Medical Verdicts

Because of migraines, severe preeclampsia diagnosis is delayed

A WOMAN IN HER 35TH WEEK OF PREGNANCY awoke with what she thought was a migraine headache. When home remedies did not provide relief, she called her ObGyn. He sent her to the hospital for testing. The results suggested preeclampsia, and her blood pressure was at a level that would not cause bleeding in the brain, he believed. It was decided to admit the patient overnight, and then reassess her condition and consider a cesarean delivery on the following day. When the patient reported her headache was severe and the pain radiated to the back of her neck, she was administered Demerol. Her blood pressure and pain decreased. Two hours later, she was unresponsive and the fetal heart rate had dropped. An emergent cesarean delivery was performed, resulting in the birth of a healthy infant.

Following transfer of the mother to another hospital, a CT scan indicated acute intracranial bleeding at the left basal ganglia and frontal lobes. An emergency craniotomy left her semicomatose. During a 6-month stay at a rehabilitation hospital, a shunt placed in her head became infected and required several procedures to treat the infection and replace the shunt. At discharge, she required 24-hour care because of cognitive and physical impairments. She suffers severe memory lapses and poor vision and is unable to walk without a brace.

PATIENT’S CLAIM The ObGyn was negligent for failing to diagnose and treat severe preeclampsia in a timely manner.

PHYSICIAN’S DEFENSE Considering the patient’s history of migraines, the diagnosis and treatment were reasonable. The patient and her husband were informed of the benefits and risks of overnight observation at the hospital. They also wanted to delay the child’s delivery to avoid the complications of a premature birth.

VERDICT $6,420,000 Massachusetts verdict.

After removing right ovary, Gyn discovers no ovary on the left

BECAUSE OF A PAINFUL CYST, a gynecologist removed the right ovary of a 33-year-old patient. During the procedure, adhesions were found on the patient’s left side—but not the left ovary or fallopian tube. Postoperatively, the patient was found to be menopausal, suggesting the absence of a left ovary.

PATIENT’S CLAIM She did not give informed consent. The gynecologist was negligent for removing the right ovary before checking for the presence of the left ovary and for removing the right ovary rather than limiting surgery to removal of the cyst.

PHYSICIAN’S DEFENSE It was necessary to remove the right ovary, whether or not the patient had a left ovary.

VERDICT Texas defense verdict. Prior to trial, the radiologist settled for an undisclosed amount.

$11.5 million for waterbirth dystocia case; infant has CP

DURING A WATERBIRTH in a birthing tub, shoulder dystocia was encountered. The child has cerebral palsy as a result of oxygen deprivation and brain damage.

PATIENT’S CLAIM The birthing tub was not drained quickly enough to use the standard maneuvers for resolving shoulder dystocia.

PHYSICIAN’S DEFENSE The injuries resulted from an infection in the placenta. The maneuvers to resolve the dystocia were performed as quickly as if the mother had not been in a tub.

VERDICT $11.5 million Illinois settlement.

Patient needs vaginal sling, cystocele repair; suffers foot drop

A WOMAN WENT TO THE HOSPITAL for a vaginal sling procedure and repair of a cystocele. Two surgeons, Dr. A and Dr. B, performed the urology part of the surgery. Then an ObGyn, Dr. C, performed the sacrospinous vaginal vault suspension, which included placement of two sutures. Postoperatively, the patient suffered right foot drop. Four days later, Dr. C removed the sutures. The foot drop persisted. At first, she sued several parties. Only Dr. C and his group went to trial.

PATIENT’S CLAIM Not reported.

PHYSICIAN’S DEFENSE Not reported.

VERDICT Confidential Alabama settlement. The first trial ended in a mistrial by the court. The second trial resulted in a $1 million verdict, but the court set it aside and ordered a new trial. Then the parties settled.

Because of migraines, severe preeclampsia diagnosis is delayed

A WOMAN IN HER 35TH WEEK OF PREGNANCY awoke with what she thought was a migraine headache. When home remedies did not provide relief, she called her ObGyn. He sent her to the hospital for testing. The results suggested preeclampsia, and her blood pressure was at a level that would not cause bleeding in the brain, he believed. It was decided to admit the patient overnight, and then reassess her condition and consider a cesarean delivery on the following day. When the patient reported her headache was severe and the pain radiated to the back of her neck, she was administered Demerol. Her blood pressure and pain decreased. Two hours later, she was unresponsive and the fetal heart rate had dropped. An emergent cesarean delivery was performed, resulting in the birth of a healthy infant.

Following transfer of the mother to another hospital, a CT scan indicated acute intracranial bleeding at the left basal ganglia and frontal lobes. An emergency craniotomy left her semicomatose. During a 6-month stay at a rehabilitation hospital, a shunt placed in her head became infected and required several procedures to treat the infection and replace the shunt. At discharge, she required 24-hour care because of cognitive and physical impairments. She suffers severe memory lapses and poor vision and is unable to walk without a brace.

PATIENT’S CLAIM The ObGyn was negligent for failing to diagnose and treat severe preeclampsia in a timely manner.

PHYSICIAN’S DEFENSE Considering the patient’s history of migraines, the diagnosis and treatment were reasonable. The patient and her husband were informed of the benefits and risks of overnight observation at the hospital. They also wanted to delay the child’s delivery to avoid the complications of a premature birth.

VERDICT $6,420,000 Massachusetts verdict.

After removing right ovary, Gyn discovers no ovary on the left

BECAUSE OF A PAINFUL CYST, a gynecologist removed the right ovary of a 33-year-old patient. During the procedure, adhesions were found on the patient’s left side—but not the left ovary or fallopian tube. Postoperatively, the patient was found to be menopausal, suggesting the absence of a left ovary.

PATIENT’S CLAIM She did not give informed consent. The gynecologist was negligent for removing the right ovary before checking for the presence of the left ovary and for removing the right ovary rather than limiting surgery to removal of the cyst.

PHYSICIAN’S DEFENSE It was necessary to remove the right ovary, whether or not the patient had a left ovary.

VERDICT Texas defense verdict. Prior to trial, the radiologist settled for an undisclosed amount.

$11.5 million for waterbirth dystocia case; infant has CP

DURING A WATERBIRTH in a birthing tub, shoulder dystocia was encountered. The child has cerebral palsy as a result of oxygen deprivation and brain damage.

PATIENT’S CLAIM The birthing tub was not drained quickly enough to use the standard maneuvers for resolving shoulder dystocia.

PHYSICIAN’S DEFENSE The injuries resulted from an infection in the placenta. The maneuvers to resolve the dystocia were performed as quickly as if the mother had not been in a tub.

VERDICT $11.5 million Illinois settlement.

Patient needs vaginal sling, cystocele repair; suffers foot drop

A WOMAN WENT TO THE HOSPITAL for a vaginal sling procedure and repair of a cystocele. Two surgeons, Dr. A and Dr. B, performed the urology part of the surgery. Then an ObGyn, Dr. C, performed the sacrospinous vaginal vault suspension, which included placement of two sutures. Postoperatively, the patient suffered right foot drop. Four days later, Dr. C removed the sutures. The foot drop persisted. At first, she sued several parties. Only Dr. C and his group went to trial.

PATIENT’S CLAIM Not reported.

PHYSICIAN’S DEFENSE Not reported.

VERDICT Confidential Alabama settlement. The first trial ended in a mistrial by the court. The second trial resulted in a $1 million verdict, but the court set it aside and ordered a new trial. Then the parties settled.

Because of migraines, severe preeclampsia diagnosis is delayed

A WOMAN IN HER 35TH WEEK OF PREGNANCY awoke with what she thought was a migraine headache. When home remedies did not provide relief, she called her ObGyn. He sent her to the hospital for testing. The results suggested preeclampsia, and her blood pressure was at a level that would not cause bleeding in the brain, he believed. It was decided to admit the patient overnight, and then reassess her condition and consider a cesarean delivery on the following day. When the patient reported her headache was severe and the pain radiated to the back of her neck, she was administered Demerol. Her blood pressure and pain decreased. Two hours later, she was unresponsive and the fetal heart rate had dropped. An emergent cesarean delivery was performed, resulting in the birth of a healthy infant.

Following transfer of the mother to another hospital, a CT scan indicated acute intracranial bleeding at the left basal ganglia and frontal lobes. An emergency craniotomy left her semicomatose. During a 6-month stay at a rehabilitation hospital, a shunt placed in her head became infected and required several procedures to treat the infection and replace the shunt. At discharge, she required 24-hour care because of cognitive and physical impairments. She suffers severe memory lapses and poor vision and is unable to walk without a brace.

PATIENT’S CLAIM The ObGyn was negligent for failing to diagnose and treat severe preeclampsia in a timely manner.

PHYSICIAN’S DEFENSE Considering the patient’s history of migraines, the diagnosis and treatment were reasonable. The patient and her husband were informed of the benefits and risks of overnight observation at the hospital. They also wanted to delay the child’s delivery to avoid the complications of a premature birth.

VERDICT $6,420,000 Massachusetts verdict.

After removing right ovary, Gyn discovers no ovary on the left

BECAUSE OF A PAINFUL CYST, a gynecologist removed the right ovary of a 33-year-old patient. During the procedure, adhesions were found on the patient’s left side—but not the left ovary or fallopian tube. Postoperatively, the patient was found to be menopausal, suggesting the absence of a left ovary.

PATIENT’S CLAIM She did not give informed consent. The gynecologist was negligent for removing the right ovary before checking for the presence of the left ovary and for removing the right ovary rather than limiting surgery to removal of the cyst.

PHYSICIAN’S DEFENSE It was necessary to remove the right ovary, whether or not the patient had a left ovary.

VERDICT Texas defense verdict. Prior to trial, the radiologist settled for an undisclosed amount.

$11.5 million for waterbirth dystocia case; infant has CP

DURING A WATERBIRTH in a birthing tub, shoulder dystocia was encountered. The child has cerebral palsy as a result of oxygen deprivation and brain damage.

PATIENT’S CLAIM The birthing tub was not drained quickly enough to use the standard maneuvers for resolving shoulder dystocia.

PHYSICIAN’S DEFENSE The injuries resulted from an infection in the placenta. The maneuvers to resolve the dystocia were performed as quickly as if the mother had not been in a tub.

VERDICT $11.5 million Illinois settlement.

Patient needs vaginal sling, cystocele repair; suffers foot drop

A WOMAN WENT TO THE HOSPITAL for a vaginal sling procedure and repair of a cystocele. Two surgeons, Dr. A and Dr. B, performed the urology part of the surgery. Then an ObGyn, Dr. C, performed the sacrospinous vaginal vault suspension, which included placement of two sutures. Postoperatively, the patient suffered right foot drop. Four days later, Dr. C removed the sutures. The foot drop persisted. At first, she sued several parties. Only Dr. C and his group went to trial.

PATIENT’S CLAIM Not reported.

PHYSICIAN’S DEFENSE Not reported.

VERDICT Confidential Alabama settlement. The first trial ended in a mistrial by the court. The second trial resulted in a $1 million verdict, but the court set it aside and ordered a new trial. Then the parties settled.

Was gastroschisis of late onset—or visible on sonograms?

BECAUSE OF ADVANCED AGE and the presence of uterine fibroids, a woman underwent prenatal ultrasonography in the fifth, sixth, and seventh months of pregnancy. The sonograms were performed and interpreted by a specialist in maternal–fetal medicine. The baby was born with most of his intestines outside his abdomen and was transferred to another hospital, where surgery was performed nearly 4 hours after birth, revealing necrosis of a significant length of bowel. The child suffered short-gut syndrome and required intravenous catheter and tube feeding until the age of 5 years. His growth was stunted.

PATIENT’S CLAIM The sonograms showed gastroschisis. If this had been recognized at that time, the birth could have taken place in a hospital where surgical repair could be performed within 2 hours of birth. Because of the delay in surgery, necrosis of most of the small intestine occurred.

PHYSICIAN’S DEFENSE The child suffered late-onset gastroschisis, or ruptured umbilical hernia, which the sonograms did not show. No matter where the child was born, the outcome would have been the same.

VERDICT Illinois defense verdict for the specialist in maternal–fetal medicine. Prior to trial, the hospital and radiologist settled for $35,000 and $200,000, respectively.

Unsigned death certificate delays cremation of stillborn

FOLLOWING THE STILLBIRTH of their child, a couple waited 3 weeks for the death certificate to be signed. Only then were they given the body for cremation.

PLAINTIFFS’ CLAIM Dr. A, the attending physician, was negligent for not signing the baby’s death certificate in a timely manner, thus delaying the cremation and causing emotional distress. A death certificate should be signed within 1 day of determining the cause of death or knowing that there will be no further information about the cause.

PHYSICIAN’S DEFENSE According to Dr. A, his stated cause of death was rejected initially. While he was waiting for additional clinical information, Dr. B signed the certificate, giving only a general cause of death. Dr. A claimed his own actions caused no damages.

VERDICT $11,000 California verdict.

MDs find ovarian cyst, then, 7 months later, peritoneal cancer

A 49-YEAR-OLD WOMAN with an ovarian cyst underwent laparoscopy. Dr. C, the ObGyn who performed the surgery, found ovaries that were normal, but also the presence of endometriosis and adhesions. Dr. D and Dr. E provided follow-up care. When the patient visited Dr. E 5 months later complaining of bloating and gastrointestinal pain, ultrasonography was performed. She then followed up with her primary care physician and a gastroenterologist. Three months later, she underwent emergency surgery. Stage IIIC primary papillary serous carcinoma of the peritoneum was discovered in her pelvis and abdomen. Despite multiple surgeries and chemotherapy over the next year and a half, the patient died.

PLAINTIFF’S CLAIM Dr. C should have performed a biopsy during the original laparoscopy; this would have allowed an earlier diagnosis with a better prognosis.

PHYSICIAN’S DEFENSE A biopsy was not required initially; in fact, the cancer was probably either not present or microscopic at that time. Even with a diagnosis then, the odds of survival would have been much the same.

VERDICT Illinois defense verdict. The jury deadlocked, 11 to 1. The parties agreed to a less than unanimous verdict and a high/low agreement of $750,000/$100,000. Then the jury returned a defense verdict.

Still incontinent after undergoing retropubic urethropexy

A 43-YEAR-OLD WOMAN was experiencing urinary incontinence, gynecological pain, and bleeding. Her ObGyn diagnosed pelvic organ prolapse. A month later, the patient underwent a total abdominal hysterectomy with retropubic urethropexy. Following the surgery, the patient continued to be incontinent.

PATIENT’S CLAIM A sling procedure to correct the incontinence should have been performed.

PHYSICIAN’S DEFENSE The proper procedure and technique were used. As the patient was undergoing an abdominal hysterectomy, it was reasonable to perform a retropubic urethropexy at the same time.

VERDICT Texas defense verdict.

A $30.9 million verdict in the case of induced VBAC

ATTEMPTING A VAGINAL BIRTH after cesarean (VBAC), a woman arrived at the hospital for induced delivery of her child. During labor, the uterus ruptured and placental abruption occurred. For approximately 20 minutes, the fetus was deprived of oxygen. A cesarean delivery was performed, and the child was diagnosed with severe brain damage and cerebral palsy.

PATIENT’S CLAIM Uterine rupture was caused by hyperstimulation with oxytocin. After the loss of the fetal heart rate, the nurses delayed more than 15 minutes before notifying a physician.

PHYSICIAN’S DEFENSE The patient was informed of the increased risk of rupture when attempting VBAC. The nurses were following physician orders regarding use of oxytocin. Until the time of rupture and abruption, the uterus was not hyperstimulated and the heart rate was normal.

VERDICT $30,953,181 Ohio verdict against the hospital only. The case was settled under a confidential high/low agreement reached before the verdict.

While on HRT, patient with serious health concerns has stroke

DR. F PRESCRIBED oral hormone replacement therapy (HRT) to treat the menopausal symptoms of a 46-year-old patient. The following year he prescribed an estrogen patch and continued treating her for another 3 years until he died. Then Dr. G took over the patient’s care. She remained on some form of HRT until she suffered a stroke 2 years later. She suffered significant cognitive impairment and could no longer drive or work.

PATIENT’S CLAIM She should have been evaluated more thoroughly and weaned from artificial hormones. She had high blood pressure and high cholesterol, was overweight, and had a family history of cardiovascular problems.

PHYSICIAN’S DEFENSE The patient’s stroke was not necessarily related to HRT. In fact, it could have been caused by her cardiac condition.

VERDICT Missouri defense verdict.

Was laparoscopy to remove an ovary contraindicated?

A 39-YEAR-OLD WOMAN underwent multiple surgeries performed by her ObGyn: tubal ligation, dilation and curettage, hysteroscopy, and emergent hysterectomy. Following the hysterectomy, during which the ovaries were not removed, she had significant left upper quadrant pain. Ultrasonography revealed two cysts on the left ovary. During recommended surgery to remove the ovary, the physician continued laparoscopic dissection despite complications caused by extensive omental adhesions. The surgery lasted 5 hours, after which the patient required 2 days of hospitalization. Within 24 hours of leaving the hospital, she returned to the emergency room with fever, nausea, vomiting, and abdominal pain. A CT scan indicated a probable leak from the sigmoid colon. Follow-up surgery showed perforation of the sigmoid colon and a colostomy was placed. The patient developed acute respiratory distress syndrome and required intubation and mechanical ventilation during a 2-week hospitalization.

PATIENT’S CLAIM Because of her prior abdominal surgeries, laparoscopic surgery was contraindicated. Once begun, it should have been converted to an open procedure. Also, the physician should have recognized the injury to the sigmoid colon and treated it immediately.

PHYSICIAN’S DEFENSE Perforation is a known risk of laparoscopy, and the patient was informed of this.

VERDICT $437,438 Maryland verdict.

Nephrectomy is necessary after ureteral injury

A 52-YEAR-OLD WOMAN with a history of fibroids was told by her ObGyn, Dr. H, that the tumors had grown. After undergoing a recommended hysterectomy performed by Dr. H, the patient experienced ongoing pain. Three months after the surgery, she consulted Dr. J, who diagnosed ureteral obstruction. The patient then underwent surgical repair of the obstruction, but suffered permanent kidney damage. Nephrectomy was performed a month later.

PATIENT’S CLAIM Dr. H was negligent because he injured the ureter during the hysterectomy and was also negligent for failing to recognize the injury.

PHYSICIAN’S DEFENSE Ureteral injury is a known complication of the procedure. Also, the patient’s symptoms were inconsistent with such an injury.

VERDICT Tennessee defense verdict.

Was gastroschisis of late onset—or visible on sonograms?

BECAUSE OF ADVANCED AGE and the presence of uterine fibroids, a woman underwent prenatal ultrasonography in the fifth, sixth, and seventh months of pregnancy. The sonograms were performed and interpreted by a specialist in maternal–fetal medicine. The baby was born with most of his intestines outside his abdomen and was transferred to another hospital, where surgery was performed nearly 4 hours after birth, revealing necrosis of a significant length of bowel. The child suffered short-gut syndrome and required intravenous catheter and tube feeding until the age of 5 years. His growth was stunted.

PATIENT’S CLAIM The sonograms showed gastroschisis. If this had been recognized at that time, the birth could have taken place in a hospital where surgical repair could be performed within 2 hours of birth. Because of the delay in surgery, necrosis of most of the small intestine occurred.

PHYSICIAN’S DEFENSE The child suffered late-onset gastroschisis, or ruptured umbilical hernia, which the sonograms did not show. No matter where the child was born, the outcome would have been the same.

VERDICT Illinois defense verdict for the specialist in maternal–fetal medicine. Prior to trial, the hospital and radiologist settled for $35,000 and $200,000, respectively.

Unsigned death certificate delays cremation of stillborn

FOLLOWING THE STILLBIRTH of their child, a couple waited 3 weeks for the death certificate to be signed. Only then were they given the body for cremation.

PLAINTIFFS’ CLAIM Dr. A, the attending physician, was negligent for not signing the baby’s death certificate in a timely manner, thus delaying the cremation and causing emotional distress. A death certificate should be signed within 1 day of determining the cause of death or knowing that there will be no further information about the cause.

PHYSICIAN’S DEFENSE According to Dr. A, his stated cause of death was rejected initially. While he was waiting for additional clinical information, Dr. B signed the certificate, giving only a general cause of death. Dr. A claimed his own actions caused no damages.

VERDICT $11,000 California verdict.

MDs find ovarian cyst, then, 7 months later, peritoneal cancer

A 49-YEAR-OLD WOMAN with an ovarian cyst underwent laparoscopy. Dr. C, the ObGyn who performed the surgery, found ovaries that were normal, but also the presence of endometriosis and adhesions. Dr. D and Dr. E provided follow-up care. When the patient visited Dr. E 5 months later complaining of bloating and gastrointestinal pain, ultrasonography was performed. She then followed up with her primary care physician and a gastroenterologist. Three months later, she underwent emergency surgery. Stage IIIC primary papillary serous carcinoma of the peritoneum was discovered in her pelvis and abdomen. Despite multiple surgeries and chemotherapy over the next year and a half, the patient died.

PLAINTIFF’S CLAIM Dr. C should have performed a biopsy during the original laparoscopy; this would have allowed an earlier diagnosis with a better prognosis.

PHYSICIAN’S DEFENSE A biopsy was not required initially; in fact, the cancer was probably either not present or microscopic at that time. Even with a diagnosis then, the odds of survival would have been much the same.

VERDICT Illinois defense verdict. The jury deadlocked, 11 to 1. The parties agreed to a less than unanimous verdict and a high/low agreement of $750,000/$100,000. Then the jury returned a defense verdict.

Still incontinent after undergoing retropubic urethropexy

A 43-YEAR-OLD WOMAN was experiencing urinary incontinence, gynecological pain, and bleeding. Her ObGyn diagnosed pelvic organ prolapse. A month later, the patient underwent a total abdominal hysterectomy with retropubic urethropexy. Following the surgery, the patient continued to be incontinent.

PATIENT’S CLAIM A sling procedure to correct the incontinence should have been performed.

PHYSICIAN’S DEFENSE The proper procedure and technique were used. As the patient was undergoing an abdominal hysterectomy, it was reasonable to perform a retropubic urethropexy at the same time.

VERDICT Texas defense verdict.

A $30.9 million verdict in the case of induced VBAC

ATTEMPTING A VAGINAL BIRTH after cesarean (VBAC), a woman arrived at the hospital for induced delivery of her child. During labor, the uterus ruptured and placental abruption occurred. For approximately 20 minutes, the fetus was deprived of oxygen. A cesarean delivery was performed, and the child was diagnosed with severe brain damage and cerebral palsy.

PATIENT’S CLAIM Uterine rupture was caused by hyperstimulation with oxytocin. After the loss of the fetal heart rate, the nurses delayed more than 15 minutes before notifying a physician.

PHYSICIAN’S DEFENSE The patient was informed of the increased risk of rupture when attempting VBAC. The nurses were following physician orders regarding use of oxytocin. Until the time of rupture and abruption, the uterus was not hyperstimulated and the heart rate was normal.

VERDICT $30,953,181 Ohio verdict against the hospital only. The case was settled under a confidential high/low agreement reached before the verdict.

While on HRT, patient with serious health concerns has stroke

DR. F PRESCRIBED oral hormone replacement therapy (HRT) to treat the menopausal symptoms of a 46-year-old patient. The following year he prescribed an estrogen patch and continued treating her for another 3 years until he died. Then Dr. G took over the patient’s care. She remained on some form of HRT until she suffered a stroke 2 years later. She suffered significant cognitive impairment and could no longer drive or work.

PATIENT’S CLAIM She should have been evaluated more thoroughly and weaned from artificial hormones. She had high blood pressure and high cholesterol, was overweight, and had a family history of cardiovascular problems.

PHYSICIAN’S DEFENSE The patient’s stroke was not necessarily related to HRT. In fact, it could have been caused by her cardiac condition.

VERDICT Missouri defense verdict.

Was laparoscopy to remove an ovary contraindicated?

A 39-YEAR-OLD WOMAN underwent multiple surgeries performed by her ObGyn: tubal ligation, dilation and curettage, hysteroscopy, and emergent hysterectomy. Following the hysterectomy, during which the ovaries were not removed, she had significant left upper quadrant pain. Ultrasonography revealed two cysts on the left ovary. During recommended surgery to remove the ovary, the physician continued laparoscopic dissection despite complications caused by extensive omental adhesions. The surgery lasted 5 hours, after which the patient required 2 days of hospitalization. Within 24 hours of leaving the hospital, she returned to the emergency room with fever, nausea, vomiting, and abdominal pain. A CT scan indicated a probable leak from the sigmoid colon. Follow-up surgery showed perforation of the sigmoid colon and a colostomy was placed. The patient developed acute respiratory distress syndrome and required intubation and mechanical ventilation during a 2-week hospitalization.

PATIENT’S CLAIM Because of her prior abdominal surgeries, laparoscopic surgery was contraindicated. Once begun, it should have been converted to an open procedure. Also, the physician should have recognized the injury to the sigmoid colon and treated it immediately.

PHYSICIAN’S DEFENSE Perforation is a known risk of laparoscopy, and the patient was informed of this.

VERDICT $437,438 Maryland verdict.

Nephrectomy is necessary after ureteral injury

A 52-YEAR-OLD WOMAN with a history of fibroids was told by her ObGyn, Dr. H, that the tumors had grown. After undergoing a recommended hysterectomy performed by Dr. H, the patient experienced ongoing pain. Three months after the surgery, she consulted Dr. J, who diagnosed ureteral obstruction. The patient then underwent surgical repair of the obstruction, but suffered permanent kidney damage. Nephrectomy was performed a month later.

PATIENT’S CLAIM Dr. H was negligent because he injured the ureter during the hysterectomy and was also negligent for failing to recognize the injury.

PHYSICIAN’S DEFENSE Ureteral injury is a known complication of the procedure. Also, the patient’s symptoms were inconsistent with such an injury.

VERDICT Tennessee defense verdict.

Was gastroschisis of late onset—or visible on sonograms?

BECAUSE OF ADVANCED AGE and the presence of uterine fibroids, a woman underwent prenatal ultrasonography in the fifth, sixth, and seventh months of pregnancy. The sonograms were performed and interpreted by a specialist in maternal–fetal medicine. The baby was born with most of his intestines outside his abdomen and was transferred to another hospital, where surgery was performed nearly 4 hours after birth, revealing necrosis of a significant length of bowel. The child suffered short-gut syndrome and required intravenous catheter and tube feeding until the age of 5 years. His growth was stunted.

PATIENT’S CLAIM The sonograms showed gastroschisis. If this had been recognized at that time, the birth could have taken place in a hospital where surgical repair could be performed within 2 hours of birth. Because of the delay in surgery, necrosis of most of the small intestine occurred.

PHYSICIAN’S DEFENSE The child suffered late-onset gastroschisis, or ruptured umbilical hernia, which the sonograms did not show. No matter where the child was born, the outcome would have been the same.

VERDICT Illinois defense verdict for the specialist in maternal–fetal medicine. Prior to trial, the hospital and radiologist settled for $35,000 and $200,000, respectively.

Unsigned death certificate delays cremation of stillborn

FOLLOWING THE STILLBIRTH of their child, a couple waited 3 weeks for the death certificate to be signed. Only then were they given the body for cremation.

PLAINTIFFS’ CLAIM Dr. A, the attending physician, was negligent for not signing the baby’s death certificate in a timely manner, thus delaying the cremation and causing emotional distress. A death certificate should be signed within 1 day of determining the cause of death or knowing that there will be no further information about the cause.

PHYSICIAN’S DEFENSE According to Dr. A, his stated cause of death was rejected initially. While he was waiting for additional clinical information, Dr. B signed the certificate, giving only a general cause of death. Dr. A claimed his own actions caused no damages.

VERDICT $11,000 California verdict.

MDs find ovarian cyst, then, 7 months later, peritoneal cancer

A 49-YEAR-OLD WOMAN with an ovarian cyst underwent laparoscopy. Dr. C, the ObGyn who performed the surgery, found ovaries that were normal, but also the presence of endometriosis and adhesions. Dr. D and Dr. E provided follow-up care. When the patient visited Dr. E 5 months later complaining of bloating and gastrointestinal pain, ultrasonography was performed. She then followed up with her primary care physician and a gastroenterologist. Three months later, she underwent emergency surgery. Stage IIIC primary papillary serous carcinoma of the peritoneum was discovered in her pelvis and abdomen. Despite multiple surgeries and chemotherapy over the next year and a half, the patient died.

PLAINTIFF’S CLAIM Dr. C should have performed a biopsy during the original laparoscopy; this would have allowed an earlier diagnosis with a better prognosis.

PHYSICIAN’S DEFENSE A biopsy was not required initially; in fact, the cancer was probably either not present or microscopic at that time. Even with a diagnosis then, the odds of survival would have been much the same.

VERDICT Illinois defense verdict. The jury deadlocked, 11 to 1. The parties agreed to a less than unanimous verdict and a high/low agreement of $750,000/$100,000. Then the jury returned a defense verdict.

Still incontinent after undergoing retropubic urethropexy

A 43-YEAR-OLD WOMAN was experiencing urinary incontinence, gynecological pain, and bleeding. Her ObGyn diagnosed pelvic organ prolapse. A month later, the patient underwent a total abdominal hysterectomy with retropubic urethropexy. Following the surgery, the patient continued to be incontinent.

PATIENT’S CLAIM A sling procedure to correct the incontinence should have been performed.

PHYSICIAN’S DEFENSE The proper procedure and technique were used. As the patient was undergoing an abdominal hysterectomy, it was reasonable to perform a retropubic urethropexy at the same time.

VERDICT Texas defense verdict.

A $30.9 million verdict in the case of induced VBAC

ATTEMPTING A VAGINAL BIRTH after cesarean (VBAC), a woman arrived at the hospital for induced delivery of her child. During labor, the uterus ruptured and placental abruption occurred. For approximately 20 minutes, the fetus was deprived of oxygen. A cesarean delivery was performed, and the child was diagnosed with severe brain damage and cerebral palsy.

PATIENT’S CLAIM Uterine rupture was caused by hyperstimulation with oxytocin. After the loss of the fetal heart rate, the nurses delayed more than 15 minutes before notifying a physician.

PHYSICIAN’S DEFENSE The patient was informed of the increased risk of rupture when attempting VBAC. The nurses were following physician orders regarding use of oxytocin. Until the time of rupture and abruption, the uterus was not hyperstimulated and the heart rate was normal.

VERDICT $30,953,181 Ohio verdict against the hospital only. The case was settled under a confidential high/low agreement reached before the verdict.

While on HRT, patient with serious health concerns has stroke

DR. F PRESCRIBED oral hormone replacement therapy (HRT) to treat the menopausal symptoms of a 46-year-old patient. The following year he prescribed an estrogen patch and continued treating her for another 3 years until he died. Then Dr. G took over the patient’s care. She remained on some form of HRT until she suffered a stroke 2 years later. She suffered significant cognitive impairment and could no longer drive or work.

PATIENT’S CLAIM She should have been evaluated more thoroughly and weaned from artificial hormones. She had high blood pressure and high cholesterol, was overweight, and had a family history of cardiovascular problems.

PHYSICIAN’S DEFENSE The patient’s stroke was not necessarily related to HRT. In fact, it could have been caused by her cardiac condition.

VERDICT Missouri defense verdict.

Was laparoscopy to remove an ovary contraindicated?

A 39-YEAR-OLD WOMAN underwent multiple surgeries performed by her ObGyn: tubal ligation, dilation and curettage, hysteroscopy, and emergent hysterectomy. Following the hysterectomy, during which the ovaries were not removed, she had significant left upper quadrant pain. Ultrasonography revealed two cysts on the left ovary. During recommended surgery to remove the ovary, the physician continued laparoscopic dissection despite complications caused by extensive omental adhesions. The surgery lasted 5 hours, after which the patient required 2 days of hospitalization. Within 24 hours of leaving the hospital, she returned to the emergency room with fever, nausea, vomiting, and abdominal pain. A CT scan indicated a probable leak from the sigmoid colon. Follow-up surgery showed perforation of the sigmoid colon and a colostomy was placed. The patient developed acute respiratory distress syndrome and required intubation and mechanical ventilation during a 2-week hospitalization.

PATIENT’S CLAIM Because of her prior abdominal surgeries, laparoscopic surgery was contraindicated. Once begun, it should have been converted to an open procedure. Also, the physician should have recognized the injury to the sigmoid colon and treated it immediately.

PHYSICIAN’S DEFENSE Perforation is a known risk of laparoscopy, and the patient was informed of this.

VERDICT $437,438 Maryland verdict.

Nephrectomy is necessary after ureteral injury

A 52-YEAR-OLD WOMAN with a history of fibroids was told by her ObGyn, Dr. H, that the tumors had grown. After undergoing a recommended hysterectomy performed by Dr. H, the patient experienced ongoing pain. Three months after the surgery, she consulted Dr. J, who diagnosed ureteral obstruction. The patient then underwent surgical repair of the obstruction, but suffered permanent kidney damage. Nephrectomy was performed a month later.

PATIENT’S CLAIM Dr. H was negligent because he injured the ureter during the hysterectomy and was also negligent for failing to recognize the injury.

PHYSICIAN’S DEFENSE Ureteral injury is a known complication of the procedure. Also, the patient’s symptoms were inconsistent with such an injury.

VERDICT Tennessee defense verdict.

An overlooked finding and missed opportunity

A WOMAN IN HER LATE 70s had an abdominal and pelvic computed tomography (CT) scan, which was reported as normal. Four years later she had a second abdominal and pelvic scan because of blood in her urine. A comparison with the previous scan noted that “the endometrium is thickened, measuring approximately 22 mm, compared to 17 mm” on the first scan.

Endometrial cancer was diagnosed, and the woman underwent a radical hysterectomy and other procedures before being discharged from the hospital. She died about 4 months later of complications from the cancer.

PLAINTIFF’S CLAIM The thickness of the endometrium on the first CT scan should have prompted follow-up because a thickness >10 mm almost always suggests possible endometrial cancer in postmenopausal women. Diagnosing and treating the cancer at the time of the first scan would have prevented metastasis.

THE DEFENSE No information about the defense is available.

VERDICT $600,000 Massachusetts settlement.

COMMENT Incidental findings can be the bane of one’s existence; make sure you read those imaging reports carefully.

A headache, then death, for a 13-year-old

A COMPLAINT OF HEADACHE prompted a 13-year-old girl to seek treatment at a health center. She subsequently developed bacterial meningitis, attributed to sinusitis, and died.

PLAINTIFF’S CLAIM The physician who saw the girl at the health center failed to review records of a previous trip to an emergency room, ask the patient about the severity of her headache, or prescribe antibiotics.

THE DEFENSE No information about the defense is available.

VERDICT $3.75M Illinois verdict.

COMMENT The old lesson of considering not only the most common but also the “have-to-make” diagnoses remains timeless.

Did a failure to communicate cost this patient his life?

A MAN WITH A DRY, NONPRODUCTIVE COUGH and a long history of sinus problems and upper respiratory issues was seen several times by his family care group. One physician ordered a chest radiograph, which a technician performed in house and a radiologist read at another location of the practice. The radiologist compared the radiograph with a chest film done several years earlier and reported a new finding: a 1-cm lung nodule. He recommended further evaluation with a computed tomography (CT) scan.

On the same day as the chest radiograph, the patient was referred to an ear, nose, and throat specialist, who examined him the following day and ordered a CT scan of the sinus. The patient was never notified of the abnormality on the chest radiograph or the need for a follow-up CT scan.

Almost 2 years later, the patient began losing weight and experiencing shortness of breath and chest pain. He went to another medical group and was referred for radiologic evaluation. He was subsequently diagnosed with stage IV terminal lung cancer and died about 9 months later.

PLAINTIFFS’ CLAIM The family care group was negligent for failing to communicate the results of the chest radiograph to the patient. Treatment at the time of the chest x-ray would likely have been curative.

THE DEFENSE No information about the defense is available.

VERDICT $900,000 Virginia settlement.

COMMENT Another abnormal radiograph, another example of inadequate communication leads to a $900,000 settlement.

An overlooked finding and missed opportunity

A WOMAN IN HER LATE 70s had an abdominal and pelvic computed tomography (CT) scan, which was reported as normal. Four years later she had a second abdominal and pelvic scan because of blood in her urine. A comparison with the previous scan noted that “the endometrium is thickened, measuring approximately 22 mm, compared to 17 mm” on the first scan.

Endometrial cancer was diagnosed, and the woman underwent a radical hysterectomy and other procedures before being discharged from the hospital. She died about 4 months later of complications from the cancer.

PLAINTIFF’S CLAIM The thickness of the endometrium on the first CT scan should have prompted follow-up because a thickness >10 mm almost always suggests possible endometrial cancer in postmenopausal women. Diagnosing and treating the cancer at the time of the first scan would have prevented metastasis.

THE DEFENSE No information about the defense is available.

VERDICT $600,000 Massachusetts settlement.

COMMENT Incidental findings can be the bane of one’s existence; make sure you read those imaging reports carefully.

A headache, then death, for a 13-year-old

A COMPLAINT OF HEADACHE prompted a 13-year-old girl to seek treatment at a health center. She subsequently developed bacterial meningitis, attributed to sinusitis, and died.

PLAINTIFF’S CLAIM The physician who saw the girl at the health center failed to review records of a previous trip to an emergency room, ask the patient about the severity of her headache, or prescribe antibiotics.

THE DEFENSE No information about the defense is available.

VERDICT $3.75M Illinois verdict.

COMMENT The old lesson of considering not only the most common but also the “have-to-make” diagnoses remains timeless.

Did a failure to communicate cost this patient his life?

A MAN WITH A DRY, NONPRODUCTIVE COUGH and a long history of sinus problems and upper respiratory issues was seen several times by his family care group. One physician ordered a chest radiograph, which a technician performed in house and a radiologist read at another location of the practice. The radiologist compared the radiograph with a chest film done several years earlier and reported a new finding: a 1-cm lung nodule. He recommended further evaluation with a computed tomography (CT) scan.

On the same day as the chest radiograph, the patient was referred to an ear, nose, and throat specialist, who examined him the following day and ordered a CT scan of the sinus. The patient was never notified of the abnormality on the chest radiograph or the need for a follow-up CT scan.

Almost 2 years later, the patient began losing weight and experiencing shortness of breath and chest pain. He went to another medical group and was referred for radiologic evaluation. He was subsequently diagnosed with stage IV terminal lung cancer and died about 9 months later.

PLAINTIFFS’ CLAIM The family care group was negligent for failing to communicate the results of the chest radiograph to the patient. Treatment at the time of the chest x-ray would likely have been curative.

THE DEFENSE No information about the defense is available.

VERDICT $900,000 Virginia settlement.

COMMENT Another abnormal radiograph, another example of inadequate communication leads to a $900,000 settlement.

An overlooked finding and missed opportunity

A WOMAN IN HER LATE 70s had an abdominal and pelvic computed tomography (CT) scan, which was reported as normal. Four years later she had a second abdominal and pelvic scan because of blood in her urine. A comparison with the previous scan noted that “the endometrium is thickened, measuring approximately 22 mm, compared to 17 mm” on the first scan.

Endometrial cancer was diagnosed, and the woman underwent a radical hysterectomy and other procedures before being discharged from the hospital. She died about 4 months later of complications from the cancer.

PLAINTIFF’S CLAIM The thickness of the endometrium on the first CT scan should have prompted follow-up because a thickness >10 mm almost always suggests possible endometrial cancer in postmenopausal women. Diagnosing and treating the cancer at the time of the first scan would have prevented metastasis.

THE DEFENSE No information about the defense is available.

VERDICT $600,000 Massachusetts settlement.

COMMENT Incidental findings can be the bane of one’s existence; make sure you read those imaging reports carefully.

A headache, then death, for a 13-year-old

A COMPLAINT OF HEADACHE prompted a 13-year-old girl to seek treatment at a health center. She subsequently developed bacterial meningitis, attributed to sinusitis, and died.

PLAINTIFF’S CLAIM The physician who saw the girl at the health center failed to review records of a previous trip to an emergency room, ask the patient about the severity of her headache, or prescribe antibiotics.

THE DEFENSE No information about the defense is available.

VERDICT $3.75M Illinois verdict.

COMMENT The old lesson of considering not only the most common but also the “have-to-make” diagnoses remains timeless.

Did a failure to communicate cost this patient his life?

A MAN WITH A DRY, NONPRODUCTIVE COUGH and a long history of sinus problems and upper respiratory issues was seen several times by his family care group. One physician ordered a chest radiograph, which a technician performed in house and a radiologist read at another location of the practice. The radiologist compared the radiograph with a chest film done several years earlier and reported a new finding: a 1-cm lung nodule. He recommended further evaluation with a computed tomography (CT) scan.

On the same day as the chest radiograph, the patient was referred to an ear, nose, and throat specialist, who examined him the following day and ordered a CT scan of the sinus. The patient was never notified of the abnormality on the chest radiograph or the need for a follow-up CT scan.

Almost 2 years later, the patient began losing weight and experiencing shortness of breath and chest pain. He went to another medical group and was referred for radiologic evaluation. He was subsequently diagnosed with stage IV terminal lung cancer and died about 9 months later.

PLAINTIFFS’ CLAIM The family care group was negligent for failing to communicate the results of the chest radiograph to the patient. Treatment at the time of the chest x-ray would likely have been curative.

THE DEFENSE No information about the defense is available.

VERDICT $900,000 Virginia settlement.

COMMENT Another abnormal radiograph, another example of inadequate communication leads to a $900,000 settlement.

Parties settle for $11 million after uterine rupture

A PREGNANT WOMAN REPORTED to her local hospital complaining of uterine contractions. Under the supervision of an attending physician, a resident started oxytocin to initiate vaginal delivery. Decelerations in the fetal heart rate were observed, but the plan of delivery did not change. When decelerations became severe, however, cesarean delivery was performed, and uterine rupture was discovered. The infant was later given a diagnosis of cerebral palsy and cognitive and visual impairment. Tube feeding is necessary.

PATIENT’S CLAIM Contractions were weak when she first presented to the hospital, and labor questionable, so oxytocin should not have been administered. Also, the physicians failed to recognize the likelihood of uterine rupture and performed the cesarean too late to prevent it.

PHYSICIANS’ DEFENSE Not reported.

VERDICT $11 million Illinois settlement.

Radiologist: It’s Ca. Gyns: No, it is not. Patient dies—of Ca.

A 65-YEAR-OLD WOMAN with postmenopausal bleeding underwent pelvic ultrasonography (US). The radiologist reported abnormal findings and a primary diagnostic consideration of endometrial cancer. Dr. A, the patient’s gynecologist, performed an office biopsy after informing her of concern about abnormal tissue and cancer but never mentioned the US results. The patient was then referred to Dr. B, a gynecologic oncologist, for a hysteroscopy and dilation and curettage (D & C). Dr. A and Dr. B agreed that all results were negative for cancer, and Dr. B told the patient she did not have cancer.

Six months later, she returned to Dr. A because of postcoital bleeding, and topical estrogen was recommended for vaginal dryness. On vacation the following year, the woman experienced heavy bleeding. Dr. C, another gynecologist, found abnormal tissue and sent her back to her own physicians. Dr. B performed an immediate hysterectomy and gave her a diagnosis of stage 2 endometrial cancer that had spread to the lymph nodes. Nine months later, after two courses of chemotherapy and radiation therapy, the patient died.

CLAIM ON BEHALF OF PATIENT’S ESTATE She should have been informed of the radiologist’s concern about endometrial cancer and offered the option of a hysterectomy. If a hysterectomy had been performed within the next year, she would have had a 90% chance of survival. Also, the tissue samples obtained in the office biopsy and the D & C were too small to rule out cancer, and not all the tissue was analyzed.

PHYSICIANS’ DEFENSE They had informed the patient about the possibility of cancer and then obtained the negative test results; she did not need to be told specific details of the radiologist’s report. Also, the cancer was aggressive and developed more than a year after her first visit for bleeding.

VERDICT $1,137,444 Pennsylvania verdict.

$23 million for failure to test breast lump

A 23-YEAR-OLD WOMAN called her ObGyn in July 2003 to report a lump in her breast and asked to be seen immediately. The physician asked her to wait until her next appointment, which was 2 weeks away. At that time, the patient had to remind the physician to examine the lump. The physician diagnosed the mass as a cyst, without testing, and told the patient it was nothing to worry about. She did not document the lump in the chart or schedule any follow-up for it.

The patient became pregnant and was seen by the ObGyn for prenatal care on 16 occasions, without further evaluation of the lump. After delivery, 2 years after the lump was first reported, the patient complained that it was growing in size. She was seen by her ObGyn’s partner, who ordered a mammogram and ultrasonography that revealed a 4-cm mass. A biopsy confirmed breast cancer. Additional imaging revealed metastasis to the liver. The patient underwent chemotherapy, lumpectomy, total hysterectomy, and radiation therapy, but was told a cure was unlikely.

PATIENT’S CLAIM The first ObGyn should have ordered testing when the lump was first reported.

PHYSICIAN’S DEFENSE The lump diagnosed as cancer in 2005 was not the lump present in 2003. Even if it were the same lump, it likely had already metastasized, rendering the delay in treatment irrelevant.

VERDICT $23.6 million Tennessee verdict.

Parties settle for $11 million after uterine rupture

A PREGNANT WOMAN REPORTED to her local hospital complaining of uterine contractions. Under the supervision of an attending physician, a resident started oxytocin to initiate vaginal delivery. Decelerations in the fetal heart rate were observed, but the plan of delivery did not change. When decelerations became severe, however, cesarean delivery was performed, and uterine rupture was discovered. The infant was later given a diagnosis of cerebral palsy and cognitive and visual impairment. Tube feeding is necessary.

PATIENT’S CLAIM Contractions were weak when she first presented to the hospital, and labor questionable, so oxytocin should not have been administered. Also, the physicians failed to recognize the likelihood of uterine rupture and performed the cesarean too late to prevent it.

PHYSICIANS’ DEFENSE Not reported.

VERDICT $11 million Illinois settlement.

Radiologist: It’s Ca. Gyns: No, it is not. Patient dies—of Ca.

A 65-YEAR-OLD WOMAN with postmenopausal bleeding underwent pelvic ultrasonography (US). The radiologist reported abnormal findings and a primary diagnostic consideration of endometrial cancer. Dr. A, the patient’s gynecologist, performed an office biopsy after informing her of concern about abnormal tissue and cancer but never mentioned the US results. The patient was then referred to Dr. B, a gynecologic oncologist, for a hysteroscopy and dilation and curettage (D & C). Dr. A and Dr. B agreed that all results were negative for cancer, and Dr. B told the patient she did not have cancer.

Six months later, she returned to Dr. A because of postcoital bleeding, and topical estrogen was recommended for vaginal dryness. On vacation the following year, the woman experienced heavy bleeding. Dr. C, another gynecologist, found abnormal tissue and sent her back to her own physicians. Dr. B performed an immediate hysterectomy and gave her a diagnosis of stage 2 endometrial cancer that had spread to the lymph nodes. Nine months later, after two courses of chemotherapy and radiation therapy, the patient died.

CLAIM ON BEHALF OF PATIENT’S ESTATE She should have been informed of the radiologist’s concern about endometrial cancer and offered the option of a hysterectomy. If a hysterectomy had been performed within the next year, she would have had a 90% chance of survival. Also, the tissue samples obtained in the office biopsy and the D & C were too small to rule out cancer, and not all the tissue was analyzed.

PHYSICIANS’ DEFENSE They had informed the patient about the possibility of cancer and then obtained the negative test results; she did not need to be told specific details of the radiologist’s report. Also, the cancer was aggressive and developed more than a year after her first visit for bleeding.

VERDICT $1,137,444 Pennsylvania verdict.

$23 million for failure to test breast lump

A 23-YEAR-OLD WOMAN called her ObGyn in July 2003 to report a lump in her breast and asked to be seen immediately. The physician asked her to wait until her next appointment, which was 2 weeks away. At that time, the patient had to remind the physician to examine the lump. The physician diagnosed the mass as a cyst, without testing, and told the patient it was nothing to worry about. She did not document the lump in the chart or schedule any follow-up for it.

The patient became pregnant and was seen by the ObGyn for prenatal care on 16 occasions, without further evaluation of the lump. After delivery, 2 years after the lump was first reported, the patient complained that it was growing in size. She was seen by her ObGyn’s partner, who ordered a mammogram and ultrasonography that revealed a 4-cm mass. A biopsy confirmed breast cancer. Additional imaging revealed metastasis to the liver. The patient underwent chemotherapy, lumpectomy, total hysterectomy, and radiation therapy, but was told a cure was unlikely.

PATIENT’S CLAIM The first ObGyn should have ordered testing when the lump was first reported.

PHYSICIAN’S DEFENSE The lump diagnosed as cancer in 2005 was not the lump present in 2003. Even if it were the same lump, it likely had already metastasized, rendering the delay in treatment irrelevant.

VERDICT $23.6 million Tennessee verdict.

Parties settle for $11 million after uterine rupture

A PREGNANT WOMAN REPORTED to her local hospital complaining of uterine contractions. Under the supervision of an attending physician, a resident started oxytocin to initiate vaginal delivery. Decelerations in the fetal heart rate were observed, but the plan of delivery did not change. When decelerations became severe, however, cesarean delivery was performed, and uterine rupture was discovered. The infant was later given a diagnosis of cerebral palsy and cognitive and visual impairment. Tube feeding is necessary.

PATIENT’S CLAIM Contractions were weak when she first presented to the hospital, and labor questionable, so oxytocin should not have been administered. Also, the physicians failed to recognize the likelihood of uterine rupture and performed the cesarean too late to prevent it.

PHYSICIANS’ DEFENSE Not reported.

VERDICT $11 million Illinois settlement.

Radiologist: It’s Ca. Gyns: No, it is not. Patient dies—of Ca.

A 65-YEAR-OLD WOMAN with postmenopausal bleeding underwent pelvic ultrasonography (US). The radiologist reported abnormal findings and a primary diagnostic consideration of endometrial cancer. Dr. A, the patient’s gynecologist, performed an office biopsy after informing her of concern about abnormal tissue and cancer but never mentioned the US results. The patient was then referred to Dr. B, a gynecologic oncologist, for a hysteroscopy and dilation and curettage (D & C). Dr. A and Dr. B agreed that all results were negative for cancer, and Dr. B told the patient she did not have cancer.

Six months later, she returned to Dr. A because of postcoital bleeding, and topical estrogen was recommended for vaginal dryness. On vacation the following year, the woman experienced heavy bleeding. Dr. C, another gynecologist, found abnormal tissue and sent her back to her own physicians. Dr. B performed an immediate hysterectomy and gave her a diagnosis of stage 2 endometrial cancer that had spread to the lymph nodes. Nine months later, after two courses of chemotherapy and radiation therapy, the patient died.

CLAIM ON BEHALF OF PATIENT’S ESTATE She should have been informed of the radiologist’s concern about endometrial cancer and offered the option of a hysterectomy. If a hysterectomy had been performed within the next year, she would have had a 90% chance of survival. Also, the tissue samples obtained in the office biopsy and the D & C were too small to rule out cancer, and not all the tissue was analyzed.

PHYSICIANS’ DEFENSE They had informed the patient about the possibility of cancer and then obtained the negative test results; she did not need to be told specific details of the radiologist’s report. Also, the cancer was aggressive and developed more than a year after her first visit for bleeding.

VERDICT $1,137,444 Pennsylvania verdict.

$23 million for failure to test breast lump

A 23-YEAR-OLD WOMAN called her ObGyn in July 2003 to report a lump in her breast and asked to be seen immediately. The physician asked her to wait until her next appointment, which was 2 weeks away. At that time, the patient had to remind the physician to examine the lump. The physician diagnosed the mass as a cyst, without testing, and told the patient it was nothing to worry about. She did not document the lump in the chart or schedule any follow-up for it.

The patient became pregnant and was seen by the ObGyn for prenatal care on 16 occasions, without further evaluation of the lump. After delivery, 2 years after the lump was first reported, the patient complained that it was growing in size. She was seen by her ObGyn’s partner, who ordered a mammogram and ultrasonography that revealed a 4-cm mass. A biopsy confirmed breast cancer. Additional imaging revealed metastasis to the liver. The patient underwent chemotherapy, lumpectomy, total hysterectomy, and radiation therapy, but was told a cure was unlikely.

PATIENT’S CLAIM The first ObGyn should have ordered testing when the lump was first reported.

PHYSICIAN’S DEFENSE The lump diagnosed as cancer in 2005 was not the lump present in 2003. Even if it were the same lump, it likely had already metastasized, rendering the delay in treatment irrelevant.

VERDICT $23.6 million Tennessee verdict.

Bladder and bowel function lost to cauda equina syndrome

LOWER BACK PAIN developed in a 34-year-old woman around the time she had fibroids removed by her obstetrician-gynecologist. The woman reported the pain at her first postoperative visit. The OB/GYN offered treatment, but the patient traveled to the Dominican Republic for 2 months instead.

The month after the patient’s return, she experienced sharp pain in her legs and temporarily lost control of her bladder and bowels. Eight days later, she returned to the OB/GYN complaining of pain and occasional urinary incontinence. The doctor diagnosed neurogenic bladder, prescribed medication, and told the patient to follow up in a week. At some point over the next few days, the patient could not urinate, but didn’t return to the doctor for a week. The doctor catheterized her and drained about 3000 mL of urine. He then sent her to a hospital.

The hospital staff suspected cauda equina syndrome and consulted a neurologist, who concluded that the patient didn’t have the condition. The patient refused a magnetic resonance imaging (MRI) scan at that time because she didn’t think she could assume the required position. The patient ultimately underwent an MRI scan a week later. Another neurologist reviewed the scan and diagnosed cauda equina syndrome. Despite surgery, the patient has permanent bowel and bladder dysfunction.

PLAINTIFF’S CLAIM The defendants were negligent in failing to diagnose cauda equina syndrome earlier.

DOCTORS’ DEFENSE The OB/GYN claimed that the patient didn’t undergo the recommended follow-up treatment after surgery. The neurologist claimed that his examination didn’t reveal any objective indications of cauda equina syndrome.

VERDICT $1.5 million New York settlement.

COMMENT Suspicion of cauda equina demands prompt imaging and neurologic consultation. Failure to do so can lead to devastating consequences.

Failure to suspect stroke results in brain damage

A 37-YEAR-OLD WOMAN went to a gastroenterologist for a postoperative consult. Her blood pressure was 180/100. Her medical history included recent symptoms of blurred vision, dizziness, nosebleeds, and tingling in the face and right arm. She was taking medications that increased her risk of stroke, had preexisting Crohn’s disease, and smoked.

The day after the doctor visit, the woman went to a hospital, where she was diagnosed with a stroke from a left cerebral artery infarction and dissection with clot formation in the left internal carotid artery. She suffered brain damage with aphasia and right hemiparalysis.

PLAINTIFF’S CLAIM The doctor was negligent for failing to diagnose the patient’s condition and provide treatment.

DOCTOR’S DEFENSE The doctor denied any negligence.

VERDICT Indiana defense verdict.

COMMENT In this age of thrombolysis and aggressive stroke management, rapid diagnosis and intervention has gone from an academic exercise to a standard of care.

Suspicious finding + no follow-up = lawsuit

CONGESTIVE HEART FAILURE and atrial fibrillation prompted the hospitalization of a 79-year-old woman. A radiograph showed a density in the upper left lobe of her lung, and another x-ray was ordered. The same radiologist reviewed both films and recommended that the patient undergo a third radiograph after discharge from the hospital. Although informed of the radiologist’s findings and recommendations, the patient’s physician didn’t order a radiograph or computed tomography (CT) scan. The patient wasn’t notified of the findings.

The density was still visible on radiographs taken about 19 months after the original films. Seventeen months later, the patient complained of left chest wall discomfort and had another radiograph, which showed the density and a collection of pleural fluid. A CT scan suggested cancer. The patient was ultimately diagnosed with stage-III, poorly differentiated adenocarcinoma—which has a very low survival rate—in her left pleura. Because of the prognosis, a biopsy wasn’t performed.

PLAINTIFF’S CLAIM The defendant was negligent in failing to follow up on the radiologist’s report. Proper diagnosis and treatment at the time of the original radiographs would have meant targeting the cancer at stage I, when the survival rate would have been much higher.

THE DEFENSE The primary lung cancer wasn’t in the upper left lobe, and the density was probably only a scar. The cancer was likely somewhere else, possibly the gastrointestinal tract.

VERDICT $500,000 Massachusetts arbitration award.

COMMENT Poor handoffs in care, especially follow-up of abnormal imaging tests, such as a lung or breast mass, remain an all too common cause of malpractice claims.

Doctor crosses line, pays the price

A WOMAN BECAME SEXUALLY INVOLVED with her family practitioner, an affair she claimed the doctor initiated while he was treating her for anxiety and depression. She said the physician-patient relationship had begun more than a year before the sexual involvement when she learned that her infant daughter had cerebral palsy; the doctor prescribed paroxetine and bupropion.

The affair ended about 10 months after it began. The patient said it caused her marriage to deteriorate.

PLAINTIFF’S CLAIM The patient couldn’t exercise independent judgment because she was experiencing eroticized transference; the doctor mishandled the transference phenomenon.

THE DEFENSE The sexual relationship was brief and ended 6 months before the doctor treated the patient.

VERDICT $416,500 net verdict in New York.

COMMENT It’s never prudent to become involved sexually with a patient.

Bladder and bowel function lost to cauda equina syndrome

LOWER BACK PAIN developed in a 34-year-old woman around the time she had fibroids removed by her obstetrician-gynecologist. The woman reported the pain at her first postoperative visit. The OB/GYN offered treatment, but the patient traveled to the Dominican Republic for 2 months instead.

The month after the patient’s return, she experienced sharp pain in her legs and temporarily lost control of her bladder and bowels. Eight days later, she returned to the OB/GYN complaining of pain and occasional urinary incontinence. The doctor diagnosed neurogenic bladder, prescribed medication, and told the patient to follow up in a week. At some point over the next few days, the patient could not urinate, but didn’t return to the doctor for a week. The doctor catheterized her and drained about 3000 mL of urine. He then sent her to a hospital.

The hospital staff suspected cauda equina syndrome and consulted a neurologist, who concluded that the patient didn’t have the condition. The patient refused a magnetic resonance imaging (MRI) scan at that time because she didn’t think she could assume the required position. The patient ultimately underwent an MRI scan a week later. Another neurologist reviewed the scan and diagnosed cauda equina syndrome. Despite surgery, the patient has permanent bowel and bladder dysfunction.

PLAINTIFF’S CLAIM The defendants were negligent in failing to diagnose cauda equina syndrome earlier.

DOCTORS’ DEFENSE The OB/GYN claimed that the patient didn’t undergo the recommended follow-up treatment after surgery. The neurologist claimed that his examination didn’t reveal any objective indications of cauda equina syndrome.

VERDICT $1.5 million New York settlement.

COMMENT Suspicion of cauda equina demands prompt imaging and neurologic consultation. Failure to do so can lead to devastating consequences.

Failure to suspect stroke results in brain damage

A 37-YEAR-OLD WOMAN went to a gastroenterologist for a postoperative consult. Her blood pressure was 180/100. Her medical history included recent symptoms of blurred vision, dizziness, nosebleeds, and tingling in the face and right arm. She was taking medications that increased her risk of stroke, had preexisting Crohn’s disease, and smoked.

The day after the doctor visit, the woman went to a hospital, where she was diagnosed with a stroke from a left cerebral artery infarction and dissection with clot formation in the left internal carotid artery. She suffered brain damage with aphasia and right hemiparalysis.

PLAINTIFF’S CLAIM The doctor was negligent for failing to diagnose the patient’s condition and provide treatment.

DOCTOR’S DEFENSE The doctor denied any negligence.

VERDICT Indiana defense verdict.

COMMENT In this age of thrombolysis and aggressive stroke management, rapid diagnosis and intervention has gone from an academic exercise to a standard of care.

Suspicious finding + no follow-up = lawsuit

CONGESTIVE HEART FAILURE and atrial fibrillation prompted the hospitalization of a 79-year-old woman. A radiograph showed a density in the upper left lobe of her lung, and another x-ray was ordered. The same radiologist reviewed both films and recommended that the patient undergo a third radiograph after discharge from the hospital. Although informed of the radiologist’s findings and recommendations, the patient’s physician didn’t order a radiograph or computed tomography (CT) scan. The patient wasn’t notified of the findings.

The density was still visible on radiographs taken about 19 months after the original films. Seventeen months later, the patient complained of left chest wall discomfort and had another radiograph, which showed the density and a collection of pleural fluid. A CT scan suggested cancer. The patient was ultimately diagnosed with stage-III, poorly differentiated adenocarcinoma—which has a very low survival rate—in her left pleura. Because of the prognosis, a biopsy wasn’t performed.

PLAINTIFF’S CLAIM The defendant was negligent in failing to follow up on the radiologist’s report. Proper diagnosis and treatment at the time of the original radiographs would have meant targeting the cancer at stage I, when the survival rate would have been much higher.

THE DEFENSE The primary lung cancer wasn’t in the upper left lobe, and the density was probably only a scar. The cancer was likely somewhere else, possibly the gastrointestinal tract.

VERDICT $500,000 Massachusetts arbitration award.

COMMENT Poor handoffs in care, especially follow-up of abnormal imaging tests, such as a lung or breast mass, remain an all too common cause of malpractice claims.

Doctor crosses line, pays the price

A WOMAN BECAME SEXUALLY INVOLVED with her family practitioner, an affair she claimed the doctor initiated while he was treating her for anxiety and depression. She said the physician-patient relationship had begun more than a year before the sexual involvement when she learned that her infant daughter had cerebral palsy; the doctor prescribed paroxetine and bupropion.

The affair ended about 10 months after it began. The patient said it caused her marriage to deteriorate.

PLAINTIFF’S CLAIM The patient couldn’t exercise independent judgment because she was experiencing eroticized transference; the doctor mishandled the transference phenomenon.

THE DEFENSE The sexual relationship was brief and ended 6 months before the doctor treated the patient.

VERDICT $416,500 net verdict in New York.

COMMENT It’s never prudent to become involved sexually with a patient.

Bladder and bowel function lost to cauda equina syndrome

LOWER BACK PAIN developed in a 34-year-old woman around the time she had fibroids removed by her obstetrician-gynecologist. The woman reported the pain at her first postoperative visit. The OB/GYN offered treatment, but the patient traveled to the Dominican Republic for 2 months instead.

The month after the patient’s return, she experienced sharp pain in her legs and temporarily lost control of her bladder and bowels. Eight days later, she returned to the OB/GYN complaining of pain and occasional urinary incontinence. The doctor diagnosed neurogenic bladder, prescribed medication, and told the patient to follow up in a week. At some point over the next few days, the patient could not urinate, but didn’t return to the doctor for a week. The doctor catheterized her and drained about 3000 mL of urine. He then sent her to a hospital.

The hospital staff suspected cauda equina syndrome and consulted a neurologist, who concluded that the patient didn’t have the condition. The patient refused a magnetic resonance imaging (MRI) scan at that time because she didn’t think she could assume the required position. The patient ultimately underwent an MRI scan a week later. Another neurologist reviewed the scan and diagnosed cauda equina syndrome. Despite surgery, the patient has permanent bowel and bladder dysfunction.

PLAINTIFF’S CLAIM The defendants were negligent in failing to diagnose cauda equina syndrome earlier.

DOCTORS’ DEFENSE The OB/GYN claimed that the patient didn’t undergo the recommended follow-up treatment after surgery. The neurologist claimed that his examination didn’t reveal any objective indications of cauda equina syndrome.

VERDICT $1.5 million New York settlement.

COMMENT Suspicion of cauda equina demands prompt imaging and neurologic consultation. Failure to do so can lead to devastating consequences.

Failure to suspect stroke results in brain damage

A 37-YEAR-OLD WOMAN went to a gastroenterologist for a postoperative consult. Her blood pressure was 180/100. Her medical history included recent symptoms of blurred vision, dizziness, nosebleeds, and tingling in the face and right arm. She was taking medications that increased her risk of stroke, had preexisting Crohn’s disease, and smoked.

The day after the doctor visit, the woman went to a hospital, where she was diagnosed with a stroke from a left cerebral artery infarction and dissection with clot formation in the left internal carotid artery. She suffered brain damage with aphasia and right hemiparalysis.

PLAINTIFF’S CLAIM The doctor was negligent for failing to diagnose the patient’s condition and provide treatment.

DOCTOR’S DEFENSE The doctor denied any negligence.

VERDICT Indiana defense verdict.

COMMENT In this age of thrombolysis and aggressive stroke management, rapid diagnosis and intervention has gone from an academic exercise to a standard of care.

Suspicious finding + no follow-up = lawsuit

CONGESTIVE HEART FAILURE and atrial fibrillation prompted the hospitalization of a 79-year-old woman. A radiograph showed a density in the upper left lobe of her lung, and another x-ray was ordered. The same radiologist reviewed both films and recommended that the patient undergo a third radiograph after discharge from the hospital. Although informed of the radiologist’s findings and recommendations, the patient’s physician didn’t order a radiograph or computed tomography (CT) scan. The patient wasn’t notified of the findings.

The density was still visible on radiographs taken about 19 months after the original films. Seventeen months later, the patient complained of left chest wall discomfort and had another radiograph, which showed the density and a collection of pleural fluid. A CT scan suggested cancer. The patient was ultimately diagnosed with stage-III, poorly differentiated adenocarcinoma—which has a very low survival rate—in her left pleura. Because of the prognosis, a biopsy wasn’t performed.

PLAINTIFF’S CLAIM The defendant was negligent in failing to follow up on the radiologist’s report. Proper diagnosis and treatment at the time of the original radiographs would have meant targeting the cancer at stage I, when the survival rate would have been much higher.

THE DEFENSE The primary lung cancer wasn’t in the upper left lobe, and the density was probably only a scar. The cancer was likely somewhere else, possibly the gastrointestinal tract.

VERDICT $500,000 Massachusetts arbitration award.

COMMENT Poor handoffs in care, especially follow-up of abnormal imaging tests, such as a lung or breast mass, remain an all too common cause of malpractice claims.

Doctor crosses line, pays the price

A WOMAN BECAME SEXUALLY INVOLVED with her family practitioner, an affair she claimed the doctor initiated while he was treating her for anxiety and depression. She said the physician-patient relationship had begun more than a year before the sexual involvement when she learned that her infant daughter had cerebral palsy; the doctor prescribed paroxetine and bupropion.

The affair ended about 10 months after it began. The patient said it caused her marriage to deteriorate.

PLAINTIFF’S CLAIM The patient couldn’t exercise independent judgment because she was experiencing eroticized transference; the doctor mishandled the transference phenomenon.

THE DEFENSE The sexual relationship was brief and ended 6 months before the doctor treated the patient.

VERDICT $416,500 net verdict in New York.

COMMENT It’s never prudent to become involved sexually with a patient.

Car accident blamed on lack of post-test monitoring

AN IN-OFFICE FASTING BLOOD TEST was performed at a medical clinic on a 53-year-old man with diabetes. The man had been hospitalized recently with life-threatening complications arising from poor management of his diabetes. He hadn’t eaten or taken any medication, including insulin, in the 12 hours before the test.

After his blood was taken, the patient was told that he could leave the clinic. Shortly afterwards, another patient reported that a man in the parking lot was acting confused and disoriented.

Office personnel read the blood test results—which showed a blood sugar level <50 mg/dL—and called the man’s wife.

Almost immediately afterward, the wife received a call from the police informing her that her husband had been in a single-car rollover accident. He suffered a stable T12 compression fracture. His blood sugar, taken by paramedics, was 24. The patient said he was unaware of his hypoglycemia and impaired cognitive function.

PLAINTIFF’S CLAIM The clinic didn’t have policies and procedures for testing fasting blood sugar in patients with diabetes, who have a known risk of hypoglycemia. The clinic shouldn’t have allowed a fasting patient with diabetes to leave before his blood tests were complete and he had eaten a snack.

THE DEFENSE The only explanation for the drop in the patient’s blood sugar was that he had taken his morning insulin in disregard of his doctor’s orders. Patients who are unaware of their hypoglycemia often show no outward signs of impairment. The patient failed to take responsibility for educating himself about his disease and managing it properly.

VERDICT $400,000 Missouri settlement.

COMMENT Clear office policies and procedures can reduce the risk of lawsuits.

Car accident blamed on lack of post-test monitoring

AN IN-OFFICE FASTING BLOOD TEST was performed at a medical clinic on a 53-year-old man with diabetes. The man had been hospitalized recently with life-threatening complications arising from poor management of his diabetes. He hadn’t eaten or taken any medication, including insulin, in the 12 hours before the test.

After his blood was taken, the patient was told that he could leave the clinic. Shortly afterwards, another patient reported that a man in the parking lot was acting confused and disoriented.

Office personnel read the blood test results—which showed a blood sugar level <50 mg/dL—and called the man’s wife.

Almost immediately afterward, the wife received a call from the police informing her that her husband had been in a single-car rollover accident. He suffered a stable T12 compression fracture. His blood sugar, taken by paramedics, was 24. The patient said he was unaware of his hypoglycemia and impaired cognitive function.

PLAINTIFF’S CLAIM The clinic didn’t have policies and procedures for testing fasting blood sugar in patients with diabetes, who have a known risk of hypoglycemia. The clinic shouldn’t have allowed a fasting patient with diabetes to leave before his blood tests were complete and he had eaten a snack.

THE DEFENSE The only explanation for the drop in the patient’s blood sugar was that he had taken his morning insulin in disregard of his doctor’s orders. Patients who are unaware of their hypoglycemia often show no outward signs of impairment. The patient failed to take responsibility for educating himself about his disease and managing it properly.

VERDICT $400,000 Missouri settlement.

COMMENT Clear office policies and procedures can reduce the risk of lawsuits.

Car accident blamed on lack of post-test monitoring

AN IN-OFFICE FASTING BLOOD TEST was performed at a medical clinic on a 53-year-old man with diabetes. The man had been hospitalized recently with life-threatening complications arising from poor management of his diabetes. He hadn’t eaten or taken any medication, including insulin, in the 12 hours before the test.

After his blood was taken, the patient was told that he could leave the clinic. Shortly afterwards, another patient reported that a man in the parking lot was acting confused and disoriented.

Office personnel read the blood test results—which showed a blood sugar level <50 mg/dL—and called the man’s wife.

Almost immediately afterward, the wife received a call from the police informing her that her husband had been in a single-car rollover accident. He suffered a stable T12 compression fracture. His blood sugar, taken by paramedics, was 24. The patient said he was unaware of his hypoglycemia and impaired cognitive function.

PLAINTIFF’S CLAIM The clinic didn’t have policies and procedures for testing fasting blood sugar in patients with diabetes, who have a known risk of hypoglycemia. The clinic shouldn’t have allowed a fasting patient with diabetes to leave before his blood tests were complete and he had eaten a snack.

THE DEFENSE The only explanation for the drop in the patient’s blood sugar was that he had taken his morning insulin in disregard of his doctor’s orders. Patients who are unaware of their hypoglycemia often show no outward signs of impairment. The patient failed to take responsibility for educating himself about his disease and managing it properly.

VERDICT $400,000 Missouri settlement.

COMMENT Clear office policies and procedures can reduce the risk of lawsuits.

When—and why—was this newborn’s brain injured?

A PREGNANT WOMAN at 34 weeks’ gestation, with a family history of hypertension, experienced swelling of her feet and ankles. She called the midwife prenatal clinic where she was receiving care and was advised to elevate her feet. The next day she called again to report decreased fetal movement, severe edema in her feet and ankles, dizziness, and blurred vision. She was sent to the hospital, where her normal blood pressure and urine protein measurement ruled out preeclampsia. A nonstress test was initially nonreactive and then became reactive, and a biophysical profile score was reassuring. After the results were reported to her certified nurse-midwife, the patient was discharged and instructed to perform fetal kick counts to monitor fetal movement. She was also instructed about preeclampsia. Two weeks later, at 36 weeks’ gestation, she reported contractions, low back pain, headache, and swollen feet and ankles. She was sent to the hospital, where her blood pressure was found to be severely elevated, her urine protein was 3+, and fetal heart tones were nonreassuring. The infant was born 1 hour 14 minutes later by emergency cesarean delivery performed by the ObGyn, who had been delayed by another birth. Mild placental abruption was noted; the child had low Apgar scores, decreased respiratory effort, and low cord blood gases. Diagnoses of birth depression and hypoxic–ischemic encephalopathy were given, and periventricular leukomalacia was evident on head imaging. The child has cognitive deficits and cerebral palsy.

PATIENT’S CLAIM She should have been admitted to the hospital for observation and 24-hour urine testing; then her elevated blood pressure and urine protein level would have been discovered in time for delivery before injury to the infant. Also, because of the nonreassuring fetal monitor tracing, delivery should have been performed earlier that day.

PHYSICIAN’S DEFENSE The fetus was injured in utero a month or more before birth, as periventricular leukomalacia usually occurs at 28 to 32 weeks’ gestation. Also, the patient was properly discharged, because there was no evidence of preeclampsia and the fetal status was reassuring.

VERDICT $1.625 million Michigan settlement.

OB: “Don’t blame me” for faulty IUD placement by nurse

A NURSE UNDER THE SUPERVISION of an obstetrician placed an intrauterine device (IUD) in a patient, but at a follow-up visit the nurse could not see the string of the IUD. Ultrasonography showed the IUD was not in the woman’s uterus. It was removed by laparoscopic surgery.

PATIENT’S CLAIM The nurse placed the IUD incorrectly and, as a result, the uterus was perforated. Also, the physician’s supervision of the nurse was inadequate.

PHYSICIAN’S DEFENSE Not reported.

VERDICT $379,906 Arkansas verdict against the nurse only.

Sexually inactive woman delivers 12-lb stillborn

A 28-YEAR-OLD MORBIDLY OBESE WOMAN presented at the emergency room with low-back pain. Dr. A examined her but could not find a cause for the pain. She then went to Dr. B, an ObGyn, and reported pelvic pain. She admitted having infrequent periods and being sexually inactive. Dr. B performed no pregnancy test and, because of her size, could not palpate the uterus. Dr. A examined her again 10 days later. A few days after that, an x-ray showed a deceased fetus in a breech position. A 12-lb stillborn infant was delivered later that day.

PATIENT’S CLAIM Dr. A and Dr. B were negligent for not diagnosing the pregnancy. Despite her denial of sexual activity, they should have ordered a pregnancy test, which would have discovered the fetus and allowed the birth of a healthy baby. Instead, the fetus died 2 days before delivery.

PHYSICIAN’S DEFENSE Given the history and presentation of the mother, Dr. B claimed his care was reasonable. Also, the fetus died before the mother came to him.

VERDICT Kentucky defense verdict for Dr. B. Before a trial, Dr. A settled for an undisclosed amount.

When—and why—was this newborn’s brain injured?

A PREGNANT WOMAN at 34 weeks’ gestation, with a family history of hypertension, experienced swelling of her feet and ankles. She called the midwife prenatal clinic where she was receiving care and was advised to elevate her feet. The next day she called again to report decreased fetal movement, severe edema in her feet and ankles, dizziness, and blurred vision. She was sent to the hospital, where her normal blood pressure and urine protein measurement ruled out preeclampsia. A nonstress test was initially nonreactive and then became reactive, and a biophysical profile score was reassuring. After the results were reported to her certified nurse-midwife, the patient was discharged and instructed to perform fetal kick counts to monitor fetal movement. She was also instructed about preeclampsia. Two weeks later, at 36 weeks’ gestation, she reported contractions, low back pain, headache, and swollen feet and ankles. She was sent to the hospital, where her blood pressure was found to be severely elevated, her urine protein was 3+, and fetal heart tones were nonreassuring. The infant was born 1 hour 14 minutes later by emergency cesarean delivery performed by the ObGyn, who had been delayed by another birth. Mild placental abruption was noted; the child had low Apgar scores, decreased respiratory effort, and low cord blood gases. Diagnoses of birth depression and hypoxic–ischemic encephalopathy were given, and periventricular leukomalacia was evident on head imaging. The child has cognitive deficits and cerebral palsy.

PATIENT’S CLAIM She should have been admitted to the hospital for observation and 24-hour urine testing; then her elevated blood pressure and urine protein level would have been discovered in time for delivery before injury to the infant. Also, because of the nonreassuring fetal monitor tracing, delivery should have been performed earlier that day.

PHYSICIAN’S DEFENSE The fetus was injured in utero a month or more before birth, as periventricular leukomalacia usually occurs at 28 to 32 weeks’ gestation. Also, the patient was properly discharged, because there was no evidence of preeclampsia and the fetal status was reassuring.

VERDICT $1.625 million Michigan settlement.

OB: “Don’t blame me” for faulty IUD placement by nurse

A NURSE UNDER THE SUPERVISION of an obstetrician placed an intrauterine device (IUD) in a patient, but at a follow-up visit the nurse could not see the string of the IUD. Ultrasonography showed the IUD was not in the woman’s uterus. It was removed by laparoscopic surgery.

PATIENT’S CLAIM The nurse placed the IUD incorrectly and, as a result, the uterus was perforated. Also, the physician’s supervision of the nurse was inadequate.

PHYSICIAN’S DEFENSE Not reported.

VERDICT $379,906 Arkansas verdict against the nurse only.

Sexually inactive woman delivers 12-lb stillborn

A 28-YEAR-OLD MORBIDLY OBESE WOMAN presented at the emergency room with low-back pain. Dr. A examined her but could not find a cause for the pain. She then went to Dr. B, an ObGyn, and reported pelvic pain. She admitted having infrequent periods and being sexually inactive. Dr. B performed no pregnancy test and, because of her size, could not palpate the uterus. Dr. A examined her again 10 days later. A few days after that, an x-ray showed a deceased fetus in a breech position. A 12-lb stillborn infant was delivered later that day.

PATIENT’S CLAIM Dr. A and Dr. B were negligent for not diagnosing the pregnancy. Despite her denial of sexual activity, they should have ordered a pregnancy test, which would have discovered the fetus and allowed the birth of a healthy baby. Instead, the fetus died 2 days before delivery.

PHYSICIAN’S DEFENSE Given the history and presentation of the mother, Dr. B claimed his care was reasonable. Also, the fetus died before the mother came to him.

VERDICT Kentucky defense verdict for Dr. B. Before a trial, Dr. A settled for an undisclosed amount.

When—and why—was this newborn’s brain injured?

A PREGNANT WOMAN at 34 weeks’ gestation, with a family history of hypertension, experienced swelling of her feet and ankles. She called the midwife prenatal clinic where she was receiving care and was advised to elevate her feet. The next day she called again to report decreased fetal movement, severe edema in her feet and ankles, dizziness, and blurred vision. She was sent to the hospital, where her normal blood pressure and urine protein measurement ruled out preeclampsia. A nonstress test was initially nonreactive and then became reactive, and a biophysical profile score was reassuring. After the results were reported to her certified nurse-midwife, the patient was discharged and instructed to perform fetal kick counts to monitor fetal movement. She was also instructed about preeclampsia. Two weeks later, at 36 weeks’ gestation, she reported contractions, low back pain, headache, and swollen feet and ankles. She was sent to the hospital, where her blood pressure was found to be severely elevated, her urine protein was 3+, and fetal heart tones were nonreassuring. The infant was born 1 hour 14 minutes later by emergency cesarean delivery performed by the ObGyn, who had been delayed by another birth. Mild placental abruption was noted; the child had low Apgar scores, decreased respiratory effort, and low cord blood gases. Diagnoses of birth depression and hypoxic–ischemic encephalopathy were given, and periventricular leukomalacia was evident on head imaging. The child has cognitive deficits and cerebral palsy.

PATIENT’S CLAIM She should have been admitted to the hospital for observation and 24-hour urine testing; then her elevated blood pressure and urine protein level would have been discovered in time for delivery before injury to the infant. Also, because of the nonreassuring fetal monitor tracing, delivery should have been performed earlier that day.

PHYSICIAN’S DEFENSE The fetus was injured in utero a month or more before birth, as periventricular leukomalacia usually occurs at 28 to 32 weeks’ gestation. Also, the patient was properly discharged, because there was no evidence of preeclampsia and the fetal status was reassuring.

VERDICT $1.625 million Michigan settlement.

OB: “Don’t blame me” for faulty IUD placement by nurse

A NURSE UNDER THE SUPERVISION of an obstetrician placed an intrauterine device (IUD) in a patient, but at a follow-up visit the nurse could not see the string of the IUD. Ultrasonography showed the IUD was not in the woman’s uterus. It was removed by laparoscopic surgery.

PATIENT’S CLAIM The nurse placed the IUD incorrectly and, as a result, the uterus was perforated. Also, the physician’s supervision of the nurse was inadequate.

PHYSICIAN’S DEFENSE Not reported.

VERDICT $379,906 Arkansas verdict against the nurse only.

Sexually inactive woman delivers 12-lb stillborn

A 28-YEAR-OLD MORBIDLY OBESE WOMAN presented at the emergency room with low-back pain. Dr. A examined her but could not find a cause for the pain. She then went to Dr. B, an ObGyn, and reported pelvic pain. She admitted having infrequent periods and being sexually inactive. Dr. B performed no pregnancy test and, because of her size, could not palpate the uterus. Dr. A examined her again 10 days later. A few days after that, an x-ray showed a deceased fetus in a breech position. A 12-lb stillborn infant was delivered later that day.

PATIENT’S CLAIM Dr. A and Dr. B were negligent for not diagnosing the pregnancy. Despite her denial of sexual activity, they should have ordered a pregnancy test, which would have discovered the fetus and allowed the birth of a healthy baby. Instead, the fetus died 2 days before delivery.

PHYSICIAN’S DEFENSE Given the history and presentation of the mother, Dr. B claimed his care was reasonable. Also, the fetus died before the mother came to him.

VERDICT Kentucky defense verdict for Dr. B. Before a trial, Dr. A settled for an undisclosed amount.

Cyst is discovered when it weighs 7 lb

A 22-YEAR-OLD WOMAN underwent two examinations within a year, both performed by her ObGyn. She did not report abdominal problems, and none were found. Four months after the second exam, she was discovered to have a huge dermoid ovarian cyst—30 cm by 20 cm by 10 cm, and weighing over 7 lb. It required surgery, which included an appendectomy and salpingo-oophorectomy.

PATIENT’S CLAIM The cyst should have been discovered during the first examination, and then less invasive procedures would have been needed.

PHYSICIAN’S DEFENSE The cyst could not be detected in the first exam, and the patient did not report abdominal problems at the second exam. Her treatment and outcome were not changed by a delay in diagnosis.

VERDICT New York defense verdict.

ObGyn: “I never said I nicked the bladder”

FOLLOWING A HYSTERECTOMY performed by an ObGyn employed by a government-run facility, a patient suffered incontinence and other urinary problems. She was referred to a urologist, who diagnosed a vesicovaginal fistula. The fistula was successfully repaired surgically.

PATIENT’S CLAIM The ObGyn admitted nicking the bladder, but believed it would heal on its own. She was negligent for causing the bladder injury and for not repairing it immediately. Also, the surgical note was dictated 18 days following the procedure.

PHYSICIAN’S DEFENSE The ObGyn denied the patient’s first claim. Also, the injury did not occur during surgery, but later, when the bladder wall broke down as a result of postsurgical denervation. If there had been a bladder injury, problems would have been apparent immediately, but in fact the patient’s initial urine counts were good.

VERDICT Kentucky defense verdict.

Oxytocin is given—but baby is breech

A WOMAN PREGNANT with her fifth child presented at the hospital for delivery. A vaginal exam performed by a nurse indicated 1 cm dilation, -3 to -4 station, and 40% effaced. This was reported over the phone to Dr. A, her OB, who then ordered oxytocin. Oxytocin was administered without the nurses determining the fetus’s presentation. When they could not get a reliable reading of the fetal heart tone, they placed a fetal scalp electrode. It showed a nonreassuring fetal heart pattern. Ten minutes later, the fetus was bradycardic, but Dr. A was not called immediately. Dr. B, a second OB, examined the patient 17 minutes later and ordered an immediate cesarean delivery. The fetus was found in the breech position with significant placental abruption—and the fetal scalp electrode was attached on the buttocks, not the head. The baby was born severely depressed—limp, pale, with no cry or movement. He was resuscitated, but a CT scan indicated hypoxic–ischemic brain damage.

PATIENT’S CLAIM Dr. A failed to examine her to determine the presentation, which he should have done before ordering oxytocin. The nurses failed to communicate with him about the presentation and administered oxytocin without documentation of the presentation.

PHYSICIAN’S DEFENSE The nurse indicated the baby was in the vertex position. If he had known it was a breech presentation, he would not have ordered oxytocin, would not have gone for a trial of labor, and would have proceeded directly to a cesarean delivery.

VERDICT $12 million Illinois settlement.

Mother wasn’t admitted for bed rest, and baby is injured

TOWARD THE END OF HER PREGNANCY, a woman was given a diagnosis of pregnancy-induced hypertension. Over the next 2 weeks, she developed pedal edema, elevated blood pressure, and headaches. She was sent to Dr. C for a possible cesarean delivery. He ordered testing to rule out pregnancy-induced hypertension and recommended bed rest and close observation of the blood pressure. A week later, she suffered placental abruption. At the hospital, she delivered an infant born with severe asphyxia. The resulting hypoxic–ischemic encephalopathy caused the child’s death at 5 months.

PATIENT’S CLAIM Dr. C should have admitted her to the hospital to ensure strict bed rest and monitoring of her blood pressure—and also should have ordered a nonstress test.

PHYSICIAN’S DEFENSE There was no negligence.

VERDICT $350,000 Michigan settlement.

Cyst is discovered when it weighs 7 lb

A 22-YEAR-OLD WOMAN underwent two examinations within a year, both performed by her ObGyn. She did not report abdominal problems, and none were found. Four months after the second exam, she was discovered to have a huge dermoid ovarian cyst—30 cm by 20 cm by 10 cm, and weighing over 7 lb. It required surgery, which included an appendectomy and salpingo-oophorectomy.

PATIENT’S CLAIM The cyst should have been discovered during the first examination, and then less invasive procedures would have been needed.

PHYSICIAN’S DEFENSE The cyst could not be detected in the first exam, and the patient did not report abdominal problems at the second exam. Her treatment and outcome were not changed by a delay in diagnosis.

VERDICT New York defense verdict.

ObGyn: “I never said I nicked the bladder”

FOLLOWING A HYSTERECTOMY performed by an ObGyn employed by a government-run facility, a patient suffered incontinence and other urinary problems. She was referred to a urologist, who diagnosed a vesicovaginal fistula. The fistula was successfully repaired surgically.

PATIENT’S CLAIM The ObGyn admitted nicking the bladder, but believed it would heal on its own. She was negligent for causing the bladder injury and for not repairing it immediately. Also, the surgical note was dictated 18 days following the procedure.

PHYSICIAN’S DEFENSE The ObGyn denied the patient’s first claim. Also, the injury did not occur during surgery, but later, when the bladder wall broke down as a result of postsurgical denervation. If there had been a bladder injury, problems would have been apparent immediately, but in fact the patient’s initial urine counts were good.

VERDICT Kentucky defense verdict.

Oxytocin is given—but baby is breech

A WOMAN PREGNANT with her fifth child presented at the hospital for delivery. A vaginal exam performed by a nurse indicated 1 cm dilation, -3 to -4 station, and 40% effaced. This was reported over the phone to Dr. A, her OB, who then ordered oxytocin. Oxytocin was administered without the nurses determining the fetus’s presentation. When they could not get a reliable reading of the fetal heart tone, they placed a fetal scalp electrode. It showed a nonreassuring fetal heart pattern. Ten minutes later, the fetus was bradycardic, but Dr. A was not called immediately. Dr. B, a second OB, examined the patient 17 minutes later and ordered an immediate cesarean delivery. The fetus was found in the breech position with significant placental abruption—and the fetal scalp electrode was attached on the buttocks, not the head. The baby was born severely depressed—limp, pale, with no cry or movement. He was resuscitated, but a CT scan indicated hypoxic–ischemic brain damage.

PATIENT’S CLAIM Dr. A failed to examine her to determine the presentation, which he should have done before ordering oxytocin. The nurses failed to communicate with him about the presentation and administered oxytocin without documentation of the presentation.

PHYSICIAN’S DEFENSE The nurse indicated the baby was in the vertex position. If he had known it was a breech presentation, he would not have ordered oxytocin, would not have gone for a trial of labor, and would have proceeded directly to a cesarean delivery.

VERDICT $12 million Illinois settlement.

Mother wasn’t admitted for bed rest, and baby is injured

TOWARD THE END OF HER PREGNANCY, a woman was given a diagnosis of pregnancy-induced hypertension. Over the next 2 weeks, she developed pedal edema, elevated blood pressure, and headaches. She was sent to Dr. C for a possible cesarean delivery. He ordered testing to rule out pregnancy-induced hypertension and recommended bed rest and close observation of the blood pressure. A week later, she suffered placental abruption. At the hospital, she delivered an infant born with severe asphyxia. The resulting hypoxic–ischemic encephalopathy caused the child’s death at 5 months.

PATIENT’S CLAIM Dr. C should have admitted her to the hospital to ensure strict bed rest and monitoring of her blood pressure—and also should have ordered a nonstress test.

PHYSICIAN’S DEFENSE There was no negligence.

VERDICT $350,000 Michigan settlement.

Cyst is discovered when it weighs 7 lb

A 22-YEAR-OLD WOMAN underwent two examinations within a year, both performed by her ObGyn. She did not report abdominal problems, and none were found. Four months after the second exam, she was discovered to have a huge dermoid ovarian cyst—30 cm by 20 cm by 10 cm, and weighing over 7 lb. It required surgery, which included an appendectomy and salpingo-oophorectomy.

PATIENT’S CLAIM The cyst should have been discovered during the first examination, and then less invasive procedures would have been needed.

PHYSICIAN’S DEFENSE The cyst could not be detected in the first exam, and the patient did not report abdominal problems at the second exam. Her treatment and outcome were not changed by a delay in diagnosis.

VERDICT New York defense verdict.

ObGyn: “I never said I nicked the bladder”

FOLLOWING A HYSTERECTOMY performed by an ObGyn employed by a government-run facility, a patient suffered incontinence and other urinary problems. She was referred to a urologist, who diagnosed a vesicovaginal fistula. The fistula was successfully repaired surgically.

PATIENT’S CLAIM The ObGyn admitted nicking the bladder, but believed it would heal on its own. She was negligent for causing the bladder injury and for not repairing it immediately. Also, the surgical note was dictated 18 days following the procedure.

PHYSICIAN’S DEFENSE The ObGyn denied the patient’s first claim. Also, the injury did not occur during surgery, but later, when the bladder wall broke down as a result of postsurgical denervation. If there had been a bladder injury, problems would have been apparent immediately, but in fact the patient’s initial urine counts were good.

VERDICT Kentucky defense verdict.

Oxytocin is given—but baby is breech

A WOMAN PREGNANT with her fifth child presented at the hospital for delivery. A vaginal exam performed by a nurse indicated 1 cm dilation, -3 to -4 station, and 40% effaced. This was reported over the phone to Dr. A, her OB, who then ordered oxytocin. Oxytocin was administered without the nurses determining the fetus’s presentation. When they could not get a reliable reading of the fetal heart tone, they placed a fetal scalp electrode. It showed a nonreassuring fetal heart pattern. Ten minutes later, the fetus was bradycardic, but Dr. A was not called immediately. Dr. B, a second OB, examined the patient 17 minutes later and ordered an immediate cesarean delivery. The fetus was found in the breech position with significant placental abruption—and the fetal scalp electrode was attached on the buttocks, not the head. The baby was born severely depressed—limp, pale, with no cry or movement. He was resuscitated, but a CT scan indicated hypoxic–ischemic brain damage.

PATIENT’S CLAIM Dr. A failed to examine her to determine the presentation, which he should have done before ordering oxytocin. The nurses failed to communicate with him about the presentation and administered oxytocin without documentation of the presentation.

PHYSICIAN’S DEFENSE The nurse indicated the baby was in the vertex position. If he had known it was a breech presentation, he would not have ordered oxytocin, would not have gone for a trial of labor, and would have proceeded directly to a cesarean delivery.

VERDICT $12 million Illinois settlement.

Mother wasn’t admitted for bed rest, and baby is injured

TOWARD THE END OF HER PREGNANCY, a woman was given a diagnosis of pregnancy-induced hypertension. Over the next 2 weeks, she developed pedal edema, elevated blood pressure, and headaches. She was sent to Dr. C for a possible cesarean delivery. He ordered testing to rule out pregnancy-induced hypertension and recommended bed rest and close observation of the blood pressure. A week later, she suffered placental abruption. At the hospital, she delivered an infant born with severe asphyxia. The resulting hypoxic–ischemic encephalopathy caused the child’s death at 5 months.

PATIENT’S CLAIM Dr. C should have admitted her to the hospital to ensure strict bed rest and monitoring of her blood pressure—and also should have ordered a nonstress test.

PHYSICIAN’S DEFENSE There was no negligence.

VERDICT $350,000 Michigan settlement.