Medical Verdicts

$28 million award against government for failure to test

A WOMAN delivered her first child a month early, due to fetal distress, at Balboa Naval Medical Center, where he was determined to have brain damage and given a diagnosis of cerebral palsy. She was told that his problems were due to premature separation of the placenta. When discussing the risks of a second pregnancy with physicians at Bethesda Medical Center 2.5 years later, she told them she had lupus, migraine, and supraventricular tachycardia, which caused palpitations—and that she was taking a ß-blocker and another medication. These physicians told her that the risk of brain hemorrhage—which had caused her child’s injuries—could be reduced with regular ultrasonography (US) growth studies and tests to track fetal movement and heart rate. When the physicians asked her the results of such studies—routine in a woman with her history—during her pregnancy, she said there had been no such studies. She later learned that a specialist had been consulted during that pregnancy, and that testing had been recommended. This was never discussed with her, nor the testing performed. The child, now age 9, has an IQ of 48 and functions at the level of a 3-year-old.

PATIENT’S CLAIM Intrauterine growth restriction occurred during her pregnancy because of the ß-blocker she was taking. Additional monitoring should have been conducted when this was recognized.

PHYSICIAN’S DEFENSE Not reported.

VERDICT $28 million award in Virginia, resulting from a claim brought under the Federal Torts Claim Act.

Patient says lymph node sampling was unnecessary

A 53-YEAR-OLD WOMAN went to Dr. A, her ObGyn, complaining of heavy discharge since menopause. A workup indicated an enlarged uterus with well-differentiated adenocarcinoma. Dr. A consulted with gynecologic oncologist Dr. B, and they decided on a two-phase surgical plan. Dr. A was the primary surgeon in the first phase, which involved a hysterectomy with removal of the fallopian tubes and ovaries. Surgical specimens showed that the uterine cancer was noninvasive. In the second phase, Dr. B removed the pelvic, periaortic, and renal lymph nodes. Frozen section analysis of the specimens indicated no invasive or metastatic disease. The permanent section, available 48 hours after surgery, revealed moderately differentiated adenocarcinoma with a 2-cm tumor mass, but no evidence of metastatic disease. The patient reported to the emergency room with abdominal pain 9 days after the surgery. A ureteral injury was found. A ureteral stent was placed, and stricture developed, requiring further procedures.

PATIENT’S CLAIM A hemoclip placed on the ureter during the periaortic lymph node dissection caused injury to the ureter. This phase of the surgery was unnecessary and inappropriate because preoperative evidence and specimen analysis indicated that the cancer was noninvasive—so there was no need for lymph node sampling.

PHYSICIAN’S DEFENSE Dr. A said he was entitled to rely on Dr. B’s recommendations for the treatment, as Dr. B was an expert in the field. Dr. B indicated that results from frozen samples can be unreliable, and that the risk of injury to the ureter was low.

VERDICT California defense verdict.

Lump is cancer—not sebaceous cyst as diagnosed

A WOMAN had a growing breast lump that was diagnosed as a sebaceous cyst by her gynecologist. She was advised to have it drained if it became painful, but was given no formal referral. Eleven months later, the patient was given a diagnosis of stage IV cancer.

PATIENT’S CLAIM A biopsy should have been performed when she first presented with the lump. Following the cancer diagnosis, the gynecologist altered the medical records when he added a note. Because of the note, the jury might believe that he had referred the patient to the diagnosing physician at that initial visit.

PHYSICIAN’S DEFENSE The patient did not have regular mammograms or US and, instead of following traditional protocols, underwent alternative treatment. When he learned of the cancer diagnosis, he added a note in the chart and said he had spoken with the diagnosing physician. The note was circled and in a different pen, and it did not alter information in the chart.

VERDICT $3.9 million Pennsylvania verdict, which was reduced to $2.5 million because the patient was found to be 35% at fault.

$28 million award against government for failure to test

A WOMAN delivered her first child a month early, due to fetal distress, at Balboa Naval Medical Center, where he was determined to have brain damage and given a diagnosis of cerebral palsy. She was told that his problems were due to premature separation of the placenta. When discussing the risks of a second pregnancy with physicians at Bethesda Medical Center 2.5 years later, she told them she had lupus, migraine, and supraventricular tachycardia, which caused palpitations—and that she was taking a ß-blocker and another medication. These physicians told her that the risk of brain hemorrhage—which had caused her child’s injuries—could be reduced with regular ultrasonography (US) growth studies and tests to track fetal movement and heart rate. When the physicians asked her the results of such studies—routine in a woman with her history—during her pregnancy, she said there had been no such studies. She later learned that a specialist had been consulted during that pregnancy, and that testing had been recommended. This was never discussed with her, nor the testing performed. The child, now age 9, has an IQ of 48 and functions at the level of a 3-year-old.

PATIENT’S CLAIM Intrauterine growth restriction occurred during her pregnancy because of the ß-blocker she was taking. Additional monitoring should have been conducted when this was recognized.

PHYSICIAN’S DEFENSE Not reported.

VERDICT $28 million award in Virginia, resulting from a claim brought under the Federal Torts Claim Act.

Patient says lymph node sampling was unnecessary

A 53-YEAR-OLD WOMAN went to Dr. A, her ObGyn, complaining of heavy discharge since menopause. A workup indicated an enlarged uterus with well-differentiated adenocarcinoma. Dr. A consulted with gynecologic oncologist Dr. B, and they decided on a two-phase surgical plan. Dr. A was the primary surgeon in the first phase, which involved a hysterectomy with removal of the fallopian tubes and ovaries. Surgical specimens showed that the uterine cancer was noninvasive. In the second phase, Dr. B removed the pelvic, periaortic, and renal lymph nodes. Frozen section analysis of the specimens indicated no invasive or metastatic disease. The permanent section, available 48 hours after surgery, revealed moderately differentiated adenocarcinoma with a 2-cm tumor mass, but no evidence of metastatic disease. The patient reported to the emergency room with abdominal pain 9 days after the surgery. A ureteral injury was found. A ureteral stent was placed, and stricture developed, requiring further procedures.

PATIENT’S CLAIM A hemoclip placed on the ureter during the periaortic lymph node dissection caused injury to the ureter. This phase of the surgery was unnecessary and inappropriate because preoperative evidence and specimen analysis indicated that the cancer was noninvasive—so there was no need for lymph node sampling.

PHYSICIAN’S DEFENSE Dr. A said he was entitled to rely on Dr. B’s recommendations for the treatment, as Dr. B was an expert in the field. Dr. B indicated that results from frozen samples can be unreliable, and that the risk of injury to the ureter was low.

VERDICT California defense verdict.

Lump is cancer—not sebaceous cyst as diagnosed

A WOMAN had a growing breast lump that was diagnosed as a sebaceous cyst by her gynecologist. She was advised to have it drained if it became painful, but was given no formal referral. Eleven months later, the patient was given a diagnosis of stage IV cancer.

PATIENT’S CLAIM A biopsy should have been performed when she first presented with the lump. Following the cancer diagnosis, the gynecologist altered the medical records when he added a note. Because of the note, the jury might believe that he had referred the patient to the diagnosing physician at that initial visit.

PHYSICIAN’S DEFENSE The patient did not have regular mammograms or US and, instead of following traditional protocols, underwent alternative treatment. When he learned of the cancer diagnosis, he added a note in the chart and said he had spoken with the diagnosing physician. The note was circled and in a different pen, and it did not alter information in the chart.

VERDICT $3.9 million Pennsylvania verdict, which was reduced to $2.5 million because the patient was found to be 35% at fault.

$28 million award against government for failure to test

A WOMAN delivered her first child a month early, due to fetal distress, at Balboa Naval Medical Center, where he was determined to have brain damage and given a diagnosis of cerebral palsy. She was told that his problems were due to premature separation of the placenta. When discussing the risks of a second pregnancy with physicians at Bethesda Medical Center 2.5 years later, she told them she had lupus, migraine, and supraventricular tachycardia, which caused palpitations—and that she was taking a ß-blocker and another medication. These physicians told her that the risk of brain hemorrhage—which had caused her child’s injuries—could be reduced with regular ultrasonography (US) growth studies and tests to track fetal movement and heart rate. When the physicians asked her the results of such studies—routine in a woman with her history—during her pregnancy, she said there had been no such studies. She later learned that a specialist had been consulted during that pregnancy, and that testing had been recommended. This was never discussed with her, nor the testing performed. The child, now age 9, has an IQ of 48 and functions at the level of a 3-year-old.

PATIENT’S CLAIM Intrauterine growth restriction occurred during her pregnancy because of the ß-blocker she was taking. Additional monitoring should have been conducted when this was recognized.

PHYSICIAN’S DEFENSE Not reported.

VERDICT $28 million award in Virginia, resulting from a claim brought under the Federal Torts Claim Act.

Patient says lymph node sampling was unnecessary

A 53-YEAR-OLD WOMAN went to Dr. A, her ObGyn, complaining of heavy discharge since menopause. A workup indicated an enlarged uterus with well-differentiated adenocarcinoma. Dr. A consulted with gynecologic oncologist Dr. B, and they decided on a two-phase surgical plan. Dr. A was the primary surgeon in the first phase, which involved a hysterectomy with removal of the fallopian tubes and ovaries. Surgical specimens showed that the uterine cancer was noninvasive. In the second phase, Dr. B removed the pelvic, periaortic, and renal lymph nodes. Frozen section analysis of the specimens indicated no invasive or metastatic disease. The permanent section, available 48 hours after surgery, revealed moderately differentiated adenocarcinoma with a 2-cm tumor mass, but no evidence of metastatic disease. The patient reported to the emergency room with abdominal pain 9 days after the surgery. A ureteral injury was found. A ureteral stent was placed, and stricture developed, requiring further procedures.

PATIENT’S CLAIM A hemoclip placed on the ureter during the periaortic lymph node dissection caused injury to the ureter. This phase of the surgery was unnecessary and inappropriate because preoperative evidence and specimen analysis indicated that the cancer was noninvasive—so there was no need for lymph node sampling.

PHYSICIAN’S DEFENSE Dr. A said he was entitled to rely on Dr. B’s recommendations for the treatment, as Dr. B was an expert in the field. Dr. B indicated that results from frozen samples can be unreliable, and that the risk of injury to the ureter was low.

VERDICT California defense verdict.

Lump is cancer—not sebaceous cyst as diagnosed

A WOMAN had a growing breast lump that was diagnosed as a sebaceous cyst by her gynecologist. She was advised to have it drained if it became painful, but was given no formal referral. Eleven months later, the patient was given a diagnosis of stage IV cancer.

PATIENT’S CLAIM A biopsy should have been performed when she first presented with the lump. Following the cancer diagnosis, the gynecologist altered the medical records when he added a note. Because of the note, the jury might believe that he had referred the patient to the diagnosing physician at that initial visit.

PHYSICIAN’S DEFENSE The patient did not have regular mammograms or US and, instead of following traditional protocols, underwent alternative treatment. When he learned of the cancer diagnosis, he added a note in the chart and said he had spoken with the diagnosing physician. The note was circled and in a different pen, and it did not alter information in the chart.

VERDICT $3.9 million Pennsylvania verdict, which was reduced to $2.5 million because the patient was found to be 35% at fault.

Laceration during circumcision calls for 2nd procedure

A 1-DAY-OLD BOY was circumcised using local anesthesia and a Gomco clamp. A 1-cm laceration occurred on the underside of his penis—and was repaired that same day by a consulting urologist. Two years later, follow-up surgery was performed to remove any excess skin at the site.

PATIENT’S CLAIM The boy has permanent scarring and disfigurement. The Gomco clamp was placed improperly during the procedure, and the appropriate amount of skin was not removed.

PHYSICIAN’S DEFENSE The laceration was superficial and is a recognized risk of a Gomco clamp. The cosmetic result is good, and there is no functional impairment.

VERDICT Michigan defense verdict.

Was postop death due to infection—or unrelated illness?

A HYSTERECTOMY with node dissection was performed on a 63-year-old woman with uterine cancer. She was discharged from the hospital 3 days later—and died the following month.

PLAINTIFF’S CLAIM Death was the result of an undiagnosed postoperative intra-abdominal infection.

PHYSICIAN’S DEFENSE The patient had no postoperative infection. Instead, she developed an illness weeks after the surgery, and he was not involved in its management.

VERDICT Connecticut defense verdict.

Is the “blame” on a diabetic patient for her stillborn child?

A 23-YEAR-OLD WOMAN weighed 305 lb and had a glucose level of 218 after 3 months of prenatal care with Dr. A, her obstetrician. He consulted with Dr. B, a maternal–fetal medicine specialist, in diagnosing gestational diabetes. A few days later, the patient was examined by Dr. C, a second maternal–fetal medicine specialist, and was prescribed glyburide.

The following month, a sonogram indicated an estimated fetal weight in the 95th percentile and macrosomia. The dosage of glyburide was increased several times because of elevated glucose levels. One month later, the patient saw both Dr. B and Dr. C, who instructed her about nutrition.

A few weeks later—at 36 3/7 weeks’ gestation and weighing 327 lb—the mother was admitted to the hospital because of a large thigh abscess. She was treated and her blood sugars tested normal.

Two days later, she was discharged. The following month, she presented at the hospital complaining of no fetal movement. No fetal heart tones were found, and a C-section was performed. A 12-lb stillborn baby was delivered.

PATIENT’S CLAIM The defendants failed to monitor her properly and to communicate with each other about her condition.

PHYSICIAN’S DEFENSE The patient failed to follow diet instructions, maintain her blood-glucose logs, and take the glyburide. Appropriate care had been provided by her physicians.

VERDICT Pennsylvania defense verdict. Posttrial motions were pending.

Vacuum extraction, shoulder dystocia, resuscitation…CP

TOWARD THE END OF LABOR, when a woman was about to deliver her first child, the electronic fetal monitor was picking up her heartbeat, not the child’s. This was not recognized. Application of a vacuum extractor resulted in delivery of the head—after six attempts. Then shoulder dystocia occurred. Various maneuvers were tried unsuccessfully, until the body of the infant was finally delivered 7 minutes later: flaccid and extremely depressed, with no heartbeat or respiratory effort. The child required extensive resuscitation and then could not be intubated for 20 minutes. As a result of the birth injury, he suffered cerebral palsy with spastic quadriplegia, developmental delay, and mental retardation.

PATIENT’S CLAIM The vacuum extractor was used too early—when the fetal head was too high in the pelvis—and too many times. Also, both the shoulder dystocia and the resuscitation were mismanaged.

PHYSICIAN’S DEFENSE The vacuum extractor was used properly. The occurrence of shoulder dystocia was unpredictable and unavoidable, and difficult resuscitation was the result of a congenital anomaly of the vocal cords or laryngospasm.

VERDICT $3.25 million California settlement, reached in mediation.

Laceration during circumcision calls for 2nd procedure

A 1-DAY-OLD BOY was circumcised using local anesthesia and a Gomco clamp. A 1-cm laceration occurred on the underside of his penis—and was repaired that same day by a consulting urologist. Two years later, follow-up surgery was performed to remove any excess skin at the site.

PATIENT’S CLAIM The boy has permanent scarring and disfigurement. The Gomco clamp was placed improperly during the procedure, and the appropriate amount of skin was not removed.

PHYSICIAN’S DEFENSE The laceration was superficial and is a recognized risk of a Gomco clamp. The cosmetic result is good, and there is no functional impairment.

VERDICT Michigan defense verdict.

Was postop death due to infection—or unrelated illness?

A HYSTERECTOMY with node dissection was performed on a 63-year-old woman with uterine cancer. She was discharged from the hospital 3 days later—and died the following month.

PLAINTIFF’S CLAIM Death was the result of an undiagnosed postoperative intra-abdominal infection.

PHYSICIAN’S DEFENSE The patient had no postoperative infection. Instead, she developed an illness weeks after the surgery, and he was not involved in its management.

VERDICT Connecticut defense verdict.

Is the “blame” on a diabetic patient for her stillborn child?

A 23-YEAR-OLD WOMAN weighed 305 lb and had a glucose level of 218 after 3 months of prenatal care with Dr. A, her obstetrician. He consulted with Dr. B, a maternal–fetal medicine specialist, in diagnosing gestational diabetes. A few days later, the patient was examined by Dr. C, a second maternal–fetal medicine specialist, and was prescribed glyburide.

The following month, a sonogram indicated an estimated fetal weight in the 95th percentile and macrosomia. The dosage of glyburide was increased several times because of elevated glucose levels. One month later, the patient saw both Dr. B and Dr. C, who instructed her about nutrition.

A few weeks later—at 36 3/7 weeks’ gestation and weighing 327 lb—the mother was admitted to the hospital because of a large thigh abscess. She was treated and her blood sugars tested normal.

Two days later, she was discharged. The following month, she presented at the hospital complaining of no fetal movement. No fetal heart tones were found, and a C-section was performed. A 12-lb stillborn baby was delivered.

PATIENT’S CLAIM The defendants failed to monitor her properly and to communicate with each other about her condition.

PHYSICIAN’S DEFENSE The patient failed to follow diet instructions, maintain her blood-glucose logs, and take the glyburide. Appropriate care had been provided by her physicians.

VERDICT Pennsylvania defense verdict. Posttrial motions were pending.

Vacuum extraction, shoulder dystocia, resuscitation…CP

TOWARD THE END OF LABOR, when a woman was about to deliver her first child, the electronic fetal monitor was picking up her heartbeat, not the child’s. This was not recognized. Application of a vacuum extractor resulted in delivery of the head—after six attempts. Then shoulder dystocia occurred. Various maneuvers were tried unsuccessfully, until the body of the infant was finally delivered 7 minutes later: flaccid and extremely depressed, with no heartbeat or respiratory effort. The child required extensive resuscitation and then could not be intubated for 20 minutes. As a result of the birth injury, he suffered cerebral palsy with spastic quadriplegia, developmental delay, and mental retardation.

PATIENT’S CLAIM The vacuum extractor was used too early—when the fetal head was too high in the pelvis—and too many times. Also, both the shoulder dystocia and the resuscitation were mismanaged.

PHYSICIAN’S DEFENSE The vacuum extractor was used properly. The occurrence of shoulder dystocia was unpredictable and unavoidable, and difficult resuscitation was the result of a congenital anomaly of the vocal cords or laryngospasm.

VERDICT $3.25 million California settlement, reached in mediation.

Laceration during circumcision calls for 2nd procedure

A 1-DAY-OLD BOY was circumcised using local anesthesia and a Gomco clamp. A 1-cm laceration occurred on the underside of his penis—and was repaired that same day by a consulting urologist. Two years later, follow-up surgery was performed to remove any excess skin at the site.

PATIENT’S CLAIM The boy has permanent scarring and disfigurement. The Gomco clamp was placed improperly during the procedure, and the appropriate amount of skin was not removed.

PHYSICIAN’S DEFENSE The laceration was superficial and is a recognized risk of a Gomco clamp. The cosmetic result is good, and there is no functional impairment.

VERDICT Michigan defense verdict.

Was postop death due to infection—or unrelated illness?

A HYSTERECTOMY with node dissection was performed on a 63-year-old woman with uterine cancer. She was discharged from the hospital 3 days later—and died the following month.

PLAINTIFF’S CLAIM Death was the result of an undiagnosed postoperative intra-abdominal infection.

PHYSICIAN’S DEFENSE The patient had no postoperative infection. Instead, she developed an illness weeks after the surgery, and he was not involved in its management.

VERDICT Connecticut defense verdict.

Is the “blame” on a diabetic patient for her stillborn child?

A 23-YEAR-OLD WOMAN weighed 305 lb and had a glucose level of 218 after 3 months of prenatal care with Dr. A, her obstetrician. He consulted with Dr. B, a maternal–fetal medicine specialist, in diagnosing gestational diabetes. A few days later, the patient was examined by Dr. C, a second maternal–fetal medicine specialist, and was prescribed glyburide.

The following month, a sonogram indicated an estimated fetal weight in the 95th percentile and macrosomia. The dosage of glyburide was increased several times because of elevated glucose levels. One month later, the patient saw both Dr. B and Dr. C, who instructed her about nutrition.

A few weeks later—at 36 3/7 weeks’ gestation and weighing 327 lb—the mother was admitted to the hospital because of a large thigh abscess. She was treated and her blood sugars tested normal.

Two days later, she was discharged. The following month, she presented at the hospital complaining of no fetal movement. No fetal heart tones were found, and a C-section was performed. A 12-lb stillborn baby was delivered.

PATIENT’S CLAIM The defendants failed to monitor her properly and to communicate with each other about her condition.

PHYSICIAN’S DEFENSE The patient failed to follow diet instructions, maintain her blood-glucose logs, and take the glyburide. Appropriate care had been provided by her physicians.

VERDICT Pennsylvania defense verdict. Posttrial motions were pending.

Vacuum extraction, shoulder dystocia, resuscitation…CP

TOWARD THE END OF LABOR, when a woman was about to deliver her first child, the electronic fetal monitor was picking up her heartbeat, not the child’s. This was not recognized. Application of a vacuum extractor resulted in delivery of the head—after six attempts. Then shoulder dystocia occurred. Various maneuvers were tried unsuccessfully, until the body of the infant was finally delivered 7 minutes later: flaccid and extremely depressed, with no heartbeat or respiratory effort. The child required extensive resuscitation and then could not be intubated for 20 minutes. As a result of the birth injury, he suffered cerebral palsy with spastic quadriplegia, developmental delay, and mental retardation.

PATIENT’S CLAIM The vacuum extractor was used too early—when the fetal head was too high in the pelvis—and too many times. Also, both the shoulder dystocia and the resuscitation were mismanaged.

PHYSICIAN’S DEFENSE The vacuum extractor was used properly. The occurrence of shoulder dystocia was unpredictable and unavoidable, and difficult resuscitation was the result of a congenital anomaly of the vocal cords or laryngospasm.

VERDICT $3.25 million California settlement, reached in mediation.

Delayed testing leads to death from embolism

SWELLING OF HIS RIGHT FOOT prompted a 75-year-old man to seek medical attention. He had a history of blood clots and wore compression stockings. The physician spent 10 minutes with the patient; he did not remove the compression stockings during the examination. The physician scheduled a sonogram for the next day.

After the sonogram, the patient returned to the physician complaining of a back problem. While in the waiting room, the patient collapsed and died of a massive pulmonary embolism.

PLAINTIFF’S CLAIM: The patient had classic symptoms of a blood clot and should have been tested immediately.

DOCTOR’S DEFENSE: The patient didn’t wear compression stockings to prevent blood clots but because of swelling from a long history of postphlebitic syndrome. The foot and back complaints were similar to previous complaints related to the patient’s postphlebitic syndrome and degenerative disc disease. Moreover, the sonogram was negative for acute clots.

VERDICT: $5.2 million Texas verdict.

COMMENT: Although the facts of this case aren’t altogether clear, timely evaluation might have prevented the unfortunate outcome. As with many malpractice allegations, documentation remains key to a physician’s defense. If it’s not documented, it didn’t happen. JLS

Heart attack blamed on lack of workup, referral

A 57-YEAR-OLD MAN, who had been under the regular care of an internist for 5 years, died suddenly of an acute myocardial infarction. He had a history of high cholesterol and high blood pressure, as well as a family history of heart disease, and he was a heavy smoker. The internist had ordered resting electrocardiograms over the years but hadn’t done a workup for heart disease or referred the patient to a cardiologist.

PLAINTIFF’S CLAIM: The internist should have performed appropriate testing or referred the patient to a cardiologist because the patient had all the risk factors for heart disease. If the doctor had done any of these things, the patient’s heart disease would have been diagnosed and cardiac bypass surgery would have saved his life.

DOCTOR’S DEFENSE: The patient’s continued heavy smoking caused or contributed to his fatal heart attack. The attack was unpredictable and untreatable because it was caused by new and unstable plaque rupture and thrombosis. (The plaintiff countered that the patient didn’t suffer from ruptured plaque or thrombosis.)

VERDICT: $377,500 Michigan settlement.

COMMENT: How aggressively should we evaluate the patient with multiple cardiac risk factors? This case suggests that we need to strongly consider definitive evaluation of the patient at high risk of coronary artery disease. JLS

Death after repeated calls to doctors

AFTER SUFFERING SEVERE BURNS to his leg and foot while cooking French fries, a 48-year-old man was treated by his family physician as well as a surgeon specializing in skin grafts. During rehabilitation, the patient became disoriented and short of breath; he hyperventilated and reported that he was seeing aliens. He was also depressed.

His wife called the offices of both the family physician and the surgeon 4 times over 2 days. She never spoke to a doctor. Two days later, a nurse practitioner returned her call and prescribed fluoxetine for depression. Very shortly thereafter, the patient suffered a massive pulmonary embolism. He was taken to an emergency room, where he was pronounced dead.

PLAINTIFF’S CLAIM: The physician and surgeon were negligent in their failure to respond properly to the wife’s phone calls. Prompt intervention would have prevented the pulmonary embolism.

DOCTORS’ DEFENSE: The only information that was relayed to the doctors’ offices was that the patient was depressed and “talking funny.”

VERDICT: Indiana defense verdict.

COMMENT: We’re only as good as our staff and systems of care. Here’s another patient with pulmonary embolus who might have survived if appropriate evaluation had occurred promptly. JLS

2 cases, 1 theme: A purported lack of follow-up

A 62-YEAR-OLD MAN with an abdominal aortic aneurysm was seen by an internist at a Veterans Administration hospital. The aneurysm subsequently ruptured, necessitating emergency surgery. The surgery was successful, but the patient required attendant living assistance and neuropsychological retraining.

PLAINTIFF’S CLAIM: The internist was told that the patient’s father had been diagnosed with an abdominal aortic aneurysm, and that the patient himself had been diagnosed with a 2- to 3-cm aortic aneurysm and advised to have it rescanned periodically. The patient further informed the internist that he had been told that the aneurysm would require surgery if it reached 5 or 6 cm.

The patient saw the doctor many times after the first visit, but no history of abdominal aortic aneurysm was ever recorded and no scanning was performed. Serial monitoring would have revealed a slowly enlarging aneurysm, and elective surgery could have treated it.

DOCTOR’S DEFENSE: The patient failed to inform the internist of the history of abdominal aortic aneurysm. An aneurysm of 2 to 3 cm does not require follow-up.

VERDICT: $200,000 California settlement.

A CHEST RADIOGRAPH of a 74-year-old woman showed lung densities and artifacts. No follow-up radiography was performed. Two years later, the patient was diagnosed with lung cancer, which had metastasized to her liver. The patient died 5 months after the diagnosis.

PLAINTIFF’S CLAIM: The internist should have ordered a CT scan to further investigate the abnormalities.

DOCTOR’S DEFENSE: A follow-up radiograph was ordered, which the patient refused. (The plaintiff denied that follow-up radiographs were ordered and argued that even if they had been performed, the outcome would have been the same.)

VERDICT: Illinois defense verdict.

COMMENT: Tracking and following up test results is often a challenge in primary care offices. Although the advice given to the first patient concerning follow-up of his abdominal aortic aneurysm appears to be sound, the lack of follow-through resulted in serious consequences. It’s important to assure timely reevaluation of abnormalities, such as repeat CT or workup of a chest mass, repeat mammography, or tracking of an abdominal aortic aneurysm. JLS

Delayed testing leads to death from embolism

SWELLING OF HIS RIGHT FOOT prompted a 75-year-old man to seek medical attention. He had a history of blood clots and wore compression stockings. The physician spent 10 minutes with the patient; he did not remove the compression stockings during the examination. The physician scheduled a sonogram for the next day.

After the sonogram, the patient returned to the physician complaining of a back problem. While in the waiting room, the patient collapsed and died of a massive pulmonary embolism.

PLAINTIFF’S CLAIM: The patient had classic symptoms of a blood clot and should have been tested immediately.

DOCTOR’S DEFENSE: The patient didn’t wear compression stockings to prevent blood clots but because of swelling from a long history of postphlebitic syndrome. The foot and back complaints were similar to previous complaints related to the patient’s postphlebitic syndrome and degenerative disc disease. Moreover, the sonogram was negative for acute clots.

VERDICT: $5.2 million Texas verdict.

COMMENT: Although the facts of this case aren’t altogether clear, timely evaluation might have prevented the unfortunate outcome. As with many malpractice allegations, documentation remains key to a physician’s defense. If it’s not documented, it didn’t happen. JLS

Heart attack blamed on lack of workup, referral

A 57-YEAR-OLD MAN, who had been under the regular care of an internist for 5 years, died suddenly of an acute myocardial infarction. He had a history of high cholesterol and high blood pressure, as well as a family history of heart disease, and he was a heavy smoker. The internist had ordered resting electrocardiograms over the years but hadn’t done a workup for heart disease or referred the patient to a cardiologist.

PLAINTIFF’S CLAIM: The internist should have performed appropriate testing or referred the patient to a cardiologist because the patient had all the risk factors for heart disease. If the doctor had done any of these things, the patient’s heart disease would have been diagnosed and cardiac bypass surgery would have saved his life.

DOCTOR’S DEFENSE: The patient’s continued heavy smoking caused or contributed to his fatal heart attack. The attack was unpredictable and untreatable because it was caused by new and unstable plaque rupture and thrombosis. (The plaintiff countered that the patient didn’t suffer from ruptured plaque or thrombosis.)

VERDICT: $377,500 Michigan settlement.

COMMENT: How aggressively should we evaluate the patient with multiple cardiac risk factors? This case suggests that we need to strongly consider definitive evaluation of the patient at high risk of coronary artery disease. JLS

Death after repeated calls to doctors

AFTER SUFFERING SEVERE BURNS to his leg and foot while cooking French fries, a 48-year-old man was treated by his family physician as well as a surgeon specializing in skin grafts. During rehabilitation, the patient became disoriented and short of breath; he hyperventilated and reported that he was seeing aliens. He was also depressed.

His wife called the offices of both the family physician and the surgeon 4 times over 2 days. She never spoke to a doctor. Two days later, a nurse practitioner returned her call and prescribed fluoxetine for depression. Very shortly thereafter, the patient suffered a massive pulmonary embolism. He was taken to an emergency room, where he was pronounced dead.

PLAINTIFF’S CLAIM: The physician and surgeon were negligent in their failure to respond properly to the wife’s phone calls. Prompt intervention would have prevented the pulmonary embolism.

DOCTORS’ DEFENSE: The only information that was relayed to the doctors’ offices was that the patient was depressed and “talking funny.”

VERDICT: Indiana defense verdict.

COMMENT: We’re only as good as our staff and systems of care. Here’s another patient with pulmonary embolus who might have survived if appropriate evaluation had occurred promptly. JLS

2 cases, 1 theme: A purported lack of follow-up

A 62-YEAR-OLD MAN with an abdominal aortic aneurysm was seen by an internist at a Veterans Administration hospital. The aneurysm subsequently ruptured, necessitating emergency surgery. The surgery was successful, but the patient required attendant living assistance and neuropsychological retraining.

PLAINTIFF’S CLAIM: The internist was told that the patient’s father had been diagnosed with an abdominal aortic aneurysm, and that the patient himself had been diagnosed with a 2- to 3-cm aortic aneurysm and advised to have it rescanned periodically. The patient further informed the internist that he had been told that the aneurysm would require surgery if it reached 5 or 6 cm.

The patient saw the doctor many times after the first visit, but no history of abdominal aortic aneurysm was ever recorded and no scanning was performed. Serial monitoring would have revealed a slowly enlarging aneurysm, and elective surgery could have treated it.

DOCTOR’S DEFENSE: The patient failed to inform the internist of the history of abdominal aortic aneurysm. An aneurysm of 2 to 3 cm does not require follow-up.

VERDICT: $200,000 California settlement.

A CHEST RADIOGRAPH of a 74-year-old woman showed lung densities and artifacts. No follow-up radiography was performed. Two years later, the patient was diagnosed with lung cancer, which had metastasized to her liver. The patient died 5 months after the diagnosis.

PLAINTIFF’S CLAIM: The internist should have ordered a CT scan to further investigate the abnormalities.

DOCTOR’S DEFENSE: A follow-up radiograph was ordered, which the patient refused. (The plaintiff denied that follow-up radiographs were ordered and argued that even if they had been performed, the outcome would have been the same.)

VERDICT: Illinois defense verdict.

COMMENT: Tracking and following up test results is often a challenge in primary care offices. Although the advice given to the first patient concerning follow-up of his abdominal aortic aneurysm appears to be sound, the lack of follow-through resulted in serious consequences. It’s important to assure timely reevaluation of abnormalities, such as repeat CT or workup of a chest mass, repeat mammography, or tracking of an abdominal aortic aneurysm. JLS

Delayed testing leads to death from embolism

SWELLING OF HIS RIGHT FOOT prompted a 75-year-old man to seek medical attention. He had a history of blood clots and wore compression stockings. The physician spent 10 minutes with the patient; he did not remove the compression stockings during the examination. The physician scheduled a sonogram for the next day.

After the sonogram, the patient returned to the physician complaining of a back problem. While in the waiting room, the patient collapsed and died of a massive pulmonary embolism.

PLAINTIFF’S CLAIM: The patient had classic symptoms of a blood clot and should have been tested immediately.

DOCTOR’S DEFENSE: The patient didn’t wear compression stockings to prevent blood clots but because of swelling from a long history of postphlebitic syndrome. The foot and back complaints were similar to previous complaints related to the patient’s postphlebitic syndrome and degenerative disc disease. Moreover, the sonogram was negative for acute clots.

VERDICT: $5.2 million Texas verdict.

COMMENT: Although the facts of this case aren’t altogether clear, timely evaluation might have prevented the unfortunate outcome. As with many malpractice allegations, documentation remains key to a physician’s defense. If it’s not documented, it didn’t happen. JLS

Heart attack blamed on lack of workup, referral

A 57-YEAR-OLD MAN, who had been under the regular care of an internist for 5 years, died suddenly of an acute myocardial infarction. He had a history of high cholesterol and high blood pressure, as well as a family history of heart disease, and he was a heavy smoker. The internist had ordered resting electrocardiograms over the years but hadn’t done a workup for heart disease or referred the patient to a cardiologist.

PLAINTIFF’S CLAIM: The internist should have performed appropriate testing or referred the patient to a cardiologist because the patient had all the risk factors for heart disease. If the doctor had done any of these things, the patient’s heart disease would have been diagnosed and cardiac bypass surgery would have saved his life.

DOCTOR’S DEFENSE: The patient’s continued heavy smoking caused or contributed to his fatal heart attack. The attack was unpredictable and untreatable because it was caused by new and unstable plaque rupture and thrombosis. (The plaintiff countered that the patient didn’t suffer from ruptured plaque or thrombosis.)

VERDICT: $377,500 Michigan settlement.

COMMENT: How aggressively should we evaluate the patient with multiple cardiac risk factors? This case suggests that we need to strongly consider definitive evaluation of the patient at high risk of coronary artery disease. JLS

Death after repeated calls to doctors

AFTER SUFFERING SEVERE BURNS to his leg and foot while cooking French fries, a 48-year-old man was treated by his family physician as well as a surgeon specializing in skin grafts. During rehabilitation, the patient became disoriented and short of breath; he hyperventilated and reported that he was seeing aliens. He was also depressed.

His wife called the offices of both the family physician and the surgeon 4 times over 2 days. She never spoke to a doctor. Two days later, a nurse practitioner returned her call and prescribed fluoxetine for depression. Very shortly thereafter, the patient suffered a massive pulmonary embolism. He was taken to an emergency room, where he was pronounced dead.

PLAINTIFF’S CLAIM: The physician and surgeon were negligent in their failure to respond properly to the wife’s phone calls. Prompt intervention would have prevented the pulmonary embolism.

DOCTORS’ DEFENSE: The only information that was relayed to the doctors’ offices was that the patient was depressed and “talking funny.”

VERDICT: Indiana defense verdict.

COMMENT: We’re only as good as our staff and systems of care. Here’s another patient with pulmonary embolus who might have survived if appropriate evaluation had occurred promptly. JLS

2 cases, 1 theme: A purported lack of follow-up

A 62-YEAR-OLD MAN with an abdominal aortic aneurysm was seen by an internist at a Veterans Administration hospital. The aneurysm subsequently ruptured, necessitating emergency surgery. The surgery was successful, but the patient required attendant living assistance and neuropsychological retraining.

PLAINTIFF’S CLAIM: The internist was told that the patient’s father had been diagnosed with an abdominal aortic aneurysm, and that the patient himself had been diagnosed with a 2- to 3-cm aortic aneurysm and advised to have it rescanned periodically. The patient further informed the internist that he had been told that the aneurysm would require surgery if it reached 5 or 6 cm.

The patient saw the doctor many times after the first visit, but no history of abdominal aortic aneurysm was ever recorded and no scanning was performed. Serial monitoring would have revealed a slowly enlarging aneurysm, and elective surgery could have treated it.

DOCTOR’S DEFENSE: The patient failed to inform the internist of the history of abdominal aortic aneurysm. An aneurysm of 2 to 3 cm does not require follow-up.

VERDICT: $200,000 California settlement.

A CHEST RADIOGRAPH of a 74-year-old woman showed lung densities and artifacts. No follow-up radiography was performed. Two years later, the patient was diagnosed with lung cancer, which had metastasized to her liver. The patient died 5 months after the diagnosis.

PLAINTIFF’S CLAIM: The internist should have ordered a CT scan to further investigate the abnormalities.

DOCTOR’S DEFENSE: A follow-up radiograph was ordered, which the patient refused. (The plaintiff denied that follow-up radiographs were ordered and argued that even if they had been performed, the outcome would have been the same.)

VERDICT: Illinois defense verdict.

COMMENT: Tracking and following up test results is often a challenge in primary care offices. Although the advice given to the first patient concerning follow-up of his abdominal aortic aneurysm appears to be sound, the lack of follow-through resulted in serious consequences. It’s important to assure timely reevaluation of abnormalities, such as repeat CT or workup of a chest mass, repeat mammography, or tracking of an abdominal aortic aneurysm. JLS

Gyn neglected—twice—to read patient’s lab reports

PATIENT’S CLAIM The gynecologist was negligent for failing to read the reports and failing to perform proper pelvic exams. The lab was negligent for misreading the Pap smears. Also, the first Pap smear showed an unreported high-grade intraepithelial lesion, and the second showed unreported invasive squamous cell carcinoma.

DOCTOR’S DEFENSE The gynecologist admitted that she never read the lab reports as they were filed by another who apparently read them. No further testing was needed as the results were within normal limits.

VERDICT $2.5 million settlement with the laboratory during trial; a $30 million gross New York verdict was returned. A jury found negligence by the gynecologist, and assigned 10% of liability to the laboratory. Net recovery was $29.5 million, reached by offsetting the liability finding and adding the settlement. Pending was a posttrial motion arguing that the verdict was excessive.

Adolescent mom has hysterectomy due to infection

A 16-YEAR-OLD PATIENT presented at the hospital at term for delivery of her infant. Her labor arrested, and a family practitioner delivered a healthy baby by cesarean section. The mother developed a surgical wound infection, which was treated with intravenous antibiotics. She improved initially. One week after surgery, the wound opened and drained spontaneously. Further surgery showed a deep uterine infection or endomyometritis. To save the patient’s life, a hysterectomy was performed. She recovered eventually with no residual problems.

PATIENT’S CLAIM The physician should have administered prophylactic antibiotics at the time of delivery because of the patient’s high risk of infection.

DOCTOR’S DEFENSE Use of prophylactic antibiotics at delivery is not the standard of care. Also, the infection could not have been diagnosed earlier.

VERDICT Illinois defense verdict.

Surgery causes, but can’t fix, foreshortened vagina

A 52-YEAR-OLD WOMAN experiencing urinary incontinence, constipation, and pressure in her pelvis was diagnosed by her ObGyn with a cystocele, rectocele and enterocele. Of two surgical options offered, she chose the one that would allow normal sexual relations. The surgery went well. At her second postop follow-up exam, she was told that everything had healed, the vaginal wall was intact, and she could resume sexual intercourse. But intercourse was impossible due to a foreshortened vagina—only 4 cm—and her incontinence had worsened. Two years later, a second physician performed reconstructive surgery, which corrected the incontinence but only slightly improved the foreshortened vagina.

PATIENT’S CLAIM The ObGyn did not perform the correct procedure; his technique was not good; there was no informed consent; and the procedure caused excessive scarring and removed more than half of the vagina.

DOCTOR’S DEFENSE There was informed consent; excessive scarring is a recognized complication; and the patient failed to return for further follow-up exams and to follow instructions on the use of estrogen and dilators.

VERDICT $1,580,000 Indiana verdict, including $300,000 to the husband for loss of consortium. This was reduced to the statutory cap of $1,250,000.

Gyn neglected—twice—to read patient’s lab reports

PATIENT’S CLAIM The gynecologist was negligent for failing to read the reports and failing to perform proper pelvic exams. The lab was negligent for misreading the Pap smears. Also, the first Pap smear showed an unreported high-grade intraepithelial lesion, and the second showed unreported invasive squamous cell carcinoma.

DOCTOR’S DEFENSE The gynecologist admitted that she never read the lab reports as they were filed by another who apparently read them. No further testing was needed as the results were within normal limits.

VERDICT $2.5 million settlement with the laboratory during trial; a $30 million gross New York verdict was returned. A jury found negligence by the gynecologist, and assigned 10% of liability to the laboratory. Net recovery was $29.5 million, reached by offsetting the liability finding and adding the settlement. Pending was a posttrial motion arguing that the verdict was excessive.

Adolescent mom has hysterectomy due to infection

A 16-YEAR-OLD PATIENT presented at the hospital at term for delivery of her infant. Her labor arrested, and a family practitioner delivered a healthy baby by cesarean section. The mother developed a surgical wound infection, which was treated with intravenous antibiotics. She improved initially. One week after surgery, the wound opened and drained spontaneously. Further surgery showed a deep uterine infection or endomyometritis. To save the patient’s life, a hysterectomy was performed. She recovered eventually with no residual problems.

PATIENT’S CLAIM The physician should have administered prophylactic antibiotics at the time of delivery because of the patient’s high risk of infection.

DOCTOR’S DEFENSE Use of prophylactic antibiotics at delivery is not the standard of care. Also, the infection could not have been diagnosed earlier.

VERDICT Illinois defense verdict.

Surgery causes, but can’t fix, foreshortened vagina

A 52-YEAR-OLD WOMAN experiencing urinary incontinence, constipation, and pressure in her pelvis was diagnosed by her ObGyn with a cystocele, rectocele and enterocele. Of two surgical options offered, she chose the one that would allow normal sexual relations. The surgery went well. At her second postop follow-up exam, she was told that everything had healed, the vaginal wall was intact, and she could resume sexual intercourse. But intercourse was impossible due to a foreshortened vagina—only 4 cm—and her incontinence had worsened. Two years later, a second physician performed reconstructive surgery, which corrected the incontinence but only slightly improved the foreshortened vagina.

PATIENT’S CLAIM The ObGyn did not perform the correct procedure; his technique was not good; there was no informed consent; and the procedure caused excessive scarring and removed more than half of the vagina.

DOCTOR’S DEFENSE There was informed consent; excessive scarring is a recognized complication; and the patient failed to return for further follow-up exams and to follow instructions on the use of estrogen and dilators.

VERDICT $1,580,000 Indiana verdict, including $300,000 to the husband for loss of consortium. This was reduced to the statutory cap of $1,250,000.

Gyn neglected—twice—to read patient’s lab reports

PATIENT’S CLAIM The gynecologist was negligent for failing to read the reports and failing to perform proper pelvic exams. The lab was negligent for misreading the Pap smears. Also, the first Pap smear showed an unreported high-grade intraepithelial lesion, and the second showed unreported invasive squamous cell carcinoma.

DOCTOR’S DEFENSE The gynecologist admitted that she never read the lab reports as they were filed by another who apparently read them. No further testing was needed as the results were within normal limits.

VERDICT $2.5 million settlement with the laboratory during trial; a $30 million gross New York verdict was returned. A jury found negligence by the gynecologist, and assigned 10% of liability to the laboratory. Net recovery was $29.5 million, reached by offsetting the liability finding and adding the settlement. Pending was a posttrial motion arguing that the verdict was excessive.

Adolescent mom has hysterectomy due to infection

A 16-YEAR-OLD PATIENT presented at the hospital at term for delivery of her infant. Her labor arrested, and a family practitioner delivered a healthy baby by cesarean section. The mother developed a surgical wound infection, which was treated with intravenous antibiotics. She improved initially. One week after surgery, the wound opened and drained spontaneously. Further surgery showed a deep uterine infection or endomyometritis. To save the patient’s life, a hysterectomy was performed. She recovered eventually with no residual problems.

PATIENT’S CLAIM The physician should have administered prophylactic antibiotics at the time of delivery because of the patient’s high risk of infection.

DOCTOR’S DEFENSE Use of prophylactic antibiotics at delivery is not the standard of care. Also, the infection could not have been diagnosed earlier.

VERDICT Illinois defense verdict.

Surgery causes, but can’t fix, foreshortened vagina

A 52-YEAR-OLD WOMAN experiencing urinary incontinence, constipation, and pressure in her pelvis was diagnosed by her ObGyn with a cystocele, rectocele and enterocele. Of two surgical options offered, she chose the one that would allow normal sexual relations. The surgery went well. At her second postop follow-up exam, she was told that everything had healed, the vaginal wall was intact, and she could resume sexual intercourse. But intercourse was impossible due to a foreshortened vagina—only 4 cm—and her incontinence had worsened. Two years later, a second physician performed reconstructive surgery, which corrected the incontinence but only slightly improved the foreshortened vagina.

PATIENT’S CLAIM The ObGyn did not perform the correct procedure; his technique was not good; there was no informed consent; and the procedure caused excessive scarring and removed more than half of the vagina.

DOCTOR’S DEFENSE There was informed consent; excessive scarring is a recognized complication; and the patient failed to return for further follow-up exams and to follow instructions on the use of estrogen and dilators.

VERDICT $1,580,000 Indiana verdict, including $300,000 to the husband for loss of consortium. This was reduced to the statutory cap of $1,250,000.

Vacuum extraction cause of child’s deep brain bleed?

A PREGNANT 24-YEAR-OLD WOMAN had regular prenatal care but smoked throughout her pregnancy. At 3 days past her due date, she was admitted to the hospital for induction of labor. Labor progressed normally but the fetal heart rate pattern was occasionally nonreassuring. A first-year resident performed a vacuum extraction under supervision and delivered the 8 lb 15 oz infant after one pull of the vacuum extractor. Apgar scores were 8 and 9, and blood gases were normal, but there was some molding of the head. The baby’s 25-hour stay in the hospital was normal. Three days later, a visiting nurse noted the child was not feeding well and was jaundiced. On a pediatrician’s advice, the child was taken to the hospital, where a cephalohematoma and jaundice were discovered. After suffering seizures, the child was transferred to another facility, where bleeding deep in the brain—believed to be due to the vacuum delivery—was diagnosed. The child has mild cerebral palsy and seizure disorder, as well as mild behavioral problems and learning deficits.

PATIENT’S CLAIM A C-section should have been performed.

DOCTOR’S DEFENSE There was no need for a C-section, as shown by the reassuring fetal strips, normal Apgar scores, and normal neonatal course in the hospital. There was no evidence of trauma, as vacuum succeeded with only one pull and was attached for only 1 or 2 minutes. Also, vacuum extraction cannot cause deep brain bleeds; the child must have suffered trauma after leaving the hospital. Surgery can correct the seizures.

VERDICT $1.125 million Michigan settlement.

Radiologist underestimates size of fetus—by 3.5 lb

ACCORDING TO THE RADIOLOGIST, a sonogram indicated the size of a woman’s fetus to be 8.5 lb at 39 weeks’ gestation. The attending physician thus planned a vaginal delivery, which was performed by a nurse-midwife. The infant, however, weighed 12 lb at birth. Shoulder dystocia occurred, and the baby was born with Erb’s palsy of the left arm.

PATIENT’S CLAIM The radiologist underestimated the fetus’s size, so that a vaginal delivery was planned instead of a C-section. Also, the nurse-midwife used excessive force when shoulder dystocia occurred, thus injuring the infant.

DOCTOR’S DEFENSE Not reported.

VERDICT $1.2 million New Jersey settlement; 60% to be paid on behalf of the nurse-midwife, and 40% on behalf of the radiologist.

New mother has uterine infection, sepsis; dies

SIX DAYS AFTER GIVING BIRTH TO TWINS, a 25-year-old woman was at a restaurant when she experienced a gush of bloody, smelly fluid from her vagina. The nurse who answered her call to her physician’s office advised her to wait and see. An ObGyn with the group reviewed the call card. When the patient was examined by a physician at the office 5 days later, she had obvious signs of an infection. Following exploratory surgery, the patient did not improve. She developed sepsis, adult respiratory distress syndrome, and further complications. Two months after her children’s birth, she died.

PATIENT’S CLAIM The nurse or ObGyn should have instructed the patient to go to the emergency room when she first called about the emitted fluid. She had a uterine infection and would have survived with earlier treatment.

DOCTOR’S DEFENSE The call was handled properly, and she was treated in a timely manner. Sepsis only began 3 days after her office visit, and it was pre-existing conditions—a pulmonary disorder and Crohn’s disease—that caused her death.

VERDICT Tennessee defense verdict.

Vacuum extraction cause of child’s deep brain bleed?

A PREGNANT 24-YEAR-OLD WOMAN had regular prenatal care but smoked throughout her pregnancy. At 3 days past her due date, she was admitted to the hospital for induction of labor. Labor progressed normally but the fetal heart rate pattern was occasionally nonreassuring. A first-year resident performed a vacuum extraction under supervision and delivered the 8 lb 15 oz infant after one pull of the vacuum extractor. Apgar scores were 8 and 9, and blood gases were normal, but there was some molding of the head. The baby’s 25-hour stay in the hospital was normal. Three days later, a visiting nurse noted the child was not feeding well and was jaundiced. On a pediatrician’s advice, the child was taken to the hospital, where a cephalohematoma and jaundice were discovered. After suffering seizures, the child was transferred to another facility, where bleeding deep in the brain—believed to be due to the vacuum delivery—was diagnosed. The child has mild cerebral palsy and seizure disorder, as well as mild behavioral problems and learning deficits.

PATIENT’S CLAIM A C-section should have been performed.

DOCTOR’S DEFENSE There was no need for a C-section, as shown by the reassuring fetal strips, normal Apgar scores, and normal neonatal course in the hospital. There was no evidence of trauma, as vacuum succeeded with only one pull and was attached for only 1 or 2 minutes. Also, vacuum extraction cannot cause deep brain bleeds; the child must have suffered trauma after leaving the hospital. Surgery can correct the seizures.

VERDICT $1.125 million Michigan settlement.

Radiologist underestimates size of fetus—by 3.5 lb

ACCORDING TO THE RADIOLOGIST, a sonogram indicated the size of a woman’s fetus to be 8.5 lb at 39 weeks’ gestation. The attending physician thus planned a vaginal delivery, which was performed by a nurse-midwife. The infant, however, weighed 12 lb at birth. Shoulder dystocia occurred, and the baby was born with Erb’s palsy of the left arm.

PATIENT’S CLAIM The radiologist underestimated the fetus’s size, so that a vaginal delivery was planned instead of a C-section. Also, the nurse-midwife used excessive force when shoulder dystocia occurred, thus injuring the infant.

DOCTOR’S DEFENSE Not reported.

VERDICT $1.2 million New Jersey settlement; 60% to be paid on behalf of the nurse-midwife, and 40% on behalf of the radiologist.

New mother has uterine infection, sepsis; dies

SIX DAYS AFTER GIVING BIRTH TO TWINS, a 25-year-old woman was at a restaurant when she experienced a gush of bloody, smelly fluid from her vagina. The nurse who answered her call to her physician’s office advised her to wait and see. An ObGyn with the group reviewed the call card. When the patient was examined by a physician at the office 5 days later, she had obvious signs of an infection. Following exploratory surgery, the patient did not improve. She developed sepsis, adult respiratory distress syndrome, and further complications. Two months after her children’s birth, she died.

PATIENT’S CLAIM The nurse or ObGyn should have instructed the patient to go to the emergency room when she first called about the emitted fluid. She had a uterine infection and would have survived with earlier treatment.

DOCTOR’S DEFENSE The call was handled properly, and she was treated in a timely manner. Sepsis only began 3 days after her office visit, and it was pre-existing conditions—a pulmonary disorder and Crohn’s disease—that caused her death.

VERDICT Tennessee defense verdict.

Vacuum extraction cause of child’s deep brain bleed?

A PREGNANT 24-YEAR-OLD WOMAN had regular prenatal care but smoked throughout her pregnancy. At 3 days past her due date, she was admitted to the hospital for induction of labor. Labor progressed normally but the fetal heart rate pattern was occasionally nonreassuring. A first-year resident performed a vacuum extraction under supervision and delivered the 8 lb 15 oz infant after one pull of the vacuum extractor. Apgar scores were 8 and 9, and blood gases were normal, but there was some molding of the head. The baby’s 25-hour stay in the hospital was normal. Three days later, a visiting nurse noted the child was not feeding well and was jaundiced. On a pediatrician’s advice, the child was taken to the hospital, where a cephalohematoma and jaundice were discovered. After suffering seizures, the child was transferred to another facility, where bleeding deep in the brain—believed to be due to the vacuum delivery—was diagnosed. The child has mild cerebral palsy and seizure disorder, as well as mild behavioral problems and learning deficits.

PATIENT’S CLAIM A C-section should have been performed.

DOCTOR’S DEFENSE There was no need for a C-section, as shown by the reassuring fetal strips, normal Apgar scores, and normal neonatal course in the hospital. There was no evidence of trauma, as vacuum succeeded with only one pull and was attached for only 1 or 2 minutes. Also, vacuum extraction cannot cause deep brain bleeds; the child must have suffered trauma after leaving the hospital. Surgery can correct the seizures.

VERDICT $1.125 million Michigan settlement.

Radiologist underestimates size of fetus—by 3.5 lb

ACCORDING TO THE RADIOLOGIST, a sonogram indicated the size of a woman’s fetus to be 8.5 lb at 39 weeks’ gestation. The attending physician thus planned a vaginal delivery, which was performed by a nurse-midwife. The infant, however, weighed 12 lb at birth. Shoulder dystocia occurred, and the baby was born with Erb’s palsy of the left arm.

PATIENT’S CLAIM The radiologist underestimated the fetus’s size, so that a vaginal delivery was planned instead of a C-section. Also, the nurse-midwife used excessive force when shoulder dystocia occurred, thus injuring the infant.

DOCTOR’S DEFENSE Not reported.

VERDICT $1.2 million New Jersey settlement; 60% to be paid on behalf of the nurse-midwife, and 40% on behalf of the radiologist.

New mother has uterine infection, sepsis; dies

SIX DAYS AFTER GIVING BIRTH TO TWINS, a 25-year-old woman was at a restaurant when she experienced a gush of bloody, smelly fluid from her vagina. The nurse who answered her call to her physician’s office advised her to wait and see. An ObGyn with the group reviewed the call card. When the patient was examined by a physician at the office 5 days later, she had obvious signs of an infection. Following exploratory surgery, the patient did not improve. She developed sepsis, adult respiratory distress syndrome, and further complications. Two months after her children’s birth, she died.

PATIENT’S CLAIM The nurse or ObGyn should have instructed the patient to go to the emergency room when she first called about the emitted fluid. She had a uterine infection and would have survived with earlier treatment.

DOCTOR’S DEFENSE The call was handled properly, and she was treated in a timely manner. Sepsis only began 3 days after her office visit, and it was pre-existing conditions—a pulmonary disorder and Crohn’s disease—that caused her death.

VERDICT Tennessee defense verdict.

6 hours in lithotomy position leads to nerve damage

FOLLOWING A HYSTERECTOMY, a patient remained in the hospital for 18 days, during which time she developed agonizing pain in her legs. Also, her kidneys failed and she needed many rounds of dialysis.

• PATIENT’S CLAIM The physician was negligent for failing to reposition or lower her legs during the 6-hour surgery, for which she remained in a lithotomy position with her legs elevated. This caused compartment syndrome, as well as injury to motor and sensory femoral nerves and sciatic nerve involvement of the superficial perineal nerve.
  
• DOCTOR’S DEFENSE Although injury to the legs can occur if left in the lithotomy position for an extended time, the patient could not be repositioned because she was experiencing life-threatening hemorrhaging.
  
• VERDICT $700,000 California award, including $450,000 for economic losses and $250,000 for noneconomic losses.
  

Lost Pap smear delays diagnosis and treatment

A 36-YEAR-OLD WOMAN went to a new physician for gynecologic care. A Pap smear was not performed at her first visit, as her last one—only 6 months earlier—was normal. She was advised to return for another test in 6 months.

A Pap smear was performed at the patient’s next annual exam 10 months later. The physician said he would contact her if the results were abnormal. Three months later, the patient complained of vaginal discharge, and then continued to contact the physician’s office concerning urinary tract infections.

At her next annual exam the following year, a Pap smear was performed, during which the cervix bled easily. She learned that the results of the earlier Pap smear were not in the record. The current Pap test indicated low-grade intra-epithelial lesion and mild dysplasia with possible extension into the glands.

A few days after learning of the results, the patient underwent a colposcopy and biopsy. The pathology report revealed severe dysplasia with involvement of the endocervical glands. The physician noted at this time that the lab had never received the previous year’s specimen.

Two months later, the patient underwent a cone biopsy. Pathologic evaluation indicated moderate to severe dysplasia with extensive involvement in several areas. The patient had a vaginal hysterectomy for cervical carcinoma in situ 3 months later.

• PATIENT’S CLAIM If the physician had followed up on the results of the first Pap smear, he would have learned that the specimen never reached the laboratory, and he would have contacted the patient to have a repeat Pap test—instead of letting more than 2 years pass between two Pap smears. An earlier cancer diagnosis would have allowed her to undergo ablative therapy and avoid the hysterectomy.
  
• DOCTOR’S DEFENSE Nothing would have changed the patient’s outcome.
  
• VERDICT $500,000 Massachusetts settlement.
  

Sphincter laceration causes bowel and sexual problems

A 31-YEAR-OLD WOMAN gave birth by forceps delivery with the fetus at +2 station. The mother suffered a fourth degree laceration, which the OB tried to—but could not—repair. After discharge, the patient experienced constipation and difficulty controlling her bowel movements and could not have sexual intercourse. Nine months later, she underwent vaginal reconstruction, but impairment to her bowels and difficulties with intercourse are expected to continue.

• PATIENT’S CLAIM The physician was negligent during the delivery and repair of the laceration. The repair should have been performed by a physician with colorectal training and experience in such procedures. Also, forceps were used prematurely.
  
• DOCTOR’S DEFENSE Sphincter laceration is a recognized complication of delivery. Also, a colorectal surgeon was not needed.
  
• VERDICT $1,726,000 Pennsylvania verdict; recovery was limited by a confidential high–low agreement.
  

6 hours in lithotomy position leads to nerve damage

FOLLOWING A HYSTERECTOMY, a patient remained in the hospital for 18 days, during which time she developed agonizing pain in her legs. Also, her kidneys failed and she needed many rounds of dialysis.

• PATIENT’S CLAIM The physician was negligent for failing to reposition or lower her legs during the 6-hour surgery, for which she remained in a lithotomy position with her legs elevated. This caused compartment syndrome, as well as injury to motor and sensory femoral nerves and sciatic nerve involvement of the superficial perineal nerve.
  
• DOCTOR’S DEFENSE Although injury to the legs can occur if left in the lithotomy position for an extended time, the patient could not be repositioned because she was experiencing life-threatening hemorrhaging.
  
• VERDICT $700,000 California award, including $450,000 for economic losses and $250,000 for noneconomic losses.
  

Lost Pap smear delays diagnosis and treatment

A 36-YEAR-OLD WOMAN went to a new physician for gynecologic care. A Pap smear was not performed at her first visit, as her last one—only 6 months earlier—was normal. She was advised to return for another test in 6 months.

A Pap smear was performed at the patient’s next annual exam 10 months later. The physician said he would contact her if the results were abnormal. Three months later, the patient complained of vaginal discharge, and then continued to contact the physician’s office concerning urinary tract infections.

At her next annual exam the following year, a Pap smear was performed, during which the cervix bled easily. She learned that the results of the earlier Pap smear were not in the record. The current Pap test indicated low-grade intra-epithelial lesion and mild dysplasia with possible extension into the glands.

A few days after learning of the results, the patient underwent a colposcopy and biopsy. The pathology report revealed severe dysplasia with involvement of the endocervical glands. The physician noted at this time that the lab had never received the previous year’s specimen.

Two months later, the patient underwent a cone biopsy. Pathologic evaluation indicated moderate to severe dysplasia with extensive involvement in several areas. The patient had a vaginal hysterectomy for cervical carcinoma in situ 3 months later.

• PATIENT’S CLAIM If the physician had followed up on the results of the first Pap smear, he would have learned that the specimen never reached the laboratory, and he would have contacted the patient to have a repeat Pap test—instead of letting more than 2 years pass between two Pap smears. An earlier cancer diagnosis would have allowed her to undergo ablative therapy and avoid the hysterectomy.
  
• DOCTOR’S DEFENSE Nothing would have changed the patient’s outcome.
  
• VERDICT $500,000 Massachusetts settlement.
  

Sphincter laceration causes bowel and sexual problems

A 31-YEAR-OLD WOMAN gave birth by forceps delivery with the fetus at +2 station. The mother suffered a fourth degree laceration, which the OB tried to—but could not—repair. After discharge, the patient experienced constipation and difficulty controlling her bowel movements and could not have sexual intercourse. Nine months later, she underwent vaginal reconstruction, but impairment to her bowels and difficulties with intercourse are expected to continue.

• PATIENT’S CLAIM The physician was negligent during the delivery and repair of the laceration. The repair should have been performed by a physician with colorectal training and experience in such procedures. Also, forceps were used prematurely.
  
• DOCTOR’S DEFENSE Sphincter laceration is a recognized complication of delivery. Also, a colorectal surgeon was not needed.
  
• VERDICT $1,726,000 Pennsylvania verdict; recovery was limited by a confidential high–low agreement.
  

6 hours in lithotomy position leads to nerve damage

FOLLOWING A HYSTERECTOMY, a patient remained in the hospital for 18 days, during which time she developed agonizing pain in her legs. Also, her kidneys failed and she needed many rounds of dialysis.

• PATIENT’S CLAIM The physician was negligent for failing to reposition or lower her legs during the 6-hour surgery, for which she remained in a lithotomy position with her legs elevated. This caused compartment syndrome, as well as injury to motor and sensory femoral nerves and sciatic nerve involvement of the superficial perineal nerve.
  
• DOCTOR’S DEFENSE Although injury to the legs can occur if left in the lithotomy position for an extended time, the patient could not be repositioned because she was experiencing life-threatening hemorrhaging.
  
• VERDICT $700,000 California award, including $450,000 for economic losses and $250,000 for noneconomic losses.
  

Lost Pap smear delays diagnosis and treatment

A 36-YEAR-OLD WOMAN went to a new physician for gynecologic care. A Pap smear was not performed at her first visit, as her last one—only 6 months earlier—was normal. She was advised to return for another test in 6 months.

A Pap smear was performed at the patient’s next annual exam 10 months later. The physician said he would contact her if the results were abnormal. Three months later, the patient complained of vaginal discharge, and then continued to contact the physician’s office concerning urinary tract infections.

At her next annual exam the following year, a Pap smear was performed, during which the cervix bled easily. She learned that the results of the earlier Pap smear were not in the record. The current Pap test indicated low-grade intra-epithelial lesion and mild dysplasia with possible extension into the glands.

A few days after learning of the results, the patient underwent a colposcopy and biopsy. The pathology report revealed severe dysplasia with involvement of the endocervical glands. The physician noted at this time that the lab had never received the previous year’s specimen.

Two months later, the patient underwent a cone biopsy. Pathologic evaluation indicated moderate to severe dysplasia with extensive involvement in several areas. The patient had a vaginal hysterectomy for cervical carcinoma in situ 3 months later.

• PATIENT’S CLAIM If the physician had followed up on the results of the first Pap smear, he would have learned that the specimen never reached the laboratory, and he would have contacted the patient to have a repeat Pap test—instead of letting more than 2 years pass between two Pap smears. An earlier cancer diagnosis would have allowed her to undergo ablative therapy and avoid the hysterectomy.
  
• DOCTOR’S DEFENSE Nothing would have changed the patient’s outcome.
  
• VERDICT $500,000 Massachusetts settlement.
  

Sphincter laceration causes bowel and sexual problems

A 31-YEAR-OLD WOMAN gave birth by forceps delivery with the fetus at +2 station. The mother suffered a fourth degree laceration, which the OB tried to—but could not—repair. After discharge, the patient experienced constipation and difficulty controlling her bowel movements and could not have sexual intercourse. Nine months later, she underwent vaginal reconstruction, but impairment to her bowels and difficulties with intercourse are expected to continue.

• PATIENT’S CLAIM The physician was negligent during the delivery and repair of the laceration. The repair should have been performed by a physician with colorectal training and experience in such procedures. Also, forceps were used prematurely.
  
• DOCTOR’S DEFENSE Sphincter laceration is a recognized complication of delivery. Also, a colorectal surgeon was not needed.
  
• VERDICT $1,726,000 Pennsylvania verdict; recovery was limited by a confidential high–low agreement.
  

Was bowel perforated during laparoscopy?
Patient, physician disagree

A 56-YEAR-OLD WOMAN underwent diagnostic laparoscopic surgery as an outpatient after she complained to her physician of abdominal pain. The evening after surgery, her husband called the physician to report that she was in pain. He was told that the pain was probably caused by gas and to have his wife telephone in the morning if pain persisted. The husband called 2 days later with the same complaint; 3 days after surgery, the woman was brought to an emergency room and admitted. Another physician performed further surgery and discovered two bowel perforations and an abdominal infection. The patient required colostomy for 5 months and underwent several more surgeries.

• PATIENT’S CLAIM The first physician was negligent for not diagnosing the bowel perforation in a timely manner. Also, the patient has ongoing bowel problems.
  
• DOCTOR’S DEFENSE Bowel perforation occurred after the patient left the hospital. No calls were made about the pain after surgery.
  
• VERDICT Missouri defense verdict.
  

Patient dies after surgery to repair second perforation

DURING A D&C PROCEDURE to remove a uterine mass, a gynecologist noted a small perforation in the patient’s uterine wall. During follow-up laparoscopic surgery, he repaired the uterine perforation and checked for other injuries, but failed to detect a small-bowel perforation. At discharge, he advised the patient to contact him if she suffered complications. At home, she began to deteriorate. Her husband took her back to her physician, who sent her to the hospital for emergency surgery to repair the bowel perforation. The patient suffered sepsis and necrosis, which led to septic shock and multiple-organ failure. She died the following week.

• PATIENT’S CLAIM The gynecologist failed to detect a small-bowel perforation during laparoscopic surgery to repair a prior small uterine perforation.
  
• DOCTOR’S DEFENSE Not reported.
  
• VERDICT Indiana defense verdict.
  

Was bowel perforated during laparoscopy?
Patient, physician disagree

A 56-YEAR-OLD WOMAN underwent diagnostic laparoscopic surgery as an outpatient after she complained to her physician of abdominal pain. The evening after surgery, her husband called the physician to report that she was in pain. He was told that the pain was probably caused by gas and to have his wife telephone in the morning if pain persisted. The husband called 2 days later with the same complaint; 3 days after surgery, the woman was brought to an emergency room and admitted. Another physician performed further surgery and discovered two bowel perforations and an abdominal infection. The patient required colostomy for 5 months and underwent several more surgeries.

• PATIENT’S CLAIM The first physician was negligent for not diagnosing the bowel perforation in a timely manner. Also, the patient has ongoing bowel problems.
  
• DOCTOR’S DEFENSE Bowel perforation occurred after the patient left the hospital. No calls were made about the pain after surgery.
  
• VERDICT Missouri defense verdict.
  

Patient dies after surgery to repair second perforation

DURING A D&C PROCEDURE to remove a uterine mass, a gynecologist noted a small perforation in the patient’s uterine wall. During follow-up laparoscopic surgery, he repaired the uterine perforation and checked for other injuries, but failed to detect a small-bowel perforation. At discharge, he advised the patient to contact him if she suffered complications. At home, she began to deteriorate. Her husband took her back to her physician, who sent her to the hospital for emergency surgery to repair the bowel perforation. The patient suffered sepsis and necrosis, which led to septic shock and multiple-organ failure. She died the following week.

• PATIENT’S CLAIM The gynecologist failed to detect a small-bowel perforation during laparoscopic surgery to repair a prior small uterine perforation.
  
• DOCTOR’S DEFENSE Not reported.
  
• VERDICT Indiana defense verdict.
  

Was bowel perforated during laparoscopy?
Patient, physician disagree

A 56-YEAR-OLD WOMAN underwent diagnostic laparoscopic surgery as an outpatient after she complained to her physician of abdominal pain. The evening after surgery, her husband called the physician to report that she was in pain. He was told that the pain was probably caused by gas and to have his wife telephone in the morning if pain persisted. The husband called 2 days later with the same complaint; 3 days after surgery, the woman was brought to an emergency room and admitted. Another physician performed further surgery and discovered two bowel perforations and an abdominal infection. The patient required colostomy for 5 months and underwent several more surgeries.

• PATIENT’S CLAIM The first physician was negligent for not diagnosing the bowel perforation in a timely manner. Also, the patient has ongoing bowel problems.
  
• DOCTOR’S DEFENSE Bowel perforation occurred after the patient left the hospital. No calls were made about the pain after surgery.
  
• VERDICT Missouri defense verdict.
  

Patient dies after surgery to repair second perforation

DURING A D&C PROCEDURE to remove a uterine mass, a gynecologist noted a small perforation in the patient’s uterine wall. During follow-up laparoscopic surgery, he repaired the uterine perforation and checked for other injuries, but failed to detect a small-bowel perforation. At discharge, he advised the patient to contact him if she suffered complications. At home, she began to deteriorate. Her husband took her back to her physician, who sent her to the hospital for emergency surgery to repair the bowel perforation. The patient suffered sepsis and necrosis, which led to septic shock and multiple-organ failure. She died the following week.

• PATIENT’S CLAIM The gynecologist failed to detect a small-bowel perforation during laparoscopic surgery to repair a prior small uterine perforation.
  
• DOCTOR’S DEFENSE Not reported.
  
• VERDICT Indiana defense verdict.
  

$24.5 million verdict after oxytocin, then uterine rupture

A 37-YEAR-OLD WOMAN in labor was administered oxytocin. Her uterus ruptured, and oxytocin was continued for another 3 minutes. In an emergency C-section, the baby was found to be half-extruded from the uterus into the abdominal cavity. He was born asphyxiated; his Apgar scores were low; and umbilical artery blood gas indicated hypoxia and metabolic acidosis. He was diagnosed with cerebral palsy and requires a feeding tube.

• PATIENT’S CLAIM The nurses were negligent for not contacting a physician and for continuing oxytocin.
  
• DOCTOR’S DEFENSE There was no negligence.
  
• VERDICT $24,554,880 Illinois bench verdict.
  

ObGyn follows fetal distress remotely—child born with CP

WHEN A PREGNANT WOMAN presented at the hospital, both she and her fetus were found to be healthy with no complications. About 4½ hours later, the fetal monitor indicated decelerations of the fetal heart rate, and the ObGyn was notified. After another 1½ hours, it had increased without returning to baseline, and the decelerations became more frequent, severe, and prolonged, with coupling of contractions. These changes were relayed to the ObGyn, who then reviewed the monitoring strips with the nurse and ordered oxytocin to be started. Increasing heart rate and decelerations continued over the next hour. The depressed heart rate then was slow to return to baseline, and the fetal tracings began to flatten. Again the strips were reviewed by the nurses and physician. After 3 more hours, the ObGyn was informed of the continuing signs of fetal distress—the patient was 8 cm dilated and labor had shown no progress in the previous 2 hours. The ObGyn ordered increased oxytocin. After 45 minutes, the mother was dilated 9 cm and was told to start pushing. When she pushed, fetal decelerations decreased to as low as 60 bpm during contractions. Again the ObGyn was informed of persistent ominous signs of fetal distress. Without assessing the patient, he asked to be told when the baby began to crown—and then went to take a nap. Nearly 2 hours later, informed of a lack of progress and continued decelerations, he reviewed the strips and ordered increased oxytocin. Within 2 hours, the baby was born. She was covered with meconium and had Apgar scores of 2, 3, and 4 at 1, 5, and 10 minutes. She was limp, gray, and not breathing, and cord gases indicated acute severe metabolic and respiratory acidosis. The infant was taken to the NICU with multiple problems, including no primary reflexes, seizure disorder, and cerebral edema. She was diagnosed with cerebral palsy with right hemiplegia, chronic head pain, memory deficits, motor dysfunction, and many other deficits.

• PATIENT’S CLAIM Not reported.
  
• DOCTOR’S DEFENSE Not reported.
  
• VERDICT $3.45 million California settlement: $1 million from the ObGyn; and $2.45 million from the hospital.
  

Midwife has turn, then MD finishes difficult delivery

DELIVERY OF AN INFANT at term was performed by a physician who used forceps to assist. The child suffered brain damage and died.

• PATIENT’S CLAIM The physician failed to deliver the child in a timely manner, which led to brain damage and death.
  
• DOCTOR’S DEFENSE Labor was managed primarily by a midwife. The physician responded immediately when called and used appropriate emergency measures to deliver the child as quickly as possible.
  
• VERDICT $1.5 million settlement with the hospital before trial; Illinois defense verdict for the physician.
  

Embolism after C-section causes death

A 38-YEAR-OLD WOMAN pregnant with her second child had a C-section and tubal ligation performed by her ObGyn. She developed a pulmonary embolism a few days later and died.

• PATIENT’S CLAIM The patient’s age and weight were risk factors for pulmonary embolism, and she was immobilized for over 72 hours following surgery, which also increased the risk. The defendants took no steps to prevent a pulmonary embolism.
  
• DOCTOR’S DEFENSE There was no negligence.
  
• VERDICT Ohio defense verdict.
  

Surgery for pelvic pain and cyst leads to … more surgery

A SONOGRAM REVEALED an ovarian cyst in a woman, in her mid-40s, who was experiencing pelvic pain. Her physician recommended and performed surgery to find the source of the pain, as well as to possibly remove the cyst and ovaries. Following surgery, the woman was diagnosed with a colon perforation. A colostomy and two further surgeries were necessary. In addition, the patient suffered a bowel obstruction, colovaginal fistula, and scarring.

• PATIENT’S CLAIM The original surgery was unnecessary, and the colon perforation was negligent.
  
• DOCTOR’S DEFENSE Surgery was necessary to determine and treat the cause of the pain. Perforation of the colon did not occur during surgery, but resulted from the patient’s diverticulitis.
  
• VERDICT A $3,497,000 Maryland verdict was returned; however, this was reduced to $702,000 pursuant to the state cap for noneconomic damages.
  

Femoral nerve palsy occurs after hysterectomy

A 39-YEAR-OLD WOMAN was diagnosed with a leiomyomata in her lower uterus. The tissue in the area became necrotic, and prolapse resulted. Surgery was performed. A week later, the patient returned to the hospital because of pain and bleeding. The ObGyn covering for the physician who had performed the surgery recommended—then performed—a hysterectomy. Following the surgery, the woman experienced numbness in the right anterior and lateral thigh. According to a neurological consultation, the femoral nerve was damaged. The patient suffers from persistent femoral nerve palsy, affecting her ability to walk. She has undergone physical therapy and rehabilitation, as well as nerve conduction studies.

• PATIENT’S CLAIM The ObGyn negligently placed the retractor or failed to reposition the retractor blades after they moved during the surgery.
  
• DOCTOR’S DEFENSE There was no negligence. Femoral nerve injury is a known risk of pelvic surgery. The patient suffered only minor sensory and motor palsy immediately following surgery, and her ongoing complaints had no physical basis.
  
• VERDICT California defense verdict.
  

Patient fails to report continued irregular bleeding

AT HER ANNUAL EXAM, a 49-year-old woman told her gynecologist, Dr. A, about cramping and bleeding on day 10 and sometimes day 17 of her menstrual cycle over the previous 6 months. Dr. A noted a normal pelvic exam. She told the patient that the bleeding was a normal perimenopausal symptom and suggested taking Advil for the pain. No further testing was recommended. The patient failed to report continued irregular vaginal bleeding. A year later, Dr. B conducted the next annual exam and found an enlarged uterus in the 7- to 8-week range. Endometrial biopsy showed the left ovary to be tender, slightly enlarged, with a possible mass present. A sonogram 2 days later showed an enlarged right ovary with multiple cystic areas and a large complex mass of the left ovary—findings suspicious for ovarian cancer. Pathology following a D&C 1 month later indicated adenocarcinoma consistent with primary endometrial cancer. The patient was diagnosed with endometrioid type adenocarcinoma involving both ovaries and the uterus, as well as metastatic disease to the omentum and diaphragm. She underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic and periaortic lymph node dissection, omentectomy, and CUSA of the diaphragm. She is not expected to survive long-term.

• PATIENT’S CLAIM Dr. A was negligent for failing to timely diagnose and treat the cancer.
  
• DOCTOR’S DEFENSE As the patient reported irregular vaginal bleeding at one visit only, there was no indication for further testing of a woman her age and no reason to suspect any disease. Most likely, the irregular vaginal bleeding was unrelated to the ovarian cancer, and an endometrial biopsy after the first visit would not have changed the prognosis.
  
• VERDICT $750,000 Massachusetts settlement.
  

$24.5 million verdict after oxytocin, then uterine rupture

A 37-YEAR-OLD WOMAN in labor was administered oxytocin. Her uterus ruptured, and oxytocin was continued for another 3 minutes. In an emergency C-section, the baby was found to be half-extruded from the uterus into the abdominal cavity. He was born asphyxiated; his Apgar scores were low; and umbilical artery blood gas indicated hypoxia and metabolic acidosis. He was diagnosed with cerebral palsy and requires a feeding tube.

• PATIENT’S CLAIM The nurses were negligent for not contacting a physician and for continuing oxytocin.
  
• DOCTOR’S DEFENSE There was no negligence.
  
• VERDICT $24,554,880 Illinois bench verdict.
  

ObGyn follows fetal distress remotely—child born with CP

WHEN A PREGNANT WOMAN presented at the hospital, both she and her fetus were found to be healthy with no complications. About 4½ hours later, the fetal monitor indicated decelerations of the fetal heart rate, and the ObGyn was notified. After another 1½ hours, it had increased without returning to baseline, and the decelerations became more frequent, severe, and prolonged, with coupling of contractions. These changes were relayed to the ObGyn, who then reviewed the monitoring strips with the nurse and ordered oxytocin to be started. Increasing heart rate and decelerations continued over the next hour. The depressed heart rate then was slow to return to baseline, and the fetal tracings began to flatten. Again the strips were reviewed by the nurses and physician. After 3 more hours, the ObGyn was informed of the continuing signs of fetal distress—the patient was 8 cm dilated and labor had shown no progress in the previous 2 hours. The ObGyn ordered increased oxytocin. After 45 minutes, the mother was dilated 9 cm and was told to start pushing. When she pushed, fetal decelerations decreased to as low as 60 bpm during contractions. Again the ObGyn was informed of persistent ominous signs of fetal distress. Without assessing the patient, he asked to be told when the baby began to crown—and then went to take a nap. Nearly 2 hours later, informed of a lack of progress and continued decelerations, he reviewed the strips and ordered increased oxytocin. Within 2 hours, the baby was born. She was covered with meconium and had Apgar scores of 2, 3, and 4 at 1, 5, and 10 minutes. She was limp, gray, and not breathing, and cord gases indicated acute severe metabolic and respiratory acidosis. The infant was taken to the NICU with multiple problems, including no primary reflexes, seizure disorder, and cerebral edema. She was diagnosed with cerebral palsy with right hemiplegia, chronic head pain, memory deficits, motor dysfunction, and many other deficits.

• PATIENT’S CLAIM Not reported.
  
• DOCTOR’S DEFENSE Not reported.
  
• VERDICT $3.45 million California settlement: $1 million from the ObGyn; and $2.45 million from the hospital.
  

Midwife has turn, then MD finishes difficult delivery

DELIVERY OF AN INFANT at term was performed by a physician who used forceps to assist. The child suffered brain damage and died.

• PATIENT’S CLAIM The physician failed to deliver the child in a timely manner, which led to brain damage and death.
  
• DOCTOR’S DEFENSE Labor was managed primarily by a midwife. The physician responded immediately when called and used appropriate emergency measures to deliver the child as quickly as possible.
  
• VERDICT $1.5 million settlement with the hospital before trial; Illinois defense verdict for the physician.
  

Embolism after C-section causes death

A 38-YEAR-OLD WOMAN pregnant with her second child had a C-section and tubal ligation performed by her ObGyn. She developed a pulmonary embolism a few days later and died.

• PATIENT’S CLAIM The patient’s age and weight were risk factors for pulmonary embolism, and she was immobilized for over 72 hours following surgery, which also increased the risk. The defendants took no steps to prevent a pulmonary embolism.
  
• DOCTOR’S DEFENSE There was no negligence.
  
• VERDICT Ohio defense verdict.
  

Surgery for pelvic pain and cyst leads to … more surgery

A SONOGRAM REVEALED an ovarian cyst in a woman, in her mid-40s, who was experiencing pelvic pain. Her physician recommended and performed surgery to find the source of the pain, as well as to possibly remove the cyst and ovaries. Following surgery, the woman was diagnosed with a colon perforation. A colostomy and two further surgeries were necessary. In addition, the patient suffered a bowel obstruction, colovaginal fistula, and scarring.

• PATIENT’S CLAIM The original surgery was unnecessary, and the colon perforation was negligent.
  
• DOCTOR’S DEFENSE Surgery was necessary to determine and treat the cause of the pain. Perforation of the colon did not occur during surgery, but resulted from the patient’s diverticulitis.
  
• VERDICT A $3,497,000 Maryland verdict was returned; however, this was reduced to $702,000 pursuant to the state cap for noneconomic damages.
  

Femoral nerve palsy occurs after hysterectomy

A 39-YEAR-OLD WOMAN was diagnosed with a leiomyomata in her lower uterus. The tissue in the area became necrotic, and prolapse resulted. Surgery was performed. A week later, the patient returned to the hospital because of pain and bleeding. The ObGyn covering for the physician who had performed the surgery recommended—then performed—a hysterectomy. Following the surgery, the woman experienced numbness in the right anterior and lateral thigh. According to a neurological consultation, the femoral nerve was damaged. The patient suffers from persistent femoral nerve palsy, affecting her ability to walk. She has undergone physical therapy and rehabilitation, as well as nerve conduction studies.

• PATIENT’S CLAIM The ObGyn negligently placed the retractor or failed to reposition the retractor blades after they moved during the surgery.
  
• DOCTOR’S DEFENSE There was no negligence. Femoral nerve injury is a known risk of pelvic surgery. The patient suffered only minor sensory and motor palsy immediately following surgery, and her ongoing complaints had no physical basis.
  
• VERDICT California defense verdict.
  

Patient fails to report continued irregular bleeding

AT HER ANNUAL EXAM, a 49-year-old woman told her gynecologist, Dr. A, about cramping and bleeding on day 10 and sometimes day 17 of her menstrual cycle over the previous 6 months. Dr. A noted a normal pelvic exam. She told the patient that the bleeding was a normal perimenopausal symptom and suggested taking Advil for the pain. No further testing was recommended. The patient failed to report continued irregular vaginal bleeding. A year later, Dr. B conducted the next annual exam and found an enlarged uterus in the 7- to 8-week range. Endometrial biopsy showed the left ovary to be tender, slightly enlarged, with a possible mass present. A sonogram 2 days later showed an enlarged right ovary with multiple cystic areas and a large complex mass of the left ovary—findings suspicious for ovarian cancer. Pathology following a D&C 1 month later indicated adenocarcinoma consistent with primary endometrial cancer. The patient was diagnosed with endometrioid type adenocarcinoma involving both ovaries and the uterus, as well as metastatic disease to the omentum and diaphragm. She underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic and periaortic lymph node dissection, omentectomy, and CUSA of the diaphragm. She is not expected to survive long-term.

• PATIENT’S CLAIM Dr. A was negligent for failing to timely diagnose and treat the cancer.
  
• DOCTOR’S DEFENSE As the patient reported irregular vaginal bleeding at one visit only, there was no indication for further testing of a woman her age and no reason to suspect any disease. Most likely, the irregular vaginal bleeding was unrelated to the ovarian cancer, and an endometrial biopsy after the first visit would not have changed the prognosis.
  
• VERDICT $750,000 Massachusetts settlement.
  

$24.5 million verdict after oxytocin, then uterine rupture

A 37-YEAR-OLD WOMAN in labor was administered oxytocin. Her uterus ruptured, and oxytocin was continued for another 3 minutes. In an emergency C-section, the baby was found to be half-extruded from the uterus into the abdominal cavity. He was born asphyxiated; his Apgar scores were low; and umbilical artery blood gas indicated hypoxia and metabolic acidosis. He was diagnosed with cerebral palsy and requires a feeding tube.

• PATIENT’S CLAIM The nurses were negligent for not contacting a physician and for continuing oxytocin.
  
• DOCTOR’S DEFENSE There was no negligence.
  
• VERDICT $24,554,880 Illinois bench verdict.
  

ObGyn follows fetal distress remotely—child born with CP

WHEN A PREGNANT WOMAN presented at the hospital, both she and her fetus were found to be healthy with no complications. About 4½ hours later, the fetal monitor indicated decelerations of the fetal heart rate, and the ObGyn was notified. After another 1½ hours, it had increased without returning to baseline, and the decelerations became more frequent, severe, and prolonged, with coupling of contractions. These changes were relayed to the ObGyn, who then reviewed the monitoring strips with the nurse and ordered oxytocin to be started. Increasing heart rate and decelerations continued over the next hour. The depressed heart rate then was slow to return to baseline, and the fetal tracings began to flatten. Again the strips were reviewed by the nurses and physician. After 3 more hours, the ObGyn was informed of the continuing signs of fetal distress—the patient was 8 cm dilated and labor had shown no progress in the previous 2 hours. The ObGyn ordered increased oxytocin. After 45 minutes, the mother was dilated 9 cm and was told to start pushing. When she pushed, fetal decelerations decreased to as low as 60 bpm during contractions. Again the ObGyn was informed of persistent ominous signs of fetal distress. Without assessing the patient, he asked to be told when the baby began to crown—and then went to take a nap. Nearly 2 hours later, informed of a lack of progress and continued decelerations, he reviewed the strips and ordered increased oxytocin. Within 2 hours, the baby was born. She was covered with meconium and had Apgar scores of 2, 3, and 4 at 1, 5, and 10 minutes. She was limp, gray, and not breathing, and cord gases indicated acute severe metabolic and respiratory acidosis. The infant was taken to the NICU with multiple problems, including no primary reflexes, seizure disorder, and cerebral edema. She was diagnosed with cerebral palsy with right hemiplegia, chronic head pain, memory deficits, motor dysfunction, and many other deficits.

• PATIENT’S CLAIM Not reported.
  
• DOCTOR’S DEFENSE Not reported.
  
• VERDICT $3.45 million California settlement: $1 million from the ObGyn; and $2.45 million from the hospital.
  

Midwife has turn, then MD finishes difficult delivery

DELIVERY OF AN INFANT at term was performed by a physician who used forceps to assist. The child suffered brain damage and died.

• PATIENT’S CLAIM The physician failed to deliver the child in a timely manner, which led to brain damage and death.
  
• DOCTOR’S DEFENSE Labor was managed primarily by a midwife. The physician responded immediately when called and used appropriate emergency measures to deliver the child as quickly as possible.
  
• VERDICT $1.5 million settlement with the hospital before trial; Illinois defense verdict for the physician.
  

Embolism after C-section causes death

A 38-YEAR-OLD WOMAN pregnant with her second child had a C-section and tubal ligation performed by her ObGyn. She developed a pulmonary embolism a few days later and died.

• PATIENT’S CLAIM The patient’s age and weight were risk factors for pulmonary embolism, and she was immobilized for over 72 hours following surgery, which also increased the risk. The defendants took no steps to prevent a pulmonary embolism.
  
• DOCTOR’S DEFENSE There was no negligence.
  
• VERDICT Ohio defense verdict.
  

Surgery for pelvic pain and cyst leads to … more surgery

A SONOGRAM REVEALED an ovarian cyst in a woman, in her mid-40s, who was experiencing pelvic pain. Her physician recommended and performed surgery to find the source of the pain, as well as to possibly remove the cyst and ovaries. Following surgery, the woman was diagnosed with a colon perforation. A colostomy and two further surgeries were necessary. In addition, the patient suffered a bowel obstruction, colovaginal fistula, and scarring.

• PATIENT’S CLAIM The original surgery was unnecessary, and the colon perforation was negligent.
  
• DOCTOR’S DEFENSE Surgery was necessary to determine and treat the cause of the pain. Perforation of the colon did not occur during surgery, but resulted from the patient’s diverticulitis.
  
• VERDICT A $3,497,000 Maryland verdict was returned; however, this was reduced to $702,000 pursuant to the state cap for noneconomic damages.
  

Femoral nerve palsy occurs after hysterectomy

A 39-YEAR-OLD WOMAN was diagnosed with a leiomyomata in her lower uterus. The tissue in the area became necrotic, and prolapse resulted. Surgery was performed. A week later, the patient returned to the hospital because of pain and bleeding. The ObGyn covering for the physician who had performed the surgery recommended—then performed—a hysterectomy. Following the surgery, the woman experienced numbness in the right anterior and lateral thigh. According to a neurological consultation, the femoral nerve was damaged. The patient suffers from persistent femoral nerve palsy, affecting her ability to walk. She has undergone physical therapy and rehabilitation, as well as nerve conduction studies.

• PATIENT’S CLAIM The ObGyn negligently placed the retractor or failed to reposition the retractor blades after they moved during the surgery.
  
• DOCTOR’S DEFENSE There was no negligence. Femoral nerve injury is a known risk of pelvic surgery. The patient suffered only minor sensory and motor palsy immediately following surgery, and her ongoing complaints had no physical basis.
  
• VERDICT California defense verdict.
  

Patient fails to report continued irregular bleeding

AT HER ANNUAL EXAM, a 49-year-old woman told her gynecologist, Dr. A, about cramping and bleeding on day 10 and sometimes day 17 of her menstrual cycle over the previous 6 months. Dr. A noted a normal pelvic exam. She told the patient that the bleeding was a normal perimenopausal symptom and suggested taking Advil for the pain. No further testing was recommended. The patient failed to report continued irregular vaginal bleeding. A year later, Dr. B conducted the next annual exam and found an enlarged uterus in the 7- to 8-week range. Endometrial biopsy showed the left ovary to be tender, slightly enlarged, with a possible mass present. A sonogram 2 days later showed an enlarged right ovary with multiple cystic areas and a large complex mass of the left ovary—findings suspicious for ovarian cancer. Pathology following a D&C 1 month later indicated adenocarcinoma consistent with primary endometrial cancer. The patient was diagnosed with endometrioid type adenocarcinoma involving both ovaries and the uterus, as well as metastatic disease to the omentum and diaphragm. She underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic and periaortic lymph node dissection, omentectomy, and CUSA of the diaphragm. She is not expected to survive long-term.

• PATIENT’S CLAIM Dr. A was negligent for failing to timely diagnose and treat the cancer.
  
• DOCTOR’S DEFENSE As the patient reported irregular vaginal bleeding at one visit only, there was no indication for further testing of a woman her age and no reason to suspect any disease. Most likely, the irregular vaginal bleeding was unrelated to the ovarian cancer, and an endometrial biopsy after the first visit would not have changed the prognosis.
  
• VERDICT $750,000 Massachusetts settlement.
  

Missed meningitis—mother and twins die

A 46-year-old woman pregnant with twins presented to a high-risk ObGyn because of her age. She complained of having a fever for several days, cold-like symptoms, headache, and coughing. The ObGyn diagnosed an upper respiratory infection, prescribed Reglan, Pepcid, and Tussin, and asked her to return in 3 weeks. Her headache and fever continued. After a couple of weeks, she called the ObGyn three times on different days complaining of headache and fever and was advised to take over-the-counter medications. After another 2 days, she called again and was told to take Advil. The following day she died. The twins, at 30 weeks’ gestation, also died. An autopsy indicated that the woman died from untreated streptococcal meningitis.

Patient’s claim The ObGyn (1) failed to properly monitor, diagnose, and treat the patient’s condition; (2) failed to properly conduct testing that would have detected the bacterial infection; and (3) allowed her condition to worsen without treatment.

Doctor’s defense Not reported.

Verdict Florida defense verdict.

Undetected injury leads to extensive surgery

A 37-year-old woman with endometriosis that was causing pelvic pain underwent diagnostic laparoscopic surgery. During the surgery, a trocar perforated her right common iliac artery. The injury was noticed immediately, and assistance was requested. Following vascular repair surgery, the patient experienced a more complex recovery than expected.

Patient’s claim The physician was negligent in perforating the artery.

Doctor’s defense This type of injury is a known risk of the procedure. Its repair was properly handled.

Verdict $312,645 Tennessee verdict.

Alleged substance abuse hurts her infant

A 15-year-old girl with a history of smoking cigarettes, drinking alcohol, and using marijuana and crack was found to be pregnant. It was unclear if she had used the substances early in her pregnancy. When she was admitted to the hospital for delivery, oxytocin was administered over 1½ days until the infant was delivered using vacuum extraction. Neurological damage was apparent soon after delivery. The child suffers from cerebral palsy and microcephalia.

Patient’s claim Protracted labor and slow descent of the baby indicated cephalopelvic disproportion. A cesarean section should have been performed.

Doctor’s defense There was no negligence. As this was a first pregnancy, the slow progress of delivery was not unusual. The child’s neurological problems resulted from (1) maternal drug use early in the pregnancy and (2) maternal viral infection at the time of delivery.

Verdict Nebraska defense verdict.

Fetal distress or viral infection? Baby has CP

A pregnant woman several days past her due date was admitted to the hospital for induction of labor with oxytocin. Initially, the fetal heart tracing indicated no signs of distress. After a few hours, however, the heart rate pattern became irregular, and a significant deceleration occurred. As instructed, the mother began pushing. This continued for 4 hours. About 12 hours after admission, the mother gave birth to a severely depressed infant, whose Apgar score was 0 at 1 and 5 minutes. The child was resuscitated at 12 minutes and was later determined to have suffered severe asphyxia. He has cerebral palsy and spastic quadriplegia and needs 24-hour care.

Patient’s claim The defendants responded improperly to fetal distress and failed to perform a cesarean section.

Doctor’s defense Brain damage was caused by a prenatal viral infection. Also, the fetal heart tracings did not show fetal distress.

Verdict $18 million Illinois settlement: $14.5 million from the hospital; $1 million each from the obstetrician and her employer; and $1.5 million from the delivery nurse’s employer.

Second surgery rules out injury

A 51-year-old woman with a host of medical and physical problems—osteoarthritis, rheumatoid arthritis, ruptured and displaced spinal discs, irritable bowel syndrome—was taking 30 prescriptions each day, including eight for pain from providers other than her ObGyn, Dr. A. When she complained of postmenopausal bleeding and pain, but wanted to continue hormone therapy, Dr. A said that her only option was a hysterectomy. The surgery was performed. Immediately afterward, Dr. A left the practice and Dr. B, a second ObGyn, assumed the patient’s care. Following the hysterectomy, the patient suffered a postoperative abdominal hematoma, of which Dr. B was aware. For 2 to 3 days after the surgery, the patient was given hemoglobin and her blood count increased. On day 4, she began to show signs of confusion. A surgeon was called because septic infection from a perforated bowel was suspected. Laparoscopy was performed. As no source of bleeding was found in the abdomen or pelvis, her confusion was believed to be due to withdrawal from the pain medications. She acquired a hospital infection during her second hospitalization and required several weeks of inpatient therapy to recover.

Patient’s claim Dr. A injured a major artery, resulting in a hematoma. The second surgery should have been done sooner, or may even have been unnecessary.

Doctor’s defense There was no artery injury or bowel perforation. In order to rule out any bleed, the second surgery was necessary. Also, hospital infection is a known complication of surgery.

Verdict Michigan defense verdict.

Foot drop follows transvaginal taping

A 53-year-old woman underwent a transvaginal taping to correct urinary incontinence. Following surgery, she complained of pain along the side of her right leg—from her hip down to her foot. Right foot drop was diagnosed. She needs an ankle brace and cane to walk.

Patient’s claim The injury was a result of inappropriate positioning during surgery that caused pressure on her common peroneal nerve.

Doctor’s defense Most likely, the injury was secondary to a preexisting sciatic nerve dysfunction.

Verdict Illinois defense verdict.

Missed meningitis—mother and twins die

A 46-year-old woman pregnant with twins presented to a high-risk ObGyn because of her age. She complained of having a fever for several days, cold-like symptoms, headache, and coughing. The ObGyn diagnosed an upper respiratory infection, prescribed Reglan, Pepcid, and Tussin, and asked her to return in 3 weeks. Her headache and fever continued. After a couple of weeks, she called the ObGyn three times on different days complaining of headache and fever and was advised to take over-the-counter medications. After another 2 days, she called again and was told to take Advil. The following day she died. The twins, at 30 weeks’ gestation, also died. An autopsy indicated that the woman died from untreated streptococcal meningitis.

Patient’s claim The ObGyn (1) failed to properly monitor, diagnose, and treat the patient’s condition; (2) failed to properly conduct testing that would have detected the bacterial infection; and (3) allowed her condition to worsen without treatment.

Doctor’s defense Not reported.

Verdict Florida defense verdict.

Undetected injury leads to extensive surgery

A 37-year-old woman with endometriosis that was causing pelvic pain underwent diagnostic laparoscopic surgery. During the surgery, a trocar perforated her right common iliac artery. The injury was noticed immediately, and assistance was requested. Following vascular repair surgery, the patient experienced a more complex recovery than expected.

Patient’s claim The physician was negligent in perforating the artery.

Doctor’s defense This type of injury is a known risk of the procedure. Its repair was properly handled.

Verdict $312,645 Tennessee verdict.

Alleged substance abuse hurts her infant

A 15-year-old girl with a history of smoking cigarettes, drinking alcohol, and using marijuana and crack was found to be pregnant. It was unclear if she had used the substances early in her pregnancy. When she was admitted to the hospital for delivery, oxytocin was administered over 1½ days until the infant was delivered using vacuum extraction. Neurological damage was apparent soon after delivery. The child suffers from cerebral palsy and microcephalia.

Patient’s claim Protracted labor and slow descent of the baby indicated cephalopelvic disproportion. A cesarean section should have been performed.

Doctor’s defense There was no negligence. As this was a first pregnancy, the slow progress of delivery was not unusual. The child’s neurological problems resulted from (1) maternal drug use early in the pregnancy and (2) maternal viral infection at the time of delivery.

Verdict Nebraska defense verdict.

Fetal distress or viral infection? Baby has CP

A pregnant woman several days past her due date was admitted to the hospital for induction of labor with oxytocin. Initially, the fetal heart tracing indicated no signs of distress. After a few hours, however, the heart rate pattern became irregular, and a significant deceleration occurred. As instructed, the mother began pushing. This continued for 4 hours. About 12 hours after admission, the mother gave birth to a severely depressed infant, whose Apgar score was 0 at 1 and 5 minutes. The child was resuscitated at 12 minutes and was later determined to have suffered severe asphyxia. He has cerebral palsy and spastic quadriplegia and needs 24-hour care.

Patient’s claim The defendants responded improperly to fetal distress and failed to perform a cesarean section.

Doctor’s defense Brain damage was caused by a prenatal viral infection. Also, the fetal heart tracings did not show fetal distress.

Verdict $18 million Illinois settlement: $14.5 million from the hospital; $1 million each from the obstetrician and her employer; and $1.5 million from the delivery nurse’s employer.

Second surgery rules out injury

A 51-year-old woman with a host of medical and physical problems—osteoarthritis, rheumatoid arthritis, ruptured and displaced spinal discs, irritable bowel syndrome—was taking 30 prescriptions each day, including eight for pain from providers other than her ObGyn, Dr. A. When she complained of postmenopausal bleeding and pain, but wanted to continue hormone therapy, Dr. A said that her only option was a hysterectomy. The surgery was performed. Immediately afterward, Dr. A left the practice and Dr. B, a second ObGyn, assumed the patient’s care. Following the hysterectomy, the patient suffered a postoperative abdominal hematoma, of which Dr. B was aware. For 2 to 3 days after the surgery, the patient was given hemoglobin and her blood count increased. On day 4, she began to show signs of confusion. A surgeon was called because septic infection from a perforated bowel was suspected. Laparoscopy was performed. As no source of bleeding was found in the abdomen or pelvis, her confusion was believed to be due to withdrawal from the pain medications. She acquired a hospital infection during her second hospitalization and required several weeks of inpatient therapy to recover.

Patient’s claim Dr. A injured a major artery, resulting in a hematoma. The second surgery should have been done sooner, or may even have been unnecessary.

Doctor’s defense There was no artery injury or bowel perforation. In order to rule out any bleed, the second surgery was necessary. Also, hospital infection is a known complication of surgery.

Verdict Michigan defense verdict.

Foot drop follows transvaginal taping

A 53-year-old woman underwent a transvaginal taping to correct urinary incontinence. Following surgery, she complained of pain along the side of her right leg—from her hip down to her foot. Right foot drop was diagnosed. She needs an ankle brace and cane to walk.

Patient’s claim The injury was a result of inappropriate positioning during surgery that caused pressure on her common peroneal nerve.

Doctor’s defense Most likely, the injury was secondary to a preexisting sciatic nerve dysfunction.

Verdict Illinois defense verdict.

Missed meningitis—mother and twins die

A 46-year-old woman pregnant with twins presented to a high-risk ObGyn because of her age. She complained of having a fever for several days, cold-like symptoms, headache, and coughing. The ObGyn diagnosed an upper respiratory infection, prescribed Reglan, Pepcid, and Tussin, and asked her to return in 3 weeks. Her headache and fever continued. After a couple of weeks, she called the ObGyn three times on different days complaining of headache and fever and was advised to take over-the-counter medications. After another 2 days, she called again and was told to take Advil. The following day she died. The twins, at 30 weeks’ gestation, also died. An autopsy indicated that the woman died from untreated streptococcal meningitis.

Patient’s claim The ObGyn (1) failed to properly monitor, diagnose, and treat the patient’s condition; (2) failed to properly conduct testing that would have detected the bacterial infection; and (3) allowed her condition to worsen without treatment.

Doctor’s defense Not reported.

Verdict Florida defense verdict.

Undetected injury leads to extensive surgery

A 37-year-old woman with endometriosis that was causing pelvic pain underwent diagnostic laparoscopic surgery. During the surgery, a trocar perforated her right common iliac artery. The injury was noticed immediately, and assistance was requested. Following vascular repair surgery, the patient experienced a more complex recovery than expected.

Patient’s claim The physician was negligent in perforating the artery.

Doctor’s defense This type of injury is a known risk of the procedure. Its repair was properly handled.

Verdict $312,645 Tennessee verdict.

Alleged substance abuse hurts her infant

A 15-year-old girl with a history of smoking cigarettes, drinking alcohol, and using marijuana and crack was found to be pregnant. It was unclear if she had used the substances early in her pregnancy. When she was admitted to the hospital for delivery, oxytocin was administered over 1½ days until the infant was delivered using vacuum extraction. Neurological damage was apparent soon after delivery. The child suffers from cerebral palsy and microcephalia.

Patient’s claim Protracted labor and slow descent of the baby indicated cephalopelvic disproportion. A cesarean section should have been performed.

Doctor’s defense There was no negligence. As this was a first pregnancy, the slow progress of delivery was not unusual. The child’s neurological problems resulted from (1) maternal drug use early in the pregnancy and (2) maternal viral infection at the time of delivery.

Verdict Nebraska defense verdict.

Fetal distress or viral infection? Baby has CP

A pregnant woman several days past her due date was admitted to the hospital for induction of labor with oxytocin. Initially, the fetal heart tracing indicated no signs of distress. After a few hours, however, the heart rate pattern became irregular, and a significant deceleration occurred. As instructed, the mother began pushing. This continued for 4 hours. About 12 hours after admission, the mother gave birth to a severely depressed infant, whose Apgar score was 0 at 1 and 5 minutes. The child was resuscitated at 12 minutes and was later determined to have suffered severe asphyxia. He has cerebral palsy and spastic quadriplegia and needs 24-hour care.

Patient’s claim The defendants responded improperly to fetal distress and failed to perform a cesarean section.

Doctor’s defense Brain damage was caused by a prenatal viral infection. Also, the fetal heart tracings did not show fetal distress.

Verdict $18 million Illinois settlement: $14.5 million from the hospital; $1 million each from the obstetrician and her employer; and $1.5 million from the delivery nurse’s employer.

Second surgery rules out injury

A 51-year-old woman with a host of medical and physical problems—osteoarthritis, rheumatoid arthritis, ruptured and displaced spinal discs, irritable bowel syndrome—was taking 30 prescriptions each day, including eight for pain from providers other than her ObGyn, Dr. A. When she complained of postmenopausal bleeding and pain, but wanted to continue hormone therapy, Dr. A said that her only option was a hysterectomy. The surgery was performed. Immediately afterward, Dr. A left the practice and Dr. B, a second ObGyn, assumed the patient’s care. Following the hysterectomy, the patient suffered a postoperative abdominal hematoma, of which Dr. B was aware. For 2 to 3 days after the surgery, the patient was given hemoglobin and her blood count increased. On day 4, she began to show signs of confusion. A surgeon was called because septic infection from a perforated bowel was suspected. Laparoscopy was performed. As no source of bleeding was found in the abdomen or pelvis, her confusion was believed to be due to withdrawal from the pain medications. She acquired a hospital infection during her second hospitalization and required several weeks of inpatient therapy to recover.

Patient’s claim Dr. A injured a major artery, resulting in a hematoma. The second surgery should have been done sooner, or may even have been unnecessary.

Doctor’s defense There was no artery injury or bowel perforation. In order to rule out any bleed, the second surgery was necessary. Also, hospital infection is a known complication of surgery.

Verdict Michigan defense verdict.

Foot drop follows transvaginal taping

A 53-year-old woman underwent a transvaginal taping to correct urinary incontinence. Following surgery, she complained of pain along the side of her right leg—from her hip down to her foot. Right foot drop was diagnosed. She needs an ankle brace and cane to walk.

Patient’s claim The injury was a result of inappropriate positioning during surgery that caused pressure on her common peroneal nerve.

Doctor’s defense Most likely, the injury was secondary to a preexisting sciatic nerve dysfunction.

Verdict Illinois defense verdict.