Medical Verdicts

Hospital discharge is followed by stillbirth

A 38-year-old woman’s pregnancy was proceeding uneventfully. After about 7 months of prenatal care, she presented to her physician with persistent vaginal bleeding and abdominal and back pain. One hour of monitoring at the hospital indicated that she was not in labor and the signs of fetal well-being were reassuring. Despite continued bleeding and abdominal pain, the woman was discharged. She returned to her physician’s office in early afternoon with increased bleeding and pain, and was sent to the hospital for delivery. On the way there, she suffered massive hemorrhaging due to placental abruption. Before an emergency cesarean section could be performed, the child was stillborn. The mother received transfusions for disseminated intravascular coagulation and blood loss.

Patient’s claim She was discharged without a proper workup for the bleeding and abdominal pain. A sonogram should have been ordered, and she should not have been discharged.

Doctor’s defense The mother’s condition had improved and delivery was not imminent, so the discharge was proper. The sudden massive placental abruption could not have been predicted.

Verdict $1,651,166 Illinois verdict.

Did MD cause kidney loss by injuring ureter?

A 36-year-old woman underwent a total hysterectomy performed by her ObGyn. A week later, she still complained about right flank pain. Additional surgery indicated an atrophied right kidney and an injured ureter, and a nephrectomy was performed.

Patient’s claim The physician injured the ureter during the hysterectomy, and this caused the loss of the kidney. He should have protected the ureter during the surgery—and identified the injury once it occurred.

Doctor’s defense The ureter was not injured during the surgery; rather, the patient had a slow-developing ureteral blockage.

Verdict $974,683 Kentucky verdict. Posttrial motions were pending.

$57 million verdict after admission of fault

A 39-year-old woman was in labor for 8 hours under the care of an ObGyn, an anesthesiologist, and a nurse midwife. When the child was eventually delivered by cesarean section, he was limp and pale, with no heart rate. He was diagnosed later as quadriplegic with cerebral palsy. He has global developmental delay and both bladder and bowel incontinence, and will never walk or live on his own.

Patient’s claim Despite significant abnormalities on the fetal heart monitor, labor was allowed to continue. A cesarean section should have been performed sooner. Also, it was negligent to not have specialists present at delivery; 11 minutes elapsed before a neonatologist arrived to resuscitate the infant.

Doctor’s defense Before the start of the trial, all defendants conceded liability.

Verdict $57,623,113 Pennsylvania verdict, which was reduced to $23,000,000 under a high-low agreement.

Was hysterectomy overly invasive?

Following laparoscopic surgery, a 33-year-old woman reported vaginal bleeding to her ObGyn. Three weeks later, he performed a total hysterectomy.

Patient’s claim The ObGyn made an improper diagnosis. Less invasive methods were available to address the vaginal bleeding.

Doctor’s defense Treatment with less invasive procedures was unsuccessful. Also, the patient was informed of the risks before the surgery.

Verdict Kentucky defense verdict.

Undetected injury leads to extensive surgery

A woman underwent endometrial ablation, performed by an ObGyn. During the procedure, the uterus was perforated. The physician did not recognize the perforation. The ablation device was acti vated, and a thermal injury to the bowel occurred. Ten days later, the patient returned to the hospital with extreme abdominal pain. She was diagnosed with peritonitis and taken to surgery, where the removal of 32 cm of small intestine and repair of the colon and uterus were performed. She returned to the hospital 2 weeks after this and was hospitalized for another 2 weeks for peritonitis.

Patient’s claim The physician was negligent for failing to recognize and treat the uterine perforation.

Doctor’s defense Not reported.

Verdict $245,000 Minnesota settlement was reached in mediation.

Mom blames injury on lack of cerclage

A woman who had already experienced preterm delivery was pregnant with twins and was being seen by both her ObGyn and a perinatologist. At 23 weeks’ gestation, she was admitted to a hospital for bed rest. A month later, due to signs of immediate delivery, she was transferred to a hospital with a better neonatal intensive care unit. She gave birth the following day to both a healthy twin and a twin suffering an intraventricular brain bleed, leading to diplegia, microcephaly, cognitive defects, and visual problems.

Patient’s claim She required cerclage for an incompetent cervix. If cerclage had been performed, the baby’s injuries would have been avoided. She disputed the defendants’ claim.

Doctor’s defense A cerclage had been offered, but the mother declined.

Verdict California defense verdict. A posttrial motion was pending.

Did mother’s behavior cause preterm births?

A woman pregnant with twins first sought prenatal care at 12 weeks’ gestation, at which time she was smoking half a pack of cigarettes a day. At 27 weeks, ultrasonography indicated that both twins were growing normally, although twin B had duodenal atresia and polyhydramnios. It also showed that the mother had a shortened cervix. To avoid preterm delivery, she was placed on strict bed rest. She presented at the hospital a few weeks later with vaginal pressure with contractions. She was placed on a fetal monitor, given tocolytics to stop contractions, and prescribed betamethasone to mature the twins’ lungs. Later records indicated that she had been non-compliant regarding bed rest and smoking cessation. She was discharged with no sign of contractions. Several weeks later, she was admitted to the hospital with diarrhea and contractions. Again she was administered tocolytics and betamethasone; a fetal monitor was placed and biophysical profiles were obtained. On day 4, the fetal monitor showed nonreassuring signs and did not always monitor both twins, so a cesarean section was scheduled for 4:10 pm. The delivering OB arrived at 5:20 pm and delivered the twins, now at 30 weeks’ gestation. Both showed signs of decreased oxygenation and were placed in the neonatal intensive care unit. Twin A developed meningitis 9 days later; a brain scan indicated hypoxic–ischemic encephalopathy. Twin B was discharged after 44 days, and twin A after 66 days.

Patient’s claim The babies suffered metabolic acidosis, so they should have been delivered a few days earlier. The fetal monitors were not functioning properly all of the time. Also, the mother was compliant while she was hospitalized.

Doctor’s defense Because of the twins’ prematurity, an earlier delivery was contra-indicated. Twin A’s brain injury occurred 10 to 14 days before birth. The twins’ deficits were due to both genetics and the mother’s smoking and noncompliance. Twin B had no brain injury, and her mild condition was a result of prematurity.

Verdict $2,250,000 Michigan settlement.

Midwife and nurse deliver CP baby

A 20-year-old primigravida went to the hospital in labor at term. A midwife and nurse examined her, conducted fetal monitoring, and administered oxytocin to enhance labor. The child was delivered about 24 hours later. He was diagnosed with spastic quadriplegic cerebral palsy, is almost blind, and will remain in diapers.

Patient’s claim Failure to recognize signs of fetal distress and summon an obstetrician was negligent. Oxytocin contributed to a fetal heart rate deceleration, at which time an obstetrician should have been called and oxytocin discontinued.

Doctor’s defense An obstetrician was not needed. The fetal heart rate never decreased to an unsafe level, and oxytocin did not affect the fetus. An infection caused the cerebral palsy, the onset of which occurred 24 hours prior to birth.

Verdict Pennsylvania defense verdict. A posttrial motion was pending.

Hospital discharge is followed by stillbirth

A 38-year-old woman’s pregnancy was proceeding uneventfully. After about 7 months of prenatal care, she presented to her physician with persistent vaginal bleeding and abdominal and back pain. One hour of monitoring at the hospital indicated that she was not in labor and the signs of fetal well-being were reassuring. Despite continued bleeding and abdominal pain, the woman was discharged. She returned to her physician’s office in early afternoon with increased bleeding and pain, and was sent to the hospital for delivery. On the way there, she suffered massive hemorrhaging due to placental abruption. Before an emergency cesarean section could be performed, the child was stillborn. The mother received transfusions for disseminated intravascular coagulation and blood loss.

Patient’s claim She was discharged without a proper workup for the bleeding and abdominal pain. A sonogram should have been ordered, and she should not have been discharged.

Doctor’s defense The mother’s condition had improved and delivery was not imminent, so the discharge was proper. The sudden massive placental abruption could not have been predicted.

Verdict $1,651,166 Illinois verdict.

Did MD cause kidney loss by injuring ureter?

A 36-year-old woman underwent a total hysterectomy performed by her ObGyn. A week later, she still complained about right flank pain. Additional surgery indicated an atrophied right kidney and an injured ureter, and a nephrectomy was performed.

Patient’s claim The physician injured the ureter during the hysterectomy, and this caused the loss of the kidney. He should have protected the ureter during the surgery—and identified the injury once it occurred.

Doctor’s defense The ureter was not injured during the surgery; rather, the patient had a slow-developing ureteral blockage.

Verdict $974,683 Kentucky verdict. Posttrial motions were pending.

$57 million verdict after admission of fault

A 39-year-old woman was in labor for 8 hours under the care of an ObGyn, an anesthesiologist, and a nurse midwife. When the child was eventually delivered by cesarean section, he was limp and pale, with no heart rate. He was diagnosed later as quadriplegic with cerebral palsy. He has global developmental delay and both bladder and bowel incontinence, and will never walk or live on his own.

Patient’s claim Despite significant abnormalities on the fetal heart monitor, labor was allowed to continue. A cesarean section should have been performed sooner. Also, it was negligent to not have specialists present at delivery; 11 minutes elapsed before a neonatologist arrived to resuscitate the infant.

Doctor’s defense Before the start of the trial, all defendants conceded liability.

Verdict $57,623,113 Pennsylvania verdict, which was reduced to $23,000,000 under a high-low agreement.

Was hysterectomy overly invasive?

Following laparoscopic surgery, a 33-year-old woman reported vaginal bleeding to her ObGyn. Three weeks later, he performed a total hysterectomy.

Patient’s claim The ObGyn made an improper diagnosis. Less invasive methods were available to address the vaginal bleeding.

Doctor’s defense Treatment with less invasive procedures was unsuccessful. Also, the patient was informed of the risks before the surgery.

Verdict Kentucky defense verdict.

Undetected injury leads to extensive surgery

A woman underwent endometrial ablation, performed by an ObGyn. During the procedure, the uterus was perforated. The physician did not recognize the perforation. The ablation device was acti vated, and a thermal injury to the bowel occurred. Ten days later, the patient returned to the hospital with extreme abdominal pain. She was diagnosed with peritonitis and taken to surgery, where the removal of 32 cm of small intestine and repair of the colon and uterus were performed. She returned to the hospital 2 weeks after this and was hospitalized for another 2 weeks for peritonitis.

Patient’s claim The physician was negligent for failing to recognize and treat the uterine perforation.

Doctor’s defense Not reported.

Verdict $245,000 Minnesota settlement was reached in mediation.

Mom blames injury on lack of cerclage

A woman who had already experienced preterm delivery was pregnant with twins and was being seen by both her ObGyn and a perinatologist. At 23 weeks’ gestation, she was admitted to a hospital for bed rest. A month later, due to signs of immediate delivery, she was transferred to a hospital with a better neonatal intensive care unit. She gave birth the following day to both a healthy twin and a twin suffering an intraventricular brain bleed, leading to diplegia, microcephaly, cognitive defects, and visual problems.

Patient’s claim She required cerclage for an incompetent cervix. If cerclage had been performed, the baby’s injuries would have been avoided. She disputed the defendants’ claim.

Doctor’s defense A cerclage had been offered, but the mother declined.

Verdict California defense verdict. A posttrial motion was pending.

Did mother’s behavior cause preterm births?

A woman pregnant with twins first sought prenatal care at 12 weeks’ gestation, at which time she was smoking half a pack of cigarettes a day. At 27 weeks, ultrasonography indicated that both twins were growing normally, although twin B had duodenal atresia and polyhydramnios. It also showed that the mother had a shortened cervix. To avoid preterm delivery, she was placed on strict bed rest. She presented at the hospital a few weeks later with vaginal pressure with contractions. She was placed on a fetal monitor, given tocolytics to stop contractions, and prescribed betamethasone to mature the twins’ lungs. Later records indicated that she had been non-compliant regarding bed rest and smoking cessation. She was discharged with no sign of contractions. Several weeks later, she was admitted to the hospital with diarrhea and contractions. Again she was administered tocolytics and betamethasone; a fetal monitor was placed and biophysical profiles were obtained. On day 4, the fetal monitor showed nonreassuring signs and did not always monitor both twins, so a cesarean section was scheduled for 4:10 pm. The delivering OB arrived at 5:20 pm and delivered the twins, now at 30 weeks’ gestation. Both showed signs of decreased oxygenation and were placed in the neonatal intensive care unit. Twin A developed meningitis 9 days later; a brain scan indicated hypoxic–ischemic encephalopathy. Twin B was discharged after 44 days, and twin A after 66 days.

Patient’s claim The babies suffered metabolic acidosis, so they should have been delivered a few days earlier. The fetal monitors were not functioning properly all of the time. Also, the mother was compliant while she was hospitalized.

Doctor’s defense Because of the twins’ prematurity, an earlier delivery was contra-indicated. Twin A’s brain injury occurred 10 to 14 days before birth. The twins’ deficits were due to both genetics and the mother’s smoking and noncompliance. Twin B had no brain injury, and her mild condition was a result of prematurity.

Verdict $2,250,000 Michigan settlement.

Midwife and nurse deliver CP baby

A 20-year-old primigravida went to the hospital in labor at term. A midwife and nurse examined her, conducted fetal monitoring, and administered oxytocin to enhance labor. The child was delivered about 24 hours later. He was diagnosed with spastic quadriplegic cerebral palsy, is almost blind, and will remain in diapers.

Patient’s claim Failure to recognize signs of fetal distress and summon an obstetrician was negligent. Oxytocin contributed to a fetal heart rate deceleration, at which time an obstetrician should have been called and oxytocin discontinued.

Doctor’s defense An obstetrician was not needed. The fetal heart rate never decreased to an unsafe level, and oxytocin did not affect the fetus. An infection caused the cerebral palsy, the onset of which occurred 24 hours prior to birth.

Verdict Pennsylvania defense verdict. A posttrial motion was pending.

Hospital discharge is followed by stillbirth

A 38-year-old woman’s pregnancy was proceeding uneventfully. After about 7 months of prenatal care, she presented to her physician with persistent vaginal bleeding and abdominal and back pain. One hour of monitoring at the hospital indicated that she was not in labor and the signs of fetal well-being were reassuring. Despite continued bleeding and abdominal pain, the woman was discharged. She returned to her physician’s office in early afternoon with increased bleeding and pain, and was sent to the hospital for delivery. On the way there, she suffered massive hemorrhaging due to placental abruption. Before an emergency cesarean section could be performed, the child was stillborn. The mother received transfusions for disseminated intravascular coagulation and blood loss.

Patient’s claim She was discharged without a proper workup for the bleeding and abdominal pain. A sonogram should have been ordered, and she should not have been discharged.

Doctor’s defense The mother’s condition had improved and delivery was not imminent, so the discharge was proper. The sudden massive placental abruption could not have been predicted.

Verdict $1,651,166 Illinois verdict.

Did MD cause kidney loss by injuring ureter?

A 36-year-old woman underwent a total hysterectomy performed by her ObGyn. A week later, she still complained about right flank pain. Additional surgery indicated an atrophied right kidney and an injured ureter, and a nephrectomy was performed.

Patient’s claim The physician injured the ureter during the hysterectomy, and this caused the loss of the kidney. He should have protected the ureter during the surgery—and identified the injury once it occurred.

Doctor’s defense The ureter was not injured during the surgery; rather, the patient had a slow-developing ureteral blockage.

Verdict $974,683 Kentucky verdict. Posttrial motions were pending.

$57 million verdict after admission of fault

A 39-year-old woman was in labor for 8 hours under the care of an ObGyn, an anesthesiologist, and a nurse midwife. When the child was eventually delivered by cesarean section, he was limp and pale, with no heart rate. He was diagnosed later as quadriplegic with cerebral palsy. He has global developmental delay and both bladder and bowel incontinence, and will never walk or live on his own.

Patient’s claim Despite significant abnormalities on the fetal heart monitor, labor was allowed to continue. A cesarean section should have been performed sooner. Also, it was negligent to not have specialists present at delivery; 11 minutes elapsed before a neonatologist arrived to resuscitate the infant.

Doctor’s defense Before the start of the trial, all defendants conceded liability.

Verdict $57,623,113 Pennsylvania verdict, which was reduced to $23,000,000 under a high-low agreement.

Was hysterectomy overly invasive?

Following laparoscopic surgery, a 33-year-old woman reported vaginal bleeding to her ObGyn. Three weeks later, he performed a total hysterectomy.

Patient’s claim The ObGyn made an improper diagnosis. Less invasive methods were available to address the vaginal bleeding.

Doctor’s defense Treatment with less invasive procedures was unsuccessful. Also, the patient was informed of the risks before the surgery.

Verdict Kentucky defense verdict.

Undetected injury leads to extensive surgery

A woman underwent endometrial ablation, performed by an ObGyn. During the procedure, the uterus was perforated. The physician did not recognize the perforation. The ablation device was acti vated, and a thermal injury to the bowel occurred. Ten days later, the patient returned to the hospital with extreme abdominal pain. She was diagnosed with peritonitis and taken to surgery, where the removal of 32 cm of small intestine and repair of the colon and uterus were performed. She returned to the hospital 2 weeks after this and was hospitalized for another 2 weeks for peritonitis.

Patient’s claim The physician was negligent for failing to recognize and treat the uterine perforation.

Doctor’s defense Not reported.

Verdict $245,000 Minnesota settlement was reached in mediation.

Mom blames injury on lack of cerclage

A woman who had already experienced preterm delivery was pregnant with twins and was being seen by both her ObGyn and a perinatologist. At 23 weeks’ gestation, she was admitted to a hospital for bed rest. A month later, due to signs of immediate delivery, she was transferred to a hospital with a better neonatal intensive care unit. She gave birth the following day to both a healthy twin and a twin suffering an intraventricular brain bleed, leading to diplegia, microcephaly, cognitive defects, and visual problems.

Patient’s claim She required cerclage for an incompetent cervix. If cerclage had been performed, the baby’s injuries would have been avoided. She disputed the defendants’ claim.

Doctor’s defense A cerclage had been offered, but the mother declined.

Verdict California defense verdict. A posttrial motion was pending.

Did mother’s behavior cause preterm births?

A woman pregnant with twins first sought prenatal care at 12 weeks’ gestation, at which time she was smoking half a pack of cigarettes a day. At 27 weeks, ultrasonography indicated that both twins were growing normally, although twin B had duodenal atresia and polyhydramnios. It also showed that the mother had a shortened cervix. To avoid preterm delivery, she was placed on strict bed rest. She presented at the hospital a few weeks later with vaginal pressure with contractions. She was placed on a fetal monitor, given tocolytics to stop contractions, and prescribed betamethasone to mature the twins’ lungs. Later records indicated that she had been non-compliant regarding bed rest and smoking cessation. She was discharged with no sign of contractions. Several weeks later, she was admitted to the hospital with diarrhea and contractions. Again she was administered tocolytics and betamethasone; a fetal monitor was placed and biophysical profiles were obtained. On day 4, the fetal monitor showed nonreassuring signs and did not always monitor both twins, so a cesarean section was scheduled for 4:10 pm. The delivering OB arrived at 5:20 pm and delivered the twins, now at 30 weeks’ gestation. Both showed signs of decreased oxygenation and were placed in the neonatal intensive care unit. Twin A developed meningitis 9 days later; a brain scan indicated hypoxic–ischemic encephalopathy. Twin B was discharged after 44 days, and twin A after 66 days.

Patient’s claim The babies suffered metabolic acidosis, so they should have been delivered a few days earlier. The fetal monitors were not functioning properly all of the time. Also, the mother was compliant while she was hospitalized.

Doctor’s defense Because of the twins’ prematurity, an earlier delivery was contra-indicated. Twin A’s brain injury occurred 10 to 14 days before birth. The twins’ deficits were due to both genetics and the mother’s smoking and noncompliance. Twin B had no brain injury, and her mild condition was a result of prematurity.

Verdict $2,250,000 Michigan settlement.

Midwife and nurse deliver CP baby

A 20-year-old primigravida went to the hospital in labor at term. A midwife and nurse examined her, conducted fetal monitoring, and administered oxytocin to enhance labor. The child was delivered about 24 hours later. He was diagnosed with spastic quadriplegic cerebral palsy, is almost blind, and will remain in diapers.

Patient’s claim Failure to recognize signs of fetal distress and summon an obstetrician was negligent. Oxytocin contributed to a fetal heart rate deceleration, at which time an obstetrician should have been called and oxytocin discontinued.

Doctor’s defense An obstetrician was not needed. The fetal heart rate never decreased to an unsafe level, and oxytocin did not affect the fetus. An infection caused the cerebral palsy, the onset of which occurred 24 hours prior to birth.

Verdict Pennsylvania defense verdict. A posttrial motion was pending.

Difficult birth blamed for death at 1 year

A woman in labor had been pushing for 10 minutes when her OB began using a vacuum extractor to facilitate delivery. Shoulder dystocia occurred. The OB applied fundal pressure while a second physician dislodged the infant. At birth, the child was not breathing and had no heart rate. One year later, the child died because of birth-related complications.

Patient’s claim She never gave consent to use the vacuum extractor. The OB used fundal pressure at least twice before the infant’s head emerged.

Doctor’s defense There was no negligence.

Verdict $8,181,725 Maryland verdict, which included $7.5 million in noneconomic damages. The latter was expected to be reduced to $2.2 million pursuant to the statutory cap.

Genetic testing fails to detect Fabry’s disease

Unable to become pregnant despite trying for over 2 years, a woman decided on in vitro fertilization. A genetics consultation determined that she was a carrier for Fabry’s disease. Eggs and sperm were harvested and resulted in six fertilized embryos. It was recommended that each embryo be tested genetically by polymerase chain reaction (PCR). On day 3, single-cell biopsies were performed on the six developing embryos and the cells sent to a lab for PCR testing. Two embryos were found to be carriers of the mutation; two others were males with Fabry’s disease; and no results were obtained from the last two. Pregnancy occurred when the female carrier embryos were implanted. Ultrasonography showed the fetus to be male, a blood test suggested risk of Down’s syndrome, and amniocentesis indicated the fetus had Fabry’s disease. When the child was born, Fabry’s disease was confirmed.

Patient’s claim The fertility center was negligent for misrepresenting its experience with preimplantation genetic diagnosis. The lab failed to take precautions to avoid contamination and also failed to have a second person check that sample switching did not occur.

Doctor’s defense There was no evidence that samples were switched or that DNA contamination occurred during the testing and implantation. More likely, the problem was due to an unknown failure in the PCR testing technology, unavoidable DNA contamination, or mosaicism of the embryo tested.

Verdict California defense verdict.

Did surgery—or drugs—cause incontinence?

An ObGyn performed surgery on a 41-year-old woman with urinary incontinence to correct a cystocele. The patient developed chronic retention of urine and needed corrective surgery. She was referred to a urologist. All tests were normal, and she eventually had stoma surgery to allow her to empty her bladder with a catheter through the stoma.

Patient’s claim The surgery was premature and unnecessary, and the ObGyn used a negligent operative technique that led to chronic urinary retention and the need for a permanent stoma. Conservative treatment should have been used first.

Doctor’s defense Because of the anatomic cause of the patient’s stress urinary incontinence, surgery was necessary—and performed properly. Urinary retention was unrelated to the surgery, as cystoscopies showed there was no obstruction in the bladder or urethra. The patient’s psychiatric medication may have led to neurogenic bladder failure and her problems.

Verdict Virginia defense verdict.

Obese woman’s TAH incision heals—in a year

A 300-lb woman who had experienced intermittent heavy uterine bleeding for years underwent an open total abdominal hysterectomy (TAH), performed by an ObGyn. Bowel contents leaked into the abdominal wall, causing a wound infection that required several more procedures to repair the bowel and remove necrotic tissue from the abdomen. After 3 weeks in the hospital, the patient was discharged, but the surgical incision required about 1 year to heal completely. She has a 21-inch scar from hip to hip.

Patient’s claim The bowel was stitched to the peritoneum when the incision was closed, and the ObGyn failed to notice the error. The suture caused bowel contents to leak, causing the infection and need for further procedures.

Doctor’s defense Proper precautions were taken to avoid bowel injury, but it is a risk nonetheless of TAH—which the patient chose rather than a less invasive alternative. Her bowel was densely adhered to the peritoneum because of previous abdominal surgeries, making it impossible to distinguish bowel tissue from peritoneum when the incision was being closed.

Verdict Missouri defense verdict; an appeal was expected.

Difficult birth blamed for death at 1 year

A woman in labor had been pushing for 10 minutes when her OB began using a vacuum extractor to facilitate delivery. Shoulder dystocia occurred. The OB applied fundal pressure while a second physician dislodged the infant. At birth, the child was not breathing and had no heart rate. One year later, the child died because of birth-related complications.

Patient’s claim She never gave consent to use the vacuum extractor. The OB used fundal pressure at least twice before the infant’s head emerged.

Doctor’s defense There was no negligence.

Verdict $8,181,725 Maryland verdict, which included $7.5 million in noneconomic damages. The latter was expected to be reduced to $2.2 million pursuant to the statutory cap.

Genetic testing fails to detect Fabry’s disease

Unable to become pregnant despite trying for over 2 years, a woman decided on in vitro fertilization. A genetics consultation determined that she was a carrier for Fabry’s disease. Eggs and sperm were harvested and resulted in six fertilized embryos. It was recommended that each embryo be tested genetically by polymerase chain reaction (PCR). On day 3, single-cell biopsies were performed on the six developing embryos and the cells sent to a lab for PCR testing. Two embryos were found to be carriers of the mutation; two others were males with Fabry’s disease; and no results were obtained from the last two. Pregnancy occurred when the female carrier embryos were implanted. Ultrasonography showed the fetus to be male, a blood test suggested risk of Down’s syndrome, and amniocentesis indicated the fetus had Fabry’s disease. When the child was born, Fabry’s disease was confirmed.

Patient’s claim The fertility center was negligent for misrepresenting its experience with preimplantation genetic diagnosis. The lab failed to take precautions to avoid contamination and also failed to have a second person check that sample switching did not occur.

Doctor’s defense There was no evidence that samples were switched or that DNA contamination occurred during the testing and implantation. More likely, the problem was due to an unknown failure in the PCR testing technology, unavoidable DNA contamination, or mosaicism of the embryo tested.

Verdict California defense verdict.

Did surgery—or drugs—cause incontinence?

An ObGyn performed surgery on a 41-year-old woman with urinary incontinence to correct a cystocele. The patient developed chronic retention of urine and needed corrective surgery. She was referred to a urologist. All tests were normal, and she eventually had stoma surgery to allow her to empty her bladder with a catheter through the stoma.

Patient’s claim The surgery was premature and unnecessary, and the ObGyn used a negligent operative technique that led to chronic urinary retention and the need for a permanent stoma. Conservative treatment should have been used first.

Doctor’s defense Because of the anatomic cause of the patient’s stress urinary incontinence, surgery was necessary—and performed properly. Urinary retention was unrelated to the surgery, as cystoscopies showed there was no obstruction in the bladder or urethra. The patient’s psychiatric medication may have led to neurogenic bladder failure and her problems.

Verdict Virginia defense verdict.

Obese woman’s TAH incision heals—in a year

A 300-lb woman who had experienced intermittent heavy uterine bleeding for years underwent an open total abdominal hysterectomy (TAH), performed by an ObGyn. Bowel contents leaked into the abdominal wall, causing a wound infection that required several more procedures to repair the bowel and remove necrotic tissue from the abdomen. After 3 weeks in the hospital, the patient was discharged, but the surgical incision required about 1 year to heal completely. She has a 21-inch scar from hip to hip.

Patient’s claim The bowel was stitched to the peritoneum when the incision was closed, and the ObGyn failed to notice the error. The suture caused bowel contents to leak, causing the infection and need for further procedures.

Doctor’s defense Proper precautions were taken to avoid bowel injury, but it is a risk nonetheless of TAH—which the patient chose rather than a less invasive alternative. Her bowel was densely adhered to the peritoneum because of previous abdominal surgeries, making it impossible to distinguish bowel tissue from peritoneum when the incision was being closed.

Verdict Missouri defense verdict; an appeal was expected.

Difficult birth blamed for death at 1 year

A woman in labor had been pushing for 10 minutes when her OB began using a vacuum extractor to facilitate delivery. Shoulder dystocia occurred. The OB applied fundal pressure while a second physician dislodged the infant. At birth, the child was not breathing and had no heart rate. One year later, the child died because of birth-related complications.

Patient’s claim She never gave consent to use the vacuum extractor. The OB used fundal pressure at least twice before the infant’s head emerged.

Doctor’s defense There was no negligence.

Verdict $8,181,725 Maryland verdict, which included $7.5 million in noneconomic damages. The latter was expected to be reduced to $2.2 million pursuant to the statutory cap.

Genetic testing fails to detect Fabry’s disease

Unable to become pregnant despite trying for over 2 years, a woman decided on in vitro fertilization. A genetics consultation determined that she was a carrier for Fabry’s disease. Eggs and sperm were harvested and resulted in six fertilized embryos. It was recommended that each embryo be tested genetically by polymerase chain reaction (PCR). On day 3, single-cell biopsies were performed on the six developing embryos and the cells sent to a lab for PCR testing. Two embryos were found to be carriers of the mutation; two others were males with Fabry’s disease; and no results were obtained from the last two. Pregnancy occurred when the female carrier embryos were implanted. Ultrasonography showed the fetus to be male, a blood test suggested risk of Down’s syndrome, and amniocentesis indicated the fetus had Fabry’s disease. When the child was born, Fabry’s disease was confirmed.

Patient’s claim The fertility center was negligent for misrepresenting its experience with preimplantation genetic diagnosis. The lab failed to take precautions to avoid contamination and also failed to have a second person check that sample switching did not occur.

Doctor’s defense There was no evidence that samples were switched or that DNA contamination occurred during the testing and implantation. More likely, the problem was due to an unknown failure in the PCR testing technology, unavoidable DNA contamination, or mosaicism of the embryo tested.

Verdict California defense verdict.

Did surgery—or drugs—cause incontinence?

An ObGyn performed surgery on a 41-year-old woman with urinary incontinence to correct a cystocele. The patient developed chronic retention of urine and needed corrective surgery. She was referred to a urologist. All tests were normal, and she eventually had stoma surgery to allow her to empty her bladder with a catheter through the stoma.

Patient’s claim The surgery was premature and unnecessary, and the ObGyn used a negligent operative technique that led to chronic urinary retention and the need for a permanent stoma. Conservative treatment should have been used first.

Doctor’s defense Because of the anatomic cause of the patient’s stress urinary incontinence, surgery was necessary—and performed properly. Urinary retention was unrelated to the surgery, as cystoscopies showed there was no obstruction in the bladder or urethra. The patient’s psychiatric medication may have led to neurogenic bladder failure and her problems.

Verdict Virginia defense verdict.

Obese woman’s TAH incision heals—in a year

A 300-lb woman who had experienced intermittent heavy uterine bleeding for years underwent an open total abdominal hysterectomy (TAH), performed by an ObGyn. Bowel contents leaked into the abdominal wall, causing a wound infection that required several more procedures to repair the bowel and remove necrotic tissue from the abdomen. After 3 weeks in the hospital, the patient was discharged, but the surgical incision required about 1 year to heal completely. She has a 21-inch scar from hip to hip.

Patient’s claim The bowel was stitched to the peritoneum when the incision was closed, and the ObGyn failed to notice the error. The suture caused bowel contents to leak, causing the infection and need for further procedures.

Doctor’s defense Proper precautions were taken to avoid bowel injury, but it is a risk nonetheless of TAH—which the patient chose rather than a less invasive alternative. Her bowel was densely adhered to the peritoneum because of previous abdominal surgeries, making it impossible to distinguish bowel tissue from peritoneum when the incision was being closed.

Verdict Missouri defense verdict; an appeal was expected.

Child is born with CP after oxytocin treatment

A woman who was given a diagnosis of eclampsia at the end of her pregnancy was admitted to the hospital and administered oxytocin with fetal monitoring. After 24 hours of labor, she was fully dilated and began pushing. Eventually, a cesarean delivery was performed. The child was born depressed and needed to be resuscitated, and was later transferred to another facility. The child has cerebral palsy, spastic quadriplegia, and a seizure disorder and requires 24-hour care.

Patient’s claim Oxytocin should have been discontinued and a cesarean section performed sooner. Also, the fetal monitor indicated tachycardia, evidence of uterine hyperstimulation, and other nonreassuring signs.

Doctor’s defense There was no hyperstimulation or fetal distress.

Verdict $9.5 million Illinois settlement.

Did midwife’s tugging cause birth trauma?

A woman in labor 9 days past her due date presented at the hospital, where fetal monitoring showed a fetal heart rate of 120 to 130 beats per minute. After 1.5 hours, the membranes were ruptured and the amniotic fluid was lightly stained with meconium. An hour later, the child was born weighing 8 lb 5 oz, with an Apgar score of 9.

For 4 days he appeared to be fine, despite not feeding well. On day 4, he was admitted to the NICU, because he displayed abnormal movements of the extremities and clenching of the fists. A CT scan performed on day 6 indicated axial hemorrhage associated with bony disruption and evidence of a right-sided subdural hemorrhage, consistent with birth trauma. An MRI later that day showed a subdural hemorrhage, but no bony disruption or evidence of birth trauma. The child has cerebral palsy with autistic features and has difficulty walking.

Patient’s claim Negligence during the delivery resulted in birth trauma and the child’s problems. The mother and her sister, also present at the birth, claimed the nurse midwife pulled, tugged, and had difficulty while delivering the child.

Doctor’s defense There was no birth trauma, and the Apgar Scores and MRI confirm that the birth occurred without incident and was nontraumatic.

Verdict A $1.1 million mediated settlement in New York.

D&C, perforations, then more surgery

When a 46-year-old woman experienced excessive bleeding during her last menstrual period, her gynecologist recommended a hysteroscopy with dilation and curettage. The operative report indicated a myomatous uterus and an endometrial polyp. A sharp curettage was done, the polyp was removed by polyp forceps, and the tissue was sent to pathology.

Initially stable following surgery, the patient began to suffer severe abdominal and pelvic pain. Oral oxycodone/acetaminophen and intravenous morphine sulfate were administered. The gynecologist was called but did not evaluate the patient. After she was discharged home, the patient called the gynecologist twice to complain of severe abdominal pain, and was advised to take acetaminophen. The pain persisted, and the patient was sent to the emergency room the next morning.

The pathologist discovered that the endometrial curettings were really small bowel fragments and the endometrial polyp was a loop of small bowel. Abdominal radiographs indicated free air in the abdomen. Diagnostic laparoscopy revealed a 5-mm serosal defect of the uterus, a 3-cm small bowel defect, and enteric bowel contents and filmy adhesions present intra-abdominally.

A general surgeon performed exploratory laparotomy, lysis of adhesions, resection of 36 cm of small bowel, and reanastamosic of the small bowel. Following surgery, intravenous antibiotics were administered for small bowel spillage, and the patient was hospitalized for 10 days, during which she continued to suffer severe abdominal pain, loss of bowel function, depression, and nightmares.

Patient’s claim The gynecologist perforated the small bowel and uterus during surgery, failed to recognize the uterine perforation while performing the hysteroscopy, and failed to investigate her complaints of severe abdominal and back pain.

Doctor’s defense Perforation of the uterus and small bowel are known complications of a dilation and curettage, and the perforations were properly diagnosed and treated. Also, the patient healed well, with a minor surgical scar.

Verdict $477,677 New York verdict against the physician; $120,000 settlement with the hospital.

Child is born with CP after oxytocin treatment

A woman who was given a diagnosis of eclampsia at the end of her pregnancy was admitted to the hospital and administered oxytocin with fetal monitoring. After 24 hours of labor, she was fully dilated and began pushing. Eventually, a cesarean delivery was performed. The child was born depressed and needed to be resuscitated, and was later transferred to another facility. The child has cerebral palsy, spastic quadriplegia, and a seizure disorder and requires 24-hour care.

Patient’s claim Oxytocin should have been discontinued and a cesarean section performed sooner. Also, the fetal monitor indicated tachycardia, evidence of uterine hyperstimulation, and other nonreassuring signs.

Doctor’s defense There was no hyperstimulation or fetal distress.

Verdict $9.5 million Illinois settlement.

Did midwife’s tugging cause birth trauma?

A woman in labor 9 days past her due date presented at the hospital, where fetal monitoring showed a fetal heart rate of 120 to 130 beats per minute. After 1.5 hours, the membranes were ruptured and the amniotic fluid was lightly stained with meconium. An hour later, the child was born weighing 8 lb 5 oz, with an Apgar score of 9.

For 4 days he appeared to be fine, despite not feeding well. On day 4, he was admitted to the NICU, because he displayed abnormal movements of the extremities and clenching of the fists. A CT scan performed on day 6 indicated axial hemorrhage associated with bony disruption and evidence of a right-sided subdural hemorrhage, consistent with birth trauma. An MRI later that day showed a subdural hemorrhage, but no bony disruption or evidence of birth trauma. The child has cerebral palsy with autistic features and has difficulty walking.

Patient’s claim Negligence during the delivery resulted in birth trauma and the child’s problems. The mother and her sister, also present at the birth, claimed the nurse midwife pulled, tugged, and had difficulty while delivering the child.

Doctor’s defense There was no birth trauma, and the Apgar Scores and MRI confirm that the birth occurred without incident and was nontraumatic.

Verdict A $1.1 million mediated settlement in New York.

D&C, perforations, then more surgery

When a 46-year-old woman experienced excessive bleeding during her last menstrual period, her gynecologist recommended a hysteroscopy with dilation and curettage. The operative report indicated a myomatous uterus and an endometrial polyp. A sharp curettage was done, the polyp was removed by polyp forceps, and the tissue was sent to pathology.

Initially stable following surgery, the patient began to suffer severe abdominal and pelvic pain. Oral oxycodone/acetaminophen and intravenous morphine sulfate were administered. The gynecologist was called but did not evaluate the patient. After she was discharged home, the patient called the gynecologist twice to complain of severe abdominal pain, and was advised to take acetaminophen. The pain persisted, and the patient was sent to the emergency room the next morning.

The pathologist discovered that the endometrial curettings were really small bowel fragments and the endometrial polyp was a loop of small bowel. Abdominal radiographs indicated free air in the abdomen. Diagnostic laparoscopy revealed a 5-mm serosal defect of the uterus, a 3-cm small bowel defect, and enteric bowel contents and filmy adhesions present intra-abdominally.

A general surgeon performed exploratory laparotomy, lysis of adhesions, resection of 36 cm of small bowel, and reanastamosic of the small bowel. Following surgery, intravenous antibiotics were administered for small bowel spillage, and the patient was hospitalized for 10 days, during which she continued to suffer severe abdominal pain, loss of bowel function, depression, and nightmares.

Patient’s claim The gynecologist perforated the small bowel and uterus during surgery, failed to recognize the uterine perforation while performing the hysteroscopy, and failed to investigate her complaints of severe abdominal and back pain.

Doctor’s defense Perforation of the uterus and small bowel are known complications of a dilation and curettage, and the perforations were properly diagnosed and treated. Also, the patient healed well, with a minor surgical scar.

Verdict $477,677 New York verdict against the physician; $120,000 settlement with the hospital.

Child is born with CP after oxytocin treatment

A woman who was given a diagnosis of eclampsia at the end of her pregnancy was admitted to the hospital and administered oxytocin with fetal monitoring. After 24 hours of labor, she was fully dilated and began pushing. Eventually, a cesarean delivery was performed. The child was born depressed and needed to be resuscitated, and was later transferred to another facility. The child has cerebral palsy, spastic quadriplegia, and a seizure disorder and requires 24-hour care.

Patient’s claim Oxytocin should have been discontinued and a cesarean section performed sooner. Also, the fetal monitor indicated tachycardia, evidence of uterine hyperstimulation, and other nonreassuring signs.

Doctor’s defense There was no hyperstimulation or fetal distress.

Verdict $9.5 million Illinois settlement.

Did midwife’s tugging cause birth trauma?

A woman in labor 9 days past her due date presented at the hospital, where fetal monitoring showed a fetal heart rate of 120 to 130 beats per minute. After 1.5 hours, the membranes were ruptured and the amniotic fluid was lightly stained with meconium. An hour later, the child was born weighing 8 lb 5 oz, with an Apgar score of 9.

For 4 days he appeared to be fine, despite not feeding well. On day 4, he was admitted to the NICU, because he displayed abnormal movements of the extremities and clenching of the fists. A CT scan performed on day 6 indicated axial hemorrhage associated with bony disruption and evidence of a right-sided subdural hemorrhage, consistent with birth trauma. An MRI later that day showed a subdural hemorrhage, but no bony disruption or evidence of birth trauma. The child has cerebral palsy with autistic features and has difficulty walking.

Patient’s claim Negligence during the delivery resulted in birth trauma and the child’s problems. The mother and her sister, also present at the birth, claimed the nurse midwife pulled, tugged, and had difficulty while delivering the child.

Doctor’s defense There was no birth trauma, and the Apgar Scores and MRI confirm that the birth occurred without incident and was nontraumatic.

Verdict A $1.1 million mediated settlement in New York.

D&C, perforations, then more surgery

When a 46-year-old woman experienced excessive bleeding during her last menstrual period, her gynecologist recommended a hysteroscopy with dilation and curettage. The operative report indicated a myomatous uterus and an endometrial polyp. A sharp curettage was done, the polyp was removed by polyp forceps, and the tissue was sent to pathology.

Initially stable following surgery, the patient began to suffer severe abdominal and pelvic pain. Oral oxycodone/acetaminophen and intravenous morphine sulfate were administered. The gynecologist was called but did not evaluate the patient. After she was discharged home, the patient called the gynecologist twice to complain of severe abdominal pain, and was advised to take acetaminophen. The pain persisted, and the patient was sent to the emergency room the next morning.

The pathologist discovered that the endometrial curettings were really small bowel fragments and the endometrial polyp was a loop of small bowel. Abdominal radiographs indicated free air in the abdomen. Diagnostic laparoscopy revealed a 5-mm serosal defect of the uterus, a 3-cm small bowel defect, and enteric bowel contents and filmy adhesions present intra-abdominally.

A general surgeon performed exploratory laparotomy, lysis of adhesions, resection of 36 cm of small bowel, and reanastamosic of the small bowel. Following surgery, intravenous antibiotics were administered for small bowel spillage, and the patient was hospitalized for 10 days, during which she continued to suffer severe abdominal pain, loss of bowel function, depression, and nightmares.

Patient’s claim The gynecologist perforated the small bowel and uterus during surgery, failed to recognize the uterine perforation while performing the hysteroscopy, and failed to investigate her complaints of severe abdominal and back pain.

Doctor’s defense Perforation of the uterus and small bowel are known complications of a dilation and curettage, and the perforations were properly diagnosed and treated. Also, the patient healed well, with a minor surgical scar.

Verdict $477,677 New York verdict against the physician; $120,000 settlement with the hospital.

Several attempts, then laceration is repaired

A 45-year-old patient underwent a total abdominal hysterectomy. Near the end of the surgery, the nurse anesthetist noticed blood in the tubing of the urinary catheter bag, which the physician deemed a result of traumatic catheterization at the beginning of the procedure.

Despite the continued presence of blood in the urine and urinary leakage, a 4- to 5-cm laceration at the base of the bladder was not detected for 2 days. A vesicovaginal fistula developed. Over 8 months, several attempts to close the fistula surgically were unsuccessful. Eventually, it was repaired, and the patient has had no further leaks.

Patient’s claim Failure to detect and repair the laceration in a timely manner caused the fistula to develop. This condition lasted about 8 months.

Doctor’s defense The location of the laceration was difficult to find. Once it was discovered, the proper treatment was to drain the bladder with a catheter and wait several weeks to see if it could heal on its own. There was no reason for the repair attempts to fail.

Verdict $300,000 Illinois verdict.

Pain “like childbirth” is due to retained sponge

A 21-year-old woman suffered a perineal–vaginal tear during childbirth. This was repaired following delivery. A surgical sponge was inserted into the vagina to absorb blood during the repair. Two days later, the patient was discharged from the hospital and sent home.

Two days after that, she experienced pressure in the pelvic area that she likened to childbirth. When she felt something move inside her, she feared she was about to give birth to a second baby. She went to the emergency room, where the presence of the sponge was detected. According to the patient’s mother, who was also present, the pain was relieved almost instantly when the sponge was removed. In a phone call to the patient’s mother the next morning, the physician admitted he had neglected to tell the nursing staff that he had inserted the sponge and that he should have removed it.

Patient’s claim The physician was negligent for failing to remove the sponge.

Doctor’s defense There was no negligence.

Verdict Alabama defense verdict.

Perineal tear follows vacuum extraction

A 27-year-old primigravida experienced an essentially uncomplicated pregnancy during which she was monitored regularly by her ObGyn. When she went into labor and presented at the hospital, she was given an epidural, placed on a fetal monitor, examined regularly, and administered oxytocin. Because of normal progress to complete dilation and effacement, a vaginal delivery appeared likely. After 4.5 hours of second stage labor, a child weighing 8 lb 5 oz was delivered with the aid of a vacuum extractor.

During delivery of the shoulders, the mother suffered a third degree perineal tear extending to the rectal sphincter. This was noted immediately and repaired after completion of the delivery. Before the patient was discharged, she was examined and no problems were found at the site of the repairs.

At her 1-month postpartum visit, the woman informed her ObGyn of occasional fecal incontinence and was told the problem would probably resolve itself. The symptoms persisted, so she was referred to a colorectal surgeon. Dissatisfied with the surgical repair, the patient sought a second surgery from another physician.

Patient’s claim The ObGyn mismanaged the second stage of labor and should have performed a cesarean section rather than used vacuum extraction. Also, the defendant was negligent in the repair of the injury and failed to provide proper follow-up care.

Doctor’s defense There was no negligence. Both the delivery and repair of the tear were performed properly.

Verdict Georgia defense verdict.

During nerve ablation, ureter is damaged

A 39-year-old woman was being treated for low libido, painful intercourse, and heavy, painful menses. When conservative treatment failed to relieve the symptoms, the patient agreed to laparoscopy as recommended by her physician. Ablation of the uterosacral nerve was performed, because the physician believed it to be causing or contributing to the symptoms. The patient’s ureter was damaged and required repair surgery.

Patient’s claim There was lack of informed consent, and the physician was negligent for injuring the ureter.

Doctor’s defense There was no negligence.

Verdict California defense verdict.

Several attempts, then laceration is repaired

A 45-year-old patient underwent a total abdominal hysterectomy. Near the end of the surgery, the nurse anesthetist noticed blood in the tubing of the urinary catheter bag, which the physician deemed a result of traumatic catheterization at the beginning of the procedure.

Despite the continued presence of blood in the urine and urinary leakage, a 4- to 5-cm laceration at the base of the bladder was not detected for 2 days. A vesicovaginal fistula developed. Over 8 months, several attempts to close the fistula surgically were unsuccessful. Eventually, it was repaired, and the patient has had no further leaks.

Patient’s claim Failure to detect and repair the laceration in a timely manner caused the fistula to develop. This condition lasted about 8 months.

Doctor’s defense The location of the laceration was difficult to find. Once it was discovered, the proper treatment was to drain the bladder with a catheter and wait several weeks to see if it could heal on its own. There was no reason for the repair attempts to fail.

Verdict $300,000 Illinois verdict.

Pain “like childbirth” is due to retained sponge

A 21-year-old woman suffered a perineal–vaginal tear during childbirth. This was repaired following delivery. A surgical sponge was inserted into the vagina to absorb blood during the repair. Two days later, the patient was discharged from the hospital and sent home.

Two days after that, she experienced pressure in the pelvic area that she likened to childbirth. When she felt something move inside her, she feared she was about to give birth to a second baby. She went to the emergency room, where the presence of the sponge was detected. According to the patient’s mother, who was also present, the pain was relieved almost instantly when the sponge was removed. In a phone call to the patient’s mother the next morning, the physician admitted he had neglected to tell the nursing staff that he had inserted the sponge and that he should have removed it.

Patient’s claim The physician was negligent for failing to remove the sponge.

Doctor’s defense There was no negligence.

Verdict Alabama defense verdict.

Perineal tear follows vacuum extraction

A 27-year-old primigravida experienced an essentially uncomplicated pregnancy during which she was monitored regularly by her ObGyn. When she went into labor and presented at the hospital, she was given an epidural, placed on a fetal monitor, examined regularly, and administered oxytocin. Because of normal progress to complete dilation and effacement, a vaginal delivery appeared likely. After 4.5 hours of second stage labor, a child weighing 8 lb 5 oz was delivered with the aid of a vacuum extractor.

During delivery of the shoulders, the mother suffered a third degree perineal tear extending to the rectal sphincter. This was noted immediately and repaired after completion of the delivery. Before the patient was discharged, she was examined and no problems were found at the site of the repairs.

At her 1-month postpartum visit, the woman informed her ObGyn of occasional fecal incontinence and was told the problem would probably resolve itself. The symptoms persisted, so she was referred to a colorectal surgeon. Dissatisfied with the surgical repair, the patient sought a second surgery from another physician.

Patient’s claim The ObGyn mismanaged the second stage of labor and should have performed a cesarean section rather than used vacuum extraction. Also, the defendant was negligent in the repair of the injury and failed to provide proper follow-up care.

Doctor’s defense There was no negligence. Both the delivery and repair of the tear were performed properly.

Verdict Georgia defense verdict.

During nerve ablation, ureter is damaged

A 39-year-old woman was being treated for low libido, painful intercourse, and heavy, painful menses. When conservative treatment failed to relieve the symptoms, the patient agreed to laparoscopy as recommended by her physician. Ablation of the uterosacral nerve was performed, because the physician believed it to be causing or contributing to the symptoms. The patient’s ureter was damaged and required repair surgery.

Patient’s claim There was lack of informed consent, and the physician was negligent for injuring the ureter.

Doctor’s defense There was no negligence.

Verdict California defense verdict.

Several attempts, then laceration is repaired

A 45-year-old patient underwent a total abdominal hysterectomy. Near the end of the surgery, the nurse anesthetist noticed blood in the tubing of the urinary catheter bag, which the physician deemed a result of traumatic catheterization at the beginning of the procedure.

Despite the continued presence of blood in the urine and urinary leakage, a 4- to 5-cm laceration at the base of the bladder was not detected for 2 days. A vesicovaginal fistula developed. Over 8 months, several attempts to close the fistula surgically were unsuccessful. Eventually, it was repaired, and the patient has had no further leaks.

Patient’s claim Failure to detect and repair the laceration in a timely manner caused the fistula to develop. This condition lasted about 8 months.

Doctor’s defense The location of the laceration was difficult to find. Once it was discovered, the proper treatment was to drain the bladder with a catheter and wait several weeks to see if it could heal on its own. There was no reason for the repair attempts to fail.

Verdict $300,000 Illinois verdict.

Pain “like childbirth” is due to retained sponge

A 21-year-old woman suffered a perineal–vaginal tear during childbirth. This was repaired following delivery. A surgical sponge was inserted into the vagina to absorb blood during the repair. Two days later, the patient was discharged from the hospital and sent home.

Two days after that, she experienced pressure in the pelvic area that she likened to childbirth. When she felt something move inside her, she feared she was about to give birth to a second baby. She went to the emergency room, where the presence of the sponge was detected. According to the patient’s mother, who was also present, the pain was relieved almost instantly when the sponge was removed. In a phone call to the patient’s mother the next morning, the physician admitted he had neglected to tell the nursing staff that he had inserted the sponge and that he should have removed it.

Patient’s claim The physician was negligent for failing to remove the sponge.

Doctor’s defense There was no negligence.

Verdict Alabama defense verdict.

Perineal tear follows vacuum extraction

A 27-year-old primigravida experienced an essentially uncomplicated pregnancy during which she was monitored regularly by her ObGyn. When she went into labor and presented at the hospital, she was given an epidural, placed on a fetal monitor, examined regularly, and administered oxytocin. Because of normal progress to complete dilation and effacement, a vaginal delivery appeared likely. After 4.5 hours of second stage labor, a child weighing 8 lb 5 oz was delivered with the aid of a vacuum extractor.

During delivery of the shoulders, the mother suffered a third degree perineal tear extending to the rectal sphincter. This was noted immediately and repaired after completion of the delivery. Before the patient was discharged, she was examined and no problems were found at the site of the repairs.

At her 1-month postpartum visit, the woman informed her ObGyn of occasional fecal incontinence and was told the problem would probably resolve itself. The symptoms persisted, so she was referred to a colorectal surgeon. Dissatisfied with the surgical repair, the patient sought a second surgery from another physician.

Patient’s claim The ObGyn mismanaged the second stage of labor and should have performed a cesarean section rather than used vacuum extraction. Also, the defendant was negligent in the repair of the injury and failed to provide proper follow-up care.

Doctor’s defense There was no negligence. Both the delivery and repair of the tear were performed properly.

Verdict Georgia defense verdict.

During nerve ablation, ureter is damaged

A 39-year-old woman was being treated for low libido, painful intercourse, and heavy, painful menses. When conservative treatment failed to relieve the symptoms, the patient agreed to laparoscopy as recommended by her physician. Ablation of the uterosacral nerve was performed, because the physician believed it to be causing or contributing to the symptoms. The patient’s ureter was damaged and required repair surgery.

Patient’s claim There was lack of informed consent, and the physician was negligent for injuring the ureter.

Doctor’s defense There was no negligence.

Verdict California defense verdict.

Did maternal pelvic structure cause injury?

The plaintiff infant, whose birth was complicated by shoulder dystocia, was delivered using low forceps. Following birth, the child was found to have a brachial plexus injury and unusual bruising on the chest, back, and arm. She has mild residual loss of strength.

Patient’s claim Excessive traction was applied during delivery.

Doctor’s defense The shoulder dystocia, which was mild, was relieved with the McRoberts maneuver, and traction was never applied. The mother’s pelvic structure and positioning of the fetus caused the child’s injuries.

Verdict Illinois defense verdict.

Parents refuse, but oxytocin is given

The plaintiff child was delivered at 42 weeks’ gestation by emergency cesarean section and was diagnosed with dystonic cerebral palsy. Despite the parents’ objection, the obstetrician had the nurse administer oxytocin during labor. According to hospital rules, the oxytocin should have been discontinued when the mother’s contractions became hyperstimulated, but it was not.

Patient’s claim The mother’s contractions did not require administration of oxytocin under the hospital’s rules, and its dosage continued to be increased even when adequate labor was reached. Also, the obstetrician did not see the mother until it was time to perform the cesarean section.

Doctor’s defense There was no negligence. The sudden bradycardia in the fetal heart rate could not have been anticipated.

Verdict $30.8 million Florida verdict.

Woman with fibroids dies of uterine cancer

A 41-year-old woman visited Dr. A because of abnormal uterine bleeding and infertility. After he diagnosed uterine fibroids, she chose to undergo a myomectomy instead of a hysterectomy. The abnormal bleeding continued and she was diagnosed the following month with a postoperative infection. The infection resolved after treatment with antibiotics. Six months after the surgery, the abnormal bleeding returned with increased volume and a bad odor. The next month, Dr. B performed surgery and diagnosed uterine cancer. The patient was treated for 3 years and then died.

Patient’s claim The diagnosis of cancer was delayed. More testing, including a biopsy, should have been done after the myomectomy.

Doctor’s defense The patient was treated properly for a postsurgery infection, which is not uncommon, and had healed a month following the surgery. Her condition improved until she developed an aggressive cancer, which was not foreseen.

Verdict New York defense verdict.

Did maternal pelvic structure cause injury?

The plaintiff infant, whose birth was complicated by shoulder dystocia, was delivered using low forceps. Following birth, the child was found to have a brachial plexus injury and unusual bruising on the chest, back, and arm. She has mild residual loss of strength.

Patient’s claim Excessive traction was applied during delivery.

Doctor’s defense The shoulder dystocia, which was mild, was relieved with the McRoberts maneuver, and traction was never applied. The mother’s pelvic structure and positioning of the fetus caused the child’s injuries.

Verdict Illinois defense verdict.

Parents refuse, but oxytocin is given

The plaintiff child was delivered at 42 weeks’ gestation by emergency cesarean section and was diagnosed with dystonic cerebral palsy. Despite the parents’ objection, the obstetrician had the nurse administer oxytocin during labor. According to hospital rules, the oxytocin should have been discontinued when the mother’s contractions became hyperstimulated, but it was not.

Patient’s claim The mother’s contractions did not require administration of oxytocin under the hospital’s rules, and its dosage continued to be increased even when adequate labor was reached. Also, the obstetrician did not see the mother until it was time to perform the cesarean section.

Doctor’s defense There was no negligence. The sudden bradycardia in the fetal heart rate could not have been anticipated.

Verdict $30.8 million Florida verdict.

Woman with fibroids dies of uterine cancer

A 41-year-old woman visited Dr. A because of abnormal uterine bleeding and infertility. After he diagnosed uterine fibroids, she chose to undergo a myomectomy instead of a hysterectomy. The abnormal bleeding continued and she was diagnosed the following month with a postoperative infection. The infection resolved after treatment with antibiotics. Six months after the surgery, the abnormal bleeding returned with increased volume and a bad odor. The next month, Dr. B performed surgery and diagnosed uterine cancer. The patient was treated for 3 years and then died.

Patient’s claim The diagnosis of cancer was delayed. More testing, including a biopsy, should have been done after the myomectomy.

Doctor’s defense The patient was treated properly for a postsurgery infection, which is not uncommon, and had healed a month following the surgery. Her condition improved until she developed an aggressive cancer, which was not foreseen.

Verdict New York defense verdict.

Did maternal pelvic structure cause injury?

The plaintiff infant, whose birth was complicated by shoulder dystocia, was delivered using low forceps. Following birth, the child was found to have a brachial plexus injury and unusual bruising on the chest, back, and arm. She has mild residual loss of strength.

Patient’s claim Excessive traction was applied during delivery.

Doctor’s defense The shoulder dystocia, which was mild, was relieved with the McRoberts maneuver, and traction was never applied. The mother’s pelvic structure and positioning of the fetus caused the child’s injuries.

Verdict Illinois defense verdict.

Parents refuse, but oxytocin is given

The plaintiff child was delivered at 42 weeks’ gestation by emergency cesarean section and was diagnosed with dystonic cerebral palsy. Despite the parents’ objection, the obstetrician had the nurse administer oxytocin during labor. According to hospital rules, the oxytocin should have been discontinued when the mother’s contractions became hyperstimulated, but it was not.

Patient’s claim The mother’s contractions did not require administration of oxytocin under the hospital’s rules, and its dosage continued to be increased even when adequate labor was reached. Also, the obstetrician did not see the mother until it was time to perform the cesarean section.

Doctor’s defense There was no negligence. The sudden bradycardia in the fetal heart rate could not have been anticipated.

Verdict $30.8 million Florida verdict.

Woman with fibroids dies of uterine cancer

A 41-year-old woman visited Dr. A because of abnormal uterine bleeding and infertility. After he diagnosed uterine fibroids, she chose to undergo a myomectomy instead of a hysterectomy. The abnormal bleeding continued and she was diagnosed the following month with a postoperative infection. The infection resolved after treatment with antibiotics. Six months after the surgery, the abnormal bleeding returned with increased volume and a bad odor. The next month, Dr. B performed surgery and diagnosed uterine cancer. The patient was treated for 3 years and then died.

Patient’s claim The diagnosis of cancer was delayed. More testing, including a biopsy, should have been done after the myomectomy.

Doctor’s defense The patient was treated properly for a postsurgery infection, which is not uncommon, and had healed a month following the surgery. Her condition improved until she developed an aggressive cancer, which was not foreseen.

Verdict New York defense verdict.

Diabetic smoker blames others for CP

A woman had her final visit with her ObGyn 1 week before her scheduled cesarean section. When she arrived at the hospital at 36 weeks’ gestation for the procedure, the attending ObGyn delivered the child, who was born with severe acidosis and hypoxia and was diagnosed with cerebral palsy. The mother was diabetic and a smoker.

Patient’s claim Signs of a compromised infant were evident at her last visit to the ObGyn, and the child should have been delivered that day. Also, on the day of the actual delivery, the physician should have performed the delivery more expeditiously.

Doctor’s defense The infant was harmed before 34 weeks’ gestation. This was a high-risk pregnancy: the mother did not comply with diabetes management, and she continued to smoke although warned not to.

Verdict Massachusetts defense verdict.

Brain damage occurred despite “timely” birth

An active-duty Marine pregnant with her first child was examined twice at the labor and delivery unit and sent home. Five days before her due date—and 1 day following the previous visit—she returned with ruptured membranes and was admitted by a family practice resident. Four hours later, oxytocin was started because of decreased variability in the fetal monitoring with some late decelerations. A drop in the fetal heart rate followed the start of an epidural. A fetal scalp electrode was inserted, and within 15 minutes the mother was moved to the operating room. The attending family practice physician and the attending OB were called, and delivery by cesarean section was performed within another 15 minutes.

At birth, the infant was severely distressed. Intubation was attempted by a first-year intern, but after 25 minutes, the tube was found to be in the right mainstream bronchus with complete collapse of the left lung. For 10 minutes there was no heartbeat, but the staff reported a 5-minute Apgar score of 5. The infant was transferred to a second hospital, where a feeding gastrostomy and tracheotomy were placed. Two months later, the infant was transferred to a third hospital and, finally, 3 months after that, transferred home. The child suffered severe brain damage and developmental delay.

Patient’s claim The physicians failed to recognize the nonreassuring fetal monitoring strips and deliver early.

Doctor’s defense The delivery was timely.

Verdict $5.3 million California settlement.

Was ureteral injury caused by negligence?

A 49-year-old woman presented at the hospital for removal of an ovarian mass 10 cm × 12 cm in diameter. At the first incision, the two surgeons discovered severe pelvic adhesive disease, the result of a previous hysterectomy. The mass was not visible, but they finally located it—lower in the pelvic cavity than normal and near the ureter—and removed it.

Although the patient complained of pain in the back and left flank, several days passed before physicians discovered that the ureter had been cut and urine was backing up into the left kidney. The patient demanded transfer to another hospital.

Five days after the original surgery, a nephrostomy tube was inserted to drain the left kidney, but the patient’s abdomen was too inflamed to immediately repair the injury. She was discharged 3 days later. She was readmitted for treatment of severe infection due to the nephrostomy tube and then underwent more procedures to change the tube. Finally, 6 months after the initial surgery, she underwent left distal ureteral reimplantation and placement of an indwelling left ureteral stent.

Patient’s claim The physicians were negligent for failing (1) to identify the ureter prior to cutting out the ovarian mass and (2) to check the course of the ureter after the mass had been removed.

Doctor’s defense (1) The cystic mass was difficult to dissect, and a general surgeon was called to confirm that no injury had occurred. (2) Following abdominal ultrasonography and CT, cystoscopy by a urologist confirmed a ureteral injury. The need for a nephrostomy was discussed, but the patient demanded a transfer and thus left the care of the defendants. (3) The patient’s outcome was ultimately good.

Verdict Texas defense verdict.

Placental abruption—and baby is stillborn

A woman in her 23rd week of pregnancy arrived at the hospital with ruptured membranes and bleeding. She was diagnosed with placental abruption, and the fetus was alive as confirmed by ultrasonography. Two hours after her arrival, a cesarean section was performed, but the baby was stillborn.

Patient’s claim The infant should have been delivered within 30 minutes of the decision to perform a cesarean section.

Doctor’s defense Both preparation of the mother for surgery and performance of the cesarean section were timely. Also, the child had only a 10% chance of survival because of his early gestational age.

Verdict Illinois defense verdict. Prior to the verdict, the hospital entered a confidential high/low agreement with the plaintiff.

Did surgeon fail to identify the ureter?

A breast cancer survivor in her 40s tested positive for the familial gene BRCA1, which increased her chance of developing ovarian cancer by up to 70%. To reduce that chance, she chose to have an oophorectomy, which was performed by an ObGyn. Two days after her discharge from the hospital, she complained of flank pain and inability to void. She met the ObGyn in the emergency room, where diagnostic tests confirmed an obstructed ureter. Following five stenting procedures, the patient underwent ureteral reimplantation surgery, which alleviated but did not completely cure her symptoms.

Patient’s claim The ObGyn failed to identify the ureter so as to protect it from injury and also failed to inspect for ureteral injury following surgery. When he could not find the ureter, he should have consulted with another physician to help find the ureter or convert from laparoscopic to open surgery.

Doctor’s defense The injury would have occurred even if the ureter had been identified.

Verdict $500,000 Maryland verdict.

Diabetic smoker blames others for CP

A woman had her final visit with her ObGyn 1 week before her scheduled cesarean section. When she arrived at the hospital at 36 weeks’ gestation for the procedure, the attending ObGyn delivered the child, who was born with severe acidosis and hypoxia and was diagnosed with cerebral palsy. The mother was diabetic and a smoker.

Patient’s claim Signs of a compromised infant were evident at her last visit to the ObGyn, and the child should have been delivered that day. Also, on the day of the actual delivery, the physician should have performed the delivery more expeditiously.

Doctor’s defense The infant was harmed before 34 weeks’ gestation. This was a high-risk pregnancy: the mother did not comply with diabetes management, and she continued to smoke although warned not to.

Verdict Massachusetts defense verdict.

Brain damage occurred despite “timely” birth

An active-duty Marine pregnant with her first child was examined twice at the labor and delivery unit and sent home. Five days before her due date—and 1 day following the previous visit—she returned with ruptured membranes and was admitted by a family practice resident. Four hours later, oxytocin was started because of decreased variability in the fetal monitoring with some late decelerations. A drop in the fetal heart rate followed the start of an epidural. A fetal scalp electrode was inserted, and within 15 minutes the mother was moved to the operating room. The attending family practice physician and the attending OB were called, and delivery by cesarean section was performed within another 15 minutes.

At birth, the infant was severely distressed. Intubation was attempted by a first-year intern, but after 25 minutes, the tube was found to be in the right mainstream bronchus with complete collapse of the left lung. For 10 minutes there was no heartbeat, but the staff reported a 5-minute Apgar score of 5. The infant was transferred to a second hospital, where a feeding gastrostomy and tracheotomy were placed. Two months later, the infant was transferred to a third hospital and, finally, 3 months after that, transferred home. The child suffered severe brain damage and developmental delay.

Patient’s claim The physicians failed to recognize the nonreassuring fetal monitoring strips and deliver early.

Doctor’s defense The delivery was timely.

Verdict $5.3 million California settlement.

Was ureteral injury caused by negligence?

A 49-year-old woman presented at the hospital for removal of an ovarian mass 10 cm × 12 cm in diameter. At the first incision, the two surgeons discovered severe pelvic adhesive disease, the result of a previous hysterectomy. The mass was not visible, but they finally located it—lower in the pelvic cavity than normal and near the ureter—and removed it.

Although the patient complained of pain in the back and left flank, several days passed before physicians discovered that the ureter had been cut and urine was backing up into the left kidney. The patient demanded transfer to another hospital.

Five days after the original surgery, a nephrostomy tube was inserted to drain the left kidney, but the patient’s abdomen was too inflamed to immediately repair the injury. She was discharged 3 days later. She was readmitted for treatment of severe infection due to the nephrostomy tube and then underwent more procedures to change the tube. Finally, 6 months after the initial surgery, she underwent left distal ureteral reimplantation and placement of an indwelling left ureteral stent.

Patient’s claim The physicians were negligent for failing (1) to identify the ureter prior to cutting out the ovarian mass and (2) to check the course of the ureter after the mass had been removed.

Doctor’s defense (1) The cystic mass was difficult to dissect, and a general surgeon was called to confirm that no injury had occurred. (2) Following abdominal ultrasonography and CT, cystoscopy by a urologist confirmed a ureteral injury. The need for a nephrostomy was discussed, but the patient demanded a transfer and thus left the care of the defendants. (3) The patient’s outcome was ultimately good.

Verdict Texas defense verdict.

Placental abruption—and baby is stillborn

A woman in her 23rd week of pregnancy arrived at the hospital with ruptured membranes and bleeding. She was diagnosed with placental abruption, and the fetus was alive as confirmed by ultrasonography. Two hours after her arrival, a cesarean section was performed, but the baby was stillborn.

Patient’s claim The infant should have been delivered within 30 minutes of the decision to perform a cesarean section.

Doctor’s defense Both preparation of the mother for surgery and performance of the cesarean section were timely. Also, the child had only a 10% chance of survival because of his early gestational age.

Verdict Illinois defense verdict. Prior to the verdict, the hospital entered a confidential high/low agreement with the plaintiff.

Did surgeon fail to identify the ureter?

A breast cancer survivor in her 40s tested positive for the familial gene BRCA1, which increased her chance of developing ovarian cancer by up to 70%. To reduce that chance, she chose to have an oophorectomy, which was performed by an ObGyn. Two days after her discharge from the hospital, she complained of flank pain and inability to void. She met the ObGyn in the emergency room, where diagnostic tests confirmed an obstructed ureter. Following five stenting procedures, the patient underwent ureteral reimplantation surgery, which alleviated but did not completely cure her symptoms.

Patient’s claim The ObGyn failed to identify the ureter so as to protect it from injury and also failed to inspect for ureteral injury following surgery. When he could not find the ureter, he should have consulted with another physician to help find the ureter or convert from laparoscopic to open surgery.

Doctor’s defense The injury would have occurred even if the ureter had been identified.

Verdict $500,000 Maryland verdict.

Diabetic smoker blames others for CP

A woman had her final visit with her ObGyn 1 week before her scheduled cesarean section. When she arrived at the hospital at 36 weeks’ gestation for the procedure, the attending ObGyn delivered the child, who was born with severe acidosis and hypoxia and was diagnosed with cerebral palsy. The mother was diabetic and a smoker.

Patient’s claim Signs of a compromised infant were evident at her last visit to the ObGyn, and the child should have been delivered that day. Also, on the day of the actual delivery, the physician should have performed the delivery more expeditiously.

Doctor’s defense The infant was harmed before 34 weeks’ gestation. This was a high-risk pregnancy: the mother did not comply with diabetes management, and she continued to smoke although warned not to.

Verdict Massachusetts defense verdict.

Brain damage occurred despite “timely” birth

An active-duty Marine pregnant with her first child was examined twice at the labor and delivery unit and sent home. Five days before her due date—and 1 day following the previous visit—she returned with ruptured membranes and was admitted by a family practice resident. Four hours later, oxytocin was started because of decreased variability in the fetal monitoring with some late decelerations. A drop in the fetal heart rate followed the start of an epidural. A fetal scalp electrode was inserted, and within 15 minutes the mother was moved to the operating room. The attending family practice physician and the attending OB were called, and delivery by cesarean section was performed within another 15 minutes.

At birth, the infant was severely distressed. Intubation was attempted by a first-year intern, but after 25 minutes, the tube was found to be in the right mainstream bronchus with complete collapse of the left lung. For 10 minutes there was no heartbeat, but the staff reported a 5-minute Apgar score of 5. The infant was transferred to a second hospital, where a feeding gastrostomy and tracheotomy were placed. Two months later, the infant was transferred to a third hospital and, finally, 3 months after that, transferred home. The child suffered severe brain damage and developmental delay.

Patient’s claim The physicians failed to recognize the nonreassuring fetal monitoring strips and deliver early.

Doctor’s defense The delivery was timely.

Verdict $5.3 million California settlement.

Was ureteral injury caused by negligence?

A 49-year-old woman presented at the hospital for removal of an ovarian mass 10 cm × 12 cm in diameter. At the first incision, the two surgeons discovered severe pelvic adhesive disease, the result of a previous hysterectomy. The mass was not visible, but they finally located it—lower in the pelvic cavity than normal and near the ureter—and removed it.

Although the patient complained of pain in the back and left flank, several days passed before physicians discovered that the ureter had been cut and urine was backing up into the left kidney. The patient demanded transfer to another hospital.

Five days after the original surgery, a nephrostomy tube was inserted to drain the left kidney, but the patient’s abdomen was too inflamed to immediately repair the injury. She was discharged 3 days later. She was readmitted for treatment of severe infection due to the nephrostomy tube and then underwent more procedures to change the tube. Finally, 6 months after the initial surgery, she underwent left distal ureteral reimplantation and placement of an indwelling left ureteral stent.

Patient’s claim The physicians were negligent for failing (1) to identify the ureter prior to cutting out the ovarian mass and (2) to check the course of the ureter after the mass had been removed.

Doctor’s defense (1) The cystic mass was difficult to dissect, and a general surgeon was called to confirm that no injury had occurred. (2) Following abdominal ultrasonography and CT, cystoscopy by a urologist confirmed a ureteral injury. The need for a nephrostomy was discussed, but the patient demanded a transfer and thus left the care of the defendants. (3) The patient’s outcome was ultimately good.

Verdict Texas defense verdict.

Placental abruption—and baby is stillborn

A woman in her 23rd week of pregnancy arrived at the hospital with ruptured membranes and bleeding. She was diagnosed with placental abruption, and the fetus was alive as confirmed by ultrasonography. Two hours after her arrival, a cesarean section was performed, but the baby was stillborn.

Patient’s claim The infant should have been delivered within 30 minutes of the decision to perform a cesarean section.

Doctor’s defense Both preparation of the mother for surgery and performance of the cesarean section were timely. Also, the child had only a 10% chance of survival because of his early gestational age.

Verdict Illinois defense verdict. Prior to the verdict, the hospital entered a confidential high/low agreement with the plaintiff.

Did surgeon fail to identify the ureter?

A breast cancer survivor in her 40s tested positive for the familial gene BRCA1, which increased her chance of developing ovarian cancer by up to 70%. To reduce that chance, she chose to have an oophorectomy, which was performed by an ObGyn. Two days after her discharge from the hospital, she complained of flank pain and inability to void. She met the ObGyn in the emergency room, where diagnostic tests confirmed an obstructed ureter. Following five stenting procedures, the patient underwent ureteral reimplantation surgery, which alleviated but did not completely cure her symptoms.

Patient’s claim The ObGyn failed to identify the ureter so as to protect it from injury and also failed to inspect for ureteral injury following surgery. When he could not find the ureter, he should have consulted with another physician to help find the ureter or convert from laparoscopic to open surgery.

Doctor’s defense The injury would have occurred even if the ureter had been identified.

Verdict $500,000 Maryland verdict.

Pain, brain injury due to ruptured uterus

A woman now pregnant with her third child—who had delivered her other two children by cesarean section—presented at the hospital with painful contractions 1 week before a scheduled cesarean section. Because her cervix was dilated only 1 cm, it was decided to monitor her cervical dilation until it indicated active labor and then perform a cesarean section.

Her contractions continued. Despite pain medication, she complained of pain at the “10+” level. Fetal monitoring became difficult and an emergency cesarean section was performed. The baby was found floating freely in the abdominal cavity because the uterus had ruptured. He suffered catastrophic injuries caused by a hypoxic–ischemic brain injury and will require assistance in all activities of daily living.

Patient’s claim The cesarean section should have been performed sooner. Also, the complaints of pain should have been investigated further.

Doctor’s defense Waiting for cervical dilation before proceeding to cesarean section was proper.

Verdict $5 million Minnesota settlement; part was used to purchase an annuity, and part was placed in a supplemental needs trust.

Wrong ovary removed? Judge dismisses case

A 42-year-old woman complaining of abdominal pain underwent a cholecystectomy and oophorectomy. During the surgery, the surgeon discovered that the right ovary, which was supposed to be removed, was densely adherent to the pelvic side wall. In order to leave the patient with some ovarian function, he decided to just “loosen” the right ovary and remove the left ovary, which was also diseased. The right ovary was removed in a later surgery.

Patient’s claim She alleged medical battery for removal of the left ovary, to which she had not consented. Also, failure to remove the right ovary required her to undergo additional surgery.

Doctor’s defense Consent for the surgery included authorization to perform medically indicated procedures. By removing the left ovary instead of the right one, the surgeon hoped the patient could maintain some ovarian function.

Verdict $175,000 Tennessee verdict on the battery issue. The trial judge granted the defendant’s motion for JNOV (judgment notwithstanding the verdict) and ruled there could be no medical battery. He found that (1) all experts stated that both ovaries were diseased and needed to be removed, (2) it was medically necessary to remove the left ovary, and (3) the patient had authorized any medically indicated procedure. The court dismissed the case. An appeal was pending.

Baby is entrapped by cervix; no OB to help

A 25-year-old woman presented at the hospital in preterm labor. Her ObGyn was contacted at home and prescribed medications. There was no obstetrician at the hospital when the patient’s water broke and the baby was found to be in a footling breech position. Delivery of the baby—at 23 5/7 weeks and 2 lb—began 5 minutes later, but the head became entrapped by the cervix, leading to asphyxiation. The ObGyn arrived nearly 1 hour later and completed the delivery.

Patient’s claim The mother claimed wrongful death and conscious pain and suffering of the infant, as well as negligent infliction of emotional distress for herself. Also, the ObGyn should have left immediately for the hospital when he was first contacted.

Doctor’s defense The initial information given to him did not indicate that a rapid delivery was about to occur. The second contact came after the infant had died, and the defendant left immediately for the hospital. Also, it was unlikely the infant would have been born alive because of the early gestational age.

Verdict Initially, a $175,000 verdict against the hospital for intentional infliction of emotional distress and a defense verdict for the ObGyn were returned in Illinois. The latter was overturned on appeal, and a second trial returned a $700,000 verdict for emotional distress.

Did infection cause child’s brain damage?

A woman in her 24th week of pregnancy presented with protracted vomiting and other symptoms of hyperemesis gravidarum. Her treating ObGyns ordered a peripherally inserted central line for the infusion of fluid, after which the patient was cared for at home by a home health nurse. Neither the physicians nor the nurse noticed that the central catheter had caused an infection. The patient went into septic shock but recovered. The child, however, was born with severe brain damage and requires 24-hour care, which he receives at home.

Patient’s claim The undiagnosed infection caused the fetal injury in utero.

Doctor’s defense The child’s condition was genetic and unrelated to the infection.

Verdict Michigan defense verdict.

Death following endometrial ablation

A 51-year-old woman weighing between 270 and 290 lb was to undergo endometrial ablation to control heavy menstrual bleeding. To increase her hematocrit for the surgery, her internist treated her with iron infusions. The patient told the anesthesiologist who reviewed her medical history and current physical health that, despite her weight, she could climb stairs and walk several blocks without shortness of breath. She rejected spinal anesthesia, and the anesthesiologist decided surgery could proceed safely.

About 40 minutes into the surgery, the gynecologist noticed the patent’s leg moving slightly. He then used a nerve stimulator to produce additional movement. Vital signs remained stable. The anesthesiologist administered a paralyzing agent, and the patient’s heart rate decreased 5 minutes later. The patient then died, apparently due to an embolism.

Plaintiff’s claim (1) Inappropriate hormone therapy from the gynecologist caused the need for endometrial ablation. (2) A significant fibroid made her a poor candidate for endometrial ablation. (3) A more thorough workup, including chest radiograph, echocardiogram, pulmonary function test, and arterial blood gas analysis, should have been performed by the anesthesiologist before surgery.

Doctor’s defense (1) There was no negligence involved. (2) Additional tests would not have provided helpful information. (3) Additional tests would not have changed the clinical plan.

Verdict California defense verdict.

Pain, brain injury due to ruptured uterus

A woman now pregnant with her third child—who had delivered her other two children by cesarean section—presented at the hospital with painful contractions 1 week before a scheduled cesarean section. Because her cervix was dilated only 1 cm, it was decided to monitor her cervical dilation until it indicated active labor and then perform a cesarean section.

Her contractions continued. Despite pain medication, she complained of pain at the “10+” level. Fetal monitoring became difficult and an emergency cesarean section was performed. The baby was found floating freely in the abdominal cavity because the uterus had ruptured. He suffered catastrophic injuries caused by a hypoxic–ischemic brain injury and will require assistance in all activities of daily living.

Patient’s claim The cesarean section should have been performed sooner. Also, the complaints of pain should have been investigated further.

Doctor’s defense Waiting for cervical dilation before proceeding to cesarean section was proper.

Verdict $5 million Minnesota settlement; part was used to purchase an annuity, and part was placed in a supplemental needs trust.

Wrong ovary removed? Judge dismisses case

A 42-year-old woman complaining of abdominal pain underwent a cholecystectomy and oophorectomy. During the surgery, the surgeon discovered that the right ovary, which was supposed to be removed, was densely adherent to the pelvic side wall. In order to leave the patient with some ovarian function, he decided to just “loosen” the right ovary and remove the left ovary, which was also diseased. The right ovary was removed in a later surgery.

Patient’s claim She alleged medical battery for removal of the left ovary, to which she had not consented. Also, failure to remove the right ovary required her to undergo additional surgery.

Doctor’s defense Consent for the surgery included authorization to perform medically indicated procedures. By removing the left ovary instead of the right one, the surgeon hoped the patient could maintain some ovarian function.

Verdict $175,000 Tennessee verdict on the battery issue. The trial judge granted the defendant’s motion for JNOV (judgment notwithstanding the verdict) and ruled there could be no medical battery. He found that (1) all experts stated that both ovaries were diseased and needed to be removed, (2) it was medically necessary to remove the left ovary, and (3) the patient had authorized any medically indicated procedure. The court dismissed the case. An appeal was pending.

Baby is entrapped by cervix; no OB to help

A 25-year-old woman presented at the hospital in preterm labor. Her ObGyn was contacted at home and prescribed medications. There was no obstetrician at the hospital when the patient’s water broke and the baby was found to be in a footling breech position. Delivery of the baby—at 23 5/7 weeks and 2 lb—began 5 minutes later, but the head became entrapped by the cervix, leading to asphyxiation. The ObGyn arrived nearly 1 hour later and completed the delivery.

Patient’s claim The mother claimed wrongful death and conscious pain and suffering of the infant, as well as negligent infliction of emotional distress for herself. Also, the ObGyn should have left immediately for the hospital when he was first contacted.

Doctor’s defense The initial information given to him did not indicate that a rapid delivery was about to occur. The second contact came after the infant had died, and the defendant left immediately for the hospital. Also, it was unlikely the infant would have been born alive because of the early gestational age.

Verdict Initially, a $175,000 verdict against the hospital for intentional infliction of emotional distress and a defense verdict for the ObGyn were returned in Illinois. The latter was overturned on appeal, and a second trial returned a $700,000 verdict for emotional distress.

Did infection cause child’s brain damage?

A woman in her 24th week of pregnancy presented with protracted vomiting and other symptoms of hyperemesis gravidarum. Her treating ObGyns ordered a peripherally inserted central line for the infusion of fluid, after which the patient was cared for at home by a home health nurse. Neither the physicians nor the nurse noticed that the central catheter had caused an infection. The patient went into septic shock but recovered. The child, however, was born with severe brain damage and requires 24-hour care, which he receives at home.

Patient’s claim The undiagnosed infection caused the fetal injury in utero.

Doctor’s defense The child’s condition was genetic and unrelated to the infection.

Verdict Michigan defense verdict.

Death following endometrial ablation

A 51-year-old woman weighing between 270 and 290 lb was to undergo endometrial ablation to control heavy menstrual bleeding. To increase her hematocrit for the surgery, her internist treated her with iron infusions. The patient told the anesthesiologist who reviewed her medical history and current physical health that, despite her weight, she could climb stairs and walk several blocks without shortness of breath. She rejected spinal anesthesia, and the anesthesiologist decided surgery could proceed safely.

About 40 minutes into the surgery, the gynecologist noticed the patent’s leg moving slightly. He then used a nerve stimulator to produce additional movement. Vital signs remained stable. The anesthesiologist administered a paralyzing agent, and the patient’s heart rate decreased 5 minutes later. The patient then died, apparently due to an embolism.

Plaintiff’s claim (1) Inappropriate hormone therapy from the gynecologist caused the need for endometrial ablation. (2) A significant fibroid made her a poor candidate for endometrial ablation. (3) A more thorough workup, including chest radiograph, echocardiogram, pulmonary function test, and arterial blood gas analysis, should have been performed by the anesthesiologist before surgery.

Doctor’s defense (1) There was no negligence involved. (2) Additional tests would not have provided helpful information. (3) Additional tests would not have changed the clinical plan.

Verdict California defense verdict.

Pain, brain injury due to ruptured uterus

A woman now pregnant with her third child—who had delivered her other two children by cesarean section—presented at the hospital with painful contractions 1 week before a scheduled cesarean section. Because her cervix was dilated only 1 cm, it was decided to monitor her cervical dilation until it indicated active labor and then perform a cesarean section.

Her contractions continued. Despite pain medication, she complained of pain at the “10+” level. Fetal monitoring became difficult and an emergency cesarean section was performed. The baby was found floating freely in the abdominal cavity because the uterus had ruptured. He suffered catastrophic injuries caused by a hypoxic–ischemic brain injury and will require assistance in all activities of daily living.

Patient’s claim The cesarean section should have been performed sooner. Also, the complaints of pain should have been investigated further.

Doctor’s defense Waiting for cervical dilation before proceeding to cesarean section was proper.

Verdict $5 million Minnesota settlement; part was used to purchase an annuity, and part was placed in a supplemental needs trust.

Wrong ovary removed? Judge dismisses case

A 42-year-old woman complaining of abdominal pain underwent a cholecystectomy and oophorectomy. During the surgery, the surgeon discovered that the right ovary, which was supposed to be removed, was densely adherent to the pelvic side wall. In order to leave the patient with some ovarian function, he decided to just “loosen” the right ovary and remove the left ovary, which was also diseased. The right ovary was removed in a later surgery.

Patient’s claim She alleged medical battery for removal of the left ovary, to which she had not consented. Also, failure to remove the right ovary required her to undergo additional surgery.

Doctor’s defense Consent for the surgery included authorization to perform medically indicated procedures. By removing the left ovary instead of the right one, the surgeon hoped the patient could maintain some ovarian function.

Verdict $175,000 Tennessee verdict on the battery issue. The trial judge granted the defendant’s motion for JNOV (judgment notwithstanding the verdict) and ruled there could be no medical battery. He found that (1) all experts stated that both ovaries were diseased and needed to be removed, (2) it was medically necessary to remove the left ovary, and (3) the patient had authorized any medically indicated procedure. The court dismissed the case. An appeal was pending.

Baby is entrapped by cervix; no OB to help

A 25-year-old woman presented at the hospital in preterm labor. Her ObGyn was contacted at home and prescribed medications. There was no obstetrician at the hospital when the patient’s water broke and the baby was found to be in a footling breech position. Delivery of the baby—at 23 5/7 weeks and 2 lb—began 5 minutes later, but the head became entrapped by the cervix, leading to asphyxiation. The ObGyn arrived nearly 1 hour later and completed the delivery.

Patient’s claim The mother claimed wrongful death and conscious pain and suffering of the infant, as well as negligent infliction of emotional distress for herself. Also, the ObGyn should have left immediately for the hospital when he was first contacted.

Doctor’s defense The initial information given to him did not indicate that a rapid delivery was about to occur. The second contact came after the infant had died, and the defendant left immediately for the hospital. Also, it was unlikely the infant would have been born alive because of the early gestational age.

Verdict Initially, a $175,000 verdict against the hospital for intentional infliction of emotional distress and a defense verdict for the ObGyn were returned in Illinois. The latter was overturned on appeal, and a second trial returned a $700,000 verdict for emotional distress.

Did infection cause child’s brain damage?

A woman in her 24th week of pregnancy presented with protracted vomiting and other symptoms of hyperemesis gravidarum. Her treating ObGyns ordered a peripherally inserted central line for the infusion of fluid, after which the patient was cared for at home by a home health nurse. Neither the physicians nor the nurse noticed that the central catheter had caused an infection. The patient went into septic shock but recovered. The child, however, was born with severe brain damage and requires 24-hour care, which he receives at home.

Patient’s claim The undiagnosed infection caused the fetal injury in utero.

Doctor’s defense The child’s condition was genetic and unrelated to the infection.

Verdict Michigan defense verdict.

Death following endometrial ablation

A 51-year-old woman weighing between 270 and 290 lb was to undergo endometrial ablation to control heavy menstrual bleeding. To increase her hematocrit for the surgery, her internist treated her with iron infusions. The patient told the anesthesiologist who reviewed her medical history and current physical health that, despite her weight, she could climb stairs and walk several blocks without shortness of breath. She rejected spinal anesthesia, and the anesthesiologist decided surgery could proceed safely.

About 40 minutes into the surgery, the gynecologist noticed the patent’s leg moving slightly. He then used a nerve stimulator to produce additional movement. Vital signs remained stable. The anesthesiologist administered a paralyzing agent, and the patient’s heart rate decreased 5 minutes later. The patient then died, apparently due to an embolism.

Plaintiff’s claim (1) Inappropriate hormone therapy from the gynecologist caused the need for endometrial ablation. (2) A significant fibroid made her a poor candidate for endometrial ablation. (3) A more thorough workup, including chest radiograph, echocardiogram, pulmonary function test, and arterial blood gas analysis, should have been performed by the anesthesiologist before surgery.

Doctor’s defense (1) There was no negligence involved. (2) Additional tests would not have provided helpful information. (3) Additional tests would not have changed the clinical plan.

Verdict California defense verdict.

Baby’s death in infancy blamed on difficult birth

A woman who was receiving prenatal care from a family medicine practice had a positive 1-hour glucose test, but never took the 3-hour glucose test. She later went into preterm labor and delivered a child vaginally at 34 to 36 weeks’ gestation. Shoulder dystocia occurred during delivery and a nuchal cord was present. An attempt to reduce the cord failed, and it was clamped and divided. Although the child was born depressed, he was resuscitated successfully. He later was diagnosed with hypoxic–ischemic encephalopathy. His neurological status degenerated, and he died at 3 months.

Patient’s claim Negligence occurred in several areas: failure to order a 3-hour glucose test; failure to refer the patient to an OB; failure to order a tocolytic to stop premature labor; and use of too much force to reduce the nuchal cord.

Doctor’s defense An OB consult was not required as this pregnancy was not high-risk; tocolytic treatment was not indicated; and a problem with the cord integrity caused its rupture, not excessive force. Also, a sonogram on the first day of life showed periventricular leukomalacia, indicating that a hypoxic event had occurred in utero and caused the hypoxic–ischemic encephalopathy.

Verdict Illinois defense verdict.

Did the forces of labor cause Erb’s palsy?

During a delivery marked by shoulder dystocia, the McRoberts maneuver and suprapubic pressure were used. The infant suffered injury to her brachial plexus, resulting in paralysis of the brachial plexus, shoulder, and upper arm on the right side. The child now receives physical therapy for her injury, which has caused her to be left-side dominant.

Patient’s claim The delivering physician used excessive pressure. Shoulder dystocia should have been expected because of the large fetal size.

Doctor’s defense The physician claimed that he had handled the dystocia properly and avoided possible brain damage. He also argued that the shoulder dystocia could not have been predicted. The brachial plexus injury was caused by the natural forces of labor, which were especially pronounced because the mother weighed 350 pounds.

Verdict Pennsylvania defense verdict.

Severe retardation after troubled delivery

A woman pregnant with her third child presented at a hospital in the early stages of labor. Her second child had been delivered by cesarean section. The morning after her admission, a physician noted that the pregnancy was at term and characterized by a failed trial of labor and cephalopelvic disproportion. He recommended that the woman undergo cesarean section due to failure to progress. Fetal heart tracings were within normal limits.

The woman was given general anesthesia and underwent a nonemergency cesarean section, during which uterine dehiscence was found. The child was pale, floppy, and bradycardic, lacked respiration, and had an initial Apgar score of 1.

Patient’s claim A first-year resident not fully trained in obstetrics observed repetitive decelerations on the fetal heart tracings. An emergency cesarean section should have been performed more than 2 hours before the actual delivery because of nonreassuring fetal monitor strips and evidence of uterine rupture. The child suffered hypoxic–ischemic encephalopathy, resulting in brain damage and severe mental retardation.

Doctor’s defense The doctor maintained that he had seen the child’s head during delivery, with no myometrial membranes covering it, and had used a catheter to suction the infant to prevent aspiration of meconium. The child was depressed at birth due to the anesthesia administered to the mother, but recovered and had a normal Apgar of 7 at 5 minutes after meconium was suctioned from the airway.

The physician also argued that the infant had a normal neonatal course and was moved to a regular nursery, where he thrived. He did not suffer hypoxia, multiple organ failure, or seizures during the neonatal period. Febrile seizures at 21 months resulted from a seizure disorder not related to an injury at birth.

Verdict $300,000 Illinois verdict against the physician; $4 million settlement with the hospital.

Did delay in diagnosis alter cancer outcome?

After finding a lump in her breast, a 28-year-old woman went to her ObGyn, who ordered a biopsy but did not obtain the biopsy results or follow up. Four months later, the woman consulted a second physician and was diagnosed with breast cancer. She underwent lumpectomy, chemotherapy, and radiation.

Patient’s claim Her cancer diagnosis was delayed because of the inaction of the first ObGyn, decreasing her chances of survival from 80% to 40%.

Doctor’s defense He was not negligent. Also, the delay did not significantly alter the outcome.

Verdict $750,000 Georgia verdict.

Hysterectomy results in vesicovaginal fistula

After a total abdominal hysterectomy and bilateral salpingo-oophorectomy, a woman in her late 30s experienced 3 weeks of “nonstop” urination and leakage. She was diagnosed with a vesicovaginal fistula and referred to a urologist, who confirmed the fistula by cystography. Her incontinence continued.

During open surgical repair 3 months after the hysterectomy, a suprapubic catheter was placed in the patient’s bladder and a Foley catheter in her urethra. The catheters were removed a few weeks later.

Following surgery, the patient experienced urinary tract infections, bladder infections, and incontinence. A cystogram revealed a vesicovaginal fistula from the middle area of the bladder into the vagina. A second Foley catheter was inserted. Four months later, surgery to repair the fistula and lysis of adhesions was mostly successful.

Patient’s claim A laceration that occurred during the hysterectomy led to a vesicovaginal fistula. Also, despite the apparent success of the final surgery, she continues to suffer urinary urgency, frequency, and pain.

Doctor’s defense Not reported.

Verdict $525,000 settlement, paid by the physician’s insurer and his practice.

Baby’s death in infancy blamed on difficult birth

A woman who was receiving prenatal care from a family medicine practice had a positive 1-hour glucose test, but never took the 3-hour glucose test. She later went into preterm labor and delivered a child vaginally at 34 to 36 weeks’ gestation. Shoulder dystocia occurred during delivery and a nuchal cord was present. An attempt to reduce the cord failed, and it was clamped and divided. Although the child was born depressed, he was resuscitated successfully. He later was diagnosed with hypoxic–ischemic encephalopathy. His neurological status degenerated, and he died at 3 months.

Patient’s claim Negligence occurred in several areas: failure to order a 3-hour glucose test; failure to refer the patient to an OB; failure to order a tocolytic to stop premature labor; and use of too much force to reduce the nuchal cord.

Doctor’s defense An OB consult was not required as this pregnancy was not high-risk; tocolytic treatment was not indicated; and a problem with the cord integrity caused its rupture, not excessive force. Also, a sonogram on the first day of life showed periventricular leukomalacia, indicating that a hypoxic event had occurred in utero and caused the hypoxic–ischemic encephalopathy.

Verdict Illinois defense verdict.

Did the forces of labor cause Erb’s palsy?

During a delivery marked by shoulder dystocia, the McRoberts maneuver and suprapubic pressure were used. The infant suffered injury to her brachial plexus, resulting in paralysis of the brachial plexus, shoulder, and upper arm on the right side. The child now receives physical therapy for her injury, which has caused her to be left-side dominant.

Patient’s claim The delivering physician used excessive pressure. Shoulder dystocia should have been expected because of the large fetal size.

Doctor’s defense The physician claimed that he had handled the dystocia properly and avoided possible brain damage. He also argued that the shoulder dystocia could not have been predicted. The brachial plexus injury was caused by the natural forces of labor, which were especially pronounced because the mother weighed 350 pounds.

Verdict Pennsylvania defense verdict.

Severe retardation after troubled delivery

A woman pregnant with her third child presented at a hospital in the early stages of labor. Her second child had been delivered by cesarean section. The morning after her admission, a physician noted that the pregnancy was at term and characterized by a failed trial of labor and cephalopelvic disproportion. He recommended that the woman undergo cesarean section due to failure to progress. Fetal heart tracings were within normal limits.

The woman was given general anesthesia and underwent a nonemergency cesarean section, during which uterine dehiscence was found. The child was pale, floppy, and bradycardic, lacked respiration, and had an initial Apgar score of 1.

Patient’s claim A first-year resident not fully trained in obstetrics observed repetitive decelerations on the fetal heart tracings. An emergency cesarean section should have been performed more than 2 hours before the actual delivery because of nonreassuring fetal monitor strips and evidence of uterine rupture. The child suffered hypoxic–ischemic encephalopathy, resulting in brain damage and severe mental retardation.

Doctor’s defense The doctor maintained that he had seen the child’s head during delivery, with no myometrial membranes covering it, and had used a catheter to suction the infant to prevent aspiration of meconium. The child was depressed at birth due to the anesthesia administered to the mother, but recovered and had a normal Apgar of 7 at 5 minutes after meconium was suctioned from the airway.

The physician also argued that the infant had a normal neonatal course and was moved to a regular nursery, where he thrived. He did not suffer hypoxia, multiple organ failure, or seizures during the neonatal period. Febrile seizures at 21 months resulted from a seizure disorder not related to an injury at birth.

Verdict $300,000 Illinois verdict against the physician; $4 million settlement with the hospital.

Did delay in diagnosis alter cancer outcome?

After finding a lump in her breast, a 28-year-old woman went to her ObGyn, who ordered a biopsy but did not obtain the biopsy results or follow up. Four months later, the woman consulted a second physician and was diagnosed with breast cancer. She underwent lumpectomy, chemotherapy, and radiation.

Patient’s claim Her cancer diagnosis was delayed because of the inaction of the first ObGyn, decreasing her chances of survival from 80% to 40%.

Doctor’s defense He was not negligent. Also, the delay did not significantly alter the outcome.

Verdict $750,000 Georgia verdict.

Hysterectomy results in vesicovaginal fistula

After a total abdominal hysterectomy and bilateral salpingo-oophorectomy, a woman in her late 30s experienced 3 weeks of “nonstop” urination and leakage. She was diagnosed with a vesicovaginal fistula and referred to a urologist, who confirmed the fistula by cystography. Her incontinence continued.

During open surgical repair 3 months after the hysterectomy, a suprapubic catheter was placed in the patient’s bladder and a Foley catheter in her urethra. The catheters were removed a few weeks later.

Following surgery, the patient experienced urinary tract infections, bladder infections, and incontinence. A cystogram revealed a vesicovaginal fistula from the middle area of the bladder into the vagina. A second Foley catheter was inserted. Four months later, surgery to repair the fistula and lysis of adhesions was mostly successful.

Patient’s claim A laceration that occurred during the hysterectomy led to a vesicovaginal fistula. Also, despite the apparent success of the final surgery, she continues to suffer urinary urgency, frequency, and pain.

Doctor’s defense Not reported.

Verdict $525,000 settlement, paid by the physician’s insurer and his practice.

Baby’s death in infancy blamed on difficult birth

A woman who was receiving prenatal care from a family medicine practice had a positive 1-hour glucose test, but never took the 3-hour glucose test. She later went into preterm labor and delivered a child vaginally at 34 to 36 weeks’ gestation. Shoulder dystocia occurred during delivery and a nuchal cord was present. An attempt to reduce the cord failed, and it was clamped and divided. Although the child was born depressed, he was resuscitated successfully. He later was diagnosed with hypoxic–ischemic encephalopathy. His neurological status degenerated, and he died at 3 months.

Patient’s claim Negligence occurred in several areas: failure to order a 3-hour glucose test; failure to refer the patient to an OB; failure to order a tocolytic to stop premature labor; and use of too much force to reduce the nuchal cord.

Doctor’s defense An OB consult was not required as this pregnancy was not high-risk; tocolytic treatment was not indicated; and a problem with the cord integrity caused its rupture, not excessive force. Also, a sonogram on the first day of life showed periventricular leukomalacia, indicating that a hypoxic event had occurred in utero and caused the hypoxic–ischemic encephalopathy.

Verdict Illinois defense verdict.

Did the forces of labor cause Erb’s palsy?

During a delivery marked by shoulder dystocia, the McRoberts maneuver and suprapubic pressure were used. The infant suffered injury to her brachial plexus, resulting in paralysis of the brachial plexus, shoulder, and upper arm on the right side. The child now receives physical therapy for her injury, which has caused her to be left-side dominant.

Patient’s claim The delivering physician used excessive pressure. Shoulder dystocia should have been expected because of the large fetal size.

Doctor’s defense The physician claimed that he had handled the dystocia properly and avoided possible brain damage. He also argued that the shoulder dystocia could not have been predicted. The brachial plexus injury was caused by the natural forces of labor, which were especially pronounced because the mother weighed 350 pounds.

Verdict Pennsylvania defense verdict.

Severe retardation after troubled delivery

A woman pregnant with her third child presented at a hospital in the early stages of labor. Her second child had been delivered by cesarean section. The morning after her admission, a physician noted that the pregnancy was at term and characterized by a failed trial of labor and cephalopelvic disproportion. He recommended that the woman undergo cesarean section due to failure to progress. Fetal heart tracings were within normal limits.

The woman was given general anesthesia and underwent a nonemergency cesarean section, during which uterine dehiscence was found. The child was pale, floppy, and bradycardic, lacked respiration, and had an initial Apgar score of 1.

Patient’s claim A first-year resident not fully trained in obstetrics observed repetitive decelerations on the fetal heart tracings. An emergency cesarean section should have been performed more than 2 hours before the actual delivery because of nonreassuring fetal monitor strips and evidence of uterine rupture. The child suffered hypoxic–ischemic encephalopathy, resulting in brain damage and severe mental retardation.

Doctor’s defense The doctor maintained that he had seen the child’s head during delivery, with no myometrial membranes covering it, and had used a catheter to suction the infant to prevent aspiration of meconium. The child was depressed at birth due to the anesthesia administered to the mother, but recovered and had a normal Apgar of 7 at 5 minutes after meconium was suctioned from the airway.

The physician also argued that the infant had a normal neonatal course and was moved to a regular nursery, where he thrived. He did not suffer hypoxia, multiple organ failure, or seizures during the neonatal period. Febrile seizures at 21 months resulted from a seizure disorder not related to an injury at birth.

Verdict $300,000 Illinois verdict against the physician; $4 million settlement with the hospital.

Did delay in diagnosis alter cancer outcome?

After finding a lump in her breast, a 28-year-old woman went to her ObGyn, who ordered a biopsy but did not obtain the biopsy results or follow up. Four months later, the woman consulted a second physician and was diagnosed with breast cancer. She underwent lumpectomy, chemotherapy, and radiation.

Patient’s claim Her cancer diagnosis was delayed because of the inaction of the first ObGyn, decreasing her chances of survival from 80% to 40%.

Doctor’s defense He was not negligent. Also, the delay did not significantly alter the outcome.

Verdict $750,000 Georgia verdict.

Hysterectomy results in vesicovaginal fistula

After a total abdominal hysterectomy and bilateral salpingo-oophorectomy, a woman in her late 30s experienced 3 weeks of “nonstop” urination and leakage. She was diagnosed with a vesicovaginal fistula and referred to a urologist, who confirmed the fistula by cystography. Her incontinence continued.

During open surgical repair 3 months after the hysterectomy, a suprapubic catheter was placed in the patient’s bladder and a Foley catheter in her urethra. The catheters were removed a few weeks later.

Following surgery, the patient experienced urinary tract infections, bladder infections, and incontinence. A cystogram revealed a vesicovaginal fistula from the middle area of the bladder into the vagina. A second Foley catheter was inserted. Four months later, surgery to repair the fistula and lysis of adhesions was mostly successful.

Patient’s claim A laceration that occurred during the hysterectomy led to a vesicovaginal fistula. Also, despite the apparent success of the final surgery, she continues to suffer urinary urgency, frequency, and pain.

Doctor’s defense Not reported.

Verdict $525,000 settlement, paid by the physician’s insurer and his practice.

Could cerclage have saved her pregnancy?

A woman who had received prenatal care from an ObGyn gave birth to a baby boy at 19 weeks’ gestation, but he died 2 hours later.

Patient’s claim An earlier pregnancy had ended with fetal loss before 20 weeks due to an incompetent cervix, so this pregnancy should have been watched especially carefully. Also, a cervical cerclage should have been used.

Doctor’s defense At first, the ObGyn claimed there could be no death case because the infant was nonviable. When the court denied a motion to dismiss, the ObGyn claimed the care given to the patient was proper and had no impact on the outcome.

Verdict Tennessee defense verdict. The court had denied a motion to dismiss, finding the baby was viable when he was born, no matter what his life expectancy.

Hysterectomy removes “missing” embryo

A 34-year-old woman went to a hospital where she was diagnosed with a life-threatening cervical ectopic pregnancy. After transfer to a second hospital, a physician tried to remove the embryo, but was unable to find it. He assumed that the remnants of the pregnancy had been passed, and sent his report to the patient’s private gynecologist. During a visit to her gynecologist a month later, the woman reported cramps and pain in the abdomen and was sent to the hospital. The ectopic pregnancy was found, and the embryo was removed by performing an emergency hysterectomy.

Patient’s claim The hysterectomy could have been avoided if the embryo had been removed sooner.

Doctor’s defense The patient’s gynecologist should have investigated the findings of the state’s doctor more quickly.

Verdict $750,000 New York settlement.

Hernia after laparoscopic hysterectomy

After a 47-year-old woman underwent a laparoscopic-assisted vaginal hysterectomy, she suffered a hernia and other complications that required three more surgeries. Only the case against the assistant surgeon in the case went to trial.

Patient’s claim The defendants failed to close the portal created during the surgery.

Doctor’s defense There was no negligence, and the opening was properly sutured.

Verdict New York defense verdict. Post-trial motions were pending.

Patient dies after bowel injury

A 58-year-old woman underwent an uneventful laparoscopic hysterectomy and was sent home a few hours later. On each of the next 2 days, she called her ObGyn to report nausea and was prescribed pain medications. When her condition worsened on the second evening, she was sent to the emergency room and then transferred to another hospital. When her condition was unchanged over the next 3 days, an exploratory laparotomy was performed following a surgical consult. transection of the small bowel showed free spillage and necrosis. One month later, the patient died of multiple organ failure secondary to sepsis.

Patient’s claim The defendants were negligent for failing to diagnose the bowel injury sooner.

Doctor’s defense The patient did not show signs of a bowel injury and had sustained torsion injury to her bowel. Also, earlier intervention would have resulted in the same outcome.

Verdict Kentucky defense verdict.

Could cerclage have saved her pregnancy?

A woman who had received prenatal care from an ObGyn gave birth to a baby boy at 19 weeks’ gestation, but he died 2 hours later.

Patient’s claim An earlier pregnancy had ended with fetal loss before 20 weeks due to an incompetent cervix, so this pregnancy should have been watched especially carefully. Also, a cervical cerclage should have been used.

Doctor’s defense At first, the ObGyn claimed there could be no death case because the infant was nonviable. When the court denied a motion to dismiss, the ObGyn claimed the care given to the patient was proper and had no impact on the outcome.

Verdict Tennessee defense verdict. The court had denied a motion to dismiss, finding the baby was viable when he was born, no matter what his life expectancy.

Hysterectomy removes “missing” embryo

A 34-year-old woman went to a hospital where she was diagnosed with a life-threatening cervical ectopic pregnancy. After transfer to a second hospital, a physician tried to remove the embryo, but was unable to find it. He assumed that the remnants of the pregnancy had been passed, and sent his report to the patient’s private gynecologist. During a visit to her gynecologist a month later, the woman reported cramps and pain in the abdomen and was sent to the hospital. The ectopic pregnancy was found, and the embryo was removed by performing an emergency hysterectomy.

Patient’s claim The hysterectomy could have been avoided if the embryo had been removed sooner.

Doctor’s defense The patient’s gynecologist should have investigated the findings of the state’s doctor more quickly.

Verdict $750,000 New York settlement.

Hernia after laparoscopic hysterectomy

After a 47-year-old woman underwent a laparoscopic-assisted vaginal hysterectomy, she suffered a hernia and other complications that required three more surgeries. Only the case against the assistant surgeon in the case went to trial.

Patient’s claim The defendants failed to close the portal created during the surgery.

Doctor’s defense There was no negligence, and the opening was properly sutured.

Verdict New York defense verdict. Post-trial motions were pending.

Patient dies after bowel injury

A 58-year-old woman underwent an uneventful laparoscopic hysterectomy and was sent home a few hours later. On each of the next 2 days, she called her ObGyn to report nausea and was prescribed pain medications. When her condition worsened on the second evening, she was sent to the emergency room and then transferred to another hospital. When her condition was unchanged over the next 3 days, an exploratory laparotomy was performed following a surgical consult. transection of the small bowel showed free spillage and necrosis. One month later, the patient died of multiple organ failure secondary to sepsis.

Patient’s claim The defendants were negligent for failing to diagnose the bowel injury sooner.

Doctor’s defense The patient did not show signs of a bowel injury and had sustained torsion injury to her bowel. Also, earlier intervention would have resulted in the same outcome.

Verdict Kentucky defense verdict.

Could cerclage have saved her pregnancy?

A woman who had received prenatal care from an ObGyn gave birth to a baby boy at 19 weeks’ gestation, but he died 2 hours later.

Patient’s claim An earlier pregnancy had ended with fetal loss before 20 weeks due to an incompetent cervix, so this pregnancy should have been watched especially carefully. Also, a cervical cerclage should have been used.

Doctor’s defense At first, the ObGyn claimed there could be no death case because the infant was nonviable. When the court denied a motion to dismiss, the ObGyn claimed the care given to the patient was proper and had no impact on the outcome.

Verdict Tennessee defense verdict. The court had denied a motion to dismiss, finding the baby was viable when he was born, no matter what his life expectancy.

Hysterectomy removes “missing” embryo

A 34-year-old woman went to a hospital where she was diagnosed with a life-threatening cervical ectopic pregnancy. After transfer to a second hospital, a physician tried to remove the embryo, but was unable to find it. He assumed that the remnants of the pregnancy had been passed, and sent his report to the patient’s private gynecologist. During a visit to her gynecologist a month later, the woman reported cramps and pain in the abdomen and was sent to the hospital. The ectopic pregnancy was found, and the embryo was removed by performing an emergency hysterectomy.

Patient’s claim The hysterectomy could have been avoided if the embryo had been removed sooner.

Doctor’s defense The patient’s gynecologist should have investigated the findings of the state’s doctor more quickly.

Verdict $750,000 New York settlement.

Hernia after laparoscopic hysterectomy

After a 47-year-old woman underwent a laparoscopic-assisted vaginal hysterectomy, she suffered a hernia and other complications that required three more surgeries. Only the case against the assistant surgeon in the case went to trial.

Patient’s claim The defendants failed to close the portal created during the surgery.

Doctor’s defense There was no negligence, and the opening was properly sutured.

Verdict New York defense verdict. Post-trial motions were pending.

Patient dies after bowel injury

A 58-year-old woman underwent an uneventful laparoscopic hysterectomy and was sent home a few hours later. On each of the next 2 days, she called her ObGyn to report nausea and was prescribed pain medications. When her condition worsened on the second evening, she was sent to the emergency room and then transferred to another hospital. When her condition was unchanged over the next 3 days, an exploratory laparotomy was performed following a surgical consult. transection of the small bowel showed free spillage and necrosis. One month later, the patient died of multiple organ failure secondary to sepsis.

Patient’s claim The defendants were negligent for failing to diagnose the bowel injury sooner.

Doctor’s defense The patient did not show signs of a bowel injury and had sustained torsion injury to her bowel. Also, earlier intervention would have resulted in the same outcome.

Verdict Kentucky defense verdict.

No mammogram despite family history

A 36-year-old woman with a family history of breast cancer, fibrocystic breast disease, and galactorrhea had been a patient of the defendant for 5 years. During this time, he had examined her regularly but did not recommend a mammogram. When she finally requested a mammogram, he ordered it. Cancer was indicated by the study, and she was diagnosed with stage IV breast cancer.

Patient’s claim The defendant was negligent for not ordering mammograms sooner.

Doctor’s defense A mammogram has no medical benefit for a 36-year-old, and he had acted properly.

Verdict A $1.25 million New York settlement.

Mother leaves bed, child has brain damage

An obstetric patient at an osteopathic hospital was treated mainly by resident physicians during her pregnancy. Because of mild preeclampsia, she presented for labor induction 1 to 2 weeks before her due date. Her labor was managed by a senior resident according to the protocol for an obstetric clinic patient, but the assigned attending physician never saw or examined her. During labor, variable fetal heart decelerations developed due to cord compression, and became more severe, but the fetus recovered when the mother was repositioned.

The fetal heart monitor was disconnected for 10 minutes to allow the mother to get out of bed to use the bathroom. Following this, reinstitution of fetal monitoring demonstrated a nonreassuring fetal tracing, and the patient had an emergency cesarean section. The cesarean section took 14 minutes to perform. The child suffered severe brain damage. The long-term effects include profound mental retardation, spastic quadriplegia, cerebral palsy, and the need for tube feeding.

Patient’s claim (1) She had a dysfunctional labor pattern because her cervix was not dilating. (2) The option of a cesarean section should have been presented to her. (3) While the monitor was disconnected, the fetus moved, causing cord compression and fetal distress. (4) She should have been catheterized instead of being allowed to leave her bed and go to the bathroom.

Doctor’s defense (1) The patient showed normal labor progress. (2) The fetal monitor indicated good variability and repeated fetal heart rate accelerations, so it was proper to allow the patient to go to the bathroom. (3) A rare type of umbilical cord accident caused the brain damage.

Verdict $15.4 million Michigan verdict against the hospital only.

Can CVS identify Down syndrome in twins?

A 38-year-old woman was pregnant with twins. Because of her age, she was at a higher risk of giving birth to a Down syndrome baby. When her physicians recommended amniocentesis at 16 to 18 weeks’ gestation to test for Down syndrome, she declined because she believed this was too late for her to have an abortion if the test was positive. When a blood screening test at 21 weeks’ gestation indicated an increased risk of fetal Down syndrome, she again declined amniocentesis because she could not end the pregnancy at this late date. When the twins were born, both had Down syndrome.

Patient’s claim The physicians were negligent for failing to inform her of chorionic villus sampling at 11 weeks’ gestation, which could have identified Down syndrome. If she had known, she would have had the test done and then terminated her pregnancy when Down syndrome was found.

Doctor’s defense Their care of the patient was reasonable and proper. The testing they offered was the standard of care. Also, chorionic villus sampling would not have identified Down syndrome. Even if the patient had been informed earlier in the pregnancy, she would not have had an abortion.

Verdict $4 million Virginia verdict.

Did septum in uterus cause fetal loss?

A woman in her 20s was pregnant for the fourth time. Her three previous pregnancies had miscarried—one in the early weeks of pregnancy, and two in the second trimester.

The physician group that was caring for her considered the possibility of an incompetent cervix and requested—but never received—her prior medical records. Because she went into labor and her membranes ruptured before her cervix dilated, her physicians concluded that the miscarriages were inconsistent with an incompetent cervix. She underwent regular ultrasonography during the fourth pregnancy, which progressed normally.

In week 20, she reported a vaginal discharge and was sent to the hospital, where nothing abnormal was found. She was discharged home that day, but returned the following day with a dilated cervix and membranes protruding into the vagina. The fetus died in utero, and her physicians noted that she was a candidate for a cerclage in the future. During litigation, the release of the patient’s subsequent medical records was ordered. She was found to have a septum inside her uterus, causing the uterus to be much smaller than normal.

Patient’s claim A cerclage should have been performed, and the septum should have been found and treated. Even with the septum, she could carry a child to term.

Doctor’s defense A cerclage was not a risk-free procedure, and there were no clear signs of an incompetent cervix. The septum made the uterus too small for a pregnancy to be carried to term. Also the septum could not be diagnosed while the woman was still pregnant.

Verdict Michigan defense verdict.

Hysterectomy, then hematuria, then stroke

Following an abdominal hysterectomy, the urine of a 53-year-old patient was found to be bloody, and then she suffered a stroke. After tests were performed, a laceration of the bladder’s dome and posterior wall was repaired in follow-up surgery.

Patient’s claim The laceration occurred during the hysterectomy. She suffered a stroke as a result of blood loss from that injury. She has residual impairment of attention, memory, and vision. There was negligence in performing the surgery and for failing to diagnose and treat the laceration in a timely manner.

Doctor’s defense The laceration happened during the repair surgery—or else a small laceration was made larger by the postoperative diagnostic imaging studies. Also, bleeding, lacerations, and punctures are known risks of abdominal hysterectomy.

Verdict $400,000 New York settlement with the surgeon. The claims against the assisting physician and the hospital were discontinued.

No mammogram despite family history

A 36-year-old woman with a family history of breast cancer, fibrocystic breast disease, and galactorrhea had been a patient of the defendant for 5 years. During this time, he had examined her regularly but did not recommend a mammogram. When she finally requested a mammogram, he ordered it. Cancer was indicated by the study, and she was diagnosed with stage IV breast cancer.

Patient’s claim The defendant was negligent for not ordering mammograms sooner.

Doctor’s defense A mammogram has no medical benefit for a 36-year-old, and he had acted properly.

Verdict A $1.25 million New York settlement.

Mother leaves bed, child has brain damage

An obstetric patient at an osteopathic hospital was treated mainly by resident physicians during her pregnancy. Because of mild preeclampsia, she presented for labor induction 1 to 2 weeks before her due date. Her labor was managed by a senior resident according to the protocol for an obstetric clinic patient, but the assigned attending physician never saw or examined her. During labor, variable fetal heart decelerations developed due to cord compression, and became more severe, but the fetus recovered when the mother was repositioned.

The fetal heart monitor was disconnected for 10 minutes to allow the mother to get out of bed to use the bathroom. Following this, reinstitution of fetal monitoring demonstrated a nonreassuring fetal tracing, and the patient had an emergency cesarean section. The cesarean section took 14 minutes to perform. The child suffered severe brain damage. The long-term effects include profound mental retardation, spastic quadriplegia, cerebral palsy, and the need for tube feeding.

Patient’s claim (1) She had a dysfunctional labor pattern because her cervix was not dilating. (2) The option of a cesarean section should have been presented to her. (3) While the monitor was disconnected, the fetus moved, causing cord compression and fetal distress. (4) She should have been catheterized instead of being allowed to leave her bed and go to the bathroom.

Doctor’s defense (1) The patient showed normal labor progress. (2) The fetal monitor indicated good variability and repeated fetal heart rate accelerations, so it was proper to allow the patient to go to the bathroom. (3) A rare type of umbilical cord accident caused the brain damage.

Verdict $15.4 million Michigan verdict against the hospital only.

Can CVS identify Down syndrome in twins?

A 38-year-old woman was pregnant with twins. Because of her age, she was at a higher risk of giving birth to a Down syndrome baby. When her physicians recommended amniocentesis at 16 to 18 weeks’ gestation to test for Down syndrome, she declined because she believed this was too late for her to have an abortion if the test was positive. When a blood screening test at 21 weeks’ gestation indicated an increased risk of fetal Down syndrome, she again declined amniocentesis because she could not end the pregnancy at this late date. When the twins were born, both had Down syndrome.

Patient’s claim The physicians were negligent for failing to inform her of chorionic villus sampling at 11 weeks’ gestation, which could have identified Down syndrome. If she had known, she would have had the test done and then terminated her pregnancy when Down syndrome was found.

Doctor’s defense Their care of the patient was reasonable and proper. The testing they offered was the standard of care. Also, chorionic villus sampling would not have identified Down syndrome. Even if the patient had been informed earlier in the pregnancy, she would not have had an abortion.

Verdict $4 million Virginia verdict.

Did septum in uterus cause fetal loss?

A woman in her 20s was pregnant for the fourth time. Her three previous pregnancies had miscarried—one in the early weeks of pregnancy, and two in the second trimester.

The physician group that was caring for her considered the possibility of an incompetent cervix and requested—but never received—her prior medical records. Because she went into labor and her membranes ruptured before her cervix dilated, her physicians concluded that the miscarriages were inconsistent with an incompetent cervix. She underwent regular ultrasonography during the fourth pregnancy, which progressed normally.

In week 20, she reported a vaginal discharge and was sent to the hospital, where nothing abnormal was found. She was discharged home that day, but returned the following day with a dilated cervix and membranes protruding into the vagina. The fetus died in utero, and her physicians noted that she was a candidate for a cerclage in the future. During litigation, the release of the patient’s subsequent medical records was ordered. She was found to have a septum inside her uterus, causing the uterus to be much smaller than normal.

Patient’s claim A cerclage should have been performed, and the septum should have been found and treated. Even with the septum, she could carry a child to term.

Doctor’s defense A cerclage was not a risk-free procedure, and there were no clear signs of an incompetent cervix. The septum made the uterus too small for a pregnancy to be carried to term. Also the septum could not be diagnosed while the woman was still pregnant.

Verdict Michigan defense verdict.

Hysterectomy, then hematuria, then stroke

Following an abdominal hysterectomy, the urine of a 53-year-old patient was found to be bloody, and then she suffered a stroke. After tests were performed, a laceration of the bladder’s dome and posterior wall was repaired in follow-up surgery.

Patient’s claim The laceration occurred during the hysterectomy. She suffered a stroke as a result of blood loss from that injury. She has residual impairment of attention, memory, and vision. There was negligence in performing the surgery and for failing to diagnose and treat the laceration in a timely manner.

Doctor’s defense The laceration happened during the repair surgery—or else a small laceration was made larger by the postoperative diagnostic imaging studies. Also, bleeding, lacerations, and punctures are known risks of abdominal hysterectomy.

Verdict $400,000 New York settlement with the surgeon. The claims against the assisting physician and the hospital were discontinued.

No mammogram despite family history

A 36-year-old woman with a family history of breast cancer, fibrocystic breast disease, and galactorrhea had been a patient of the defendant for 5 years. During this time, he had examined her regularly but did not recommend a mammogram. When she finally requested a mammogram, he ordered it. Cancer was indicated by the study, and she was diagnosed with stage IV breast cancer.

Patient’s claim The defendant was negligent for not ordering mammograms sooner.

Doctor’s defense A mammogram has no medical benefit for a 36-year-old, and he had acted properly.

Verdict A $1.25 million New York settlement.

Mother leaves bed, child has brain damage

An obstetric patient at an osteopathic hospital was treated mainly by resident physicians during her pregnancy. Because of mild preeclampsia, she presented for labor induction 1 to 2 weeks before her due date. Her labor was managed by a senior resident according to the protocol for an obstetric clinic patient, but the assigned attending physician never saw or examined her. During labor, variable fetal heart decelerations developed due to cord compression, and became more severe, but the fetus recovered when the mother was repositioned.

The fetal heart monitor was disconnected for 10 minutes to allow the mother to get out of bed to use the bathroom. Following this, reinstitution of fetal monitoring demonstrated a nonreassuring fetal tracing, and the patient had an emergency cesarean section. The cesarean section took 14 minutes to perform. The child suffered severe brain damage. The long-term effects include profound mental retardation, spastic quadriplegia, cerebral palsy, and the need for tube feeding.

Patient’s claim (1) She had a dysfunctional labor pattern because her cervix was not dilating. (2) The option of a cesarean section should have been presented to her. (3) While the monitor was disconnected, the fetus moved, causing cord compression and fetal distress. (4) She should have been catheterized instead of being allowed to leave her bed and go to the bathroom.

Doctor’s defense (1) The patient showed normal labor progress. (2) The fetal monitor indicated good variability and repeated fetal heart rate accelerations, so it was proper to allow the patient to go to the bathroom. (3) A rare type of umbilical cord accident caused the brain damage.

Verdict $15.4 million Michigan verdict against the hospital only.

Can CVS identify Down syndrome in twins?

A 38-year-old woman was pregnant with twins. Because of her age, she was at a higher risk of giving birth to a Down syndrome baby. When her physicians recommended amniocentesis at 16 to 18 weeks’ gestation to test for Down syndrome, she declined because she believed this was too late for her to have an abortion if the test was positive. When a blood screening test at 21 weeks’ gestation indicated an increased risk of fetal Down syndrome, she again declined amniocentesis because she could not end the pregnancy at this late date. When the twins were born, both had Down syndrome.

Patient’s claim The physicians were negligent for failing to inform her of chorionic villus sampling at 11 weeks’ gestation, which could have identified Down syndrome. If she had known, she would have had the test done and then terminated her pregnancy when Down syndrome was found.

Doctor’s defense Their care of the patient was reasonable and proper. The testing they offered was the standard of care. Also, chorionic villus sampling would not have identified Down syndrome. Even if the patient had been informed earlier in the pregnancy, she would not have had an abortion.

Verdict $4 million Virginia verdict.

Did septum in uterus cause fetal loss?

A woman in her 20s was pregnant for the fourth time. Her three previous pregnancies had miscarried—one in the early weeks of pregnancy, and two in the second trimester.

The physician group that was caring for her considered the possibility of an incompetent cervix and requested—but never received—her prior medical records. Because she went into labor and her membranes ruptured before her cervix dilated, her physicians concluded that the miscarriages were inconsistent with an incompetent cervix. She underwent regular ultrasonography during the fourth pregnancy, which progressed normally.

In week 20, she reported a vaginal discharge and was sent to the hospital, where nothing abnormal was found. She was discharged home that day, but returned the following day with a dilated cervix and membranes protruding into the vagina. The fetus died in utero, and her physicians noted that she was a candidate for a cerclage in the future. During litigation, the release of the patient’s subsequent medical records was ordered. She was found to have a septum inside her uterus, causing the uterus to be much smaller than normal.

Patient’s claim A cerclage should have been performed, and the septum should have been found and treated. Even with the septum, she could carry a child to term.

Doctor’s defense A cerclage was not a risk-free procedure, and there were no clear signs of an incompetent cervix. The septum made the uterus too small for a pregnancy to be carried to term. Also the septum could not be diagnosed while the woman was still pregnant.

Verdict Michigan defense verdict.

Hysterectomy, then hematuria, then stroke

Following an abdominal hysterectomy, the urine of a 53-year-old patient was found to be bloody, and then she suffered a stroke. After tests were performed, a laceration of the bladder’s dome and posterior wall was repaired in follow-up surgery.

Patient’s claim The laceration occurred during the hysterectomy. She suffered a stroke as a result of blood loss from that injury. She has residual impairment of attention, memory, and vision. There was negligence in performing the surgery and for failing to diagnose and treat the laceration in a timely manner.

Doctor’s defense The laceration happened during the repair surgery—or else a small laceration was made larger by the postoperative diagnostic imaging studies. Also, bleeding, lacerations, and punctures are known risks of abdominal hysterectomy.

Verdict $400,000 New York settlement with the surgeon. The claims against the assisting physician and the hospital were discontinued.