Medical Verdicts

Estate of breast cancer victim appeals

COMPLAINING OF FATIGUE, a 44-year-old woman went to a university medical center staffed by residents supervised by faculty. Resident Dr. A discovered a 1.5-cm mobile mass in her right breast. Although he never saw the patient, Dr. B, the supervising physician, suggested a mammogram with ultrasonography. Results were reported as benign, and the patient was advised to follow up in 6 months, or earlier if her condition changed.

A month later, the patient returned to the clinic. Resident Dr. C advised her to have a biopsy; the patient declined.

She returned 8 months later, after the clinic sent a reminder. The skin on her breast had the consistency of an orange, and the lump had grown. A diagnosis of metastatic breast cancer was made. Aggressive treatment was recommended, but the patient opted for herbal and other homeopathic remedies.

PATIENT’S CLAIM The physicians were negligent for not diagnosing breast cancer in a timely manner. A needle biopsy should have been performed when the lump was first detected.

PHYSICIANS’ DEFENSE The treatment plan was reasonable. The patient declined the biopsy, and failed to return when her condition changed.

VERDICT A Tennessee defense verdict was returned.

ESTATE’S APPEAL After the patient died 2 years later, an appeal trial resulted in finding Dr. B 99% at fault and the deceased 1% at fault. The jury awarded $2.7 million to the estate.

ObGyn exonerated in Erb’s palsy case

2 WEEKS BEFORE GIVING BIRTH, a woman underwent a sonogram. A radiologist evaluated the images and did not report an abnormality. The infant was delivered vaginally by an ObGyn. Later, the child was given a diagnosis of Erb’s palsy.

PATIENT’S CLAIM The radiologist failed to properly estimate the fetus’ weight. The ObGyn used excessive lateral traction during delivery.

PHYSICIANS’ DEFENSE Both physicians denied negligence.

VERDICT The radiologist settled for $150,000 before trial. A Texas jury returned a defense verdict for the ObGyn.

Profuse bleeding; patient dies

AFTER BLEEDING PROFUSELY during laparoscopic-assisted vaginal hysterectomy, a 46-year-old woman died.

ESTATE’S CLAIM The gynecologist failed to recognize bleeding complications and transfuse blood quickly enough. Type O-negative blood should have been ordered because it would have been available sooner than type-specific blood.

PHYSICIAN’S DEFENSE Bleeding is a known complication of the procedure. There was insufficient time to effectively transfuse the patient.

VERDICT An Arizona defense verdict was returned.

Estate of breast cancer victim appeals

COMPLAINING OF FATIGUE, a 44-year-old woman went to a university medical center staffed by residents supervised by faculty. Resident Dr. A discovered a 1.5-cm mobile mass in her right breast. Although he never saw the patient, Dr. B, the supervising physician, suggested a mammogram with ultrasonography. Results were reported as benign, and the patient was advised to follow up in 6 months, or earlier if her condition changed.

A month later, the patient returned to the clinic. Resident Dr. C advised her to have a biopsy; the patient declined.

She returned 8 months later, after the clinic sent a reminder. The skin on her breast had the consistency of an orange, and the lump had grown. A diagnosis of metastatic breast cancer was made. Aggressive treatment was recommended, but the patient opted for herbal and other homeopathic remedies.

PATIENT’S CLAIM The physicians were negligent for not diagnosing breast cancer in a timely manner. A needle biopsy should have been performed when the lump was first detected.

PHYSICIANS’ DEFENSE The treatment plan was reasonable. The patient declined the biopsy, and failed to return when her condition changed.

VERDICT A Tennessee defense verdict was returned.

ESTATE’S APPEAL After the patient died 2 years later, an appeal trial resulted in finding Dr. B 99% at fault and the deceased 1% at fault. The jury awarded $2.7 million to the estate.

ObGyn exonerated in Erb’s palsy case

2 WEEKS BEFORE GIVING BIRTH, a woman underwent a sonogram. A radiologist evaluated the images and did not report an abnormality. The infant was delivered vaginally by an ObGyn. Later, the child was given a diagnosis of Erb’s palsy.

PATIENT’S CLAIM The radiologist failed to properly estimate the fetus’ weight. The ObGyn used excessive lateral traction during delivery.

PHYSICIANS’ DEFENSE Both physicians denied negligence.

VERDICT The radiologist settled for $150,000 before trial. A Texas jury returned a defense verdict for the ObGyn.

Profuse bleeding; patient dies

AFTER BLEEDING PROFUSELY during laparoscopic-assisted vaginal hysterectomy, a 46-year-old woman died.

ESTATE’S CLAIM The gynecologist failed to recognize bleeding complications and transfuse blood quickly enough. Type O-negative blood should have been ordered because it would have been available sooner than type-specific blood.

PHYSICIAN’S DEFENSE Bleeding is a known complication of the procedure. There was insufficient time to effectively transfuse the patient.

VERDICT An Arizona defense verdict was returned.

Estate of breast cancer victim appeals

COMPLAINING OF FATIGUE, a 44-year-old woman went to a university medical center staffed by residents supervised by faculty. Resident Dr. A discovered a 1.5-cm mobile mass in her right breast. Although he never saw the patient, Dr. B, the supervising physician, suggested a mammogram with ultrasonography. Results were reported as benign, and the patient was advised to follow up in 6 months, or earlier if her condition changed.

A month later, the patient returned to the clinic. Resident Dr. C advised her to have a biopsy; the patient declined.

She returned 8 months later, after the clinic sent a reminder. The skin on her breast had the consistency of an orange, and the lump had grown. A diagnosis of metastatic breast cancer was made. Aggressive treatment was recommended, but the patient opted for herbal and other homeopathic remedies.

PATIENT’S CLAIM The physicians were negligent for not diagnosing breast cancer in a timely manner. A needle biopsy should have been performed when the lump was first detected.

PHYSICIANS’ DEFENSE The treatment plan was reasonable. The patient declined the biopsy, and failed to return when her condition changed.

VERDICT A Tennessee defense verdict was returned.

ESTATE’S APPEAL After the patient died 2 years later, an appeal trial resulted in finding Dr. B 99% at fault and the deceased 1% at fault. The jury awarded $2.7 million to the estate.

ObGyn exonerated in Erb’s palsy case

2 WEEKS BEFORE GIVING BIRTH, a woman underwent a sonogram. A radiologist evaluated the images and did not report an abnormality. The infant was delivered vaginally by an ObGyn. Later, the child was given a diagnosis of Erb’s palsy.

PATIENT’S CLAIM The radiologist failed to properly estimate the fetus’ weight. The ObGyn used excessive lateral traction during delivery.

PHYSICIANS’ DEFENSE Both physicians denied negligence.

VERDICT The radiologist settled for $150,000 before trial. A Texas jury returned a defense verdict for the ObGyn.

Profuse bleeding; patient dies

AFTER BLEEDING PROFUSELY during laparoscopic-assisted vaginal hysterectomy, a 46-year-old woman died.

ESTATE’S CLAIM The gynecologist failed to recognize bleeding complications and transfuse blood quickly enough. Type O-negative blood should have been ordered because it would have been available sooner than type-specific blood.

PHYSICIAN’S DEFENSE Bleeding is a known complication of the procedure. There was insufficient time to effectively transfuse the patient.

VERDICT An Arizona defense verdict was returned.

Failure to biopsy “cyst” delays cancer diagnosis

A 42-YEAR-OLD WOMAN consulted a dermatologist in October about a suspicious lesion on her face. The dermatologist diagnosed a benign cyst. The patient wanted the lesion removed; the dermatologist instead told her to return in the spring. He didn’t perform a biopsy or refer the patient to a plastic surgeon for a biopsy.

By the following May, the patient observed that the lesion was growing, comprising 2 lumps instead of 1, and had become inflamed. She immediately consulted the dermatologist, who maintained that the lesion was a cyst and didn’t biopsy it. He injected cortisone to shrink the lesion.

When the patient visited her family physician the next day for an unrelated matter, the doctor expressed concern about the facial lesion and referred the patient to a plastic surgeon, who performed a biopsy. The biopsy revealed liposarcoma.

The patient underwent 4 surgeries and extensive radiation therapy. The surgery severely disfigured her face. She subsequently developed necrosis of the cheek bone, necessitating surgical debridement and leading to the loss of 4 teeth. Extensive burns to her mouth, face, and neck as well as scar tissue made it difficult for her to open her mouth to eat and speak. She ultimately underwent 8 reconstructive facial operations.

PLAINTIFF’S CLAIM The dermatologist was negligent in failing to perform a biopsy. If the cancer had been diagnosed in October, it could have been excised easily with 1 surgery; the patient wouldn’t have needed extensive radiation or reconstructive surgeries. The delay in diagnosis increased the risk of recurrence and spread of the cancer.

THE DEFENSE Referral to a plastic surgeon was discussed in October, a claim the patient denied. The patient would have required the same treatment even if the cancer had been diagnosed in October because the cancer had been deep in the jaw muscle for several years, and had become more aggressive and appeared as a lesion on the face shortly before the patient’s initial visit.

VERDICT $5.35 million Pennsylvania verdict.

COMMENT Timely biopsy of skin lesions is imperative, particularly at a patient’s request or when a change is noted.

Did history of headaches hinder a thorough evaluation?

A THROBBING HEADACHE that became increasingly worse over 48 hours prompted a 43-year-old woman to go to her doctor’s office. She reported nausea, vomiting, and photophobia to the covering physician. The woman had a history of headaches, which she attributed to previous ear surgery. The physician prescribed pain and antinausea medications and told the patient to follow up with her regular primary care physician.

The patient went home and fell asleep on her couch; she subsequently died in her sleep. An autopsy cited bacterial meningitis as the cause of death.

PLAINTIFF’S CLAIM The question of whether the covering physician should have considered bacterial meningitis turned on whether the patient had nuchal rigidity. Witnesses called by the plaintiff testified that the patient couldn’t move her neck during the period in question.

THE DEFENSE The physician conceded that if he’d observed nuchal rigidity, he would have considered bacterial meningitis. He testified that the patient didn’t have nuchal rigidity but that he hadn’t recorded that finding.

VERDICT $1.45 million Massachusetts settlement.

COMMENT Although most headaches are explained by relatively benign causes, serious problems such as meningitis or hemorrhage should always remain in the differential diagnosis. And complete documentation is key to a successful malpractice defense.

Failure to biopsy “cyst” delays cancer diagnosis

A 42-YEAR-OLD WOMAN consulted a dermatologist in October about a suspicious lesion on her face. The dermatologist diagnosed a benign cyst. The patient wanted the lesion removed; the dermatologist instead told her to return in the spring. He didn’t perform a biopsy or refer the patient to a plastic surgeon for a biopsy.

By the following May, the patient observed that the lesion was growing, comprising 2 lumps instead of 1, and had become inflamed. She immediately consulted the dermatologist, who maintained that the lesion was a cyst and didn’t biopsy it. He injected cortisone to shrink the lesion.

When the patient visited her family physician the next day for an unrelated matter, the doctor expressed concern about the facial lesion and referred the patient to a plastic surgeon, who performed a biopsy. The biopsy revealed liposarcoma.

The patient underwent 4 surgeries and extensive radiation therapy. The surgery severely disfigured her face. She subsequently developed necrosis of the cheek bone, necessitating surgical debridement and leading to the loss of 4 teeth. Extensive burns to her mouth, face, and neck as well as scar tissue made it difficult for her to open her mouth to eat and speak. She ultimately underwent 8 reconstructive facial operations.

PLAINTIFF’S CLAIM The dermatologist was negligent in failing to perform a biopsy. If the cancer had been diagnosed in October, it could have been excised easily with 1 surgery; the patient wouldn’t have needed extensive radiation or reconstructive surgeries. The delay in diagnosis increased the risk of recurrence and spread of the cancer.

THE DEFENSE Referral to a plastic surgeon was discussed in October, a claim the patient denied. The patient would have required the same treatment even if the cancer had been diagnosed in October because the cancer had been deep in the jaw muscle for several years, and had become more aggressive and appeared as a lesion on the face shortly before the patient’s initial visit.

VERDICT $5.35 million Pennsylvania verdict.

COMMENT Timely biopsy of skin lesions is imperative, particularly at a patient’s request or when a change is noted.

Did history of headaches hinder a thorough evaluation?

A THROBBING HEADACHE that became increasingly worse over 48 hours prompted a 43-year-old woman to go to her doctor’s office. She reported nausea, vomiting, and photophobia to the covering physician. The woman had a history of headaches, which she attributed to previous ear surgery. The physician prescribed pain and antinausea medications and told the patient to follow up with her regular primary care physician.

The patient went home and fell asleep on her couch; she subsequently died in her sleep. An autopsy cited bacterial meningitis as the cause of death.

PLAINTIFF’S CLAIM The question of whether the covering physician should have considered bacterial meningitis turned on whether the patient had nuchal rigidity. Witnesses called by the plaintiff testified that the patient couldn’t move her neck during the period in question.

THE DEFENSE The physician conceded that if he’d observed nuchal rigidity, he would have considered bacterial meningitis. He testified that the patient didn’t have nuchal rigidity but that he hadn’t recorded that finding.

VERDICT $1.45 million Massachusetts settlement.

COMMENT Although most headaches are explained by relatively benign causes, serious problems such as meningitis or hemorrhage should always remain in the differential diagnosis. And complete documentation is key to a successful malpractice defense.

Failure to biopsy “cyst” delays cancer diagnosis

A 42-YEAR-OLD WOMAN consulted a dermatologist in October about a suspicious lesion on her face. The dermatologist diagnosed a benign cyst. The patient wanted the lesion removed; the dermatologist instead told her to return in the spring. He didn’t perform a biopsy or refer the patient to a plastic surgeon for a biopsy.

By the following May, the patient observed that the lesion was growing, comprising 2 lumps instead of 1, and had become inflamed. She immediately consulted the dermatologist, who maintained that the lesion was a cyst and didn’t biopsy it. He injected cortisone to shrink the lesion.

When the patient visited her family physician the next day for an unrelated matter, the doctor expressed concern about the facial lesion and referred the patient to a plastic surgeon, who performed a biopsy. The biopsy revealed liposarcoma.

The patient underwent 4 surgeries and extensive radiation therapy. The surgery severely disfigured her face. She subsequently developed necrosis of the cheek bone, necessitating surgical debridement and leading to the loss of 4 teeth. Extensive burns to her mouth, face, and neck as well as scar tissue made it difficult for her to open her mouth to eat and speak. She ultimately underwent 8 reconstructive facial operations.

PLAINTIFF’S CLAIM The dermatologist was negligent in failing to perform a biopsy. If the cancer had been diagnosed in October, it could have been excised easily with 1 surgery; the patient wouldn’t have needed extensive radiation or reconstructive surgeries. The delay in diagnosis increased the risk of recurrence and spread of the cancer.

THE DEFENSE Referral to a plastic surgeon was discussed in October, a claim the patient denied. The patient would have required the same treatment even if the cancer had been diagnosed in October because the cancer had been deep in the jaw muscle for several years, and had become more aggressive and appeared as a lesion on the face shortly before the patient’s initial visit.

VERDICT $5.35 million Pennsylvania verdict.

COMMENT Timely biopsy of skin lesions is imperative, particularly at a patient’s request or when a change is noted.

Did history of headaches hinder a thorough evaluation?

A THROBBING HEADACHE that became increasingly worse over 48 hours prompted a 43-year-old woman to go to her doctor’s office. She reported nausea, vomiting, and photophobia to the covering physician. The woman had a history of headaches, which she attributed to previous ear surgery. The physician prescribed pain and antinausea medications and told the patient to follow up with her regular primary care physician.

The patient went home and fell asleep on her couch; she subsequently died in her sleep. An autopsy cited bacterial meningitis as the cause of death.

PLAINTIFF’S CLAIM The question of whether the covering physician should have considered bacterial meningitis turned on whether the patient had nuchal rigidity. Witnesses called by the plaintiff testified that the patient couldn’t move her neck during the period in question.

THE DEFENSE The physician conceded that if he’d observed nuchal rigidity, he would have considered bacterial meningitis. He testified that the patient didn’t have nuchal rigidity but that he hadn’t recorded that finding.

VERDICT $1.45 million Massachusetts settlement.

COMMENT Although most headaches are explained by relatively benign causes, serious problems such as meningitis or hemorrhage should always remain in the differential diagnosis. And complete documentation is key to a successful malpractice defense.

Responsibility for delayed Dx cuts both ways

A 44-YEAR-OLD WOMAN went to a university medical clinic complaining of weight gain and fatigue. The clinic was staffed by residents supervised by clinical faculty. The resident who examined the woman found a 1.5-cm mobile mass in one of her breasts. After consultation with the supervising physician, a mammogram with ultrasound was ordered. The supervising physician didn’t see the patient, but signed off on the treatment plan.

The mammogram was performed 2 days later and the mass was evaluated as probably benign. The patient was advised to follow up in 6 months. A month later, a second resident consulted with the patient and told her that she could have a biopsy or follow her condition on her own. The patient decided against a biopsy.

Eight months later, the clinic sent a reminder to the patient to return for follow-up, which she did. At that time, the skin on her breast had the texture of orange rind and the mass had grown. Metastatic breast cancer was diagnosed. Aggressive treatment was recommended, but the patient opted for herbal and other homeopathic remedies.

The initial trial of the case ended in a defense verdict, which was appealed after the patient died. A second trial led to a verdict finding the supervising physician 99% at fault and the patient 1% at fault. The jury award was set aside by the trial court.

PLAINTIFF’S CLAIM Failure to diagnose breast cancer promptly constituted negligence. A needle biopsy was needed.

THE DEFENSE The follow-up plan was reasonable; the patient didn’t return for evaluation when her condition changed.

VERDICT $2.4 million verdict in the second trial, set aside by a Tennessee judge.

COMMENT Failure to appropriately diagnose breast cancer is a leading cause of medical malpractice. A persistent breast mass, no matter the mammographic findings, needs to be followed aggressively and appropriate evaluation and referral pursued.

Missed pulmonary embolism proves fatal

TWO FAINTING EPISODES caused a 41-year-old man to be transported to the emergency department (ED), where he was found to have decreased blood oxygenation, increased respiratory rate, and heart strain. The patient had hypertension and had recently taken 2 4-hour airplane trips.

An ED physician examined the man initially and admitted him to the hospital. About 12 hours after admission, an attending family physician saw the patient, but didn’t order any immediate testing. The patient subsequently died from a pulmonary embolism.

PLAINTIFFS’ CLAIM Prompt testing was needed to rule out pulmonary embolism.

THE DEFENSE Fainting isn’t a common sign of pulmonary embolism. A 4-hour plane ride usually isn’t sufficient to cause deep vein thrombosis.

VERDICT $975,000 New Jersey settlement.

COMMENT Although pulmonary embolism certainly has more classic presentations than this one, the combination of the patient’s history and clinical findings were of sufficient concern to warrant prompt evaluation.

Warfarin + a twisted back = bad outcome

A FALL DOWN A FLIGHT OF STAIRS in her home caused an 85-year-old woman to twist her back when she grabbed for the bannister (she caught herself before landing). She was taken to an emergency department, where the staff noted that she was taking warfarin; she was diagnosed with acute low back pain and strain. The patient continued to receive anticoagulation therapy.

Because the patient also had decreased sensation in her lower legs, a magnetic resonance imaging (MRI) scan of the lumbosacral spine was ordered. The wet read of the MRI reported degenerative joint disease at L4-5 and mild-to-moderate spinal stenosis at L1-2, L2-3, L3-4, and L4-5, with no other abnormalities. The radiologist who issued the formal report described similar findings.

The next morning, the patient complained of numbness in her legs. She couldn’t move either leg and needed help to turn in bed. By noon, she had minimal motor control of her legs and couldn’t stand.

The attending physician was notified, but didn’t assess the woman. When a nurse called the doctor to let her know that the physical therapist had concerns about the patient, the doctor said that she’d address the concerns the following morning.

A neurologist ultimately assessed the patient and reported that she had neurologic deficits in her legs that interfered with her ability to walk. The patient continues to have significantly impaired function in her legs.

PLAINTIFF’S CLAIM The radiologists failed to identify abnormal signal intensity on the MRI, which should have raised concerns about bleeding and prompted an immediate assessment. The patient’s warfarin therapy wasn’t managed properly.

THE DEFENSE Subdural bleeding in the spine is rare. The fall caused the neurologic impairment, which was unlikely to improve regardless of the timing of diagnosis or treatment. The proper orders were given based on the reported MRI results. Discontinuing warfarin posed a risk in light of the patient’s history of mini-strokes.

VERDICT $1.5 million Massachusetts settlement.

COMMENT Although we could debate the cause of this patient’s disability, anyone on warfarin is at risk for occult bleeding and requires careful assessment after a fall or injury.

Colon cancer blamed on failure to screen

AFTER HER PHYSICIAN LEFT HIS PRACTICE, a woman started seeing another doctor in the practice almost exclusively. The second doctor never discussed or recommended colon cancer screening. Seven years later, at 66 years of age, the patient was diagnosed with stage IIB adenocarcinoma of the colon. She underwent surgery to remove part of the large intestine and required 6 months of chemotherapy.

PLAINTIFF’S CLAIM The doctor was negligent for failing to recommend colon cancer screening. The patient wouldn’t have developed cancer if she’d undergone screening.

THE DEFENSE A screening recommendation wasn’t required because the patient visited the doctor’s office only for acute-care issues.

VERDICT $357,130 Illinois verdict.

COMMENT Even patients who are casual users of our practices should receive clearly documented screening recommendations or requests to have a complete physical.

Quinolone leads to tendon damage in patient with known allergy

SINUSITIS PROMPTED A 35-YEAR-OLD WOMAN to visit an otolaryngologist. The physician prescribed moxifloxacin, despite the woman’s well-documented history of allergy to quinolone antibiotics.

After 2 doses of the drug, the patient developed a reaction marked by tendon damage in the hips. She suffered ongoing limited mobility, which affected her work and interfered with her ability to pursue her hobbies.

PLAINTIFF’S CLAIM The doctor was negligent in prescribing moxifloxacin.

THE DEFENSE Although moxifloxacin belongs to the quinolone antibiotic class, it has differences that make prescribing it a matter of judgment.

VERDICT $203,614 Kentucky verdict.

COMMENT Although we don’t know the exact nature of the patient’s “allergy” to quinolone antibiotics—we all know of cases in which allergy is defined as a bit of diarrhea or stomach upset. I have to wonder whether the decision-making process that led to using moxifloxacin (instead of another antibiotic) was documented clearly.

Responsibility for delayed Dx cuts both ways

A 44-YEAR-OLD WOMAN went to a university medical clinic complaining of weight gain and fatigue. The clinic was staffed by residents supervised by clinical faculty. The resident who examined the woman found a 1.5-cm mobile mass in one of her breasts. After consultation with the supervising physician, a mammogram with ultrasound was ordered. The supervising physician didn’t see the patient, but signed off on the treatment plan.

The mammogram was performed 2 days later and the mass was evaluated as probably benign. The patient was advised to follow up in 6 months. A month later, a second resident consulted with the patient and told her that she could have a biopsy or follow her condition on her own. The patient decided against a biopsy.

Eight months later, the clinic sent a reminder to the patient to return for follow-up, which she did. At that time, the skin on her breast had the texture of orange rind and the mass had grown. Metastatic breast cancer was diagnosed. Aggressive treatment was recommended, but the patient opted for herbal and other homeopathic remedies.

The initial trial of the case ended in a defense verdict, which was appealed after the patient died. A second trial led to a verdict finding the supervising physician 99% at fault and the patient 1% at fault. The jury award was set aside by the trial court.

PLAINTIFF’S CLAIM Failure to diagnose breast cancer promptly constituted negligence. A needle biopsy was needed.

THE DEFENSE The follow-up plan was reasonable; the patient didn’t return for evaluation when her condition changed.

VERDICT $2.4 million verdict in the second trial, set aside by a Tennessee judge.

COMMENT Failure to appropriately diagnose breast cancer is a leading cause of medical malpractice. A persistent breast mass, no matter the mammographic findings, needs to be followed aggressively and appropriate evaluation and referral pursued.

Missed pulmonary embolism proves fatal

TWO FAINTING EPISODES caused a 41-year-old man to be transported to the emergency department (ED), where he was found to have decreased blood oxygenation, increased respiratory rate, and heart strain. The patient had hypertension and had recently taken 2 4-hour airplane trips.

An ED physician examined the man initially and admitted him to the hospital. About 12 hours after admission, an attending family physician saw the patient, but didn’t order any immediate testing. The patient subsequently died from a pulmonary embolism.

PLAINTIFFS’ CLAIM Prompt testing was needed to rule out pulmonary embolism.

THE DEFENSE Fainting isn’t a common sign of pulmonary embolism. A 4-hour plane ride usually isn’t sufficient to cause deep vein thrombosis.

VERDICT $975,000 New Jersey settlement.

COMMENT Although pulmonary embolism certainly has more classic presentations than this one, the combination of the patient’s history and clinical findings were of sufficient concern to warrant prompt evaluation.

Warfarin + a twisted back = bad outcome

A FALL DOWN A FLIGHT OF STAIRS in her home caused an 85-year-old woman to twist her back when she grabbed for the bannister (she caught herself before landing). She was taken to an emergency department, where the staff noted that she was taking warfarin; she was diagnosed with acute low back pain and strain. The patient continued to receive anticoagulation therapy.

Because the patient also had decreased sensation in her lower legs, a magnetic resonance imaging (MRI) scan of the lumbosacral spine was ordered. The wet read of the MRI reported degenerative joint disease at L4-5 and mild-to-moderate spinal stenosis at L1-2, L2-3, L3-4, and L4-5, with no other abnormalities. The radiologist who issued the formal report described similar findings.

The next morning, the patient complained of numbness in her legs. She couldn’t move either leg and needed help to turn in bed. By noon, she had minimal motor control of her legs and couldn’t stand.

The attending physician was notified, but didn’t assess the woman. When a nurse called the doctor to let her know that the physical therapist had concerns about the patient, the doctor said that she’d address the concerns the following morning.

A neurologist ultimately assessed the patient and reported that she had neurologic deficits in her legs that interfered with her ability to walk. The patient continues to have significantly impaired function in her legs.

PLAINTIFF’S CLAIM The radiologists failed to identify abnormal signal intensity on the MRI, which should have raised concerns about bleeding and prompted an immediate assessment. The patient’s warfarin therapy wasn’t managed properly.

THE DEFENSE Subdural bleeding in the spine is rare. The fall caused the neurologic impairment, which was unlikely to improve regardless of the timing of diagnosis or treatment. The proper orders were given based on the reported MRI results. Discontinuing warfarin posed a risk in light of the patient’s history of mini-strokes.

VERDICT $1.5 million Massachusetts settlement.

COMMENT Although we could debate the cause of this patient’s disability, anyone on warfarin is at risk for occult bleeding and requires careful assessment after a fall or injury.

Colon cancer blamed on failure to screen

AFTER HER PHYSICIAN LEFT HIS PRACTICE, a woman started seeing another doctor in the practice almost exclusively. The second doctor never discussed or recommended colon cancer screening. Seven years later, at 66 years of age, the patient was diagnosed with stage IIB adenocarcinoma of the colon. She underwent surgery to remove part of the large intestine and required 6 months of chemotherapy.

PLAINTIFF’S CLAIM The doctor was negligent for failing to recommend colon cancer screening. The patient wouldn’t have developed cancer if she’d undergone screening.

THE DEFENSE A screening recommendation wasn’t required because the patient visited the doctor’s office only for acute-care issues.

VERDICT $357,130 Illinois verdict.

COMMENT Even patients who are casual users of our practices should receive clearly documented screening recommendations or requests to have a complete physical.

Quinolone leads to tendon damage in patient with known allergy

SINUSITIS PROMPTED A 35-YEAR-OLD WOMAN to visit an otolaryngologist. The physician prescribed moxifloxacin, despite the woman’s well-documented history of allergy to quinolone antibiotics.

After 2 doses of the drug, the patient developed a reaction marked by tendon damage in the hips. She suffered ongoing limited mobility, which affected her work and interfered with her ability to pursue her hobbies.

PLAINTIFF’S CLAIM The doctor was negligent in prescribing moxifloxacin.

THE DEFENSE Although moxifloxacin belongs to the quinolone antibiotic class, it has differences that make prescribing it a matter of judgment.

VERDICT $203,614 Kentucky verdict.

COMMENT Although we don’t know the exact nature of the patient’s “allergy” to quinolone antibiotics—we all know of cases in which allergy is defined as a bit of diarrhea or stomach upset. I have to wonder whether the decision-making process that led to using moxifloxacin (instead of another antibiotic) was documented clearly.

Responsibility for delayed Dx cuts both ways

A 44-YEAR-OLD WOMAN went to a university medical clinic complaining of weight gain and fatigue. The clinic was staffed by residents supervised by clinical faculty. The resident who examined the woman found a 1.5-cm mobile mass in one of her breasts. After consultation with the supervising physician, a mammogram with ultrasound was ordered. The supervising physician didn’t see the patient, but signed off on the treatment plan.

The mammogram was performed 2 days later and the mass was evaluated as probably benign. The patient was advised to follow up in 6 months. A month later, a second resident consulted with the patient and told her that she could have a biopsy or follow her condition on her own. The patient decided against a biopsy.

Eight months later, the clinic sent a reminder to the patient to return for follow-up, which she did. At that time, the skin on her breast had the texture of orange rind and the mass had grown. Metastatic breast cancer was diagnosed. Aggressive treatment was recommended, but the patient opted for herbal and other homeopathic remedies.

The initial trial of the case ended in a defense verdict, which was appealed after the patient died. A second trial led to a verdict finding the supervising physician 99% at fault and the patient 1% at fault. The jury award was set aside by the trial court.

PLAINTIFF’S CLAIM Failure to diagnose breast cancer promptly constituted negligence. A needle biopsy was needed.

THE DEFENSE The follow-up plan was reasonable; the patient didn’t return for evaluation when her condition changed.

VERDICT $2.4 million verdict in the second trial, set aside by a Tennessee judge.

COMMENT Failure to appropriately diagnose breast cancer is a leading cause of medical malpractice. A persistent breast mass, no matter the mammographic findings, needs to be followed aggressively and appropriate evaluation and referral pursued.

Missed pulmonary embolism proves fatal

TWO FAINTING EPISODES caused a 41-year-old man to be transported to the emergency department (ED), where he was found to have decreased blood oxygenation, increased respiratory rate, and heart strain. The patient had hypertension and had recently taken 2 4-hour airplane trips.

An ED physician examined the man initially and admitted him to the hospital. About 12 hours after admission, an attending family physician saw the patient, but didn’t order any immediate testing. The patient subsequently died from a pulmonary embolism.

PLAINTIFFS’ CLAIM Prompt testing was needed to rule out pulmonary embolism.

THE DEFENSE Fainting isn’t a common sign of pulmonary embolism. A 4-hour plane ride usually isn’t sufficient to cause deep vein thrombosis.

VERDICT $975,000 New Jersey settlement.

COMMENT Although pulmonary embolism certainly has more classic presentations than this one, the combination of the patient’s history and clinical findings were of sufficient concern to warrant prompt evaluation.

Warfarin + a twisted back = bad outcome

A FALL DOWN A FLIGHT OF STAIRS in her home caused an 85-year-old woman to twist her back when she grabbed for the bannister (she caught herself before landing). She was taken to an emergency department, where the staff noted that she was taking warfarin; she was diagnosed with acute low back pain and strain. The patient continued to receive anticoagulation therapy.

Because the patient also had decreased sensation in her lower legs, a magnetic resonance imaging (MRI) scan of the lumbosacral spine was ordered. The wet read of the MRI reported degenerative joint disease at L4-5 and mild-to-moderate spinal stenosis at L1-2, L2-3, L3-4, and L4-5, with no other abnormalities. The radiologist who issued the formal report described similar findings.

The next morning, the patient complained of numbness in her legs. She couldn’t move either leg and needed help to turn in bed. By noon, she had minimal motor control of her legs and couldn’t stand.

The attending physician was notified, but didn’t assess the woman. When a nurse called the doctor to let her know that the physical therapist had concerns about the patient, the doctor said that she’d address the concerns the following morning.

A neurologist ultimately assessed the patient and reported that she had neurologic deficits in her legs that interfered with her ability to walk. The patient continues to have significantly impaired function in her legs.

PLAINTIFF’S CLAIM The radiologists failed to identify abnormal signal intensity on the MRI, which should have raised concerns about bleeding and prompted an immediate assessment. The patient’s warfarin therapy wasn’t managed properly.

THE DEFENSE Subdural bleeding in the spine is rare. The fall caused the neurologic impairment, which was unlikely to improve regardless of the timing of diagnosis or treatment. The proper orders were given based on the reported MRI results. Discontinuing warfarin posed a risk in light of the patient’s history of mini-strokes.

VERDICT $1.5 million Massachusetts settlement.

COMMENT Although we could debate the cause of this patient’s disability, anyone on warfarin is at risk for occult bleeding and requires careful assessment after a fall or injury.

Colon cancer blamed on failure to screen

AFTER HER PHYSICIAN LEFT HIS PRACTICE, a woman started seeing another doctor in the practice almost exclusively. The second doctor never discussed or recommended colon cancer screening. Seven years later, at 66 years of age, the patient was diagnosed with stage IIB adenocarcinoma of the colon. She underwent surgery to remove part of the large intestine and required 6 months of chemotherapy.

PLAINTIFF’S CLAIM The doctor was negligent for failing to recommend colon cancer screening. The patient wouldn’t have developed cancer if she’d undergone screening.

THE DEFENSE A screening recommendation wasn’t required because the patient visited the doctor’s office only for acute-care issues.

VERDICT $357,130 Illinois verdict.

COMMENT Even patients who are casual users of our practices should receive clearly documented screening recommendations or requests to have a complete physical.

Quinolone leads to tendon damage in patient with known allergy

SINUSITIS PROMPTED A 35-YEAR-OLD WOMAN to visit an otolaryngologist. The physician prescribed moxifloxacin, despite the woman’s well-documented history of allergy to quinolone antibiotics.

After 2 doses of the drug, the patient developed a reaction marked by tendon damage in the hips. She suffered ongoing limited mobility, which affected her work and interfered with her ability to pursue her hobbies.

PLAINTIFF’S CLAIM The doctor was negligent in prescribing moxifloxacin.

THE DEFENSE Although moxifloxacin belongs to the quinolone antibiotic class, it has differences that make prescribing it a matter of judgment.

VERDICT $203,614 Kentucky verdict.

COMMENT Although we don’t know the exact nature of the patient’s “allergy” to quinolone antibiotics—we all know of cases in which allergy is defined as a bit of diarrhea or stomach upset. I have to wonder whether the decision-making process that led to using moxifloxacin (instead of another antibiotic) was documented clearly.

Lethal liver injury blamed on birth trauma

BECAUSE OF PREMATURE CONTRACTIONS and bleeding, a woman underwent cesarean delivery by her ObGyns. When Dr. A reached in to extract the fetus, it floated away. Dr. B then attempted delivery while Dr. A applied fundal pressure. Photographs of the baby taken by the father 2 minutes after birth showed severe bruising over the liver area. Sonography performed shortly after birth revealed a liver laceration. Surgery to repair the liver was unsuccessful. The infant died.

ESTATE’S CLAIM The trauma from improper fundal pressure and improper manipulation when extracting the infant through an inadequately sized incision caused the liver to rupture. A vertical incision should have been made initially, instead of a transverse incision, because of the small size of the fetus and uterus. When the fetus could not be extracted, a reverse “T” incision should have been made so the fetus could be extracted without trauma.

PHYSICIANS’ DEFENSE The mother had a preexisting disorder that caused bleeding before delivery; the liver laceration occurred hours before delivery.

VERDICT A $1,461,507 Maryland verdict was returned, including $461,507 to the infant’s estate, and $500,000 to each parent.

Perforated colon after hysteroscopy

A 44-YEAR-OLD WOMAN UNDERWENT hysteroscopic surgery to remove polyps and a fibroid tumor. During the procedure, the ObGyn used a hysteroscopic resection loop. Two days later, the patient developed peritonitis. A perforation was detected, requiring resection of part of the colon and a temporary colostomy.

PATIENT’S CLAIM The injury occurred when the ObGyn pushed the resection loop of the hysteroscope through the uterus, burning a hole in the uterus and the colon. The ObGyn should have performed a more extensive check to ensure that no perforation had occurred.

PHYSICIAN’S DEFENSE Perforation was a delayed thermal effect that did not occur until 2 days after the procedure. There was no negligence.

VERDICT A $1.55 million New York verdict was returned.

Did retractors cause neuropathy?

AFTER CERVICAL CANCER was diagnosed, a 37-year-old woman was referred to a gynecologic oncologist. He performed a modified radical hysterectomy with pelvic node dissection and lymphadenectomy. A Pfannenstiel incision was used, and the procedure involved removal of the uterus, cervix, upper quarter of the vagina, pelvic lymph nodes, and surrounding tissue. Surgery lasted longer than 5 hours.

The next day, the patient reported pain, burning, tingling, and numbness in her left thigh, which was eventually diagnosed as lateral femoral cutaneous neuropathy. This condition did not resolve.

PATIENT’S CLAIM The surgeon failed to reposition retractors with sufficient frequency. He allowed the retractor blades to press on the psoas muscles, thus injuring the lateral femoral cutaneous nerve.

PHYSICIAN’S DEFENSE The retractors were used properly; they were periodically shifted to gain better exposure to the surgical area. The surgeon also used his hands to determine that the retractors were properly positioned.

VERDICT An Illinois defense verdict was returned.

“I would have terminated my pregnancy if…”

A PREGNANT WOMAN UNDERWENT a blood test that indicated that the fetus had an elevated risk of being born with Down syndrome. The child was born 7 months later with Down syndrome.

PATIENT’S CLAIM She was not told of the increased risk that her child would have Down syndrome. If she had been informed, she would have terminated the pregnancy.

PHYSICIAN’S DEFENSE According to the physician’s records, the mother was told the blood test results many times. Amniocentesis was recommended, but the mother had declined.

VERDICT A Maryland defense verdict was returned.

Lethal liver injury blamed on birth trauma

BECAUSE OF PREMATURE CONTRACTIONS and bleeding, a woman underwent cesarean delivery by her ObGyns. When Dr. A reached in to extract the fetus, it floated away. Dr. B then attempted delivery while Dr. A applied fundal pressure. Photographs of the baby taken by the father 2 minutes after birth showed severe bruising over the liver area. Sonography performed shortly after birth revealed a liver laceration. Surgery to repair the liver was unsuccessful. The infant died.

ESTATE’S CLAIM The trauma from improper fundal pressure and improper manipulation when extracting the infant through an inadequately sized incision caused the liver to rupture. A vertical incision should have been made initially, instead of a transverse incision, because of the small size of the fetus and uterus. When the fetus could not be extracted, a reverse “T” incision should have been made so the fetus could be extracted without trauma.

PHYSICIANS’ DEFENSE The mother had a preexisting disorder that caused bleeding before delivery; the liver laceration occurred hours before delivery.

VERDICT A $1,461,507 Maryland verdict was returned, including $461,507 to the infant’s estate, and $500,000 to each parent.

Perforated colon after hysteroscopy

A 44-YEAR-OLD WOMAN UNDERWENT hysteroscopic surgery to remove polyps and a fibroid tumor. During the procedure, the ObGyn used a hysteroscopic resection loop. Two days later, the patient developed peritonitis. A perforation was detected, requiring resection of part of the colon and a temporary colostomy.

PATIENT’S CLAIM The injury occurred when the ObGyn pushed the resection loop of the hysteroscope through the uterus, burning a hole in the uterus and the colon. The ObGyn should have performed a more extensive check to ensure that no perforation had occurred.

PHYSICIAN’S DEFENSE Perforation was a delayed thermal effect that did not occur until 2 days after the procedure. There was no negligence.

VERDICT A $1.55 million New York verdict was returned.

Did retractors cause neuropathy?

AFTER CERVICAL CANCER was diagnosed, a 37-year-old woman was referred to a gynecologic oncologist. He performed a modified radical hysterectomy with pelvic node dissection and lymphadenectomy. A Pfannenstiel incision was used, and the procedure involved removal of the uterus, cervix, upper quarter of the vagina, pelvic lymph nodes, and surrounding tissue. Surgery lasted longer than 5 hours.

The next day, the patient reported pain, burning, tingling, and numbness in her left thigh, which was eventually diagnosed as lateral femoral cutaneous neuropathy. This condition did not resolve.

PATIENT’S CLAIM The surgeon failed to reposition retractors with sufficient frequency. He allowed the retractor blades to press on the psoas muscles, thus injuring the lateral femoral cutaneous nerve.

PHYSICIAN’S DEFENSE The retractors were used properly; they were periodically shifted to gain better exposure to the surgical area. The surgeon also used his hands to determine that the retractors were properly positioned.

VERDICT An Illinois defense verdict was returned.

“I would have terminated my pregnancy if…”

A PREGNANT WOMAN UNDERWENT a blood test that indicated that the fetus had an elevated risk of being born with Down syndrome. The child was born 7 months later with Down syndrome.

PATIENT’S CLAIM She was not told of the increased risk that her child would have Down syndrome. If she had been informed, she would have terminated the pregnancy.

PHYSICIAN’S DEFENSE According to the physician’s records, the mother was told the blood test results many times. Amniocentesis was recommended, but the mother had declined.

VERDICT A Maryland defense verdict was returned.

Lethal liver injury blamed on birth trauma

BECAUSE OF PREMATURE CONTRACTIONS and bleeding, a woman underwent cesarean delivery by her ObGyns. When Dr. A reached in to extract the fetus, it floated away. Dr. B then attempted delivery while Dr. A applied fundal pressure. Photographs of the baby taken by the father 2 minutes after birth showed severe bruising over the liver area. Sonography performed shortly after birth revealed a liver laceration. Surgery to repair the liver was unsuccessful. The infant died.

ESTATE’S CLAIM The trauma from improper fundal pressure and improper manipulation when extracting the infant through an inadequately sized incision caused the liver to rupture. A vertical incision should have been made initially, instead of a transverse incision, because of the small size of the fetus and uterus. When the fetus could not be extracted, a reverse “T” incision should have been made so the fetus could be extracted without trauma.

PHYSICIANS’ DEFENSE The mother had a preexisting disorder that caused bleeding before delivery; the liver laceration occurred hours before delivery.

VERDICT A $1,461,507 Maryland verdict was returned, including $461,507 to the infant’s estate, and $500,000 to each parent.

Perforated colon after hysteroscopy

A 44-YEAR-OLD WOMAN UNDERWENT hysteroscopic surgery to remove polyps and a fibroid tumor. During the procedure, the ObGyn used a hysteroscopic resection loop. Two days later, the patient developed peritonitis. A perforation was detected, requiring resection of part of the colon and a temporary colostomy.

PATIENT’S CLAIM The injury occurred when the ObGyn pushed the resection loop of the hysteroscope through the uterus, burning a hole in the uterus and the colon. The ObGyn should have performed a more extensive check to ensure that no perforation had occurred.

PHYSICIAN’S DEFENSE Perforation was a delayed thermal effect that did not occur until 2 days after the procedure. There was no negligence.

VERDICT A $1.55 million New York verdict was returned.

Did retractors cause neuropathy?

AFTER CERVICAL CANCER was diagnosed, a 37-year-old woman was referred to a gynecologic oncologist. He performed a modified radical hysterectomy with pelvic node dissection and lymphadenectomy. A Pfannenstiel incision was used, and the procedure involved removal of the uterus, cervix, upper quarter of the vagina, pelvic lymph nodes, and surrounding tissue. Surgery lasted longer than 5 hours.

The next day, the patient reported pain, burning, tingling, and numbness in her left thigh, which was eventually diagnosed as lateral femoral cutaneous neuropathy. This condition did not resolve.

PATIENT’S CLAIM The surgeon failed to reposition retractors with sufficient frequency. He allowed the retractor blades to press on the psoas muscles, thus injuring the lateral femoral cutaneous nerve.

PHYSICIAN’S DEFENSE The retractors were used properly; they were periodically shifted to gain better exposure to the surgical area. The surgeon also used his hands to determine that the retractors were properly positioned.

VERDICT An Illinois defense verdict was returned.

“I would have terminated my pregnancy if…”

A PREGNANT WOMAN UNDERWENT a blood test that indicated that the fetus had an elevated risk of being born with Down syndrome. The child was born 7 months later with Down syndrome.

PATIENT’S CLAIM She was not told of the increased risk that her child would have Down syndrome. If she had been informed, she would have terminated the pregnancy.

PHYSICIAN’S DEFENSE According to the physician’s records, the mother was told the blood test results many times. Amniocentesis was recommended, but the mother had declined.

VERDICT A Maryland defense verdict was returned.

What caused chronic pain after repair of the vaginal wall?

A WOMAN IN HER THIRTIES underwent anterior and posterior repair of the vaginal wall, including repair of a cystocele and a rectocystocele. Postoperatively, the patient developed a chronic pain syndrome.

PATIENT’S CLAIM The ObGyn failed to properly perform the surgery, and damaged the pudendal nerve, which causes chronic pain. The ObGyn moved the levator ani muscle; the muscle shifted into the vaginal canal and damaged the pudendal nerve. Informed consent was not obtained.

PHYSICIAN’S DEFENSE The patient was fully informed of all the procedure’s risks. The injury could not have been from displacement of the levator ani muscle because the muscle cannot reach the vaginal canal. Pain is from scar formation that is entrapping a nerve.

VERDICT A New York defense verdict was returned.

DVT + estrogen-based contraception=stroke?

AFTER A DEEP VENOUS THROMBOSIS (DVT) in her leg at age 29, a woman was told by her family physician to avoid birth control that contained estrogen. She claimed she told her ObGyn of the history of DVT and the no-estrogen advice, but he prescribed and inserted a Nuva Ring, which contains ethinyl estradiol. A few months later, the woman was hospitalized with a severe headache, and suffered a stroke that affected her speech and cognitive functions.

PATIENT’S CLAIM The ObGyn was negligent in prescribing a contraceptive that contained estrogen, knowing the patient’s history of blood clot.

PHYSICIAN’S DEFENSE An injury caused the first clot; the Nuva Ring did not cause the second clot or stroke.

VERDICT A $523,000 Georgia verdict was returned.

New mother dies; was preeclampsia treated properly?

AT HER SEVENTH-MONTH VISIT to her ObGyn (Dr. A), a woman began to show signs of preeclampsia. Two weeks later, she went to the emergency department (ED) with chest pain, cough, and shortness of breath; she was found to have hypertension and tachycardia. She was examined by an emergency medicine physician (Dr. B), and discharged with a diagnosis of bronchitis and a finding of dyspnea.

At a scheduled prenatal visit 2 days later, she was hypertensive. Dr. A sent her to the ED, where a physician assistant noted signs of edema in her extremities. Attempts to draw arterial blood were unsuccessful, and crackles were heard in her lungs. She was diagnosed as having worsening preeclampsia with pulmonary edema, and admitted.

Dr. C, another ObGyn, decided to perform a cesarean delivery, but on the way to the OR, the patient became unresponsive. After delivery, she went into cardiopulmonary arrest and sustained anoxic brain injury. She died after life support was removed. An autopsy determined cause of death was anoxic encephalopathy due to respiratory arrest caused by preeclampsia.

ESTATE’S CLAIM Dr. A failed to provide proper prenatal care, and failed to recognize preeclampsia. Dr. B failed to recognize preeclampsia, failed to contact a specialist, and failed to immediately admit the patient for monitoring and treatment. Dr. C negligently administered a bolus of IV fluids when the patient showed signs of preeclampsia. He failed to administer medication to reduce fluid retention, and failed to timely admit the patient to the hospital.

PHYSICIANS’ DEFENSE All three physicians denied negligence.

VERDICT A $1.5 million Michigan settlement was reached.

Did resident use forceful traction with shoulder dystocia?

SHOULDER DYSTOCIA was encountered during vaginal delivery, and managed by a resident. The child suffered a brachial plexus injury.

PATIENT’S CLAIM The attending physician failed to 1) properly supervise the resident who was delivering the infant, and 2) prevent the use of traction after it was determined that shoulder dystocia was present.

PHYSICIANS’ DEFENSE The resident, under full supervision of the attending physician, utilized traction after the baby’s head was delivered and shoulder dystocia became evident—but traction was gentle. The maternal forces of labor caused the injury.

VERDICT A $950,000 Virginia settlement was reached.

Was patient informed that tubal ligation had not been performed?

PREGNANT WITH HER FOURTH CHILD despite birth control, a woman and her husband told the ObGyn that they did not want, nor could they afford, a fifth child. They requested bilateral tubal ligation during cesarean delivery. Two days before the scheduled birth, the mother went into labor. Her prenatal records could not be found, and the ObGyn’s office was closed. The ObGyn delivered the baby, but did not perform tubal ligation. She claimed she was never told that the tubal ligation had not been completed, even at the 6-week postpartum visit. She did not take precautions to prevent pregnancy, and later conceived a fifth child.

PATIENT’S CLAIM The ObGyn was negligent in not performing the tubal ligation and in not telling the patient until after the fifth child’s conception.

PHYSICIAN’S DEFENSE The mother was told that tubal ligation had not been performed at the 6-week visit. She was advised to use birth control until she recovered from the cesarean delivery and could undergo a tubal ligation procedure. The ObGyn acknowledged he had forgotten to perform the tubal ligation at delivery, but insisted there was no negligence under the circumstances.

VERDICT A California defense verdict was returned.

Patient claims stomach injury caused GERD

DUE TO PELVIC PAIN, a woman underwent laparoscopy by her ObGyn. During the procedure, a trocar punctured her stomach. The injury was discovered, the procedure converted to a laparotomy with a vertical incision, and the injury repaired.

PATIENT’S CLAIM She developed gastroesophageal reflux disease (GERD) because of the puncture wound, and anxiety because of the scar.

PHYSICIAN’S DEFENSE Gastric perforation is a rare but recognized complication of abdominal laparoscopy, and can occur without negligence. Her GERD is either due to a hiatal hernia or pychosomatic disorder.

VERDICT A Virginia defense verdict was returned.

Physicians not responsible for stroke

SEVERAL DAYS AFTER GIVING BIRTH, a 33-year-old woman visited the ED with chest pain, headache, and abdominal pain. An emergency medicine physician and an ObGyn ordered a chest CT scan and administered anticoagulants. By the time the CT scan was completed, the woman denied having chest pain. No pulmonary emboli (PE) were detected on chest CT, and she was discharged.

The next day, she went to another hospital’s ED with a headache and right-side weakness. A CT scan revealed a large left parietal-lobe intracerebral hematoma. A ventricular catheter was placed and she underwent a stereotactic craniotomy for evacuation of the hematoma. She was transferred to a rehabilitation facility a month later.

She suffers permanent neurologic damage, including short-term memory loss and an inability to lift or walk for any great distance.

PATIENT’S CLAIM The ED physicians failed to diagnose and treat an acute neurologic event in a timely manner, and did not obtain specialist consults. Administration of anticoagulants was negligent; protamine therapy should have been started to reverse the anticoagulant effects. Laboratory testing of clotting times and a ventilation-perfusion lung scan should have been conducted to confirm the presence of PE.

PHYSICIANS’ DEFENSE The patient’s condition was appropriately diagnosed and treated in the ED. Administration of anticoagulants was necessary because of suspected PE. There is no evidence that the heparin given to the plaintiff the day before her stroke was related to the stroke.

VERDICT A Florida defense verdict was returned.

Did failure to diagnose preeclampsia lead to infant’s death?

AT 38-WEEKS’ GESTATION, a 21-year-old woman was seen at a hospital’s obstetric clinic, and sent to the ED with complaints of leaking fluid and lack of fetal movement. She claimed she showed signs of preeclampsia, pregnancy-induced hypertension, and oligohydramnios, but was not admitted to the hospital. The baby was born 2 days later with persistent pulmonary hypertension (PPH), which led to the child’s death at 33 days of age.

PATIENT’S CLAIM There was negligence in failing to diagnose preeclampsia, pregnancy-induced hypertension, and oligohydramnios, which caused the baby to be born with PPH.

PHYSICIAN’S DEFENSE The cause of the infant’s PPH was unknown, and most likely arose in utero prior to birth. An earlier delivery would not have resulted in a different outcome.

VERDICT A Illinois defense verdict was returned.

What caused chronic pain after repair of the vaginal wall?

A WOMAN IN HER THIRTIES underwent anterior and posterior repair of the vaginal wall, including repair of a cystocele and a rectocystocele. Postoperatively, the patient developed a chronic pain syndrome.

PATIENT’S CLAIM The ObGyn failed to properly perform the surgery, and damaged the pudendal nerve, which causes chronic pain. The ObGyn moved the levator ani muscle; the muscle shifted into the vaginal canal and damaged the pudendal nerve. Informed consent was not obtained.

PHYSICIAN’S DEFENSE The patient was fully informed of all the procedure’s risks. The injury could not have been from displacement of the levator ani muscle because the muscle cannot reach the vaginal canal. Pain is from scar formation that is entrapping a nerve.

VERDICT A New York defense verdict was returned.

DVT + estrogen-based contraception=stroke?

AFTER A DEEP VENOUS THROMBOSIS (DVT) in her leg at age 29, a woman was told by her family physician to avoid birth control that contained estrogen. She claimed she told her ObGyn of the history of DVT and the no-estrogen advice, but he prescribed and inserted a Nuva Ring, which contains ethinyl estradiol. A few months later, the woman was hospitalized with a severe headache, and suffered a stroke that affected her speech and cognitive functions.

PATIENT’S CLAIM The ObGyn was negligent in prescribing a contraceptive that contained estrogen, knowing the patient’s history of blood clot.

PHYSICIAN’S DEFENSE An injury caused the first clot; the Nuva Ring did not cause the second clot or stroke.

VERDICT A $523,000 Georgia verdict was returned.

New mother dies; was preeclampsia treated properly?

AT HER SEVENTH-MONTH VISIT to her ObGyn (Dr. A), a woman began to show signs of preeclampsia. Two weeks later, she went to the emergency department (ED) with chest pain, cough, and shortness of breath; she was found to have hypertension and tachycardia. She was examined by an emergency medicine physician (Dr. B), and discharged with a diagnosis of bronchitis and a finding of dyspnea.

At a scheduled prenatal visit 2 days later, she was hypertensive. Dr. A sent her to the ED, where a physician assistant noted signs of edema in her extremities. Attempts to draw arterial blood were unsuccessful, and crackles were heard in her lungs. She was diagnosed as having worsening preeclampsia with pulmonary edema, and admitted.

Dr. C, another ObGyn, decided to perform a cesarean delivery, but on the way to the OR, the patient became unresponsive. After delivery, she went into cardiopulmonary arrest and sustained anoxic brain injury. She died after life support was removed. An autopsy determined cause of death was anoxic encephalopathy due to respiratory arrest caused by preeclampsia.

ESTATE’S CLAIM Dr. A failed to provide proper prenatal care, and failed to recognize preeclampsia. Dr. B failed to recognize preeclampsia, failed to contact a specialist, and failed to immediately admit the patient for monitoring and treatment. Dr. C negligently administered a bolus of IV fluids when the patient showed signs of preeclampsia. He failed to administer medication to reduce fluid retention, and failed to timely admit the patient to the hospital.

PHYSICIANS’ DEFENSE All three physicians denied negligence.

VERDICT A $1.5 million Michigan settlement was reached.

Did resident use forceful traction with shoulder dystocia?

SHOULDER DYSTOCIA was encountered during vaginal delivery, and managed by a resident. The child suffered a brachial plexus injury.

PATIENT’S CLAIM The attending physician failed to 1) properly supervise the resident who was delivering the infant, and 2) prevent the use of traction after it was determined that shoulder dystocia was present.

PHYSICIANS’ DEFENSE The resident, under full supervision of the attending physician, utilized traction after the baby’s head was delivered and shoulder dystocia became evident—but traction was gentle. The maternal forces of labor caused the injury.

VERDICT A $950,000 Virginia settlement was reached.

Was patient informed that tubal ligation had not been performed?

PREGNANT WITH HER FOURTH CHILD despite birth control, a woman and her husband told the ObGyn that they did not want, nor could they afford, a fifth child. They requested bilateral tubal ligation during cesarean delivery. Two days before the scheduled birth, the mother went into labor. Her prenatal records could not be found, and the ObGyn’s office was closed. The ObGyn delivered the baby, but did not perform tubal ligation. She claimed she was never told that the tubal ligation had not been completed, even at the 6-week postpartum visit. She did not take precautions to prevent pregnancy, and later conceived a fifth child.

PATIENT’S CLAIM The ObGyn was negligent in not performing the tubal ligation and in not telling the patient until after the fifth child’s conception.

PHYSICIAN’S DEFENSE The mother was told that tubal ligation had not been performed at the 6-week visit. She was advised to use birth control until she recovered from the cesarean delivery and could undergo a tubal ligation procedure. The ObGyn acknowledged he had forgotten to perform the tubal ligation at delivery, but insisted there was no negligence under the circumstances.

VERDICT A California defense verdict was returned.

Patient claims stomach injury caused GERD

DUE TO PELVIC PAIN, a woman underwent laparoscopy by her ObGyn. During the procedure, a trocar punctured her stomach. The injury was discovered, the procedure converted to a laparotomy with a vertical incision, and the injury repaired.

PATIENT’S CLAIM She developed gastroesophageal reflux disease (GERD) because of the puncture wound, and anxiety because of the scar.

PHYSICIAN’S DEFENSE Gastric perforation is a rare but recognized complication of abdominal laparoscopy, and can occur without negligence. Her GERD is either due to a hiatal hernia or pychosomatic disorder.

VERDICT A Virginia defense verdict was returned.

Physicians not responsible for stroke

SEVERAL DAYS AFTER GIVING BIRTH, a 33-year-old woman visited the ED with chest pain, headache, and abdominal pain. An emergency medicine physician and an ObGyn ordered a chest CT scan and administered anticoagulants. By the time the CT scan was completed, the woman denied having chest pain. No pulmonary emboli (PE) were detected on chest CT, and she was discharged.

The next day, she went to another hospital’s ED with a headache and right-side weakness. A CT scan revealed a large left parietal-lobe intracerebral hematoma. A ventricular catheter was placed and she underwent a stereotactic craniotomy for evacuation of the hematoma. She was transferred to a rehabilitation facility a month later.

She suffers permanent neurologic damage, including short-term memory loss and an inability to lift or walk for any great distance.

PATIENT’S CLAIM The ED physicians failed to diagnose and treat an acute neurologic event in a timely manner, and did not obtain specialist consults. Administration of anticoagulants was negligent; protamine therapy should have been started to reverse the anticoagulant effects. Laboratory testing of clotting times and a ventilation-perfusion lung scan should have been conducted to confirm the presence of PE.

PHYSICIANS’ DEFENSE The patient’s condition was appropriately diagnosed and treated in the ED. Administration of anticoagulants was necessary because of suspected PE. There is no evidence that the heparin given to the plaintiff the day before her stroke was related to the stroke.

VERDICT A Florida defense verdict was returned.

Did failure to diagnose preeclampsia lead to infant’s death?

AT 38-WEEKS’ GESTATION, a 21-year-old woman was seen at a hospital’s obstetric clinic, and sent to the ED with complaints of leaking fluid and lack of fetal movement. She claimed she showed signs of preeclampsia, pregnancy-induced hypertension, and oligohydramnios, but was not admitted to the hospital. The baby was born 2 days later with persistent pulmonary hypertension (PPH), which led to the child’s death at 33 days of age.

PATIENT’S CLAIM There was negligence in failing to diagnose preeclampsia, pregnancy-induced hypertension, and oligohydramnios, which caused the baby to be born with PPH.

PHYSICIAN’S DEFENSE The cause of the infant’s PPH was unknown, and most likely arose in utero prior to birth. An earlier delivery would not have resulted in a different outcome.

VERDICT A Illinois defense verdict was returned.

What caused chronic pain after repair of the vaginal wall?

A WOMAN IN HER THIRTIES underwent anterior and posterior repair of the vaginal wall, including repair of a cystocele and a rectocystocele. Postoperatively, the patient developed a chronic pain syndrome.

PATIENT’S CLAIM The ObGyn failed to properly perform the surgery, and damaged the pudendal nerve, which causes chronic pain. The ObGyn moved the levator ani muscle; the muscle shifted into the vaginal canal and damaged the pudendal nerve. Informed consent was not obtained.

PHYSICIAN’S DEFENSE The patient was fully informed of all the procedure’s risks. The injury could not have been from displacement of the levator ani muscle because the muscle cannot reach the vaginal canal. Pain is from scar formation that is entrapping a nerve.

VERDICT A New York defense verdict was returned.

DVT + estrogen-based contraception=stroke?

AFTER A DEEP VENOUS THROMBOSIS (DVT) in her leg at age 29, a woman was told by her family physician to avoid birth control that contained estrogen. She claimed she told her ObGyn of the history of DVT and the no-estrogen advice, but he prescribed and inserted a Nuva Ring, which contains ethinyl estradiol. A few months later, the woman was hospitalized with a severe headache, and suffered a stroke that affected her speech and cognitive functions.

PATIENT’S CLAIM The ObGyn was negligent in prescribing a contraceptive that contained estrogen, knowing the patient’s history of blood clot.

PHYSICIAN’S DEFENSE An injury caused the first clot; the Nuva Ring did not cause the second clot or stroke.

VERDICT A $523,000 Georgia verdict was returned.

New mother dies; was preeclampsia treated properly?

AT HER SEVENTH-MONTH VISIT to her ObGyn (Dr. A), a woman began to show signs of preeclampsia. Two weeks later, she went to the emergency department (ED) with chest pain, cough, and shortness of breath; she was found to have hypertension and tachycardia. She was examined by an emergency medicine physician (Dr. B), and discharged with a diagnosis of bronchitis and a finding of dyspnea.

At a scheduled prenatal visit 2 days later, she was hypertensive. Dr. A sent her to the ED, where a physician assistant noted signs of edema in her extremities. Attempts to draw arterial blood were unsuccessful, and crackles were heard in her lungs. She was diagnosed as having worsening preeclampsia with pulmonary edema, and admitted.

Dr. C, another ObGyn, decided to perform a cesarean delivery, but on the way to the OR, the patient became unresponsive. After delivery, she went into cardiopulmonary arrest and sustained anoxic brain injury. She died after life support was removed. An autopsy determined cause of death was anoxic encephalopathy due to respiratory arrest caused by preeclampsia.

ESTATE’S CLAIM Dr. A failed to provide proper prenatal care, and failed to recognize preeclampsia. Dr. B failed to recognize preeclampsia, failed to contact a specialist, and failed to immediately admit the patient for monitoring and treatment. Dr. C negligently administered a bolus of IV fluids when the patient showed signs of preeclampsia. He failed to administer medication to reduce fluid retention, and failed to timely admit the patient to the hospital.

PHYSICIANS’ DEFENSE All three physicians denied negligence.

VERDICT A $1.5 million Michigan settlement was reached.

Did resident use forceful traction with shoulder dystocia?

SHOULDER DYSTOCIA was encountered during vaginal delivery, and managed by a resident. The child suffered a brachial plexus injury.

PATIENT’S CLAIM The attending physician failed to 1) properly supervise the resident who was delivering the infant, and 2) prevent the use of traction after it was determined that shoulder dystocia was present.

PHYSICIANS’ DEFENSE The resident, under full supervision of the attending physician, utilized traction after the baby’s head was delivered and shoulder dystocia became evident—but traction was gentle. The maternal forces of labor caused the injury.

VERDICT A $950,000 Virginia settlement was reached.

Was patient informed that tubal ligation had not been performed?

PREGNANT WITH HER FOURTH CHILD despite birth control, a woman and her husband told the ObGyn that they did not want, nor could they afford, a fifth child. They requested bilateral tubal ligation during cesarean delivery. Two days before the scheduled birth, the mother went into labor. Her prenatal records could not be found, and the ObGyn’s office was closed. The ObGyn delivered the baby, but did not perform tubal ligation. She claimed she was never told that the tubal ligation had not been completed, even at the 6-week postpartum visit. She did not take precautions to prevent pregnancy, and later conceived a fifth child.

PATIENT’S CLAIM The ObGyn was negligent in not performing the tubal ligation and in not telling the patient until after the fifth child’s conception.

PHYSICIAN’S DEFENSE The mother was told that tubal ligation had not been performed at the 6-week visit. She was advised to use birth control until she recovered from the cesarean delivery and could undergo a tubal ligation procedure. The ObGyn acknowledged he had forgotten to perform the tubal ligation at delivery, but insisted there was no negligence under the circumstances.

VERDICT A California defense verdict was returned.

Patient claims stomach injury caused GERD

DUE TO PELVIC PAIN, a woman underwent laparoscopy by her ObGyn. During the procedure, a trocar punctured her stomach. The injury was discovered, the procedure converted to a laparotomy with a vertical incision, and the injury repaired.

PATIENT’S CLAIM She developed gastroesophageal reflux disease (GERD) because of the puncture wound, and anxiety because of the scar.

PHYSICIAN’S DEFENSE Gastric perforation is a rare but recognized complication of abdominal laparoscopy, and can occur without negligence. Her GERD is either due to a hiatal hernia or pychosomatic disorder.

VERDICT A Virginia defense verdict was returned.

Physicians not responsible for stroke

SEVERAL DAYS AFTER GIVING BIRTH, a 33-year-old woman visited the ED with chest pain, headache, and abdominal pain. An emergency medicine physician and an ObGyn ordered a chest CT scan and administered anticoagulants. By the time the CT scan was completed, the woman denied having chest pain. No pulmonary emboli (PE) were detected on chest CT, and she was discharged.

The next day, she went to another hospital’s ED with a headache and right-side weakness. A CT scan revealed a large left parietal-lobe intracerebral hematoma. A ventricular catheter was placed and she underwent a stereotactic craniotomy for evacuation of the hematoma. She was transferred to a rehabilitation facility a month later.

She suffers permanent neurologic damage, including short-term memory loss and an inability to lift or walk for any great distance.

PATIENT’S CLAIM The ED physicians failed to diagnose and treat an acute neurologic event in a timely manner, and did not obtain specialist consults. Administration of anticoagulants was negligent; protamine therapy should have been started to reverse the anticoagulant effects. Laboratory testing of clotting times and a ventilation-perfusion lung scan should have been conducted to confirm the presence of PE.

PHYSICIANS’ DEFENSE The patient’s condition was appropriately diagnosed and treated in the ED. Administration of anticoagulants was necessary because of suspected PE. There is no evidence that the heparin given to the plaintiff the day before her stroke was related to the stroke.

VERDICT A Florida defense verdict was returned.

Did failure to diagnose preeclampsia lead to infant’s death?

AT 38-WEEKS’ GESTATION, a 21-year-old woman was seen at a hospital’s obstetric clinic, and sent to the ED with complaints of leaking fluid and lack of fetal movement. She claimed she showed signs of preeclampsia, pregnancy-induced hypertension, and oligohydramnios, but was not admitted to the hospital. The baby was born 2 days later with persistent pulmonary hypertension (PPH), which led to the child’s death at 33 days of age.

PATIENT’S CLAIM There was negligence in failing to diagnose preeclampsia, pregnancy-induced hypertension, and oligohydramnios, which caused the baby to be born with PPH.

PHYSICIAN’S DEFENSE The cause of the infant’s PPH was unknown, and most likely arose in utero prior to birth. An earlier delivery would not have resulted in a different outcome.

VERDICT A Illinois defense verdict was returned.

Large prolapsed fibroid left untreated—despite surgery

A 48-YEAR-OLD WOMAN PRESENTED to the emergency department (ED) with vaginal pain. A large, prolapsed uterine fibroid was diagnosed. Because she was scheduled for an ObGyn visit 2 days later, she was discharged without any treatment.

The next day, she returned to the ED with vaginal bleeding. Ultrasonography (US) showed multiple fibroids. Physical exam confirmed a prolapsed uterine fibroid extending into the vaginal vault. Her ObGyn performed an open myomectomy a few days later.

She called her ObGyn’s office prior to her scheduled postoperative visit because she still felt something in her vagina, and had pelvic pain and vaginal bleeding. She also reported this at the office visit, where she met with a nurse practitioner.

Two months later, she called the ObGyn’s office to complain of vaginal bleeding, and described passing large clots.

A month later, she saw a surgeon, who determined that the large prolapsed fibroid had never been removed. Surgery was scheduled, during which her uterus was removed. The patient was hospitalized for 11 days.

PATIENT’S CLAIM The ObGyn was negligent in failing to surgically remove the fibroid, perform postoperative US, and properly examine, diagnose, and treat her postoperatively. The ObGyn’s office staff failed to relay her telephone and in-person complaints to the physician.

DEFENDANTS’ DEFENSE The ObGyn and his group denied negligence.

VERDICT A $248,160 Georgia verdict was returned against the group.

Woman claims she was never told mammogram results

AFTER MANY NORMAL MAMMOGRAMS, a woman had an abnormal annual result. However, she claimed the physician did not inform her of the reported results. A year later, she was diagnosed with breast cancer.

PATIENT’S CLAIM The physician was negligent in failing to follow-up on the abnormal mammogram and make a correct diagnosis.

PHYSICIAN’S DEFENSE The woman had refused a recommended biopsy after the abnormal mammogram, and later refused mastectomy and radiation therapy. The patient’s outcome would have been the same even if treatment had begun shortly after the abnormal mammogram.

VERDICT A $175,000 verdict was returned in Indiana.

5,386-g newborn has Erb’s palsy

OXYTOCIN WAS ADMINISTERED after a woman’s labor slowed. During vaginal delivery, the ObGyn encountered and managed shoulder dystocia. The 11-lb, 14-oz infant was later given a diagnosis of Erb’s palsy.

PLAINTIFF’S CLAIM Excessive force during the ObGyn’s management of shoulder dystocia caused the Erb’s palsy. US should have been performed prior to delivery to determine fetal weight. Cesarean section may have prevented the injury.

PHYSICIAN’S DEFENSE Fetal weight was calculated at a time when vaginal delivery could not be safely discontinued. Excessive traction was not used; if it had been used, the injury would have been more significant.

VERDICT A New York jury returned a $485,000 verdict.

Was there delay in recognizing necrotizing fasciitis?

PREGNANT WITH TWINS, a 24-year-old woman was hospitalized at 33 weeks’ gestation, and remained there until delivery. There was no clinical evidence of fever or intrauterine infection during her hospitalization. Her anogenital culture for group B Streptococcus was positive. Clindamycin was begun 11 days prior to delivery, and continued after a successful cesarean delivery by her ObGyn.

Three days later, the mother suffered a high fever and marked elevation of her white blood cell count. The ObGyn reopened and drained the wound incision. Surgical debridement was not performed. The woman continued to deteriorate.

She developed extensive necrosis of the tissue around the abdominal wound, extending to the pannus and mons pubis. The ObGyn performed wide excision of the tissue. Necrotizing fasciitis was confirmed by pathology.

The woman was diagnosed with sepsis, multi-system organ failure, disseminated intravascular coagulopathy, and respiratory dependence. She was transferred to another hospital, where she remained until her death 3 months after delivery.

ESTATE’S CLAIM The ObGyn failed to diagnose and treat the necrotizing fasciitis in a timely manner. He failed to perform emergency surgical debridement when the lesions were first identified.

PHYSICIAN’S DEFENSE Antibiotics were ordered at the first sign of the vaginal strep infection and continued due to postsurgical wound infection.

Consultations with infectious disease specialists were obtained because of the patient’s history of extreme medication reaction and numerous antibiotic allergies. Although testing reported negative results for other infection sources, the patient failed to respond to treatment. Surgical debridement was performed when necessary, and as often as the patient was deemed able to tolerate the procedure.

VERDICT A Georgia verdict of $4,317,495 was returned.

ObGyn at fault for child’s brain injury and vision loss?

AT 22 WEEKS’ GESTATION, a woman presented to the ED with cramping and bleeding. A nurse called the woman’s ObGyn, who was not at the hospital; he ordered monitoring and laboratory tests. Two hours later, the bleeding and pain increased. The ObGyn was notified, although whether he was told about the excessive bleeding or not is in dispute. He ordered morphine. The patient was sent home without being seen by a physician, with instructions to follow-up with her ObGyn.

The woman claimed she called the hospital the next morning to report continued pain and bleeding, and was told to take a bath. She returned to the hospital the next evening. US revealed a dilated cervix with hour-glassing membranes. The child was delivered at 23-weeks’ gestation and suffers from a brain injury and vision loss.

PLAINTIFF’S CLAIM Premature delivery was due to an incompetent cervix, which could have been treated with cerclage. Diagnostic US and a physical examination by the ObGyn were never performed.

DEFENDANT’S DEFENSE Postdelivery evaluation of the placenta indicated that the mother had chorioamnionitis. Cerclage would have been contraindicated; delivery would have occurred despite any efforts to prolong the pregnancy.

VERDICT A Utah defense verdict was returned.

Did untreated hypertension cause mother’s blindness?

A 34-YEAR-OLD PREGNANT WOMAN was admitted to the hospital with new onset hypertension. Three days later her BP increased to 170/98 mm Hg; her ObGyn performed an emergent cesarean delivery. During the procedure, the woman’s BP rose to 203/120, and remained high in recovery. When she awoke, she reported blurred vision, and was later declared to be legally blind.

PATIENT’S CLAIM The physician failed to properly monitor her BP. Failure to use antihypertensive drugs led to an ischemic event, resulting in vision loss.

PHYSICIAN’S DEFENSE The woman’s BP was properly monitored at all times. She had been diagnosed with Purtscher’s retinopathy syndrome, which predisposed her to pregnancy-related vision loss. Her blindness was not BP-related.

VERDICT A Tennessee defense verdict was returned.

Ruptured ectopic pregnancy not treated properly in ED

WHEN BROUGHT TO THE EMERGENCY DEPARTMENT, a 25-year-old woman was found to be in hemorrhagic shock following a ruptured ectopic pregnancy. Her BP was 42/19 mm Hg. She was taken to surgery, where the ruptured fallopian tube was removed.

After surgery, she complained of tremors in her legs and torso, and had difficulty walking unassisted. She was diagnosed with hypoxic ischemic encephalopathy and transferred to a rehabilitation facility.

PATIENT’S CLAIM She was not properly resuscitated in the ED; intravenous fluids and transfusions should have been given immediately. Delayed treatment in the ED caused hypoxic ischemic encephalopathy or a conversion disorder.

PHYSICIAN’S DEFENSE Intravenous fluids and transfusions were started appropriately and promptly in the ED. The patient did not suffer hypoxic ischemic encephalopathy; a conversion disorder could have occurred from the stress of the ruptured ectopic pregnancy.

VERDICT An Illinois jury returned a defense verdict.

Large prolapsed fibroid left untreated—despite surgery

A 48-YEAR-OLD WOMAN PRESENTED to the emergency department (ED) with vaginal pain. A large, prolapsed uterine fibroid was diagnosed. Because she was scheduled for an ObGyn visit 2 days later, she was discharged without any treatment.

The next day, she returned to the ED with vaginal bleeding. Ultrasonography (US) showed multiple fibroids. Physical exam confirmed a prolapsed uterine fibroid extending into the vaginal vault. Her ObGyn performed an open myomectomy a few days later.

She called her ObGyn’s office prior to her scheduled postoperative visit because she still felt something in her vagina, and had pelvic pain and vaginal bleeding. She also reported this at the office visit, where she met with a nurse practitioner.

Two months later, she called the ObGyn’s office to complain of vaginal bleeding, and described passing large clots.

A month later, she saw a surgeon, who determined that the large prolapsed fibroid had never been removed. Surgery was scheduled, during which her uterus was removed. The patient was hospitalized for 11 days.

PATIENT’S CLAIM The ObGyn was negligent in failing to surgically remove the fibroid, perform postoperative US, and properly examine, diagnose, and treat her postoperatively. The ObGyn’s office staff failed to relay her telephone and in-person complaints to the physician.

DEFENDANTS’ DEFENSE The ObGyn and his group denied negligence.

VERDICT A $248,160 Georgia verdict was returned against the group.

Woman claims she was never told mammogram results

AFTER MANY NORMAL MAMMOGRAMS, a woman had an abnormal annual result. However, she claimed the physician did not inform her of the reported results. A year later, she was diagnosed with breast cancer.

PATIENT’S CLAIM The physician was negligent in failing to follow-up on the abnormal mammogram and make a correct diagnosis.

PHYSICIAN’S DEFENSE The woman had refused a recommended biopsy after the abnormal mammogram, and later refused mastectomy and radiation therapy. The patient’s outcome would have been the same even if treatment had begun shortly after the abnormal mammogram.

VERDICT A $175,000 verdict was returned in Indiana.

5,386-g newborn has Erb’s palsy

OXYTOCIN WAS ADMINISTERED after a woman’s labor slowed. During vaginal delivery, the ObGyn encountered and managed shoulder dystocia. The 11-lb, 14-oz infant was later given a diagnosis of Erb’s palsy.

PLAINTIFF’S CLAIM Excessive force during the ObGyn’s management of shoulder dystocia caused the Erb’s palsy. US should have been performed prior to delivery to determine fetal weight. Cesarean section may have prevented the injury.

PHYSICIAN’S DEFENSE Fetal weight was calculated at a time when vaginal delivery could not be safely discontinued. Excessive traction was not used; if it had been used, the injury would have been more significant.

VERDICT A New York jury returned a $485,000 verdict.

Was there delay in recognizing necrotizing fasciitis?

PREGNANT WITH TWINS, a 24-year-old woman was hospitalized at 33 weeks’ gestation, and remained there until delivery. There was no clinical evidence of fever or intrauterine infection during her hospitalization. Her anogenital culture for group B Streptococcus was positive. Clindamycin was begun 11 days prior to delivery, and continued after a successful cesarean delivery by her ObGyn.

Three days later, the mother suffered a high fever and marked elevation of her white blood cell count. The ObGyn reopened and drained the wound incision. Surgical debridement was not performed. The woman continued to deteriorate.

She developed extensive necrosis of the tissue around the abdominal wound, extending to the pannus and mons pubis. The ObGyn performed wide excision of the tissue. Necrotizing fasciitis was confirmed by pathology.

The woman was diagnosed with sepsis, multi-system organ failure, disseminated intravascular coagulopathy, and respiratory dependence. She was transferred to another hospital, where she remained until her death 3 months after delivery.

ESTATE’S CLAIM The ObGyn failed to diagnose and treat the necrotizing fasciitis in a timely manner. He failed to perform emergency surgical debridement when the lesions were first identified.

PHYSICIAN’S DEFENSE Antibiotics were ordered at the first sign of the vaginal strep infection and continued due to postsurgical wound infection.

Consultations with infectious disease specialists were obtained because of the patient’s history of extreme medication reaction and numerous antibiotic allergies. Although testing reported negative results for other infection sources, the patient failed to respond to treatment. Surgical debridement was performed when necessary, and as often as the patient was deemed able to tolerate the procedure.

VERDICT A Georgia verdict of $4,317,495 was returned.

ObGyn at fault for child’s brain injury and vision loss?

AT 22 WEEKS’ GESTATION, a woman presented to the ED with cramping and bleeding. A nurse called the woman’s ObGyn, who was not at the hospital; he ordered monitoring and laboratory tests. Two hours later, the bleeding and pain increased. The ObGyn was notified, although whether he was told about the excessive bleeding or not is in dispute. He ordered morphine. The patient was sent home without being seen by a physician, with instructions to follow-up with her ObGyn.

The woman claimed she called the hospital the next morning to report continued pain and bleeding, and was told to take a bath. She returned to the hospital the next evening. US revealed a dilated cervix with hour-glassing membranes. The child was delivered at 23-weeks’ gestation and suffers from a brain injury and vision loss.

PLAINTIFF’S CLAIM Premature delivery was due to an incompetent cervix, which could have been treated with cerclage. Diagnostic US and a physical examination by the ObGyn were never performed.

DEFENDANT’S DEFENSE Postdelivery evaluation of the placenta indicated that the mother had chorioamnionitis. Cerclage would have been contraindicated; delivery would have occurred despite any efforts to prolong the pregnancy.

VERDICT A Utah defense verdict was returned.

Did untreated hypertension cause mother’s blindness?

A 34-YEAR-OLD PREGNANT WOMAN was admitted to the hospital with new onset hypertension. Three days later her BP increased to 170/98 mm Hg; her ObGyn performed an emergent cesarean delivery. During the procedure, the woman’s BP rose to 203/120, and remained high in recovery. When she awoke, she reported blurred vision, and was later declared to be legally blind.

PATIENT’S CLAIM The physician failed to properly monitor her BP. Failure to use antihypertensive drugs led to an ischemic event, resulting in vision loss.

PHYSICIAN’S DEFENSE The woman’s BP was properly monitored at all times. She had been diagnosed with Purtscher’s retinopathy syndrome, which predisposed her to pregnancy-related vision loss. Her blindness was not BP-related.

VERDICT A Tennessee defense verdict was returned.

Ruptured ectopic pregnancy not treated properly in ED

WHEN BROUGHT TO THE EMERGENCY DEPARTMENT, a 25-year-old woman was found to be in hemorrhagic shock following a ruptured ectopic pregnancy. Her BP was 42/19 mm Hg. She was taken to surgery, where the ruptured fallopian tube was removed.

After surgery, she complained of tremors in her legs and torso, and had difficulty walking unassisted. She was diagnosed with hypoxic ischemic encephalopathy and transferred to a rehabilitation facility.

PATIENT’S CLAIM She was not properly resuscitated in the ED; intravenous fluids and transfusions should have been given immediately. Delayed treatment in the ED caused hypoxic ischemic encephalopathy or a conversion disorder.

PHYSICIAN’S DEFENSE Intravenous fluids and transfusions were started appropriately and promptly in the ED. The patient did not suffer hypoxic ischemic encephalopathy; a conversion disorder could have occurred from the stress of the ruptured ectopic pregnancy.

VERDICT An Illinois jury returned a defense verdict.

Large prolapsed fibroid left untreated—despite surgery

A 48-YEAR-OLD WOMAN PRESENTED to the emergency department (ED) with vaginal pain. A large, prolapsed uterine fibroid was diagnosed. Because she was scheduled for an ObGyn visit 2 days later, she was discharged without any treatment.

The next day, she returned to the ED with vaginal bleeding. Ultrasonography (US) showed multiple fibroids. Physical exam confirmed a prolapsed uterine fibroid extending into the vaginal vault. Her ObGyn performed an open myomectomy a few days later.

She called her ObGyn’s office prior to her scheduled postoperative visit because she still felt something in her vagina, and had pelvic pain and vaginal bleeding. She also reported this at the office visit, where she met with a nurse practitioner.

Two months later, she called the ObGyn’s office to complain of vaginal bleeding, and described passing large clots.

A month later, she saw a surgeon, who determined that the large prolapsed fibroid had never been removed. Surgery was scheduled, during which her uterus was removed. The patient was hospitalized for 11 days.

PATIENT’S CLAIM The ObGyn was negligent in failing to surgically remove the fibroid, perform postoperative US, and properly examine, diagnose, and treat her postoperatively. The ObGyn’s office staff failed to relay her telephone and in-person complaints to the physician.

DEFENDANTS’ DEFENSE The ObGyn and his group denied negligence.

VERDICT A $248,160 Georgia verdict was returned against the group.

Woman claims she was never told mammogram results

AFTER MANY NORMAL MAMMOGRAMS, a woman had an abnormal annual result. However, she claimed the physician did not inform her of the reported results. A year later, she was diagnosed with breast cancer.

PATIENT’S CLAIM The physician was negligent in failing to follow-up on the abnormal mammogram and make a correct diagnosis.

PHYSICIAN’S DEFENSE The woman had refused a recommended biopsy after the abnormal mammogram, and later refused mastectomy and radiation therapy. The patient’s outcome would have been the same even if treatment had begun shortly after the abnormal mammogram.

VERDICT A $175,000 verdict was returned in Indiana.

5,386-g newborn has Erb’s palsy

OXYTOCIN WAS ADMINISTERED after a woman’s labor slowed. During vaginal delivery, the ObGyn encountered and managed shoulder dystocia. The 11-lb, 14-oz infant was later given a diagnosis of Erb’s palsy.

PLAINTIFF’S CLAIM Excessive force during the ObGyn’s management of shoulder dystocia caused the Erb’s palsy. US should have been performed prior to delivery to determine fetal weight. Cesarean section may have prevented the injury.

PHYSICIAN’S DEFENSE Fetal weight was calculated at a time when vaginal delivery could not be safely discontinued. Excessive traction was not used; if it had been used, the injury would have been more significant.

VERDICT A New York jury returned a $485,000 verdict.

Was there delay in recognizing necrotizing fasciitis?

PREGNANT WITH TWINS, a 24-year-old woman was hospitalized at 33 weeks’ gestation, and remained there until delivery. There was no clinical evidence of fever or intrauterine infection during her hospitalization. Her anogenital culture for group B Streptococcus was positive. Clindamycin was begun 11 days prior to delivery, and continued after a successful cesarean delivery by her ObGyn.

Three days later, the mother suffered a high fever and marked elevation of her white blood cell count. The ObGyn reopened and drained the wound incision. Surgical debridement was not performed. The woman continued to deteriorate.

She developed extensive necrosis of the tissue around the abdominal wound, extending to the pannus and mons pubis. The ObGyn performed wide excision of the tissue. Necrotizing fasciitis was confirmed by pathology.

The woman was diagnosed with sepsis, multi-system organ failure, disseminated intravascular coagulopathy, and respiratory dependence. She was transferred to another hospital, where she remained until her death 3 months after delivery.

ESTATE’S CLAIM The ObGyn failed to diagnose and treat the necrotizing fasciitis in a timely manner. He failed to perform emergency surgical debridement when the lesions were first identified.

PHYSICIAN’S DEFENSE Antibiotics were ordered at the first sign of the vaginal strep infection and continued due to postsurgical wound infection.

Consultations with infectious disease specialists were obtained because of the patient’s history of extreme medication reaction and numerous antibiotic allergies. Although testing reported negative results for other infection sources, the patient failed to respond to treatment. Surgical debridement was performed when necessary, and as often as the patient was deemed able to tolerate the procedure.

VERDICT A Georgia verdict of $4,317,495 was returned.

ObGyn at fault for child’s brain injury and vision loss?

AT 22 WEEKS’ GESTATION, a woman presented to the ED with cramping and bleeding. A nurse called the woman’s ObGyn, who was not at the hospital; he ordered monitoring and laboratory tests. Two hours later, the bleeding and pain increased. The ObGyn was notified, although whether he was told about the excessive bleeding or not is in dispute. He ordered morphine. The patient was sent home without being seen by a physician, with instructions to follow-up with her ObGyn.

The woman claimed she called the hospital the next morning to report continued pain and bleeding, and was told to take a bath. She returned to the hospital the next evening. US revealed a dilated cervix with hour-glassing membranes. The child was delivered at 23-weeks’ gestation and suffers from a brain injury and vision loss.

PLAINTIFF’S CLAIM Premature delivery was due to an incompetent cervix, which could have been treated with cerclage. Diagnostic US and a physical examination by the ObGyn were never performed.

DEFENDANT’S DEFENSE Postdelivery evaluation of the placenta indicated that the mother had chorioamnionitis. Cerclage would have been contraindicated; delivery would have occurred despite any efforts to prolong the pregnancy.

VERDICT A Utah defense verdict was returned.

Did untreated hypertension cause mother’s blindness?

A 34-YEAR-OLD PREGNANT WOMAN was admitted to the hospital with new onset hypertension. Three days later her BP increased to 170/98 mm Hg; her ObGyn performed an emergent cesarean delivery. During the procedure, the woman’s BP rose to 203/120, and remained high in recovery. When she awoke, she reported blurred vision, and was later declared to be legally blind.

PATIENT’S CLAIM The physician failed to properly monitor her BP. Failure to use antihypertensive drugs led to an ischemic event, resulting in vision loss.

PHYSICIAN’S DEFENSE The woman’s BP was properly monitored at all times. She had been diagnosed with Purtscher’s retinopathy syndrome, which predisposed her to pregnancy-related vision loss. Her blindness was not BP-related.

VERDICT A Tennessee defense verdict was returned.

Ruptured ectopic pregnancy not treated properly in ED

WHEN BROUGHT TO THE EMERGENCY DEPARTMENT, a 25-year-old woman was found to be in hemorrhagic shock following a ruptured ectopic pregnancy. Her BP was 42/19 mm Hg. She was taken to surgery, where the ruptured fallopian tube was removed.

After surgery, she complained of tremors in her legs and torso, and had difficulty walking unassisted. She was diagnosed with hypoxic ischemic encephalopathy and transferred to a rehabilitation facility.

PATIENT’S CLAIM She was not properly resuscitated in the ED; intravenous fluids and transfusions should have been given immediately. Delayed treatment in the ED caused hypoxic ischemic encephalopathy or a conversion disorder.

PHYSICIAN’S DEFENSE Intravenous fluids and transfusions were started appropriately and promptly in the ED. The patient did not suffer hypoxic ischemic encephalopathy; a conversion disorder could have occurred from the stress of the ruptured ectopic pregnancy.

VERDICT An Illinois jury returned a defense verdict.

Back pain, then sudden death

BACK AND CHEST PAIN prompted a 42-year-old man to see a doctor. The family physician took the man’s blood pressure, which was 184/130, but performed no other testing. He prescribed pain medication and sent the patient home. The man died 3 days later of an aortic dissection.

PLAINTIFF’S CLAIM The physician was negligent because he did not try to lower the patient’s blood pressure or order a radiograph before sending him home.

THE DEFENSE There was no reason to suspect aortic dissection; the rupture was sudden and catastrophic.

VERDICT Alabama defense verdict.

COMMENT Although the defense prevailed, this case reminds us to always consider less common causes of low back pain.

Increase in morphine dose has fatal results

BREATHING DIFFICULTIES associated with chronic obstructive pulmonary disease led to the hospitalization of a 79-year-old woman. While there, she suffered respiratory arrest and a code was called. The pulmonologist on duty and the attending physician responded. After the patient was bagged, she started breathing on her own.

The attending physician subsequently discussed the patient’s treatment plan and prognosis with her daughter, who agreed to a do-not-resuscitate order. He ordered 2 mg morphine as needed for comfort.

Minutes later, the pulmonologist overrode the order and ordered 20 mg morphine by IV push. After it was given, the patient lost consciousness while talking to her daughter and granddaughter. She died about 3 hours later without regaining consciousness.

PLAINTIFF’S CLAIM The patient was improving until the night before her arrest, when she failed to get her scheduled breathing treatment. The pulmonologist was negligent in ordering 20 mg morphine, and the hospital nurses were negligent in administering it.

THE DEFENSE No negligence occurred. The patient would have died sooner than 3 hours after the morphine dose if morphine was, indeed, the cause of death.

VERDICT $3 million Georgia verdict.

COMMENT Do not resuscitate does not mean negligible risk of malpractice. Orders for 20 mg (!) of morphine will always be difficult to defend—even in a terminally ill patient.

Breast cancer diagnosis falls through the cracks

AFTER NOTICING A LUMP IN HER LEFT BREAST, a woman in her 40s underwent a screening mammogram rather than a diagnostic mammogram at a local facility. The mammogram showed no abnormalities, but an ultrasound examination the following year was abnormal. The report was faxed to her physician, who reportedly didn’t receive it. No follow-up occurred.

A year later, the patient made a follow-up appointment on her own and underwent diagnostic mammography and surgical biopsy, which revealed advanced breast cancer. A vacuum-assisted core biopsy and clip localization the following month revealed infiltrating ductal carcinoma. Neoadjuvant chemotherapy resulted in complications and hospitalization. The patient subsequently underwent additional chemotherapy and radiation treatments.

PLAINTIFF’S CLAIM The defendant health care facility didn’t properly evaluate the patient for breast cancer.

THE DEFENSE The defendant denied liability and asserted that its personnel acted within the standard of care.

VERDICT $575,000 South Carolina settlement.

COMMENT Follow-up and tracking of results remain key in preventing malpractice.

Back pain, then sudden death

BACK AND CHEST PAIN prompted a 42-year-old man to see a doctor. The family physician took the man’s blood pressure, which was 184/130, but performed no other testing. He prescribed pain medication and sent the patient home. The man died 3 days later of an aortic dissection.

PLAINTIFF’S CLAIM The physician was negligent because he did not try to lower the patient’s blood pressure or order a radiograph before sending him home.

THE DEFENSE There was no reason to suspect aortic dissection; the rupture was sudden and catastrophic.

VERDICT Alabama defense verdict.

COMMENT Although the defense prevailed, this case reminds us to always consider less common causes of low back pain.

Increase in morphine dose has fatal results

BREATHING DIFFICULTIES associated with chronic obstructive pulmonary disease led to the hospitalization of a 79-year-old woman. While there, she suffered respiratory arrest and a code was called. The pulmonologist on duty and the attending physician responded. After the patient was bagged, she started breathing on her own.

The attending physician subsequently discussed the patient’s treatment plan and prognosis with her daughter, who agreed to a do-not-resuscitate order. He ordered 2 mg morphine as needed for comfort.

Minutes later, the pulmonologist overrode the order and ordered 20 mg morphine by IV push. After it was given, the patient lost consciousness while talking to her daughter and granddaughter. She died about 3 hours later without regaining consciousness.

PLAINTIFF’S CLAIM The patient was improving until the night before her arrest, when she failed to get her scheduled breathing treatment. The pulmonologist was negligent in ordering 20 mg morphine, and the hospital nurses were negligent in administering it.

THE DEFENSE No negligence occurred. The patient would have died sooner than 3 hours after the morphine dose if morphine was, indeed, the cause of death.

VERDICT $3 million Georgia verdict.

COMMENT Do not resuscitate does not mean negligible risk of malpractice. Orders for 20 mg (!) of morphine will always be difficult to defend—even in a terminally ill patient.

Breast cancer diagnosis falls through the cracks

AFTER NOTICING A LUMP IN HER LEFT BREAST, a woman in her 40s underwent a screening mammogram rather than a diagnostic mammogram at a local facility. The mammogram showed no abnormalities, but an ultrasound examination the following year was abnormal. The report was faxed to her physician, who reportedly didn’t receive it. No follow-up occurred.

A year later, the patient made a follow-up appointment on her own and underwent diagnostic mammography and surgical biopsy, which revealed advanced breast cancer. A vacuum-assisted core biopsy and clip localization the following month revealed infiltrating ductal carcinoma. Neoadjuvant chemotherapy resulted in complications and hospitalization. The patient subsequently underwent additional chemotherapy and radiation treatments.

PLAINTIFF’S CLAIM The defendant health care facility didn’t properly evaluate the patient for breast cancer.

THE DEFENSE The defendant denied liability and asserted that its personnel acted within the standard of care.

VERDICT $575,000 South Carolina settlement.

COMMENT Follow-up and tracking of results remain key in preventing malpractice.

Back pain, then sudden death

BACK AND CHEST PAIN prompted a 42-year-old man to see a doctor. The family physician took the man’s blood pressure, which was 184/130, but performed no other testing. He prescribed pain medication and sent the patient home. The man died 3 days later of an aortic dissection.

PLAINTIFF’S CLAIM The physician was negligent because he did not try to lower the patient’s blood pressure or order a radiograph before sending him home.

THE DEFENSE There was no reason to suspect aortic dissection; the rupture was sudden and catastrophic.

VERDICT Alabama defense verdict.

COMMENT Although the defense prevailed, this case reminds us to always consider less common causes of low back pain.

Increase in morphine dose has fatal results

BREATHING DIFFICULTIES associated with chronic obstructive pulmonary disease led to the hospitalization of a 79-year-old woman. While there, she suffered respiratory arrest and a code was called. The pulmonologist on duty and the attending physician responded. After the patient was bagged, she started breathing on her own.

The attending physician subsequently discussed the patient’s treatment plan and prognosis with her daughter, who agreed to a do-not-resuscitate order. He ordered 2 mg morphine as needed for comfort.

Minutes later, the pulmonologist overrode the order and ordered 20 mg morphine by IV push. After it was given, the patient lost consciousness while talking to her daughter and granddaughter. She died about 3 hours later without regaining consciousness.

PLAINTIFF’S CLAIM The patient was improving until the night before her arrest, when she failed to get her scheduled breathing treatment. The pulmonologist was negligent in ordering 20 mg morphine, and the hospital nurses were negligent in administering it.

THE DEFENSE No negligence occurred. The patient would have died sooner than 3 hours after the morphine dose if morphine was, indeed, the cause of death.

VERDICT $3 million Georgia verdict.

COMMENT Do not resuscitate does not mean negligible risk of malpractice. Orders for 20 mg (!) of morphine will always be difficult to defend—even in a terminally ill patient.

Breast cancer diagnosis falls through the cracks

AFTER NOTICING A LUMP IN HER LEFT BREAST, a woman in her 40s underwent a screening mammogram rather than a diagnostic mammogram at a local facility. The mammogram showed no abnormalities, but an ultrasound examination the following year was abnormal. The report was faxed to her physician, who reportedly didn’t receive it. No follow-up occurred.

A year later, the patient made a follow-up appointment on her own and underwent diagnostic mammography and surgical biopsy, which revealed advanced breast cancer. A vacuum-assisted core biopsy and clip localization the following month revealed infiltrating ductal carcinoma. Neoadjuvant chemotherapy resulted in complications and hospitalization. The patient subsequently underwent additional chemotherapy and radiation treatments.

PLAINTIFF’S CLAIM The defendant health care facility didn’t properly evaluate the patient for breast cancer.

THE DEFENSE The defendant denied liability and asserted that its personnel acted within the standard of care.

VERDICT $575,000 South Carolina settlement.

COMMENT Follow-up and tracking of results remain key in preventing malpractice.

Rectal mucosa found in vaginal cuff closure

3 DAYS AFTER A HYSTERECTOMY by her ObGyn, a woman reported increasing pain. At an exploratory laparotomy, surgeons found serosanguineous pelvic fluid, partial dehiscence of the vaginal cuff with necrotic edges, and a suture line incorporating the anterior rectal wall in the vaginal cuff repair. They removed the sutures and repaired the vaginal cuff and several lacerations on the anterior rectal wall.

PATIENT’S CLAIM The ObGyn should have used peritoneal tissue to repair the vaginal cuff. Failure to do so caused lacerations and injuries to the anterior rectal wall and rectum.

PHYSICIAN’S DEFENSE The ObGyn denied negligence.

VERDICT A $3 million Virginia verdict was returned.

Colon injured when trocar is inserted

DIAGNOSTIC LAPAROSCOPY was performed on a 27-year-old woman to find the cause of rectal bleeding and pelvic pain. The ObGyn perforated her colon with the trocar; he immediately converted to laparotomy. The patient had a colostomy for 3 months, then developed paralytic ileus, small bowel obstruction, and incisional hernias. She required surgery for colostomy removal and hernia repair. It was later found that irritable bowel syndrome had caused the bleeding.

PLAINTIFF’S CLAIM Surgery was unnecessary; conservative treatment should have been tried first. The ObGyn blindly inserted the trocar instead of insufflating the abdomen with CO₂.

PHYSICIAN’S DEFENSE Laparoscopy was appropriate for the patient’s symptoms; insufflation was used. The patient’s transverse colon was lowlying (below the navel) rather than normal (above the navel), causing it to be in the way of the trocar. The patient had a good recovery and returned to good function.

VERDICT An Illinois verdict of $550,500 was returned.

Late cesarean blamed for newborn’s CP

A WOMAN WITH PREECLAMPSIA was admitted to the hospital. When her membranes ruptured, oxytocin and magnesium sulfate were started. After several hours, she was only dilated to 5 cm. The fetal monitor showed normal baseline, but minimal variability with virtually no accelerations.

Hours later, when she was fully dilated, the ObGyn instructed the nurse to have her push and then went to his office. Immediately upon pushing, late fetal heart rate decelerations developed with every contraction. When the ObGyn returned 30 minutes later, he allowed pushing to continue. A resident attempted forceps delivery, but the forceps slipped several times. The ObGyn reapplied the forceps twice, then allowed the resident to apply vacuum. When the baby presented with shoulder dystocia, the ObGyn stepped in. The child was born with low cord blood pH and multiple skull fractures, and was given a diagnosis of cerebral palsy.

PATIENT’S CLAIM The ObGyn should have performed a cesarean when the fetal heart tracing became nonreassuring.

The child suffered CP because of distress during labor and delivery; a sinus venous thrombosis was never present. The baby’s skull fractures were due to improper use of forceps.

PHYSICIAN’S DEFENSE The skull fractures could have occurred in normal delivery. Because the child did not have spastic quadriplegic CP, the injury was most likely from sinus venous thrombosis.

VERDICT A Wisconsin jury returned a $23.2 million verdict; the court added $187,402 in medical expenses.

OB exonerated following brachial plexus injury

WHEN SHOULDER DYSTOCIA occurred during delivery, the ObGyn performed a McRoberts maneuver and episiotomy; the baby was delivered in 3 minutes. She suffered C5–8 brachial plexus palsy, deformity of the right arm and hand, and limited use of her right hand.

She later had tendon transfer surgery to improve range of motion of her wrist, and tendon release surgery on her shoulder.

PLAINTIFF’S CLAIM Excessive traction to the head and neck and failure to use additional shoulder dystocia maneuvers caused the injury.

PHYSICIAN’S DEFENSE The maneuvers performed were appropriate. The injury was due to natural forces of labor. The baby was delivered easily in less than a minute after using proper techniques. No excessive traction or other maneuvers were needed.

VERDICT An Illinois defense verdict was returned.

Did ovarian remnant + HRT cause DVT and pain?

A 33-YEAR-OLD WOMAN underwent a hysterectomy with salpingo-oophorectomy. Her ObGyn then prescribed hormone replacement therapy (HRT). Although pathology reported the left ovary and fallopian tube were not part of postoperative specimens, the ObGyn maintained that both ovaries and fallopian tubes had been removed. Ten months later, a CT scan revealed a pelvic neoplasm. No mass was found at exploratory surgery, but adhesions were lysed. Eighteen months later, an MRI revealed remnants of the left ovary and fallopian tube. Another gynecologist determined that the ovary was producing estrogen. Two months later, the patient developed deep vein thrombosis (DVT) in her left calf. The obstruction was resolved, but the patient reported residual leg pain.

PATIENT’S CLAIM Excessive levels of estrogen caused the DVT. The ObGyn was negligent in disregarding the initial pathologist’s report. It was inappropriate to prescribe HRT if ovarian function was present after surgery.

PHYSICIAN’S DEFENSE There was no negligence. Dense adhesions and a previous bowel perforation did not allow total ovary removal. The remnant is a known risk of the procedure. Estrogen HRT was appropriately administered.

VERDICT A New York defense verdict was returned.

Severing uterosacral ligament relieved pelvic pain, but…

AFTER CONSERVATIVE THERAPY for several months, a 26-year-old woman underwent exploratory laparoscopy to determine the reason for her severe pelvic pain. Findings were negative, but the physician transected the uterosacral ligament to relieve pain. Four days after surgery, a ureteral injury was diagnosed, and a stent was placed. The patient required complex treatment for her urinary tract injury.

PATIENT’S CLAIM Severing the uterosacral ligament was performed without her consent. The ureter injury was caused by negligent use of electrocauterization. Now the patient was at high risk for future pregnancies.

PHYSICIAN’S DEFENSE The patient’s pain warranted surgery; severing the ligament was appropriate. Injury to the ureter is a known complication.

VERDICT A Tennessee defense verdict was returned.

Why did it take so long to stop her bleeding?

AFTER DELIVERING HER THIRD CHILD, a 34-year-old woman reported significant vaginal bleeding to her ObGyn. Two weeks later, a sonogram was performed but the cause of bleeding was undetermined.

Bleeding continued. Sixteen days later, another sonogram revealed a 2-cm-long mass in the uterine cavity. The ObGyn decided to wait 4 or 5 days for another sonogram to make sure the mass wasn’t a fibroid or placental remnant.

The next evening, the patient was admitted to a hospital with excessive bleeding. The ObGyn performed a hysteroscopy and found a fibroid and a placental remnant. After tissue was removed by dilation and curettage (D&C), the ObGyn reinserted the hysteroscope. She encountered severe bleeding but could not find any other suspicious matter. Pathology reported that the excised material was placental tissue. The patient was hospitalized for 2 more days.

Three days later, she returned to the ObGyn with continued bleeding; the ObGyn determined it was post-D&C bleeding.

Two weeks later, the woman suffered severe vaginal hemorrhage. She went to another hospital where the ED physician felt the woman’s life was in jeopardy. A hysterectomy was performed, including the extraction of a placental fragment determined to be the cause of the hemorrhage.

PATIENT’S CLAIM The ObGyn was negligent in not diagnosing and treating the bleeding in a timely way after the first sonogram. The pathology report after D&C confirmed placental accreta, which should have prompted aggressive evaluation. Hysteroscopy and D&C did not effectively remove the deeply implanted placenta. She should not have been discharged from the hospital until the ObGyn had confirmed full removal of any placental remnants. Continued bleeding after D&C should have elicited further evaluation.

PHYSICIAN’S DEFENSE All the patient’s reports of bleeding were quickly and appropriately addressed. The ObGyn denied being told that the patient was still bleeding heavily until 16 days following the first sonogram. It was reasonable to conclude that the D&C had excised all suspicious matters. Post-D&C bleeding was due to an intraoperative laceration of the cervix; medication and a clamp had halted bleeding. Intraoperative bleeding made failure to remove the placental remnant reasonable. Earlier treatment would not have changed the outcome.

VERDICT A New York jury returned a $625,000 verdict.

Rectal mucosa found in vaginal cuff closure

3 DAYS AFTER A HYSTERECTOMY by her ObGyn, a woman reported increasing pain. At an exploratory laparotomy, surgeons found serosanguineous pelvic fluid, partial dehiscence of the vaginal cuff with necrotic edges, and a suture line incorporating the anterior rectal wall in the vaginal cuff repair. They removed the sutures and repaired the vaginal cuff and several lacerations on the anterior rectal wall.

PATIENT’S CLAIM The ObGyn should have used peritoneal tissue to repair the vaginal cuff. Failure to do so caused lacerations and injuries to the anterior rectal wall and rectum.

PHYSICIAN’S DEFENSE The ObGyn denied negligence.

VERDICT A $3 million Virginia verdict was returned.

Colon injured when trocar is inserted

DIAGNOSTIC LAPAROSCOPY was performed on a 27-year-old woman to find the cause of rectal bleeding and pelvic pain. The ObGyn perforated her colon with the trocar; he immediately converted to laparotomy. The patient had a colostomy for 3 months, then developed paralytic ileus, small bowel obstruction, and incisional hernias. She required surgery for colostomy removal and hernia repair. It was later found that irritable bowel syndrome had caused the bleeding.

PLAINTIFF’S CLAIM Surgery was unnecessary; conservative treatment should have been tried first. The ObGyn blindly inserted the trocar instead of insufflating the abdomen with CO₂.

PHYSICIAN’S DEFENSE Laparoscopy was appropriate for the patient’s symptoms; insufflation was used. The patient’s transverse colon was lowlying (below the navel) rather than normal (above the navel), causing it to be in the way of the trocar. The patient had a good recovery and returned to good function.

VERDICT An Illinois verdict of $550,500 was returned.

Late cesarean blamed for newborn’s CP

A WOMAN WITH PREECLAMPSIA was admitted to the hospital. When her membranes ruptured, oxytocin and magnesium sulfate were started. After several hours, she was only dilated to 5 cm. The fetal monitor showed normal baseline, but minimal variability with virtually no accelerations.

Hours later, when she was fully dilated, the ObGyn instructed the nurse to have her push and then went to his office. Immediately upon pushing, late fetal heart rate decelerations developed with every contraction. When the ObGyn returned 30 minutes later, he allowed pushing to continue. A resident attempted forceps delivery, but the forceps slipped several times. The ObGyn reapplied the forceps twice, then allowed the resident to apply vacuum. When the baby presented with shoulder dystocia, the ObGyn stepped in. The child was born with low cord blood pH and multiple skull fractures, and was given a diagnosis of cerebral palsy.

PATIENT’S CLAIM The ObGyn should have performed a cesarean when the fetal heart tracing became nonreassuring.

The child suffered CP because of distress during labor and delivery; a sinus venous thrombosis was never present. The baby’s skull fractures were due to improper use of forceps.

PHYSICIAN’S DEFENSE The skull fractures could have occurred in normal delivery. Because the child did not have spastic quadriplegic CP, the injury was most likely from sinus venous thrombosis.

VERDICT A Wisconsin jury returned a $23.2 million verdict; the court added $187,402 in medical expenses.

OB exonerated following brachial plexus injury

WHEN SHOULDER DYSTOCIA occurred during delivery, the ObGyn performed a McRoberts maneuver and episiotomy; the baby was delivered in 3 minutes. She suffered C5–8 brachial plexus palsy, deformity of the right arm and hand, and limited use of her right hand.

She later had tendon transfer surgery to improve range of motion of her wrist, and tendon release surgery on her shoulder.

PLAINTIFF’S CLAIM Excessive traction to the head and neck and failure to use additional shoulder dystocia maneuvers caused the injury.

PHYSICIAN’S DEFENSE The maneuvers performed were appropriate. The injury was due to natural forces of labor. The baby was delivered easily in less than a minute after using proper techniques. No excessive traction or other maneuvers were needed.

VERDICT An Illinois defense verdict was returned.

Did ovarian remnant + HRT cause DVT and pain?

A 33-YEAR-OLD WOMAN underwent a hysterectomy with salpingo-oophorectomy. Her ObGyn then prescribed hormone replacement therapy (HRT). Although pathology reported the left ovary and fallopian tube were not part of postoperative specimens, the ObGyn maintained that both ovaries and fallopian tubes had been removed. Ten months later, a CT scan revealed a pelvic neoplasm. No mass was found at exploratory surgery, but adhesions were lysed. Eighteen months later, an MRI revealed remnants of the left ovary and fallopian tube. Another gynecologist determined that the ovary was producing estrogen. Two months later, the patient developed deep vein thrombosis (DVT) in her left calf. The obstruction was resolved, but the patient reported residual leg pain.

PATIENT’S CLAIM Excessive levels of estrogen caused the DVT. The ObGyn was negligent in disregarding the initial pathologist’s report. It was inappropriate to prescribe HRT if ovarian function was present after surgery.

PHYSICIAN’S DEFENSE There was no negligence. Dense adhesions and a previous bowel perforation did not allow total ovary removal. The remnant is a known risk of the procedure. Estrogen HRT was appropriately administered.

VERDICT A New York defense verdict was returned.

Severing uterosacral ligament relieved pelvic pain, but…

AFTER CONSERVATIVE THERAPY for several months, a 26-year-old woman underwent exploratory laparoscopy to determine the reason for her severe pelvic pain. Findings were negative, but the physician transected the uterosacral ligament to relieve pain. Four days after surgery, a ureteral injury was diagnosed, and a stent was placed. The patient required complex treatment for her urinary tract injury.

PATIENT’S CLAIM Severing the uterosacral ligament was performed without her consent. The ureter injury was caused by negligent use of electrocauterization. Now the patient was at high risk for future pregnancies.

PHYSICIAN’S DEFENSE The patient’s pain warranted surgery; severing the ligament was appropriate. Injury to the ureter is a known complication.

VERDICT A Tennessee defense verdict was returned.

Why did it take so long to stop her bleeding?

AFTER DELIVERING HER THIRD CHILD, a 34-year-old woman reported significant vaginal bleeding to her ObGyn. Two weeks later, a sonogram was performed but the cause of bleeding was undetermined.

Bleeding continued. Sixteen days later, another sonogram revealed a 2-cm-long mass in the uterine cavity. The ObGyn decided to wait 4 or 5 days for another sonogram to make sure the mass wasn’t a fibroid or placental remnant.

The next evening, the patient was admitted to a hospital with excessive bleeding. The ObGyn performed a hysteroscopy and found a fibroid and a placental remnant. After tissue was removed by dilation and curettage (D&C), the ObGyn reinserted the hysteroscope. She encountered severe bleeding but could not find any other suspicious matter. Pathology reported that the excised material was placental tissue. The patient was hospitalized for 2 more days.

Three days later, she returned to the ObGyn with continued bleeding; the ObGyn determined it was post-D&C bleeding.

Two weeks later, the woman suffered severe vaginal hemorrhage. She went to another hospital where the ED physician felt the woman’s life was in jeopardy. A hysterectomy was performed, including the extraction of a placental fragment determined to be the cause of the hemorrhage.

PATIENT’S CLAIM The ObGyn was negligent in not diagnosing and treating the bleeding in a timely way after the first sonogram. The pathology report after D&C confirmed placental accreta, which should have prompted aggressive evaluation. Hysteroscopy and D&C did not effectively remove the deeply implanted placenta. She should not have been discharged from the hospital until the ObGyn had confirmed full removal of any placental remnants. Continued bleeding after D&C should have elicited further evaluation.

PHYSICIAN’S DEFENSE All the patient’s reports of bleeding were quickly and appropriately addressed. The ObGyn denied being told that the patient was still bleeding heavily until 16 days following the first sonogram. It was reasonable to conclude that the D&C had excised all suspicious matters. Post-D&C bleeding was due to an intraoperative laceration of the cervix; medication and a clamp had halted bleeding. Intraoperative bleeding made failure to remove the placental remnant reasonable. Earlier treatment would not have changed the outcome.

VERDICT A New York jury returned a $625,000 verdict.

Rectal mucosa found in vaginal cuff closure

3 DAYS AFTER A HYSTERECTOMY by her ObGyn, a woman reported increasing pain. At an exploratory laparotomy, surgeons found serosanguineous pelvic fluid, partial dehiscence of the vaginal cuff with necrotic edges, and a suture line incorporating the anterior rectal wall in the vaginal cuff repair. They removed the sutures and repaired the vaginal cuff and several lacerations on the anterior rectal wall.

PATIENT’S CLAIM The ObGyn should have used peritoneal tissue to repair the vaginal cuff. Failure to do so caused lacerations and injuries to the anterior rectal wall and rectum.

PHYSICIAN’S DEFENSE The ObGyn denied negligence.

VERDICT A $3 million Virginia verdict was returned.

Colon injured when trocar is inserted

DIAGNOSTIC LAPAROSCOPY was performed on a 27-year-old woman to find the cause of rectal bleeding and pelvic pain. The ObGyn perforated her colon with the trocar; he immediately converted to laparotomy. The patient had a colostomy for 3 months, then developed paralytic ileus, small bowel obstruction, and incisional hernias. She required surgery for colostomy removal and hernia repair. It was later found that irritable bowel syndrome had caused the bleeding.

PLAINTIFF’S CLAIM Surgery was unnecessary; conservative treatment should have been tried first. The ObGyn blindly inserted the trocar instead of insufflating the abdomen with CO₂.

PHYSICIAN’S DEFENSE Laparoscopy was appropriate for the patient’s symptoms; insufflation was used. The patient’s transverse colon was lowlying (below the navel) rather than normal (above the navel), causing it to be in the way of the trocar. The patient had a good recovery and returned to good function.

VERDICT An Illinois verdict of $550,500 was returned.

Late cesarean blamed for newborn’s CP

A WOMAN WITH PREECLAMPSIA was admitted to the hospital. When her membranes ruptured, oxytocin and magnesium sulfate were started. After several hours, she was only dilated to 5 cm. The fetal monitor showed normal baseline, but minimal variability with virtually no accelerations.

Hours later, when she was fully dilated, the ObGyn instructed the nurse to have her push and then went to his office. Immediately upon pushing, late fetal heart rate decelerations developed with every contraction. When the ObGyn returned 30 minutes later, he allowed pushing to continue. A resident attempted forceps delivery, but the forceps slipped several times. The ObGyn reapplied the forceps twice, then allowed the resident to apply vacuum. When the baby presented with shoulder dystocia, the ObGyn stepped in. The child was born with low cord blood pH and multiple skull fractures, and was given a diagnosis of cerebral palsy.

PATIENT’S CLAIM The ObGyn should have performed a cesarean when the fetal heart tracing became nonreassuring.

The child suffered CP because of distress during labor and delivery; a sinus venous thrombosis was never present. The baby’s skull fractures were due to improper use of forceps.

PHYSICIAN’S DEFENSE The skull fractures could have occurred in normal delivery. Because the child did not have spastic quadriplegic CP, the injury was most likely from sinus venous thrombosis.

VERDICT A Wisconsin jury returned a $23.2 million verdict; the court added $187,402 in medical expenses.

OB exonerated following brachial plexus injury

WHEN SHOULDER DYSTOCIA occurred during delivery, the ObGyn performed a McRoberts maneuver and episiotomy; the baby was delivered in 3 minutes. She suffered C5–8 brachial plexus palsy, deformity of the right arm and hand, and limited use of her right hand.

She later had tendon transfer surgery to improve range of motion of her wrist, and tendon release surgery on her shoulder.

PLAINTIFF’S CLAIM Excessive traction to the head and neck and failure to use additional shoulder dystocia maneuvers caused the injury.

PHYSICIAN’S DEFENSE The maneuvers performed were appropriate. The injury was due to natural forces of labor. The baby was delivered easily in less than a minute after using proper techniques. No excessive traction or other maneuvers were needed.

VERDICT An Illinois defense verdict was returned.

Did ovarian remnant + HRT cause DVT and pain?

A 33-YEAR-OLD WOMAN underwent a hysterectomy with salpingo-oophorectomy. Her ObGyn then prescribed hormone replacement therapy (HRT). Although pathology reported the left ovary and fallopian tube were not part of postoperative specimens, the ObGyn maintained that both ovaries and fallopian tubes had been removed. Ten months later, a CT scan revealed a pelvic neoplasm. No mass was found at exploratory surgery, but adhesions were lysed. Eighteen months later, an MRI revealed remnants of the left ovary and fallopian tube. Another gynecologist determined that the ovary was producing estrogen. Two months later, the patient developed deep vein thrombosis (DVT) in her left calf. The obstruction was resolved, but the patient reported residual leg pain.

PATIENT’S CLAIM Excessive levels of estrogen caused the DVT. The ObGyn was negligent in disregarding the initial pathologist’s report. It was inappropriate to prescribe HRT if ovarian function was present after surgery.

PHYSICIAN’S DEFENSE There was no negligence. Dense adhesions and a previous bowel perforation did not allow total ovary removal. The remnant is a known risk of the procedure. Estrogen HRT was appropriately administered.

VERDICT A New York defense verdict was returned.

Severing uterosacral ligament relieved pelvic pain, but…

AFTER CONSERVATIVE THERAPY for several months, a 26-year-old woman underwent exploratory laparoscopy to determine the reason for her severe pelvic pain. Findings were negative, but the physician transected the uterosacral ligament to relieve pain. Four days after surgery, a ureteral injury was diagnosed, and a stent was placed. The patient required complex treatment for her urinary tract injury.

PATIENT’S CLAIM Severing the uterosacral ligament was performed without her consent. The ureter injury was caused by negligent use of electrocauterization. Now the patient was at high risk for future pregnancies.

PHYSICIAN’S DEFENSE The patient’s pain warranted surgery; severing the ligament was appropriate. Injury to the ureter is a known complication.

VERDICT A Tennessee defense verdict was returned.

Why did it take so long to stop her bleeding?

AFTER DELIVERING HER THIRD CHILD, a 34-year-old woman reported significant vaginal bleeding to her ObGyn. Two weeks later, a sonogram was performed but the cause of bleeding was undetermined.

Bleeding continued. Sixteen days later, another sonogram revealed a 2-cm-long mass in the uterine cavity. The ObGyn decided to wait 4 or 5 days for another sonogram to make sure the mass wasn’t a fibroid or placental remnant.

The next evening, the patient was admitted to a hospital with excessive bleeding. The ObGyn performed a hysteroscopy and found a fibroid and a placental remnant. After tissue was removed by dilation and curettage (D&C), the ObGyn reinserted the hysteroscope. She encountered severe bleeding but could not find any other suspicious matter. Pathology reported that the excised material was placental tissue. The patient was hospitalized for 2 more days.

Three days later, she returned to the ObGyn with continued bleeding; the ObGyn determined it was post-D&C bleeding.

Two weeks later, the woman suffered severe vaginal hemorrhage. She went to another hospital where the ED physician felt the woman’s life was in jeopardy. A hysterectomy was performed, including the extraction of a placental fragment determined to be the cause of the hemorrhage.

PATIENT’S CLAIM The ObGyn was negligent in not diagnosing and treating the bleeding in a timely way after the first sonogram. The pathology report after D&C confirmed placental accreta, which should have prompted aggressive evaluation. Hysteroscopy and D&C did not effectively remove the deeply implanted placenta. She should not have been discharged from the hospital until the ObGyn had confirmed full removal of any placental remnants. Continued bleeding after D&C should have elicited further evaluation.

PHYSICIAN’S DEFENSE All the patient’s reports of bleeding were quickly and appropriately addressed. The ObGyn denied being told that the patient was still bleeding heavily until 16 days following the first sonogram. It was reasonable to conclude that the D&C had excised all suspicious matters. Post-D&C bleeding was due to an intraoperative laceration of the cervix; medication and a clamp had halted bleeding. Intraoperative bleeding made failure to remove the placental remnant reasonable. Earlier treatment would not have changed the outcome.

VERDICT A New York jury returned a $625,000 verdict.