANTS’ DEFENSE The physician’s return to the ED was proper because he handed over care to the critical care physician; promethazine was not contraindicated; appropriate care was provided, including attempts at resuscitation. The nursing staff never informed the ED physician of the patient’s history of congestive heart failure with a previous pregnancy.

VERDICT A Florida defense verdict was returned.

Heated solution burns genital area

A WOMAN UNDERWENT endometrial ablation for menorrhagia. A few days later, she discovered infected and painful blisters in her genital area.

PATIENT’S CLAIM The gynecologist was negligent in how he performed endometrial ablation. He ignored several warning beeps from the machine while the wand was filling the woman’s uterus with heated solution, and he removed the wand while it was still releasing hot liquid. The heated solution leaked from the uterus and damaged the vagina, rectal area, and other genital areas. The patient was not informed that the liquid had escaped, nor did she receive treatment for her second- and third-degree burns before she was discharged.

DEFENDANTS’ DEFENSE The gynecologist admitted that he never reviewed the operator’s manual for the procedure but denied negligence. He claimed two nurses assisting him failed to respond to his instructions to turn off the machine in time to avoid the incident. The nurses denied hearing any such instructions.

VERDICT The hospital was given a directed verdict and dismissed from the case. A $32,000 verdict was returned against the gynecologist.

READ Update on MIGS

Surgical towel found 6 years later

AFTER SUFFERING ABDOMINAL PAIN, a woman underwent a hysterectomy. She continued to report abdominal pain to her gynecologist for several years. Six years after the initial surgery, she sought care from another physician. During an exploratory laparotomy, a blue surgical towel was found adhered to the patient’s abdominal wall and bowel.

PATIENT’S CLAIM The gynecologist was negligent in leaving the surgical towel in the abdomen, and in failing to appropriately respond to her complaints of postoperative pain.

DEFENDANTS’ DEFENSE The hospital provides white radiopaque sponges for internal use during surgery, and those sponges were carefully counted. The blue towels were not counted because they are not intended for internal use; they are provided for medical personnel to wipe hands and medical equipment. The gynecologist claimed the hospital had not informed him that it was not counting blue towels, and that it was reasonable to expect that the blue towels had been counted.

VERDICT A $564,000 Indiana verdict was reached against the gynecologist; the hospital was vindicated.

Biopsy showed dysplasia; woman dies

AFTER AN ABNORMAL PAP SMEAR, a 27-year-old woman underwent colposcopy and cervical biopsy. When he received the test results, the gynecologist told her to return in 6 months. Three months later, she began having suspicious symptoms. When further testing yielded abnormal findings, she was referred to a gynecologic oncologist, who diagnosed cervical cancer. The woman underwent radical hysterectomy, radiotherapy, and chemotherapy, but the cancer had metastasized, and she died.

ESTATE’S CLAIM The gynecologist should have ordered additional testing when the original biopsy report was inconclusive. Advising 6-month follow-up was negligent.

PHYSICIAN’S DEFENSE The report indicated cervical dysplasia, making the 6-month time-frame proper.

VERDICT A South Carolina defense verdict was returned.

Premature baby succumbs

A PREGNANT WOMAN WAS REFERRED to a perinatal evaluation center for a full cervical examination because prior pregnancies had required cerclage. She was treated by Dr. A, a first-year intern, under the supervision of Dr. B, a fourth-year resident, and Dr. C, the attending ObGyn. Cerclage was not performed. Ten days later, the child was born at 19 weeks’ gestation, and died shortly after birth.

PATIENT’S CLAIM The hospital should have had a policy mandating that an attending physician evaluate obstetric patients whose cervical exam is abnormal. Cerclage should have been performed; cervical weakness had been treated in her second and third pregnancies, resulting in successful deliveries at 29 weeks and 34 weeks, respectively. The attending ObGyn never examined the patient.

DEFENDANTS’ DEFENSE The hospital claimed that a cervical examination showed that cerclage was unnecessary. Dr. C indicated that the correct decision and treatment were rendered; the intern and resident had reported their findings to him.

VERDICT A $3 million Pennsylvania verdict was returned.

Breast discharge during pregnancy

AT 7 MONTHS’ GESTATION, a 29-year-old woman reported burning pain and clear discharge from her right breast. The ObGyn told her he believed the complaints were related to her pregnancy; he did not examine her breasts.

The ObGyn’s partner palpated a lump in the woman’s right breast at her 6-week postpartum visit. Triple negative breast cancer was diagnosed. She underwent chemotherapy, mastectomy, and radiotherapy, but died of metastatic breast cancer.

ESTATE’S CLAIM The ObGyn failed to conduct a breast examination when the woman first complained of symptoms. This caused a delay in diagnosis, which reduced her chance of survival.

PHYSICIAN’S DEFENSE The ObGyn first denied the patient reported breast symptoms at her 7-month visit, as his records did not indicate a complaint. However, in a documented telephone call 4 days before the visit, the patient complained of burning pain and clear fluid leaking from her right breast. The ObGyn admitted that he would have followed up on the phone call, and that she must have told him complaints had subsided, or he would have noted continuing symptoms and performed a breast exam. He claimed a 3-month delay in diagnosis did not change the outcome because hers was a highly aggressive type of tumor that 1) is unresponsive to treatment and 2) carries an extremely poor survival rate compared with other types of breast cancer.

VERDICT A $1.5 million Illinois verdict was reached.

PATIENT’S CLAIM The ED physician should have remained with the patient until she was in the ICU; promethazine was contraindicated and led to cardiopulmonary arrest; the ED physician failed to intubate the patient in a timely manner.

DEFENDANTS’ DEFENSE The physician’s return to the ED was proper because he handed over care to the critical care physician; promethazine was not contraindicated; appropriate care was provided, including attempts at resuscitation. The nursing staff never informed the ED physician of the patient’s history of congestive heart failure with a previous pregnancy.

VERDICT A Florida defense verdict was returned.

Heated solution burns genital area

A WOMAN UNDERWENT endometrial ablation for menorrhagia. A few days later, she discovered infected and painful blisters in her genital area.

PATIENT’S CLAIM The gynecologist was negligent in how he performed endometrial ablation. He ignored several warning beeps from the machine while the wand was filling the woman’s uterus with heated solution, and he removed the wand while it was still releasing hot liquid. The heated solution leaked from the uterus and damaged the vagina, rectal area, and other genital areas. The patient was not informed that the liquid had escaped, nor did she receive treatment for her second- and third-degree burns before she was discharged.

DEFENDANTS’ DEFENSE The gynecologist admitted that he never reviewed the operator’s manual for the procedure but denied negligence. He claimed two nurses assisting him failed to respond to his instructions to turn off the machine in time to avoid the incident. The nurses denied hearing any such instructions.

VERDICT The hospital was given a directed verdict and dismissed from the case. A $32,000 verdict was returned against the gynecologist.

READ Update on MIGS

Surgical towel found 6 years later

AFTER SUFFERING ABDOMINAL PAIN, a woman underwent a hysterectomy. She continued to report abdominal pain to her gynecologist for several years. Six years after the initial surgery, she sought care from another physician. During an exploratory laparotomy, a blue surgical towel was found adhered to the patient’s abdominal wall and bowel.

PATIENT’S CLAIM The gynecologist was negligent in leaving the surgical towel in the abdomen, and in failing to appropriately respond to her complaints of postoperative pain.

DEFENDANTS’ DEFENSE The hospital provides white radiopaque sponges for internal use during surgery, and those sponges were carefully counted. The blue towels were not counted because they are not intended for internal use; they are provided for medical personnel to wipe hands and medical equipment. The gynecologist claimed the hospital had not informed him that it was not counting blue towels, and that it was reasonable to expect that the blue towels had been counted.

VERDICT A $564,000 Indiana verdict was reached against the gynecologist; the hospital was vindicated.

Biopsy showed dysplasia; woman dies

AFTER AN ABNORMAL PAP SMEAR, a 27-year-old woman underwent colposcopy and cervical biopsy. When he received the test results, the gynecologist told her to return in 6 months. Three months later, she began having suspicious symptoms. When further testing yielded abnormal findings, she was referred to a gynecologic oncologist, who diagnosed cervical cancer. The woman underwent radical hysterectomy, radiotherapy, and chemotherapy, but the cancer had metastasized, and she died.

ESTATE’S CLAIM The gynecologist should have ordered additional testing when the original biopsy report was inconclusive. Advising 6-month follow-up was negligent.

PHYSICIAN’S DEFENSE The report indicated cervical dysplasia, making the 6-month time-frame proper.

VERDICT A South Carolina defense verdict was returned.

Premature baby succumbs

A PREGNANT WOMAN WAS REFERRED to a perinatal evaluation center for a full cervical examination because prior pregnancies had required cerclage. She was treated by Dr. A, a first-year intern, under the supervision of Dr. B, a fourth-year resident, and Dr. C, the attending ObGyn. Cerclage was not performed. Ten days later, the child was born at 19 weeks’ gestation, and died shortly after birth.

PATIENT’S CLAIM The hospital should have had a policy mandating that an attending physician evaluate obstetric patients whose cervical exam is abnormal. Cerclage should have been performed; cervical weakness had been treated in her second and third pregnancies, resulting in successful deliveries at 29 weeks and 34 weeks, respectively. The attending ObGyn never examined the patient.

DEFENDANTS’ DEFENSE The hospital claimed that a cervical examination showed that cerclage was unnecessary. Dr. C indicated that the correct decision and treatment were rendered; the intern and resident had reported their findings to him.

VERDICT A $3 million Pennsylvania verdict was returned.

Breast discharge during pregnancy

AT 7 MONTHS’ GESTATION, a 29-year-old woman reported burning pain and clear discharge from her right breast. The ObGyn told her he believed the complaints were related to her pregnancy; he did not examine her breasts.

The ObGyn’s partner palpated a lump in the woman’s right breast at her 6-week postpartum visit. Triple negative breast cancer was diagnosed. She underwent chemotherapy, mastectomy, and radiotherapy, but died of metastatic breast cancer.

ESTATE’S CLAIM The ObGyn failed to conduct a breast examination when the woman first complained of symptoms. This caused a delay in diagnosis, which reduced her chance of survival.

PHYSICIAN’S DEFENSE The ObGyn first denied the patient reported breast symptoms at her 7-month visit, as his records did not indicate a complaint. However, in a documented telephone call 4 days before the visit, the patient complained of burning pain and clear fluid leaking from her right breast. The ObGyn admitted that he would have followed up on the phone call, and that she must have told him complaints had subsided, or he would have noted continuing symptoms and performed a breast exam. He claimed a 3-month delay in diagnosis did not change the outcome because hers was a highly aggressive type of tumor that 1) is unresponsive to treatment and 2) carries an extremely poor survival rate compared with other types of breast cancer.

VERDICT A $1.5 million Illinois verdict was reached.

PATIENT’S CLAIM The ED physician should have remained with the patient until she was in the ICU; promethazine was contraindicated and led to cardiopulmonary arrest; the ED physician failed to intubate the patient in a timely manner.

DEFENDANTS’ DEFENSE The physician’s return to the ED was proper because he handed over care to the critical care physician; promethazine was not contraindicated; appropriate care was provided, including attempts at resuscitation. The nursing staff never informed the ED physician of the patient’s history of congestive heart failure with a previous pregnancy.

VERDICT A Florida defense verdict was returned.

Heated solution burns genital area

A WOMAN UNDERWENT endometrial ablation for menorrhagia. A few days later, she discovered infected and painful blisters in her genital area.

PATIENT’S CLAIM The gynecologist was negligent in how he performed endometrial ablation. He ignored several warning beeps from the machine while the wand was filling the woman’s uterus with heated solution, and he removed the wand while it was still releasing hot liquid. The heated solution leaked from the uterus and damaged the vagina, rectal area, and other genital areas. The patient was not informed that the liquid had escaped, nor did she receive treatment for her second- and third-degree burns before she was discharged.

DEFENDANTS’ DEFENSE The gynecologist admitted that he never reviewed the operator’s manual for the procedure but denied negligence. He claimed two nurses assisting him failed to respond to his instructions to turn off the machine in time to avoid the incident. The nurses denied hearing any such instructions.

VERDICT The hospital was given a directed verdict and dismissed from the case. A $32,000 verdict was returned against the gynecologist.

READ Update on MIGS

Surgical towel found 6 years later

AFTER SUFFERING ABDOMINAL PAIN, a woman underwent a hysterectomy. She continued to report abdominal pain to her gynecologist for several years. Six years after the initial surgery, she sought care from another physician. During an exploratory laparotomy, a blue surgical towel was found adhered to the patient’s abdominal wall and bowel.

PATIENT’S CLAIM The gynecologist was negligent in leaving the surgical towel in the abdomen, and in failing to appropriately respond to her complaints of postoperative pain.

DEFENDANTS’ DEFENSE The hospital provides white radiopaque sponges for internal use during surgery, and those sponges were carefully counted. The blue towels were not counted because they are not intended for internal use; they are provided for medical personnel to wipe hands and medical equipment. The gynecologist claimed the hospital had not informed him that it was not counting blue towels, and that it was reasonable to expect that the blue towels had been counted.

VERDICT A $564,000 Indiana verdict was reached against the gynecologist; the hospital was vindicated.

Biopsy showed dysplasia; woman dies

AFTER AN ABNORMAL PAP SMEAR, a 27-year-old woman underwent colposcopy and cervical biopsy. When he received the test results, the gynecologist told her to return in 6 months. Three months later, she began having suspicious symptoms. When further testing yielded abnormal findings, she was referred to a gynecologic oncologist, who diagnosed cervical cancer. The woman underwent radical hysterectomy, radiotherapy, and chemotherapy, but the cancer had metastasized, and she died.

ESTATE’S CLAIM The gynecologist should have ordered additional testing when the original biopsy report was inconclusive. Advising 6-month follow-up was negligent.

PHYSICIAN’S DEFENSE The report indicated cervical dysplasia, making the 6-month time-frame proper.

VERDICT A South Carolina defense verdict was returned.

Premature baby succumbs

A PREGNANT WOMAN WAS REFERRED to a perinatal evaluation center for a full cervical examination because prior pregnancies had required cerclage. She was treated by Dr. A, a first-year intern, under the supervision of Dr. B, a fourth-year resident, and Dr. C, the attending ObGyn. Cerclage was not performed. Ten days later, the child was born at 19 weeks’ gestation, and died shortly after birth.

PATIENT’S CLAIM The hospital should have had a policy mandating that an attending physician evaluate obstetric patients whose cervical exam is abnormal. Cerclage should have been performed; cervical weakness had been treated in her second and third pregnancies, resulting in successful deliveries at 29 weeks and 34 weeks, respectively. The attending ObGyn never examined the patient.

DEFENDANTS’ DEFENSE The hospital claimed that a cervical examination showed that cerclage was unnecessary. Dr. C indicated that the correct decision and treatment were rendered; the intern and resident had reported their findings to him.

VERDICT A $3 million Pennsylvania verdict was returned.

Breast discharge during pregnancy

AT 7 MONTHS’ GESTATION, a 29-year-old woman reported burning pain and clear discharge from her right breast. The ObGyn told her he believed the complaints were related to her pregnancy; he did not examine her breasts.

The ObGyn’s partner palpated a lump in the woman’s right breast at her 6-week postpartum visit. Triple negative breast cancer was diagnosed. She underwent chemotherapy, mastectomy, and radiotherapy, but died of metastatic breast cancer.

ESTATE’S CLAIM The ObGyn failed to conduct a breast examination when the woman first complained of symptoms. This caused a delay in diagnosis, which reduced her chance of survival.

PHYSICIAN’S DEFENSE The ObGyn first denied the patient reported breast symptoms at her 7-month visit, as his records did not indicate a complaint. However, in a documented telephone call 4 days before the visit, the patient complained of burning pain and clear fluid leaking from her right breast. The ObGyn admitted that he would have followed up on the phone call, and that she must have told him complaints had subsided, or he would have noted continuing symptoms and performed a breast exam. He claimed a 3-month delay in diagnosis did not change the outcome because hers was a highly aggressive type of tumor that 1) is unresponsive to treatment and 2) carries an extremely poor survival rate compared with other types of breast cancer.

VERDICT A $1.5 million Illinois verdict was reached.

Woman refuses hysterectomy,
dies of invasive cancer

A 37-YEAR-OLD WOMAN VISITED HER GYNECOLOGIST for an annual physical exam. A Pap smear revealed human papillomavirus (HPV) infection and abnormal cells. The pathology report after cone biopsy indicated adenoid cystic carcinoma. The physician told the patient that she needed a hysterectomy, which she refused.

The patient visited her primary care physician 9 months later because of abdominal bloating. He palpated a pelvic mass and sent her for a CT scan, which showed a mass within the pelvis as well as liver metastases. Surgery was not an option because of the metastases. Chemotherapy was started but the woman died in less than a month.

ESTATE’S CLAIM Although the gynecologist told the patient she needed a hysterectomy, he did not 1) correctly report the results of the biopsy or 2) explain the reasons why he was recommending hysterectomy.

PHYSICIAN’S DEFENSE The patient was properly treated when advised to have a hysterectomy. She refused treatment

VERDICT A $1.4 million Virginia settlement was reached.

NEONATAL DEATH FROM GROUP B STREP

AN INMATE AT A STATE PRISON gave birth to a healthy baby at 39 weeks’ gestation. The baby died the next day from a perinatal group B Streptococcal (GBS) infection.

ESTATE’S CLAIM The two ObGyns who treated the mother were negligent: the mother’s GBS status was unknown; she was never informed that she needed GBS testing; testing was not administered.

PHYSICIANS’ DEFENSE The primary ObGyn (Dr. A) denied negligence. The other (Dr. B) claimed that he had no duty to administer GBS testing because he was not the primary ObGyn. Prophylactic antibiotics in the absence of certain risk factors—none were present—were inappropriate.

VERDICT A $150,000 California settlement was reached with Dr. A. A defense verdict was returned for Dr. B.

>> READ New group B strep guidelines clarify management of key groups.

DIFFICULT DELIVERY, INJURED BABY

FETAL HEART RATE TRACING was not reassuring, and the fetus did not descend during prolonged labor and delivery. After more than 15 minutes of bradycardia, the hospital staff contacted the ObGyn, who then ordered cesarean delivery. At the initiation of surgery, the anesthetic was insufficient and the mother was unable to tolerate the abdominal incision.

The child has cerebral palsy and suffers motor delays and moderate cognitive deficits.

PATIENTS’ CLAIM The ObGyn failed to recognize cephalopelvic dispro-portion. The hospital staff misread fetal monitoring strips, delaying response to fetal distress because the umbilical cord was compressed between the baby’s cheekbone and maternal pelvis. A cesarean delivery should have been performed earlier, immediately after the baby showed signs of distress. The staff administered the wrong type of anesthetic to the mother before surgery.

DEFENDANTS’ DEFENSE Proper care was provided. An occult prolapsed cord was unpredictable, unpreventable, and unforeseeable.

VERDICT A $6.5 million Illinois settlement was reached, including $300,000 for the mother.

FISTULA CAUSES INCONTINENCE, PROMPTS MULTIPLE SURGERIES

SEVERAL WEEKS AFTER a vaginal hysterectomy, a woman presented with urinary incontinence; vesicovaginal fistula was diagnosed. She underwent 9 surgeries to repair the bladder injury and fistula.

PATIENT’S CLAIM The injury occurred because the gynecologist used improper technique when retracting the bladder. He should have inspected the bladder for injury before finishing the operation.

PHYSICIAN’S DEFENSE Bladder injury is a known risk of laparoscopic transvaginal hysterectomy.

VERDICT A $796,617 Michigan verdict was returned.

URETER KINKS DURING DIFFICULT HYSTERECTOMY

A 36-YEAR-OLD WOMAN PRESENTED to her gynecologist complaining of heavy menses and abdominal and pelvic pain, especially in the lower left quadrant. Total abdominal hysterectomy was scheduled. During surgery, the gynecologist found that the bladder was densely adhered to the uterus. Brisk bleeding followed attempts to separate the bladder from the uterus. The physician placed a single suture to stop the bleeding, and the procedure was completed.

Three days later, she had pain in the right kidney area; testing determined her right ureter was kinked. She was sent to another hospital for placement of a stent and nephrostomy tube, which were removed 4 months later.

PATIENT’S CLAIM The gynecologist was negligent in failing to provide the patient with alternatives to hysterectomy, and in injuring the ureter during hysterectomy.

PHYSICIAN’S DEFENSE Four treatment options were provided to the patient. The injury is a known complication of the surgery. The patient has completely recovered.

VERDICT A Pennsylvania defense verdict was returned.

WOMAN DELIVERS AT HOME AFTER FETUS DIES

AT 16 WEEKS’ GESTATION, a woman went to the hospital complaining of vaginal discharge. Ultrasonography revealed that the fetus had died. The woman’s cervix was not dilated; when the hospital staff attempted to discharge her, she resisted. Hospital officials threatened to call the police if she did not leave. She left, and later delivered the dead fetus at home. She then called her ObGyn, who promptly admitted her for emergency dilation and curettage to remove the remaining placental tissue.

PATIENT’S CLAIM She alleged a violation of the Emergency Medical Treatment and Active Labor Act (EMTALA), arguing that instead of stabilizing her, she was sent home under the threat of police intervention.

DEFENDANT’S DEFENSE The hospital claimed it had done all it could for the patient; she was not ready to deliver the fetus. She was given instructions to see her ObGyn or return if her condition changed. She never returned.

VERDICT A Maine verdict of $50,000 compensatory damages was returned against the hospital. The jury added $150,000 for punitive damages.

A SECOND ECTOPIC PREGNANCY?

FOUR YEARS AFTER SUFFERING a ruptured tubal ectopic pregnancy that necessitated salpingectomy, a 30-year-old woman became pregnant again. At her first prenatal visit to a hospital clinic, she saw a certified nurse midwife. The patient reported the prior ectopic pregnancy and complained of spotting with left-sided pain, nausea, and vomiting. Six days later, she went to the emergency department and was given a diagnosis of a ruptured fallopian tube from an ectopic pregnancy. Surgery was performed to remove the fallopian tube, thus making her unable to naturally conceive a child.

PATIENT’S CLAIM The midwife should have responded immediately to the patient’s symptoms, ordered a sonogram, and sent her to the hospital. Any of several available options would have saved the fallopian tube if the ectopic pregnancy had been diagnosed before rupture. The patient has spiritual and moral objections to in vitro fertilization.

MIDWIFE’S DEFENSE The midwife ordered a Stat sonogram at the first prenatal visit, but the prescription form was never removed from the chart, and the sonogram never scheduled. It was the hospital’s responsibility to get the form to the plaintiff and have the procedure scheduled. The midwife was therefore not at fault.

VERDICT A $2.5 million Maryland verdict was returned; it was reduced under the state cap to $650,000.

OBGYN UNDERESTIMATES BIRTH WEIGHT—BY APPROXIMATELY 50%

A PREGNANT WOMAN WITH BACK PAIN went to the emergency department. She was discharged but returned the next day with the same complaint, and, shortly, went into labor. The ObGyn, who estimated fetal weight at 7 or 8 lbs, delivered the baby using a vacuum extractor. Shoulder dystocia was encountered, and four maneuvers were used to deliver the baby, who weighed more than 11 lbs at birth. The baby suffered global brachial plexus injury.

PATIENT’S CLAIM The ObGyn was negligent: in underestimating fetal weight; in failing to offer cesarean delivery after 2 hours of second-stage labor; and in applying excessive force to deliver the baby.

PHYSICIAN’S DEFENSE Fetal weight is almost impossible to accurately estimate. A cesarean delivery was unnecessary. Only gentle traction was used to deliver the child.

VERDICT An Illinois defense verdict was returned.

Woman refuses hysterectomy,
dies of invasive cancer

A 37-YEAR-OLD WOMAN VISITED HER GYNECOLOGIST for an annual physical exam. A Pap smear revealed human papillomavirus (HPV) infection and abnormal cells. The pathology report after cone biopsy indicated adenoid cystic carcinoma. The physician told the patient that she needed a hysterectomy, which she refused.

The patient visited her primary care physician 9 months later because of abdominal bloating. He palpated a pelvic mass and sent her for a CT scan, which showed a mass within the pelvis as well as liver metastases. Surgery was not an option because of the metastases. Chemotherapy was started but the woman died in less than a month.

ESTATE’S CLAIM Although the gynecologist told the patient she needed a hysterectomy, he did not 1) correctly report the results of the biopsy or 2) explain the reasons why he was recommending hysterectomy.

PHYSICIAN’S DEFENSE The patient was properly treated when advised to have a hysterectomy. She refused treatment

VERDICT A $1.4 million Virginia settlement was reached.

NEONATAL DEATH FROM GROUP B STREP

AN INMATE AT A STATE PRISON gave birth to a healthy baby at 39 weeks’ gestation. The baby died the next day from a perinatal group B Streptococcal (GBS) infection.

ESTATE’S CLAIM The two ObGyns who treated the mother were negligent: the mother’s GBS status was unknown; she was never informed that she needed GBS testing; testing was not administered.

PHYSICIANS’ DEFENSE The primary ObGyn (Dr. A) denied negligence. The other (Dr. B) claimed that he had no duty to administer GBS testing because he was not the primary ObGyn. Prophylactic antibiotics in the absence of certain risk factors—none were present—were inappropriate.

VERDICT A $150,000 California settlement was reached with Dr. A. A defense verdict was returned for Dr. B.

>> READ New group B strep guidelines clarify management of key groups.

DIFFICULT DELIVERY, INJURED BABY

FETAL HEART RATE TRACING was not reassuring, and the fetus did not descend during prolonged labor and delivery. After more than 15 minutes of bradycardia, the hospital staff contacted the ObGyn, who then ordered cesarean delivery. At the initiation of surgery, the anesthetic was insufficient and the mother was unable to tolerate the abdominal incision.

The child has cerebral palsy and suffers motor delays and moderate cognitive deficits.

PATIENTS’ CLAIM The ObGyn failed to recognize cephalopelvic dispro-portion. The hospital staff misread fetal monitoring strips, delaying response to fetal distress because the umbilical cord was compressed between the baby’s cheekbone and maternal pelvis. A cesarean delivery should have been performed earlier, immediately after the baby showed signs of distress. The staff administered the wrong type of anesthetic to the mother before surgery.

DEFENDANTS’ DEFENSE Proper care was provided. An occult prolapsed cord was unpredictable, unpreventable, and unforeseeable.

VERDICT A $6.5 million Illinois settlement was reached, including $300,000 for the mother.

FISTULA CAUSES INCONTINENCE, PROMPTS MULTIPLE SURGERIES

SEVERAL WEEKS AFTER a vaginal hysterectomy, a woman presented with urinary incontinence; vesicovaginal fistula was diagnosed. She underwent 9 surgeries to repair the bladder injury and fistula.

PATIENT’S CLAIM The injury occurred because the gynecologist used improper technique when retracting the bladder. He should have inspected the bladder for injury before finishing the operation.

PHYSICIAN’S DEFENSE Bladder injury is a known risk of laparoscopic transvaginal hysterectomy.

VERDICT A $796,617 Michigan verdict was returned.

URETER KINKS DURING DIFFICULT HYSTERECTOMY

A 36-YEAR-OLD WOMAN PRESENTED to her gynecologist complaining of heavy menses and abdominal and pelvic pain, especially in the lower left quadrant. Total abdominal hysterectomy was scheduled. During surgery, the gynecologist found that the bladder was densely adhered to the uterus. Brisk bleeding followed attempts to separate the bladder from the uterus. The physician placed a single suture to stop the bleeding, and the procedure was completed.

Three days later, she had pain in the right kidney area; testing determined her right ureter was kinked. She was sent to another hospital for placement of a stent and nephrostomy tube, which were removed 4 months later.

PATIENT’S CLAIM The gynecologist was negligent in failing to provide the patient with alternatives to hysterectomy, and in injuring the ureter during hysterectomy.

PHYSICIAN’S DEFENSE Four treatment options were provided to the patient. The injury is a known complication of the surgery. The patient has completely recovered.

VERDICT A Pennsylvania defense verdict was returned.

WOMAN DELIVERS AT HOME AFTER FETUS DIES

AT 16 WEEKS’ GESTATION, a woman went to the hospital complaining of vaginal discharge. Ultrasonography revealed that the fetus had died. The woman’s cervix was not dilated; when the hospital staff attempted to discharge her, she resisted. Hospital officials threatened to call the police if she did not leave. She left, and later delivered the dead fetus at home. She then called her ObGyn, who promptly admitted her for emergency dilation and curettage to remove the remaining placental tissue.

PATIENT’S CLAIM She alleged a violation of the Emergency Medical Treatment and Active Labor Act (EMTALA), arguing that instead of stabilizing her, she was sent home under the threat of police intervention.

DEFENDANT’S DEFENSE The hospital claimed it had done all it could for the patient; she was not ready to deliver the fetus. She was given instructions to see her ObGyn or return if her condition changed. She never returned.

VERDICT A Maine verdict of $50,000 compensatory damages was returned against the hospital. The jury added $150,000 for punitive damages.

A SECOND ECTOPIC PREGNANCY?

FOUR YEARS AFTER SUFFERING a ruptured tubal ectopic pregnancy that necessitated salpingectomy, a 30-year-old woman became pregnant again. At her first prenatal visit to a hospital clinic, she saw a certified nurse midwife. The patient reported the prior ectopic pregnancy and complained of spotting with left-sided pain, nausea, and vomiting. Six days later, she went to the emergency department and was given a diagnosis of a ruptured fallopian tube from an ectopic pregnancy. Surgery was performed to remove the fallopian tube, thus making her unable to naturally conceive a child.

PATIENT’S CLAIM The midwife should have responded immediately to the patient’s symptoms, ordered a sonogram, and sent her to the hospital. Any of several available options would have saved the fallopian tube if the ectopic pregnancy had been diagnosed before rupture. The patient has spiritual and moral objections to in vitro fertilization.

MIDWIFE’S DEFENSE The midwife ordered a Stat sonogram at the first prenatal visit, but the prescription form was never removed from the chart, and the sonogram never scheduled. It was the hospital’s responsibility to get the form to the plaintiff and have the procedure scheduled. The midwife was therefore not at fault.

VERDICT A $2.5 million Maryland verdict was returned; it was reduced under the state cap to $650,000.

OBGYN UNDERESTIMATES BIRTH WEIGHT—BY APPROXIMATELY 50%

A PREGNANT WOMAN WITH BACK PAIN went to the emergency department. She was discharged but returned the next day with the same complaint, and, shortly, went into labor. The ObGyn, who estimated fetal weight at 7 or 8 lbs, delivered the baby using a vacuum extractor. Shoulder dystocia was encountered, and four maneuvers were used to deliver the baby, who weighed more than 11 lbs at birth. The baby suffered global brachial plexus injury.

PATIENT’S CLAIM The ObGyn was negligent: in underestimating fetal weight; in failing to offer cesarean delivery after 2 hours of second-stage labor; and in applying excessive force to deliver the baby.

PHYSICIAN’S DEFENSE Fetal weight is almost impossible to accurately estimate. A cesarean delivery was unnecessary. Only gentle traction was used to deliver the child.

VERDICT An Illinois defense verdict was returned.

Woman refuses hysterectomy,
dies of invasive cancer

A 37-YEAR-OLD WOMAN VISITED HER GYNECOLOGIST for an annual physical exam. A Pap smear revealed human papillomavirus (HPV) infection and abnormal cells. The pathology report after cone biopsy indicated adenoid cystic carcinoma. The physician told the patient that she needed a hysterectomy, which she refused.

The patient visited her primary care physician 9 months later because of abdominal bloating. He palpated a pelvic mass and sent her for a CT scan, which showed a mass within the pelvis as well as liver metastases. Surgery was not an option because of the metastases. Chemotherapy was started but the woman died in less than a month.

ESTATE’S CLAIM Although the gynecologist told the patient she needed a hysterectomy, he did not 1) correctly report the results of the biopsy or 2) explain the reasons why he was recommending hysterectomy.

PHYSICIAN’S DEFENSE The patient was properly treated when advised to have a hysterectomy. She refused treatment

VERDICT A $1.4 million Virginia settlement was reached.

NEONATAL DEATH FROM GROUP B STREP

AN INMATE AT A STATE PRISON gave birth to a healthy baby at 39 weeks’ gestation. The baby died the next day from a perinatal group B Streptococcal (GBS) infection.

ESTATE’S CLAIM The two ObGyns who treated the mother were negligent: the mother’s GBS status was unknown; she was never informed that she needed GBS testing; testing was not administered.

PHYSICIANS’ DEFENSE The primary ObGyn (Dr. A) denied negligence. The other (Dr. B) claimed that he had no duty to administer GBS testing because he was not the primary ObGyn. Prophylactic antibiotics in the absence of certain risk factors—none were present—were inappropriate.

VERDICT A $150,000 California settlement was reached with Dr. A. A defense verdict was returned for Dr. B.

>> READ New group B strep guidelines clarify management of key groups.

DIFFICULT DELIVERY, INJURED BABY

FETAL HEART RATE TRACING was not reassuring, and the fetus did not descend during prolonged labor and delivery. After more than 15 minutes of bradycardia, the hospital staff contacted the ObGyn, who then ordered cesarean delivery. At the initiation of surgery, the anesthetic was insufficient and the mother was unable to tolerate the abdominal incision.

The child has cerebral palsy and suffers motor delays and moderate cognitive deficits.

PATIENTS’ CLAIM The ObGyn failed to recognize cephalopelvic dispro-portion. The hospital staff misread fetal monitoring strips, delaying response to fetal distress because the umbilical cord was compressed between the baby’s cheekbone and maternal pelvis. A cesarean delivery should have been performed earlier, immediately after the baby showed signs of distress. The staff administered the wrong type of anesthetic to the mother before surgery.

DEFENDANTS’ DEFENSE Proper care was provided. An occult prolapsed cord was unpredictable, unpreventable, and unforeseeable.

VERDICT A $6.5 million Illinois settlement was reached, including $300,000 for the mother.

FISTULA CAUSES INCONTINENCE, PROMPTS MULTIPLE SURGERIES

SEVERAL WEEKS AFTER a vaginal hysterectomy, a woman presented with urinary incontinence; vesicovaginal fistula was diagnosed. She underwent 9 surgeries to repair the bladder injury and fistula.

PATIENT’S CLAIM The injury occurred because the gynecologist used improper technique when retracting the bladder. He should have inspected the bladder for injury before finishing the operation.

PHYSICIAN’S DEFENSE Bladder injury is a known risk of laparoscopic transvaginal hysterectomy.

VERDICT A $796,617 Michigan verdict was returned.

URETER KINKS DURING DIFFICULT HYSTERECTOMY

A 36-YEAR-OLD WOMAN PRESENTED to her gynecologist complaining of heavy menses and abdominal and pelvic pain, especially in the lower left quadrant. Total abdominal hysterectomy was scheduled. During surgery, the gynecologist found that the bladder was densely adhered to the uterus. Brisk bleeding followed attempts to separate the bladder from the uterus. The physician placed a single suture to stop the bleeding, and the procedure was completed.

Three days later, she had pain in the right kidney area; testing determined her right ureter was kinked. She was sent to another hospital for placement of a stent and nephrostomy tube, which were removed 4 months later.

PATIENT’S CLAIM The gynecologist was negligent in failing to provide the patient with alternatives to hysterectomy, and in injuring the ureter during hysterectomy.

PHYSICIAN’S DEFENSE Four treatment options were provided to the patient. The injury is a known complication of the surgery. The patient has completely recovered.

VERDICT A Pennsylvania defense verdict was returned.

WOMAN DELIVERS AT HOME AFTER FETUS DIES

AT 16 WEEKS’ GESTATION, a woman went to the hospital complaining of vaginal discharge. Ultrasonography revealed that the fetus had died. The woman’s cervix was not dilated; when the hospital staff attempted to discharge her, she resisted. Hospital officials threatened to call the police if she did not leave. She left, and later delivered the dead fetus at home. She then called her ObGyn, who promptly admitted her for emergency dilation and curettage to remove the remaining placental tissue.

PATIENT’S CLAIM She alleged a violation of the Emergency Medical Treatment and Active Labor Act (EMTALA), arguing that instead of stabilizing her, she was sent home under the threat of police intervention.

DEFENDANT’S DEFENSE The hospital claimed it had done all it could for the patient; she was not ready to deliver the fetus. She was given instructions to see her ObGyn or return if her condition changed. She never returned.

VERDICT A Maine verdict of $50,000 compensatory damages was returned against the hospital. The jury added $150,000 for punitive damages.

A SECOND ECTOPIC PREGNANCY?

FOUR YEARS AFTER SUFFERING a ruptured tubal ectopic pregnancy that necessitated salpingectomy, a 30-year-old woman became pregnant again. At her first prenatal visit to a hospital clinic, she saw a certified nurse midwife. The patient reported the prior ectopic pregnancy and complained of spotting with left-sided pain, nausea, and vomiting. Six days later, she went to the emergency department and was given a diagnosis of a ruptured fallopian tube from an ectopic pregnancy. Surgery was performed to remove the fallopian tube, thus making her unable to naturally conceive a child.

PATIENT’S CLAIM The midwife should have responded immediately to the patient’s symptoms, ordered a sonogram, and sent her to the hospital. Any of several available options would have saved the fallopian tube if the ectopic pregnancy had been diagnosed before rupture. The patient has spiritual and moral objections to in vitro fertilization.

MIDWIFE’S DEFENSE The midwife ordered a Stat sonogram at the first prenatal visit, but the prescription form was never removed from the chart, and the sonogram never scheduled. It was the hospital’s responsibility to get the form to the plaintiff and have the procedure scheduled. The midwife was therefore not at fault.

VERDICT A $2.5 million Maryland verdict was returned; it was reduced under the state cap to $650,000.

OBGYN UNDERESTIMATES BIRTH WEIGHT—BY APPROXIMATELY 50%

A PREGNANT WOMAN WITH BACK PAIN went to the emergency department. She was discharged but returned the next day with the same complaint, and, shortly, went into labor. The ObGyn, who estimated fetal weight at 7 or 8 lbs, delivered the baby using a vacuum extractor. Shoulder dystocia was encountered, and four maneuvers were used to deliver the baby, who weighed more than 11 lbs at birth. The baby suffered global brachial plexus injury.

PATIENT’S CLAIM The ObGyn was negligent: in underestimating fetal weight; in failing to offer cesarean delivery after 2 hours of second-stage labor; and in applying excessive force to deliver the baby.

PHYSICIAN’S DEFENSE Fetal weight is almost impossible to accurately estimate. A cesarean delivery was unnecessary. Only gentle traction was used to deliver the child.

VERDICT An Illinois defense verdict was returned.

Hemorrhage, death follow placenta percreta

A 30-YEAR-OLD WOMAN WAS ADMITTED TO THE HOSPITAL for cesarean delivery of a stillborn child at 6 months’ gestation. The patient was known to have placenta previa.

After delivery and attempted removal of the placenta, she began to hemorrhage profusely. It was determined that the placenta had grown through the uterine wall and into the bladder.

Despite attempts to control bleeding surgically, she continued to hemorrhage, suffered cardiopulmonary arrest, and could not be resuscitated.

ESTATE’S CLAIM The obstetrician who performed the delivery was negligent in failing to diagnose placenta percreta. Both the OB and the nurse-anesthetist should have been able to assess and control the bleeding.

The hospital failed to deliver blood products to the operating room in a timely manner, thereby contributing to the patient’s death.

DEFENDANTS’ DEFENSE The patient’s condition was managed appropriately. Everything was done to resuscitate her in a timely and proper fashion.

VERDICT The estate settled with the OB and nurse-anesthetist for an undisclosed amount. A $2,124,200 Texas verdict was returned against the hospital.

Brachial paralysis in 11 lb, 5 oz newborn

A WOMAN HAD RISK FACTORS for a macrosomic fetus, including obesity before pregnancy, excessive weight gain during pregnancy, and small stature. Before delivery, the OB estimated the fetal weight to be as much as 10 lb.

Shoulder dystocia was encountered during delivery. The baby weighed 11 lb, 5 oz at birth. A diagnosis of brachial plexus injury was made.

PATIENTS’ CLAIM The child’s right arm is paralyzed. He has undergone three surgeries and continues to require physical therapy.

The mother was never told of the risks of vaginal delivery, including shoulder dystocia and brachial plexus injury. She should have been offered cesarean delivery.

The OB applied inappropriate traction to the baby’s head and neck during delivery.

PHYSICIAN’S DEFENSE There is no requirement to tell the mother all the risks of childbirth because they are too numerous and too frightening. Shoulder dystocia was appropriately treated.

VERDICT A $3.27 million Illinois verdict was returned.

Twins die after premature birth

A WOMAN PREGNANT WITH TWINS had a history of incompetent cervix. Her OB performed cervical cerclage in May.

At 26 weeks’ gestation, the mother experienced preterm contractions. She went to the hospital, where she was examined and discharged.

Three days later, the cerclage tore, and she gave birth vaginally. The twins suffered from respiratory distress syndrome, hyaline membrane disease, and intraventricular hemorrhage. One twin died in October; the other, the following May.

PATIENT’S CLAIM She should have been admitted when contractions began, to be monitored and given antenatal steroids and medication to control contractions. After cervical cerclage tore, the OB should have performed transabdominal cerclage.

PHYSICIAN’S DEFENSE The OB denied negligence.

VERDICT A $160,000 Michigan settlement was reached.

Bowel injury during tubal ligation

AFTER A VAGINAL DELIVERY of a healthy child, a 28-year-old woman’s OB performed laparoscopic bilateral tubal ligation.

Several days later, she suffered bowel obstruction. Exploratory laparotomy revealed that a suture had injured the bowel; a portion was resected. The woman made a complete recovery.

PATIENT’S CLAIM The OB was negligent for 1) passing suture into bowel and 2) not checking to ensure there were no injuries after tubal ligation.

PHYSICIAN’S DEFENSE Inadvertent suturing of bowel is a recognized complication of laparoscopic tubal ligation.

VERDICT A Tennessee defense verdict was returned.

Hemorrhage, death follow placenta percreta

A 30-YEAR-OLD WOMAN WAS ADMITTED TO THE HOSPITAL for cesarean delivery of a stillborn child at 6 months’ gestation. The patient was known to have placenta previa.

After delivery and attempted removal of the placenta, she began to hemorrhage profusely. It was determined that the placenta had grown through the uterine wall and into the bladder.

Despite attempts to control bleeding surgically, she continued to hemorrhage, suffered cardiopulmonary arrest, and could not be resuscitated.

ESTATE’S CLAIM The obstetrician who performed the delivery was negligent in failing to diagnose placenta percreta. Both the OB and the nurse-anesthetist should have been able to assess and control the bleeding.

The hospital failed to deliver blood products to the operating room in a timely manner, thereby contributing to the patient’s death.

DEFENDANTS’ DEFENSE The patient’s condition was managed appropriately. Everything was done to resuscitate her in a timely and proper fashion.

VERDICT The estate settled with the OB and nurse-anesthetist for an undisclosed amount. A $2,124,200 Texas verdict was returned against the hospital.

Brachial paralysis in 11 lb, 5 oz newborn

A WOMAN HAD RISK FACTORS for a macrosomic fetus, including obesity before pregnancy, excessive weight gain during pregnancy, and small stature. Before delivery, the OB estimated the fetal weight to be as much as 10 lb.

Shoulder dystocia was encountered during delivery. The baby weighed 11 lb, 5 oz at birth. A diagnosis of brachial plexus injury was made.

PATIENTS’ CLAIM The child’s right arm is paralyzed. He has undergone three surgeries and continues to require physical therapy.

The mother was never told of the risks of vaginal delivery, including shoulder dystocia and brachial plexus injury. She should have been offered cesarean delivery.

The OB applied inappropriate traction to the baby’s head and neck during delivery.

PHYSICIAN’S DEFENSE There is no requirement to tell the mother all the risks of childbirth because they are too numerous and too frightening. Shoulder dystocia was appropriately treated.

VERDICT A $3.27 million Illinois verdict was returned.

Twins die after premature birth

A WOMAN PREGNANT WITH TWINS had a history of incompetent cervix. Her OB performed cervical cerclage in May.

At 26 weeks’ gestation, the mother experienced preterm contractions. She went to the hospital, where she was examined and discharged.

Three days later, the cerclage tore, and she gave birth vaginally. The twins suffered from respiratory distress syndrome, hyaline membrane disease, and intraventricular hemorrhage. One twin died in October; the other, the following May.

PATIENT’S CLAIM She should have been admitted when contractions began, to be monitored and given antenatal steroids and medication to control contractions. After cervical cerclage tore, the OB should have performed transabdominal cerclage.

PHYSICIAN’S DEFENSE The OB denied negligence.

VERDICT A $160,000 Michigan settlement was reached.

Bowel injury during tubal ligation

AFTER A VAGINAL DELIVERY of a healthy child, a 28-year-old woman’s OB performed laparoscopic bilateral tubal ligation.

Several days later, she suffered bowel obstruction. Exploratory laparotomy revealed that a suture had injured the bowel; a portion was resected. The woman made a complete recovery.

PATIENT’S CLAIM The OB was negligent for 1) passing suture into bowel and 2) not checking to ensure there were no injuries after tubal ligation.

PHYSICIAN’S DEFENSE Inadvertent suturing of bowel is a recognized complication of laparoscopic tubal ligation.

VERDICT A Tennessee defense verdict was returned.

Hemorrhage, death follow placenta percreta

A 30-YEAR-OLD WOMAN WAS ADMITTED TO THE HOSPITAL for cesarean delivery of a stillborn child at 6 months’ gestation. The patient was known to have placenta previa.

After delivery and attempted removal of the placenta, she began to hemorrhage profusely. It was determined that the placenta had grown through the uterine wall and into the bladder.

Despite attempts to control bleeding surgically, she continued to hemorrhage, suffered cardiopulmonary arrest, and could not be resuscitated.

ESTATE’S CLAIM The obstetrician who performed the delivery was negligent in failing to diagnose placenta percreta. Both the OB and the nurse-anesthetist should have been able to assess and control the bleeding.

The hospital failed to deliver blood products to the operating room in a timely manner, thereby contributing to the patient’s death.

DEFENDANTS’ DEFENSE The patient’s condition was managed appropriately. Everything was done to resuscitate her in a timely and proper fashion.

VERDICT The estate settled with the OB and nurse-anesthetist for an undisclosed amount. A $2,124,200 Texas verdict was returned against the hospital.

Brachial paralysis in 11 lb, 5 oz newborn

A WOMAN HAD RISK FACTORS for a macrosomic fetus, including obesity before pregnancy, excessive weight gain during pregnancy, and small stature. Before delivery, the OB estimated the fetal weight to be as much as 10 lb.

Shoulder dystocia was encountered during delivery. The baby weighed 11 lb, 5 oz at birth. A diagnosis of brachial plexus injury was made.

PATIENTS’ CLAIM The child’s right arm is paralyzed. He has undergone three surgeries and continues to require physical therapy.

The mother was never told of the risks of vaginal delivery, including shoulder dystocia and brachial plexus injury. She should have been offered cesarean delivery.

The OB applied inappropriate traction to the baby’s head and neck during delivery.

PHYSICIAN’S DEFENSE There is no requirement to tell the mother all the risks of childbirth because they are too numerous and too frightening. Shoulder dystocia was appropriately treated.

VERDICT A $3.27 million Illinois verdict was returned.

Twins die after premature birth

A WOMAN PREGNANT WITH TWINS had a history of incompetent cervix. Her OB performed cervical cerclage in May.

At 26 weeks’ gestation, the mother experienced preterm contractions. She went to the hospital, where she was examined and discharged.

Three days later, the cerclage tore, and she gave birth vaginally. The twins suffered from respiratory distress syndrome, hyaline membrane disease, and intraventricular hemorrhage. One twin died in October; the other, the following May.

PATIENT’S CLAIM She should have been admitted when contractions began, to be monitored and given antenatal steroids and medication to control contractions. After cervical cerclage tore, the OB should have performed transabdominal cerclage.

PHYSICIAN’S DEFENSE The OB denied negligence.

VERDICT A $160,000 Michigan settlement was reached.

Bowel injury during tubal ligation

AFTER A VAGINAL DELIVERY of a healthy child, a 28-year-old woman’s OB performed laparoscopic bilateral tubal ligation.

Several days later, she suffered bowel obstruction. Exploratory laparotomy revealed that a suture had injured the bowel; a portion was resected. The woman made a complete recovery.

PATIENT’S CLAIM The OB was negligent for 1) passing suture into bowel and 2) not checking to ensure there were no injuries after tubal ligation.

PHYSICIAN’S DEFENSE Inadvertent suturing of bowel is a recognized complication of laparoscopic tubal ligation.

VERDICT A Tennessee defense verdict was returned.