Medical Verdicts

MD fails to check for metastasis of Ca

A woman in her late 50s underwent a total abdominal hysterectomy performed by a gynecologist. The postoperative pathology report indicated cancer. The initial tests showed endometrioid adenocarcinoma, and later tests indicated uterine papillary serous carcinoma (UPSC), a rare and aggressive cancer. The woman returned to the gynecologist twice a year for physical exams, as instructed. A year and a half after the surgery, she went to her family physician complaining of stomach, shoulder, and chest pains. Lesions on her diaphragm, liver, and abdomen, consistent with metastatic disease, were evident on a CT scan. Eventually, the patient died.

Patient’s claim The postoperative pathology report showed two different cancers, but the gynecologist did not inform her of the UPSC. She should have been referred to an oncologist so that she could have been given chemotherapy and had a chance for a prolonged life.

Doctor’s defense He did inform the patient about the UPSC, but she chose not to undergo chemotherapy. At the time, there was no standard of care for UPSC, and when she was healthy for several years, he chose not to check for metastasis of the cancer.

Verdict $575,000 Pennsylvania verdict.

Profound neurologic damage to one triplet

A 48-year-old woman pregnant carrying triplets—conceived through in vitro fertilization—was admitted to the hospital for preterm labor at 20 weeks’ gestation. She was given a diagnosis of insulin-dependent gestational diabetes and sent home. At 31 weeks, she was readmitted for preterm labor and was given magnesium sulfate. After 3 weeks in the hospital, she was moved to labor and delivery when a low heart rate was detected in one fetus. One nurse cared for the mother for several hours, during which late decelerations in the fetal heart pattern were evident. The nurse notified the other defendants, but there was allegedly a delay in responding. When a cesarean section was performed, one of the three babies was born with profound neurologic damage. Diagnosed with spastic diplegia, he cannot walk or stand without help; cannot speak or communicate effectively; and has low vision. He requires physical, occupational, and speech therapy.

Patient’s claim A delay in performing the cesarean section caused the one baby’s neurologic damage.

Doctor’s defense Not reported.

Verdict $4.2 million Massachusetts settlement.

“Stay home,” despite reports of problems

When a woman at 35 weeks’ gestation presented to her physician with signs consistent with premature labor, she was sent home. Later that day she was advised to go to the hospital, where tests conducted over a 72-hour period indicated premature labor and a healthy, viable fetus. Steroids were administered to increase lung maturity. Then the woman was instructed to monitor herself for increased frequency of contractions, decreased fetal movement, or leakage of fluid, and sent home. After 4 days, she reported significantly decreased fetal movement, but was advised to continue monitoring at home. After 2 more days, she reported leakage of fluid, but was again told to stay at home. One week later, she noted no fetal movement. Fetal death was confirmed at the hospital, and the fetus was delivered later that day.

Patient’s claim A nuchal cord led to fetal death. She should have been admitted for monitoring or delivery when she reported decreased fetal movement and fluid leakage.

Doctor’s defense The nuchal cord was an unforeseeable complication.

Verdict $2.5 million Ohio verdict.

Resident asks for help too late in birth

Dr. A, a first-year family practice resident, provided prenatal care to a woman pregnant with her first child; Dr. B was the attending physician. The pregnancy had no serious complications, but the woman had mildly elevated blood pressure and discomfort at the end of the pregnancy. She requested an elective cesarean section several times, but Dr. A declined the request and consulted with neither an OB nor Dr. B. When she noted decreased fetal movement, a fetal non-stress test was done and was nonreactive. A low level of amniotic fluid and low fetal tone were confirmed. The woman was hospitalized and administered oxytocin to stimulate uterine contractions. Intermittent decelerations and diminished variability were evident in the fetal heart rate, but a cesarean section was not discussed. She progressed to active labor. Dr. B was on his way to the hospital as requested by Dr. A, but Dr. A—who had limited obstetrical experience—did not seek the aid of any other physician. He failed to interpret the fetal monitor strip correctly, and the labor and delivery nurse neglected to call a more experienced physician—although one was available. Just prior to delivery the fetal heart rate was not monitored for 20 minutes. At delivery, a nuchal cord was detected, then clamped and cut by Dr. A. The chief resident was called in and completed delivery in 2 minutes. The child was born blue and lifeless. A full neonatal resuscitation team was unavailable, and intubation was performed after 4 minutes. Dr. B arrived 5 minutes after delivery. The child suffered catastrophic brain damage due to hypoxic–ischemic encephalopathy.

Patient’s claim The brain damage occurred just before delivery.

Doctor’s defense Not reported.

Verdict $3.2 million Washington settlement.

MD fails to check for metastasis of Ca

A woman in her late 50s underwent a total abdominal hysterectomy performed by a gynecologist. The postoperative pathology report indicated cancer. The initial tests showed endometrioid adenocarcinoma, and later tests indicated uterine papillary serous carcinoma (UPSC), a rare and aggressive cancer. The woman returned to the gynecologist twice a year for physical exams, as instructed. A year and a half after the surgery, she went to her family physician complaining of stomach, shoulder, and chest pains. Lesions on her diaphragm, liver, and abdomen, consistent with metastatic disease, were evident on a CT scan. Eventually, the patient died.

Patient’s claim The postoperative pathology report showed two different cancers, but the gynecologist did not inform her of the UPSC. She should have been referred to an oncologist so that she could have been given chemotherapy and had a chance for a prolonged life.

Doctor’s defense He did inform the patient about the UPSC, but she chose not to undergo chemotherapy. At the time, there was no standard of care for UPSC, and when she was healthy for several years, he chose not to check for metastasis of the cancer.

Verdict $575,000 Pennsylvania verdict.

Profound neurologic damage to one triplet

A 48-year-old woman pregnant carrying triplets—conceived through in vitro fertilization—was admitted to the hospital for preterm labor at 20 weeks’ gestation. She was given a diagnosis of insulin-dependent gestational diabetes and sent home. At 31 weeks, she was readmitted for preterm labor and was given magnesium sulfate. After 3 weeks in the hospital, she was moved to labor and delivery when a low heart rate was detected in one fetus. One nurse cared for the mother for several hours, during which late decelerations in the fetal heart pattern were evident. The nurse notified the other defendants, but there was allegedly a delay in responding. When a cesarean section was performed, one of the three babies was born with profound neurologic damage. Diagnosed with spastic diplegia, he cannot walk or stand without help; cannot speak or communicate effectively; and has low vision. He requires physical, occupational, and speech therapy.

Patient’s claim A delay in performing the cesarean section caused the one baby’s neurologic damage.

Doctor’s defense Not reported.

Verdict $4.2 million Massachusetts settlement.

“Stay home,” despite reports of problems

When a woman at 35 weeks’ gestation presented to her physician with signs consistent with premature labor, she was sent home. Later that day she was advised to go to the hospital, where tests conducted over a 72-hour period indicated premature labor and a healthy, viable fetus. Steroids were administered to increase lung maturity. Then the woman was instructed to monitor herself for increased frequency of contractions, decreased fetal movement, or leakage of fluid, and sent home. After 4 days, she reported significantly decreased fetal movement, but was advised to continue monitoring at home. After 2 more days, she reported leakage of fluid, but was again told to stay at home. One week later, she noted no fetal movement. Fetal death was confirmed at the hospital, and the fetus was delivered later that day.

Patient’s claim A nuchal cord led to fetal death. She should have been admitted for monitoring or delivery when she reported decreased fetal movement and fluid leakage.

Doctor’s defense The nuchal cord was an unforeseeable complication.

Verdict $2.5 million Ohio verdict.

Resident asks for help too late in birth

Dr. A, a first-year family practice resident, provided prenatal care to a woman pregnant with her first child; Dr. B was the attending physician. The pregnancy had no serious complications, but the woman had mildly elevated blood pressure and discomfort at the end of the pregnancy. She requested an elective cesarean section several times, but Dr. A declined the request and consulted with neither an OB nor Dr. B. When she noted decreased fetal movement, a fetal non-stress test was done and was nonreactive. A low level of amniotic fluid and low fetal tone were confirmed. The woman was hospitalized and administered oxytocin to stimulate uterine contractions. Intermittent decelerations and diminished variability were evident in the fetal heart rate, but a cesarean section was not discussed. She progressed to active labor. Dr. B was on his way to the hospital as requested by Dr. A, but Dr. A—who had limited obstetrical experience—did not seek the aid of any other physician. He failed to interpret the fetal monitor strip correctly, and the labor and delivery nurse neglected to call a more experienced physician—although one was available. Just prior to delivery the fetal heart rate was not monitored for 20 minutes. At delivery, a nuchal cord was detected, then clamped and cut by Dr. A. The chief resident was called in and completed delivery in 2 minutes. The child was born blue and lifeless. A full neonatal resuscitation team was unavailable, and intubation was performed after 4 minutes. Dr. B arrived 5 minutes after delivery. The child suffered catastrophic brain damage due to hypoxic–ischemic encephalopathy.

Patient’s claim The brain damage occurred just before delivery.

Doctor’s defense Not reported.

Verdict $3.2 million Washington settlement.

MD fails to check for metastasis of Ca

A woman in her late 50s underwent a total abdominal hysterectomy performed by a gynecologist. The postoperative pathology report indicated cancer. The initial tests showed endometrioid adenocarcinoma, and later tests indicated uterine papillary serous carcinoma (UPSC), a rare and aggressive cancer. The woman returned to the gynecologist twice a year for physical exams, as instructed. A year and a half after the surgery, she went to her family physician complaining of stomach, shoulder, and chest pains. Lesions on her diaphragm, liver, and abdomen, consistent with metastatic disease, were evident on a CT scan. Eventually, the patient died.

Patient’s claim The postoperative pathology report showed two different cancers, but the gynecologist did not inform her of the UPSC. She should have been referred to an oncologist so that she could have been given chemotherapy and had a chance for a prolonged life.

Doctor’s defense He did inform the patient about the UPSC, but she chose not to undergo chemotherapy. At the time, there was no standard of care for UPSC, and when she was healthy for several years, he chose not to check for metastasis of the cancer.

Verdict $575,000 Pennsylvania verdict.

Profound neurologic damage to one triplet

A 48-year-old woman pregnant carrying triplets—conceived through in vitro fertilization—was admitted to the hospital for preterm labor at 20 weeks’ gestation. She was given a diagnosis of insulin-dependent gestational diabetes and sent home. At 31 weeks, she was readmitted for preterm labor and was given magnesium sulfate. After 3 weeks in the hospital, she was moved to labor and delivery when a low heart rate was detected in one fetus. One nurse cared for the mother for several hours, during which late decelerations in the fetal heart pattern were evident. The nurse notified the other defendants, but there was allegedly a delay in responding. When a cesarean section was performed, one of the three babies was born with profound neurologic damage. Diagnosed with spastic diplegia, he cannot walk or stand without help; cannot speak or communicate effectively; and has low vision. He requires physical, occupational, and speech therapy.

Patient’s claim A delay in performing the cesarean section caused the one baby’s neurologic damage.

Doctor’s defense Not reported.

Verdict $4.2 million Massachusetts settlement.

“Stay home,” despite reports of problems

When a woman at 35 weeks’ gestation presented to her physician with signs consistent with premature labor, she was sent home. Later that day she was advised to go to the hospital, where tests conducted over a 72-hour period indicated premature labor and a healthy, viable fetus. Steroids were administered to increase lung maturity. Then the woman was instructed to monitor herself for increased frequency of contractions, decreased fetal movement, or leakage of fluid, and sent home. After 4 days, she reported significantly decreased fetal movement, but was advised to continue monitoring at home. After 2 more days, she reported leakage of fluid, but was again told to stay at home. One week later, she noted no fetal movement. Fetal death was confirmed at the hospital, and the fetus was delivered later that day.

Patient’s claim A nuchal cord led to fetal death. She should have been admitted for monitoring or delivery when she reported decreased fetal movement and fluid leakage.

Doctor’s defense The nuchal cord was an unforeseeable complication.

Verdict $2.5 million Ohio verdict.

Resident asks for help too late in birth

Dr. A, a first-year family practice resident, provided prenatal care to a woman pregnant with her first child; Dr. B was the attending physician. The pregnancy had no serious complications, but the woman had mildly elevated blood pressure and discomfort at the end of the pregnancy. She requested an elective cesarean section several times, but Dr. A declined the request and consulted with neither an OB nor Dr. B. When she noted decreased fetal movement, a fetal non-stress test was done and was nonreactive. A low level of amniotic fluid and low fetal tone were confirmed. The woman was hospitalized and administered oxytocin to stimulate uterine contractions. Intermittent decelerations and diminished variability were evident in the fetal heart rate, but a cesarean section was not discussed. She progressed to active labor. Dr. B was on his way to the hospital as requested by Dr. A, but Dr. A—who had limited obstetrical experience—did not seek the aid of any other physician. He failed to interpret the fetal monitor strip correctly, and the labor and delivery nurse neglected to call a more experienced physician—although one was available. Just prior to delivery the fetal heart rate was not monitored for 20 minutes. At delivery, a nuchal cord was detected, then clamped and cut by Dr. A. The chief resident was called in and completed delivery in 2 minutes. The child was born blue and lifeless. A full neonatal resuscitation team was unavailable, and intubation was performed after 4 minutes. Dr. B arrived 5 minutes after delivery. The child suffered catastrophic brain damage due to hypoxic–ischemic encephalopathy.

Patient’s claim The brain damage occurred just before delivery.

Doctor’s defense Not reported.

Verdict $3.2 million Washington settlement.

Did gallstones mask perforated bowel?

A woman complained of intermittent gastric pain for 3 days following her abdominal hysterectomy. She also vomited bilious gastric fluid at one point. She was discharged, but was readmitted 30 hours later. A CT scan showed perforation of the small intestine as well as peritonitis.

Patient’s claim The perforation occurred during surgery, and the physician was negligent for failing to note it then or during the immediate postoperative period.

Doctor’s defense The patient’s symptoms were consistent with gallstones, which she had experienced before, and which ultrasonography confirmed during the recovery period. Also, the injury to the bowel was not detectable during surgery and developed after she was discharged.

Verdict An $860,000 Connecticut verdict was returned: $110,000 for medical expenses, $675,000 for noneconomic damages, and $75,000 for the husband’s loss of consortium.

Severe infection, preterm birth—and CP

An 18-year-old woman presented at the hospital at 28 weeks’ gestation with obvious rupture of membranes. She was diagnosed with chorioamnionitis because her temperature, white blood cell count, and band count were elevated. She was given antibiotics, epidural anesthesia, and acetaminophen as needed. Delivery was imminent, so steroids were not given. A nurse documented that the fetal monitor tracing showed a change in heart pattern that was not reassuring for fetal well-being, and that the physicians were aware of this. Oxygen was administered and an internal scalp electrode was placed. A cesarean section was performed an hour later.

The infant, floppy and dusky with no respiratory effort at delivery, was intubated and transferred to the NICU. The placenta was grossly infected; chorioamnionitis with necrosis of the fetal membrane and group B strep were confirmed. A sonogram of the brain indicated Grade-III hemorrhage. The child developed seizure activity and remained metabolically unstable, and was given a diagnosis of cerebral palsy. He is legally blind and significantly developmentally delayed.

Patient’s claim The child should have been delivered earlier.

Doctor’s defense There was no negligence. Brain damage was due to prematurity.

Verdict $3 million Massachusetts settlement.

For more on ruptured membranes, see “PROM dilemmas: Choosing a strategy, knowing when to call it quits,” by M. Sean Esplin, MD.

Teen’s oophorectomy leads to more surgery

A 16-year-old patient underwent left oophorectomy surgery to remove an ovarian cyst. Postoperatively, intra-abdominal bleeding developed but stopped spontaneously. Because of severe infection and abdominal pain, she was readmitted and intra-abdominal abscesses were drained. She was left with pelvic adhesions and impaired fertility.

Patient’s claim The physician was negligent for failing to control postoperative bleeding and to timely diagnose postoperative infection.

Doctor’s defense Not reported.

Verdict Illinois defense verdict.

Did gallstones mask perforated bowel?

A woman complained of intermittent gastric pain for 3 days following her abdominal hysterectomy. She also vomited bilious gastric fluid at one point. She was discharged, but was readmitted 30 hours later. A CT scan showed perforation of the small intestine as well as peritonitis.

Patient’s claim The perforation occurred during surgery, and the physician was negligent for failing to note it then or during the immediate postoperative period.

Doctor’s defense The patient’s symptoms were consistent with gallstones, which she had experienced before, and which ultrasonography confirmed during the recovery period. Also, the injury to the bowel was not detectable during surgery and developed after she was discharged.

Verdict An $860,000 Connecticut verdict was returned: $110,000 for medical expenses, $675,000 for noneconomic damages, and $75,000 for the husband’s loss of consortium.

Severe infection, preterm birth—and CP

An 18-year-old woman presented at the hospital at 28 weeks’ gestation with obvious rupture of membranes. She was diagnosed with chorioamnionitis because her temperature, white blood cell count, and band count were elevated. She was given antibiotics, epidural anesthesia, and acetaminophen as needed. Delivery was imminent, so steroids were not given. A nurse documented that the fetal monitor tracing showed a change in heart pattern that was not reassuring for fetal well-being, and that the physicians were aware of this. Oxygen was administered and an internal scalp electrode was placed. A cesarean section was performed an hour later.

The infant, floppy and dusky with no respiratory effort at delivery, was intubated and transferred to the NICU. The placenta was grossly infected; chorioamnionitis with necrosis of the fetal membrane and group B strep were confirmed. A sonogram of the brain indicated Grade-III hemorrhage. The child developed seizure activity and remained metabolically unstable, and was given a diagnosis of cerebral palsy. He is legally blind and significantly developmentally delayed.

Patient’s claim The child should have been delivered earlier.

Doctor’s defense There was no negligence. Brain damage was due to prematurity.

Verdict $3 million Massachusetts settlement.

For more on ruptured membranes, see “PROM dilemmas: Choosing a strategy, knowing when to call it quits,” by M. Sean Esplin, MD.

Teen’s oophorectomy leads to more surgery

A 16-year-old patient underwent left oophorectomy surgery to remove an ovarian cyst. Postoperatively, intra-abdominal bleeding developed but stopped spontaneously. Because of severe infection and abdominal pain, she was readmitted and intra-abdominal abscesses were drained. She was left with pelvic adhesions and impaired fertility.

Patient’s claim The physician was negligent for failing to control postoperative bleeding and to timely diagnose postoperative infection.

Doctor’s defense Not reported.

Verdict Illinois defense verdict.

Did gallstones mask perforated bowel?

A woman complained of intermittent gastric pain for 3 days following her abdominal hysterectomy. She also vomited bilious gastric fluid at one point. She was discharged, but was readmitted 30 hours later. A CT scan showed perforation of the small intestine as well as peritonitis.

Patient’s claim The perforation occurred during surgery, and the physician was negligent for failing to note it then or during the immediate postoperative period.

Doctor’s defense The patient’s symptoms were consistent with gallstones, which she had experienced before, and which ultrasonography confirmed during the recovery period. Also, the injury to the bowel was not detectable during surgery and developed after she was discharged.

Verdict An $860,000 Connecticut verdict was returned: $110,000 for medical expenses, $675,000 for noneconomic damages, and $75,000 for the husband’s loss of consortium.

Severe infection, preterm birth—and CP

An 18-year-old woman presented at the hospital at 28 weeks’ gestation with obvious rupture of membranes. She was diagnosed with chorioamnionitis because her temperature, white blood cell count, and band count were elevated. She was given antibiotics, epidural anesthesia, and acetaminophen as needed. Delivery was imminent, so steroids were not given. A nurse documented that the fetal monitor tracing showed a change in heart pattern that was not reassuring for fetal well-being, and that the physicians were aware of this. Oxygen was administered and an internal scalp electrode was placed. A cesarean section was performed an hour later.

The infant, floppy and dusky with no respiratory effort at delivery, was intubated and transferred to the NICU. The placenta was grossly infected; chorioamnionitis with necrosis of the fetal membrane and group B strep were confirmed. A sonogram of the brain indicated Grade-III hemorrhage. The child developed seizure activity and remained metabolically unstable, and was given a diagnosis of cerebral palsy. He is legally blind and significantly developmentally delayed.

Patient’s claim The child should have been delivered earlier.

Doctor’s defense There was no negligence. Brain damage was due to prematurity.

Verdict $3 million Massachusetts settlement.

For more on ruptured membranes, see “PROM dilemmas: Choosing a strategy, knowing when to call it quits,” by M. Sean Esplin, MD.

Teen’s oophorectomy leads to more surgery

A 16-year-old patient underwent left oophorectomy surgery to remove an ovarian cyst. Postoperatively, intra-abdominal bleeding developed but stopped spontaneously. Because of severe infection and abdominal pain, she was readmitted and intra-abdominal abscesses were drained. She was left with pelvic adhesions and impaired fertility.

Patient’s claim The physician was negligent for failing to control postoperative bleeding and to timely diagnose postoperative infection.

Doctor’s defense Not reported.

Verdict Illinois defense verdict.

Vacuum extraction for shoulder dystocia

A 28-year-old woman in labor presented at the hospital. While delivering her child, the ObGyn encountered shoulder dystocia and proceeded to use vacuum extraction. Diagnosed with Erb’s palsy, the child has undergone physical and occupational therapy and is now doing well.

Patient’s claim The ObGyn did not manage the shoulder dystocia properly. Vacuum extraction, which was not needed, was performed by an inexperienced assisting physician after shoulder dystocia had occurred. Asymmetry of the child’s chest, as well as arm length discrepancy, will increase as the child grows.

Doctor’s defense Vacuum extraction was used to alleviate stress on the infant, who had mitral valve prolapse. The assisting physician was directly observed and supervised by the ObGyn, who was performing the McRoberts maneuver.

Verdict New York defense verdict.

Monochorionic monoamniotic twin dies

A 29-year-old woman pregnant with monochorionic, monoamniotic twins was admitted to the hospital when she went into premature labor. Despite her request for delivery, the ObGyn decided to delay delivery and administered terbutaline. Five days later, the twins were delivered: one healthy, the other stillborn.

Patient’s claim Delivery should have occurred earlier, before the one fetus had died.

Doctor’s defense Unpredictable and un-preventable complications of the pregnancy caused the stillbirth.

Verdict $487,000 Indiana verdict. An appeal was pending.

For more on twin gestations, see the cover article by Victoria Belogolovkin, MD, and Joanne Stone, MD.

Oversized head went unnoticed despite US

A woman in her 17th week of pregnancy underwent ultrasonography (US) with radiologist A to check for a fetal heartbeat and to confirm both the presence of the fetus in the uterus and a single pregnancy. She also underwent a blood test for Down’s syndrome, Trisomy 18, and neural tube defects. All tests were normal. At her next appointment, radiologist B used US to verify the sex of the fetus. The remainder of her pregnancy passed without incident. The child was delivered by cesarean section and had a grossly enlarged head and other congenital defects. An MRI 2 days later showed the right hemisphere of the brain to be huge with a severely abnormal structure. The child had multiple brain surgeries but continues to suffer from intractable seizures. He is severely retarded and has been diagnosed with Proteus syndrome, also known as Elephant Man syndrome.

Patient’s claim Instead of limited US on 2 occasions (which led her to believe the fetus was normal), a full US should have been done. This would have allowed the brain abnormalities to be diagnosed while there was still time for a legal abortion. During the second US, Dr. B noted that the baby had a big head. The sonogram taken by Dr. A showed the early stages of disease, and if Dr. B had taken one during the second US, the dramatic difference in head size would have been evident. She denied that she requested the second US to verify the sex.

Doctor’s defense Dr. A claimed he tells all patients that US does not look for fetal anatomical abnormalities and that they can be referred to a perinatologist for that information. Dr. B claimed the second US was only to verify the sex. Both denied liability, claiming that the child’s disorder is very rare and a full US was not needed. Also, a diagnosis might not have been made, and it was un-likely the fetus would have been aborted.

Verdict California defense verdict.

Small bowel is injured in repeat C-section

A 25-year-old woman underwent a second cesarean section performed by the same OB who had handled her first cesarean section 3 years earlier. During the second procedure, the small bowel was perforated, requiring emergency intraoperative corrective surgery.

Patient’s claim She lost 3 inches of her small bowel and suffers severe intermittent diarrhea, pain, and a partial bowel obstruction.

Doctor’s defense The woman’s problems predated the cesarean section. She was not under a doctor’s care or taking medication, and she had not been hospitalized since the corrective surgery. Bowel perforation, a known risk, was complicated by a bowel loop adherent to the abdominal rectus muscle. Also, the woman was not a candidate for vaginal delivery because of her history: colostomy, blood transfusions, digestive problems, and failure to progress in the first pregnancy.

Verdict New York defense verdict.

Why a hysterectomy and not another D&C?

A 72-year-old woman with a uterine polyp presented at the hospital for a dilation and curettage (D&C) procedure. Because of her stenotic cervix, which was abnormally constructed, the physician discontinued the surgery after trying unsuccessfully to dilate the cervix. The patient later underwent abdominal hysterectomy and developed incontinence and constant pelvic pain.

Patient’s claim The hysterectomy was unnecessary and lacked informed consent. The physician said she had cancer and would die without the hysterectomy, but cancer was not found. A repeat D&C was warranted.

Doctor’s defense He stopped the original surgery because he didn’t want to perforate the bowel; he never told the patient she had cancer; and a simple hysterectomy cannot cause incontinence.

Verdict New York defense verdict.

FP, not OB, delivers severely injured child

A woman hospitalized at 38 weeks’ gestation—with high blood pressure and at risk for toxemia—was diagnosed with pregnancy-induced hypertension (PIH). Fetal monitoring showed the fetus to be stable. The woman was given magnesium sulfate for the PIH, misoprostol and oxytocin to induce and augment labor, and an epidural. After decelerations were noted the following evening, amnioinfusion was ordered. Scalp stimulation 3 hours later yielded no response. Oxygen saturation of the fetus was normal. Oxytocin was increased, and the infant was delivered several hours later, but required 10 minutes of resuscitation before it began breathing. The diagnosis was severe hypoxic–ischemic encephalopathy, and the child requires a ventilator and tube feeding.

Patient’s claim The family practice physician should have transferred care to an obstetrician, and a cesarean section should have been performed.

Doctor’s defense Not reported.

Verdict Mediated California settlement: $3.4 million from the hospital, $100,000 from the obstetrical group, and $1.5 million from an unidentified defendant.

Vacuum extraction for shoulder dystocia

A 28-year-old woman in labor presented at the hospital. While delivering her child, the ObGyn encountered shoulder dystocia and proceeded to use vacuum extraction. Diagnosed with Erb’s palsy, the child has undergone physical and occupational therapy and is now doing well.

Patient’s claim The ObGyn did not manage the shoulder dystocia properly. Vacuum extraction, which was not needed, was performed by an inexperienced assisting physician after shoulder dystocia had occurred. Asymmetry of the child’s chest, as well as arm length discrepancy, will increase as the child grows.

Doctor’s defense Vacuum extraction was used to alleviate stress on the infant, who had mitral valve prolapse. The assisting physician was directly observed and supervised by the ObGyn, who was performing the McRoberts maneuver.

Verdict New York defense verdict.

Monochorionic monoamniotic twin dies

A 29-year-old woman pregnant with monochorionic, monoamniotic twins was admitted to the hospital when she went into premature labor. Despite her request for delivery, the ObGyn decided to delay delivery and administered terbutaline. Five days later, the twins were delivered: one healthy, the other stillborn.

Patient’s claim Delivery should have occurred earlier, before the one fetus had died.

Doctor’s defense Unpredictable and un-preventable complications of the pregnancy caused the stillbirth.

Verdict $487,000 Indiana verdict. An appeal was pending.

For more on twin gestations, see the cover article by Victoria Belogolovkin, MD, and Joanne Stone, MD.

Oversized head went unnoticed despite US

A woman in her 17th week of pregnancy underwent ultrasonography (US) with radiologist A to check for a fetal heartbeat and to confirm both the presence of the fetus in the uterus and a single pregnancy. She also underwent a blood test for Down’s syndrome, Trisomy 18, and neural tube defects. All tests were normal. At her next appointment, radiologist B used US to verify the sex of the fetus. The remainder of her pregnancy passed without incident. The child was delivered by cesarean section and had a grossly enlarged head and other congenital defects. An MRI 2 days later showed the right hemisphere of the brain to be huge with a severely abnormal structure. The child had multiple brain surgeries but continues to suffer from intractable seizures. He is severely retarded and has been diagnosed with Proteus syndrome, also known as Elephant Man syndrome.

Patient’s claim Instead of limited US on 2 occasions (which led her to believe the fetus was normal), a full US should have been done. This would have allowed the brain abnormalities to be diagnosed while there was still time for a legal abortion. During the second US, Dr. B noted that the baby had a big head. The sonogram taken by Dr. A showed the early stages of disease, and if Dr. B had taken one during the second US, the dramatic difference in head size would have been evident. She denied that she requested the second US to verify the sex.

Doctor’s defense Dr. A claimed he tells all patients that US does not look for fetal anatomical abnormalities and that they can be referred to a perinatologist for that information. Dr. B claimed the second US was only to verify the sex. Both denied liability, claiming that the child’s disorder is very rare and a full US was not needed. Also, a diagnosis might not have been made, and it was un-likely the fetus would have been aborted.

Verdict California defense verdict.

Small bowel is injured in repeat C-section

A 25-year-old woman underwent a second cesarean section performed by the same OB who had handled her first cesarean section 3 years earlier. During the second procedure, the small bowel was perforated, requiring emergency intraoperative corrective surgery.

Patient’s claim She lost 3 inches of her small bowel and suffers severe intermittent diarrhea, pain, and a partial bowel obstruction.

Doctor’s defense The woman’s problems predated the cesarean section. She was not under a doctor’s care or taking medication, and she had not been hospitalized since the corrective surgery. Bowel perforation, a known risk, was complicated by a bowel loop adherent to the abdominal rectus muscle. Also, the woman was not a candidate for vaginal delivery because of her history: colostomy, blood transfusions, digestive problems, and failure to progress in the first pregnancy.

Verdict New York defense verdict.

Why a hysterectomy and not another D&C?

A 72-year-old woman with a uterine polyp presented at the hospital for a dilation and curettage (D&C) procedure. Because of her stenotic cervix, which was abnormally constructed, the physician discontinued the surgery after trying unsuccessfully to dilate the cervix. The patient later underwent abdominal hysterectomy and developed incontinence and constant pelvic pain.

Patient’s claim The hysterectomy was unnecessary and lacked informed consent. The physician said she had cancer and would die without the hysterectomy, but cancer was not found. A repeat D&C was warranted.

Doctor’s defense He stopped the original surgery because he didn’t want to perforate the bowel; he never told the patient she had cancer; and a simple hysterectomy cannot cause incontinence.

Verdict New York defense verdict.

FP, not OB, delivers severely injured child

A woman hospitalized at 38 weeks’ gestation—with high blood pressure and at risk for toxemia—was diagnosed with pregnancy-induced hypertension (PIH). Fetal monitoring showed the fetus to be stable. The woman was given magnesium sulfate for the PIH, misoprostol and oxytocin to induce and augment labor, and an epidural. After decelerations were noted the following evening, amnioinfusion was ordered. Scalp stimulation 3 hours later yielded no response. Oxygen saturation of the fetus was normal. Oxytocin was increased, and the infant was delivered several hours later, but required 10 minutes of resuscitation before it began breathing. The diagnosis was severe hypoxic–ischemic encephalopathy, and the child requires a ventilator and tube feeding.

Patient’s claim The family practice physician should have transferred care to an obstetrician, and a cesarean section should have been performed.

Doctor’s defense Not reported.

Verdict Mediated California settlement: $3.4 million from the hospital, $100,000 from the obstetrical group, and $1.5 million from an unidentified defendant.

Vacuum extraction for shoulder dystocia

A 28-year-old woman in labor presented at the hospital. While delivering her child, the ObGyn encountered shoulder dystocia and proceeded to use vacuum extraction. Diagnosed with Erb’s palsy, the child has undergone physical and occupational therapy and is now doing well.

Patient’s claim The ObGyn did not manage the shoulder dystocia properly. Vacuum extraction, which was not needed, was performed by an inexperienced assisting physician after shoulder dystocia had occurred. Asymmetry of the child’s chest, as well as arm length discrepancy, will increase as the child grows.

Doctor’s defense Vacuum extraction was used to alleviate stress on the infant, who had mitral valve prolapse. The assisting physician was directly observed and supervised by the ObGyn, who was performing the McRoberts maneuver.

Verdict New York defense verdict.

Monochorionic monoamniotic twin dies

A 29-year-old woman pregnant with monochorionic, monoamniotic twins was admitted to the hospital when she went into premature labor. Despite her request for delivery, the ObGyn decided to delay delivery and administered terbutaline. Five days later, the twins were delivered: one healthy, the other stillborn.

Patient’s claim Delivery should have occurred earlier, before the one fetus had died.

Doctor’s defense Unpredictable and un-preventable complications of the pregnancy caused the stillbirth.

Verdict $487,000 Indiana verdict. An appeal was pending.

For more on twin gestations, see the cover article by Victoria Belogolovkin, MD, and Joanne Stone, MD.

Oversized head went unnoticed despite US

A woman in her 17th week of pregnancy underwent ultrasonography (US) with radiologist A to check for a fetal heartbeat and to confirm both the presence of the fetus in the uterus and a single pregnancy. She also underwent a blood test for Down’s syndrome, Trisomy 18, and neural tube defects. All tests were normal. At her next appointment, radiologist B used US to verify the sex of the fetus. The remainder of her pregnancy passed without incident. The child was delivered by cesarean section and had a grossly enlarged head and other congenital defects. An MRI 2 days later showed the right hemisphere of the brain to be huge with a severely abnormal structure. The child had multiple brain surgeries but continues to suffer from intractable seizures. He is severely retarded and has been diagnosed with Proteus syndrome, also known as Elephant Man syndrome.

Patient’s claim Instead of limited US on 2 occasions (which led her to believe the fetus was normal), a full US should have been done. This would have allowed the brain abnormalities to be diagnosed while there was still time for a legal abortion. During the second US, Dr. B noted that the baby had a big head. The sonogram taken by Dr. A showed the early stages of disease, and if Dr. B had taken one during the second US, the dramatic difference in head size would have been evident. She denied that she requested the second US to verify the sex.

Doctor’s defense Dr. A claimed he tells all patients that US does not look for fetal anatomical abnormalities and that they can be referred to a perinatologist for that information. Dr. B claimed the second US was only to verify the sex. Both denied liability, claiming that the child’s disorder is very rare and a full US was not needed. Also, a diagnosis might not have been made, and it was un-likely the fetus would have been aborted.

Verdict California defense verdict.

Small bowel is injured in repeat C-section

A 25-year-old woman underwent a second cesarean section performed by the same OB who had handled her first cesarean section 3 years earlier. During the second procedure, the small bowel was perforated, requiring emergency intraoperative corrective surgery.

Patient’s claim She lost 3 inches of her small bowel and suffers severe intermittent diarrhea, pain, and a partial bowel obstruction.

Doctor’s defense The woman’s problems predated the cesarean section. She was not under a doctor’s care or taking medication, and she had not been hospitalized since the corrective surgery. Bowel perforation, a known risk, was complicated by a bowel loop adherent to the abdominal rectus muscle. Also, the woman was not a candidate for vaginal delivery because of her history: colostomy, blood transfusions, digestive problems, and failure to progress in the first pregnancy.

Verdict New York defense verdict.

Why a hysterectomy and not another D&C?

A 72-year-old woman with a uterine polyp presented at the hospital for a dilation and curettage (D&C) procedure. Because of her stenotic cervix, which was abnormally constructed, the physician discontinued the surgery after trying unsuccessfully to dilate the cervix. The patient later underwent abdominal hysterectomy and developed incontinence and constant pelvic pain.

Patient’s claim The hysterectomy was unnecessary and lacked informed consent. The physician said she had cancer and would die without the hysterectomy, but cancer was not found. A repeat D&C was warranted.

Doctor’s defense He stopped the original surgery because he didn’t want to perforate the bowel; he never told the patient she had cancer; and a simple hysterectomy cannot cause incontinence.

Verdict New York defense verdict.

FP, not OB, delivers severely injured child

A woman hospitalized at 38 weeks’ gestation—with high blood pressure and at risk for toxemia—was diagnosed with pregnancy-induced hypertension (PIH). Fetal monitoring showed the fetus to be stable. The woman was given magnesium sulfate for the PIH, misoprostol and oxytocin to induce and augment labor, and an epidural. After decelerations were noted the following evening, amnioinfusion was ordered. Scalp stimulation 3 hours later yielded no response. Oxygen saturation of the fetus was normal. Oxytocin was increased, and the infant was delivered several hours later, but required 10 minutes of resuscitation before it began breathing. The diagnosis was severe hypoxic–ischemic encephalopathy, and the child requires a ventilator and tube feeding.

Patient’s claim The family practice physician should have transferred care to an obstetrician, and a cesarean section should have been performed.

Doctor’s defense Not reported.

Verdict Mediated California settlement: $3.4 million from the hospital, $100,000 from the obstetrical group, and $1.5 million from an unidentified defendant.

Did young woman need hysterectomy?

A few months after giving birth, a 22-year-old woman presented to her ObGyn with lower abdominal pain and vaginal bleeding. Although she wanted more children, she consented to a total hysterectomy to avoid developing a very dangerous condition. However, she was not clear on what that condition was.

Patient’s claim The hysterectomy was unnecessary, because she had a normal post-childbirth problem that could have been treated with Depo-Provera or oral contraceptives. She did not give informed consent, because her condition was not explained to her, and the hospital chart and physician’s office chart differed significantly. Finally, the hospital was negligent for credentialing the physician, who had a high rate of hysterectomies in women under 30 and had several lawsuits filed against him.

Doctor’s defense The ObGyn offered the patient alternatives to a hysterectomy, but she insisted on a hysterectomy. The hospital claimed it followed its credentialing procedures.

Verdict $1.75 million Washington verdict. The physician was found to be 90% at fault, and the hospital 10% at fault. Post-trial motions were pending.

Woman hears “cancer” and has hysterectomy

A 24-year-old woman underwent a hysterectomy because she believed the doctor told her she had cancer.

Patient’s claim She was told the surgery was necessary because of cancer, but she did not have cancer—thus the hysterectomy was unnecessary. Also, she did not give informed consent.

Doctor’s defense As the patient did not want the frequent follow-up needed with other options to treat her precancerous growth, a hysterectomy was a legitimate treatment choice. She was fully informed of all options, and the surgery was performed properly.

Verdict Illinois defense verdict.

Did young woman need hysterectomy?

A few months after giving birth, a 22-year-old woman presented to her ObGyn with lower abdominal pain and vaginal bleeding. Although she wanted more children, she consented to a total hysterectomy to avoid developing a very dangerous condition. However, she was not clear on what that condition was.

Patient’s claim The hysterectomy was unnecessary, because she had a normal post-childbirth problem that could have been treated with Depo-Provera or oral contraceptives. She did not give informed consent, because her condition was not explained to her, and the hospital chart and physician’s office chart differed significantly. Finally, the hospital was negligent for credentialing the physician, who had a high rate of hysterectomies in women under 30 and had several lawsuits filed against him.

Doctor’s defense The ObGyn offered the patient alternatives to a hysterectomy, but she insisted on a hysterectomy. The hospital claimed it followed its credentialing procedures.

Verdict $1.75 million Washington verdict. The physician was found to be 90% at fault, and the hospital 10% at fault. Post-trial motions were pending.

Woman hears “cancer” and has hysterectomy

A 24-year-old woman underwent a hysterectomy because she believed the doctor told her she had cancer.

Patient’s claim She was told the surgery was necessary because of cancer, but she did not have cancer—thus the hysterectomy was unnecessary. Also, she did not give informed consent.

Doctor’s defense As the patient did not want the frequent follow-up needed with other options to treat her precancerous growth, a hysterectomy was a legitimate treatment choice. She was fully informed of all options, and the surgery was performed properly.

Verdict Illinois defense verdict.

Did young woman need hysterectomy?

A few months after giving birth, a 22-year-old woman presented to her ObGyn with lower abdominal pain and vaginal bleeding. Although she wanted more children, she consented to a total hysterectomy to avoid developing a very dangerous condition. However, she was not clear on what that condition was.

Patient’s claim The hysterectomy was unnecessary, because she had a normal post-childbirth problem that could have been treated with Depo-Provera or oral contraceptives. She did not give informed consent, because her condition was not explained to her, and the hospital chart and physician’s office chart differed significantly. Finally, the hospital was negligent for credentialing the physician, who had a high rate of hysterectomies in women under 30 and had several lawsuits filed against him.

Doctor’s defense The ObGyn offered the patient alternatives to a hysterectomy, but she insisted on a hysterectomy. The hospital claimed it followed its credentialing procedures.

Verdict $1.75 million Washington verdict. The physician was found to be 90% at fault, and the hospital 10% at fault. Post-trial motions were pending.

Woman hears “cancer” and has hysterectomy

A 24-year-old woman underwent a hysterectomy because she believed the doctor told her she had cancer.

Patient’s claim She was told the surgery was necessary because of cancer, but she did not have cancer—thus the hysterectomy was unnecessary. Also, she did not give informed consent.

Doctor’s defense As the patient did not want the frequent follow-up needed with other options to treat her precancerous growth, a hysterectomy was a legitimate treatment choice. She was fully informed of all options, and the surgery was performed properly.

Verdict Illinois defense verdict.

Erb’s palsy occurs after “turtle sign”

During delivery, the infant plaintiff crowned at one point and then withdrew back into the birth canal in a “turtle sign.” The physician performed a McRoberts maneuver, one nurse allegedly applied fundal pressure, and a second nurse applied suprapubic pressure. At birth, the child had an Apgar of 2 and was soon diagnosed with Erb’s palsy because of right brachial plexus injury.

Patient’s claim The physician pulled too long on the fetus before suprapubic pressure was applied; excessive fundal pressure was used; an episiotomy should have been done; and the physician should have rotated the fetus.

Doctor’s defense He responded properly to the turtle sign. Also, the injury can occur in the absence of negligence.

Verdict Tennessee defense verdict. Post-trial motions were pending.

Was anesthesiologist late for emergency?

A pregnant 34-year-old woman presented with ruptured membranes at the hospital 5 days before her due date. She had felt good fetal movement earlier that morning, but could not detect movement by the afternoon. An electronic fetal monitor was connected and oxytocin ordered. When the nurse noted decreased long-term variability, the attending physician responded and evaluated the fetus and tracings. At about midnight of the following day, the resident physician was called, and oxytocin was increased. When the mother began pushing, the fetal heart rate dropped and remained below baseline. It was decided to do an emergency cesarean section, which was performed without the anesthesiologist when he failed to respond to a page within 20 minutes. The anesthesiologist—who was asleep in the call room and unable to hear the pages with the air conditioner on—responded immediately when he awoke, and topped off the epidural. The child was born limp, apneic, and cyanotic and was diagnosed with hypoxic–ischemic encephalopathy, severe metabolic acidosis, and respiratory depression. She cannot walk, talk, or hold her head upright, is fed through a G tube, and takes medication for a seizure disorder.

Patient’s claim Delivery should have been expedited when the resident physician was called on the second day because of signs of fetal hypoxia, and oxytocin should not have been increased.

Doctor’s defense According to the nurse, attending physician, and resident, fetal hypoxia was not evident, and the problems were caused by the anesthesiologist. The latter said there was no delay and disputed the claims of when he was paged and when he arrived.

Verdict $4 million Massachusetts settlement.

Woman refuses C-section—repeatedly

A 37-year-old pregnant woman who had previously delivered a healthy boy by cesarean section was advised to have a vaginal delivery for this pregnancy. When she was 2 weeks past her due date, she was admitted to the hospital for induction of labor and vaginal birth. The baby was at +2 to +3 station after 4 hours in the second stage of labor. The physician recommended a cesarean section, and the woman declined. A vacuum-assisted delivery with fundal pressure was unsuccessful. Again the physician recommended a cesarean section, and the woman declined. The physician then tried using forceps, but gave up when he couldn’t position the forceps properly. For a third time, he recommended a cesarean section, and she declined. When the physician ordered fundal pressure—and the nurses refused—the husband applied it. Within minutes the woman agreed to a cesarean section. The child was born with cerebral palsy, right-sided paralysis, cognitive deficits, and learning disabilities, as well as facial bruises, a large cephalohematoma, and swelling of the scalp. Three hours later the child began to have seizure motions.

Patient’s claim The physician was negligent for failing to provide enough information about cesarean sections during labor. He was also negligent for using vacuum, forceps, and fundal pressure.

Doctor’s defense The mother was sufficiently informed about cesarean sections, and he handled the attempted vaginal delivery appropriately. Also, the infarction was due to placental thrombophilia that occurred before labor.

Verdict California defense verdict.

Did she agree to the tubal ligation?

A 35-year-old woman who had previously delivered 2 children by cesarean section wanted to attempt a vaginal delivery with her third child. When labor progressed slowly, the ObGyn decided to perform a cesarean section and recommended also a tubal ligation.

Patient’s claim The tubal ligation was done without her consent and against her wishes. She refused the procedure initially and again after the cesarean section.

Doctor’s defense The patient did refuse the tubal ligation initially, but gave verbal consent in the operating room.

Verdict $435,00 North Carolina settlement, including $100,000 from the hospital and $335,000 from the physician.

Despite report, ovary was not removed

A 38-year-old woman, who had a history of sarcoidosis and hysterectomy with removal of the right ovary, presented at the hospital with lower-left-quadrant pain. A mass on the left ovary was discovered, and she underwent laparoscopic surgery 5 days later to remove the mass, and also the ovary and fallopian tube. In the operative report, the physician noted he had removed the ovary. The patient complained of postoperative pain. Several months later, a CT scan showed the presence of the left ovary and fallopian tube. Eleven months following the initial procedure, further surgery indicated extensive intra-abdominal adhesions and an ovarian mass that required laparoscopic lysis of adhesions, as well as removal of the ovary and fallopian tube. The pathology report mentioned the presence of the tube and the ovary, which had multiple cystic follicles and a focal area of fibrosis, and a hemorrhagic area. After the surgery, the patient suffered from back pain, and 5 months later was diagnosed with hydronephrosis due to a stricture of the left distal ureter.

Patient’s claim The initial surgery was not done properly, so further procedures were required. Surgical clips used in the second surgery caused the stricture of the ureter, which required more surgery to insert a stent. However, because the stricture could not be opened, ureteral reimplantation was necessary.

Doctor’s defense Not reported.

Verdict $925,000 New York settlement after opening statements.

Erb’s palsy occurs after “turtle sign”

During delivery, the infant plaintiff crowned at one point and then withdrew back into the birth canal in a “turtle sign.” The physician performed a McRoberts maneuver, one nurse allegedly applied fundal pressure, and a second nurse applied suprapubic pressure. At birth, the child had an Apgar of 2 and was soon diagnosed with Erb’s palsy because of right brachial plexus injury.

Patient’s claim The physician pulled too long on the fetus before suprapubic pressure was applied; excessive fundal pressure was used; an episiotomy should have been done; and the physician should have rotated the fetus.

Doctor’s defense He responded properly to the turtle sign. Also, the injury can occur in the absence of negligence.

Verdict Tennessee defense verdict. Post-trial motions were pending.

Was anesthesiologist late for emergency?

A pregnant 34-year-old woman presented with ruptured membranes at the hospital 5 days before her due date. She had felt good fetal movement earlier that morning, but could not detect movement by the afternoon. An electronic fetal monitor was connected and oxytocin ordered. When the nurse noted decreased long-term variability, the attending physician responded and evaluated the fetus and tracings. At about midnight of the following day, the resident physician was called, and oxytocin was increased. When the mother began pushing, the fetal heart rate dropped and remained below baseline. It was decided to do an emergency cesarean section, which was performed without the anesthesiologist when he failed to respond to a page within 20 minutes. The anesthesiologist—who was asleep in the call room and unable to hear the pages with the air conditioner on—responded immediately when he awoke, and topped off the epidural. The child was born limp, apneic, and cyanotic and was diagnosed with hypoxic–ischemic encephalopathy, severe metabolic acidosis, and respiratory depression. She cannot walk, talk, or hold her head upright, is fed through a G tube, and takes medication for a seizure disorder.

Patient’s claim Delivery should have been expedited when the resident physician was called on the second day because of signs of fetal hypoxia, and oxytocin should not have been increased.

Doctor’s defense According to the nurse, attending physician, and resident, fetal hypoxia was not evident, and the problems were caused by the anesthesiologist. The latter said there was no delay and disputed the claims of when he was paged and when he arrived.

Verdict $4 million Massachusetts settlement.

Woman refuses C-section—repeatedly

A 37-year-old pregnant woman who had previously delivered a healthy boy by cesarean section was advised to have a vaginal delivery for this pregnancy. When she was 2 weeks past her due date, she was admitted to the hospital for induction of labor and vaginal birth. The baby was at +2 to +3 station after 4 hours in the second stage of labor. The physician recommended a cesarean section, and the woman declined. A vacuum-assisted delivery with fundal pressure was unsuccessful. Again the physician recommended a cesarean section, and the woman declined. The physician then tried using forceps, but gave up when he couldn’t position the forceps properly. For a third time, he recommended a cesarean section, and she declined. When the physician ordered fundal pressure—and the nurses refused—the husband applied it. Within minutes the woman agreed to a cesarean section. The child was born with cerebral palsy, right-sided paralysis, cognitive deficits, and learning disabilities, as well as facial bruises, a large cephalohematoma, and swelling of the scalp. Three hours later the child began to have seizure motions.

Patient’s claim The physician was negligent for failing to provide enough information about cesarean sections during labor. He was also negligent for using vacuum, forceps, and fundal pressure.

Doctor’s defense The mother was sufficiently informed about cesarean sections, and he handled the attempted vaginal delivery appropriately. Also, the infarction was due to placental thrombophilia that occurred before labor.

Verdict California defense verdict.

Did she agree to the tubal ligation?

A 35-year-old woman who had previously delivered 2 children by cesarean section wanted to attempt a vaginal delivery with her third child. When labor progressed slowly, the ObGyn decided to perform a cesarean section and recommended also a tubal ligation.

Patient’s claim The tubal ligation was done without her consent and against her wishes. She refused the procedure initially and again after the cesarean section.

Doctor’s defense The patient did refuse the tubal ligation initially, but gave verbal consent in the operating room.

Verdict $435,00 North Carolina settlement, including $100,000 from the hospital and $335,000 from the physician.

Despite report, ovary was not removed

A 38-year-old woman, who had a history of sarcoidosis and hysterectomy with removal of the right ovary, presented at the hospital with lower-left-quadrant pain. A mass on the left ovary was discovered, and she underwent laparoscopic surgery 5 days later to remove the mass, and also the ovary and fallopian tube. In the operative report, the physician noted he had removed the ovary. The patient complained of postoperative pain. Several months later, a CT scan showed the presence of the left ovary and fallopian tube. Eleven months following the initial procedure, further surgery indicated extensive intra-abdominal adhesions and an ovarian mass that required laparoscopic lysis of adhesions, as well as removal of the ovary and fallopian tube. The pathology report mentioned the presence of the tube and the ovary, which had multiple cystic follicles and a focal area of fibrosis, and a hemorrhagic area. After the surgery, the patient suffered from back pain, and 5 months later was diagnosed with hydronephrosis due to a stricture of the left distal ureter.

Patient’s claim The initial surgery was not done properly, so further procedures were required. Surgical clips used in the second surgery caused the stricture of the ureter, which required more surgery to insert a stent. However, because the stricture could not be opened, ureteral reimplantation was necessary.

Doctor’s defense Not reported.

Verdict $925,000 New York settlement after opening statements.

Erb’s palsy occurs after “turtle sign”

During delivery, the infant plaintiff crowned at one point and then withdrew back into the birth canal in a “turtle sign.” The physician performed a McRoberts maneuver, one nurse allegedly applied fundal pressure, and a second nurse applied suprapubic pressure. At birth, the child had an Apgar of 2 and was soon diagnosed with Erb’s palsy because of right brachial plexus injury.

Patient’s claim The physician pulled too long on the fetus before suprapubic pressure was applied; excessive fundal pressure was used; an episiotomy should have been done; and the physician should have rotated the fetus.

Doctor’s defense He responded properly to the turtle sign. Also, the injury can occur in the absence of negligence.

Verdict Tennessee defense verdict. Post-trial motions were pending.

Was anesthesiologist late for emergency?

A pregnant 34-year-old woman presented with ruptured membranes at the hospital 5 days before her due date. She had felt good fetal movement earlier that morning, but could not detect movement by the afternoon. An electronic fetal monitor was connected and oxytocin ordered. When the nurse noted decreased long-term variability, the attending physician responded and evaluated the fetus and tracings. At about midnight of the following day, the resident physician was called, and oxytocin was increased. When the mother began pushing, the fetal heart rate dropped and remained below baseline. It was decided to do an emergency cesarean section, which was performed without the anesthesiologist when he failed to respond to a page within 20 minutes. The anesthesiologist—who was asleep in the call room and unable to hear the pages with the air conditioner on—responded immediately when he awoke, and topped off the epidural. The child was born limp, apneic, and cyanotic and was diagnosed with hypoxic–ischemic encephalopathy, severe metabolic acidosis, and respiratory depression. She cannot walk, talk, or hold her head upright, is fed through a G tube, and takes medication for a seizure disorder.

Patient’s claim Delivery should have been expedited when the resident physician was called on the second day because of signs of fetal hypoxia, and oxytocin should not have been increased.

Doctor’s defense According to the nurse, attending physician, and resident, fetal hypoxia was not evident, and the problems were caused by the anesthesiologist. The latter said there was no delay and disputed the claims of when he was paged and when he arrived.

Verdict $4 million Massachusetts settlement.

Woman refuses C-section—repeatedly

A 37-year-old pregnant woman who had previously delivered a healthy boy by cesarean section was advised to have a vaginal delivery for this pregnancy. When she was 2 weeks past her due date, she was admitted to the hospital for induction of labor and vaginal birth. The baby was at +2 to +3 station after 4 hours in the second stage of labor. The physician recommended a cesarean section, and the woman declined. A vacuum-assisted delivery with fundal pressure was unsuccessful. Again the physician recommended a cesarean section, and the woman declined. The physician then tried using forceps, but gave up when he couldn’t position the forceps properly. For a third time, he recommended a cesarean section, and she declined. When the physician ordered fundal pressure—and the nurses refused—the husband applied it. Within minutes the woman agreed to a cesarean section. The child was born with cerebral palsy, right-sided paralysis, cognitive deficits, and learning disabilities, as well as facial bruises, a large cephalohematoma, and swelling of the scalp. Three hours later the child began to have seizure motions.

Patient’s claim The physician was negligent for failing to provide enough information about cesarean sections during labor. He was also negligent for using vacuum, forceps, and fundal pressure.

Doctor’s defense The mother was sufficiently informed about cesarean sections, and he handled the attempted vaginal delivery appropriately. Also, the infarction was due to placental thrombophilia that occurred before labor.

Verdict California defense verdict.

Did she agree to the tubal ligation?

A 35-year-old woman who had previously delivered 2 children by cesarean section wanted to attempt a vaginal delivery with her third child. When labor progressed slowly, the ObGyn decided to perform a cesarean section and recommended also a tubal ligation.

Patient’s claim The tubal ligation was done without her consent and against her wishes. She refused the procedure initially and again after the cesarean section.

Doctor’s defense The patient did refuse the tubal ligation initially, but gave verbal consent in the operating room.

Verdict $435,00 North Carolina settlement, including $100,000 from the hospital and $335,000 from the physician.

Despite report, ovary was not removed

A 38-year-old woman, who had a history of sarcoidosis and hysterectomy with removal of the right ovary, presented at the hospital with lower-left-quadrant pain. A mass on the left ovary was discovered, and she underwent laparoscopic surgery 5 days later to remove the mass, and also the ovary and fallopian tube. In the operative report, the physician noted he had removed the ovary. The patient complained of postoperative pain. Several months later, a CT scan showed the presence of the left ovary and fallopian tube. Eleven months following the initial procedure, further surgery indicated extensive intra-abdominal adhesions and an ovarian mass that required laparoscopic lysis of adhesions, as well as removal of the ovary and fallopian tube. The pathology report mentioned the presence of the tube and the ovary, which had multiple cystic follicles and a focal area of fibrosis, and a hemorrhagic area. After the surgery, the patient suffered from back pain, and 5 months later was diagnosed with hydronephrosis due to a stricture of the left distal ureter.

Patient’s claim The initial surgery was not done properly, so further procedures were required. Surgical clips used in the second surgery caused the stricture of the ureter, which required more surgery to insert a stent. However, because the stricture could not be opened, ureteral reimplantation was necessary.

Doctor’s defense Not reported.

Verdict $925,000 New York settlement after opening statements.

Should patient have to ask for testing?

A man was tested by Dr. A and found to be a thalassemia carrier, but his wife was not tested. When she became pregnant and blood work at 6 weeks indicated anemia, no testing for thalassemia was performed by Dr. B. The child was born with thalassemia, a condition that affects the body’s ability to produce hemoglobin, and will need blood transfusions throughout his life.

Patient’s claim The mother would have had an abortion if she had known the baby would have thalassemia.

Doctor’s defense Because the parents knew the father was a carrier, the defendants relied on the mother to be tested if she became pregnant. Also, the parents would not have chosen an abortion.

Verdict $14 million New Jersey verdict against Dr. B only.

Advice to deaf patient is disputed

The parents of a baby girl born with spina bifida were profoundly deaf. The mother’s deafness since birth was due to the genetic disorder Waardenburg syndrome.

Patient’s claim The physician failed to communicate the importance of 1) taking folic acid to prevent birth defects and 2) maternal serum α-fetoprotein (MSAFP) testing to determine if spina bifida was present. The physician also failed to determine what caused the mother’s deafness so she could be referred for genetic counseling. They would have aborted the fetus if they had known of the spina bifida.

Doctor’s defense When the defendant asked about genetic disorders in the family, she was told there were none. She discussed folic acid with the mother, who refused MSAFP testing when it was suggested. The couple also never brought a sign language interpreter with them. The defendant added that there was no scientific evidence that folic acid affects neural tube defects associated with a genetic syndrome such as Waardenburg.

Verdict Kansas defense verdict.

Deaths due to untreated thrombocytopenia?

A 34-year-old woman who was 27½ weeks pregnant presented at the hospital with burning in the chest, diarrhea, nausea, vomiting, and headache. She had protein in her urine, and an OB diagnosed a urinary tract infection and sent her home. In less than 24 hours, she returned by ambulance to the hospital, where she remained for observation. The defendant OBs did not come and no lab tests were ordered.

The following morning, lab results indicated HELLP syndrome or thrombotic thrombocytopenic purpura (TTP). Treatment for HELLP syndrome (delivery of the fetus—a problem because of its prematurity) and TTP (plasma exchange) could not be done at the defendant hospital, but the mother was not transferred to another hospital and consultations were not sought. A day later, an internal medicine physician was consulted, and he urged that a physician specializing in TTP also be consulted, but that was not done. Later, ultrasonography indicated the fetus had died. Fifteen hours after the stillborn baby was delivered, the mother suffered cardiovascular collapse and died.

Patient’s claim The defendants were negligent in treating the woman’s thrombocytopenia and not transferring her to another hospital in a timely manner.

Doctor’s defense Not reported.

Verdict A North Carolina settlement, which included $1,325,000 from the OB defendants and $750,000 from the hospital defendants.

Doctor ignores lump, and patient delays

A patient reported a pea-sized lump in her right breast to her gynecologist after several weeks. When he examined her at a later date, she again reported the lump, but he did not order a sonogram, mammogram, or biopsy. Over a year later, the patient was examined by a family practice physician, who examined the lump and ordered a mammogram. Seven months later, a biopsy showed the presence of cancer. As the cancer had spread to her lymph nodes, she required extensive treatment.

Patient’s claim The gynecologist was negligent for not diagnosing the cancer earlier.

Doctor’s defense Not reported.

Verdict $1,275,647.61 gross verdict in Florida. The woman was found 34% at fault, and the ObGyn, 66% at fault.

Ureteral stricture follows oophorectomy

The cystic ovaries of a 59-year-old woman were removed by an ObGyn in a procedure that was uneventful despite the presence of scarring and adhesions from previous surgeries, including a hysterectomy years earlier. The operative report did not mention that the ureters were visualized, although other structures were noted. The day after surgery, the patient was discharged in satisfactory condition. Two weeks later she returned to her physician with severe left flank pain. She was hospitalized, and a radiologist and urologist were consulted. She was diagnosed with a left ureteral stricture. The urologist placed a nephroureteral stent, and the patient wore a urostomy bag for 1 month until an indwelling stent was placed. Over the next year, she underwent frequent stent changes under general anesthesia.

Patient’s claim The physician failed to visualize the ureter during the surgery and was negligent in placing a staple in it, thus causing the injury.

Doctor’s defense He had visualized the ureter and properly placed the staples. The stricture was due to scar tissue.

Verdict Three Virginia trials resulted in a hung jury, a mistrial, and finally a defense verdict.

Bladder injury during tubal ligation

A 25-year-old woman pregnant with her first child made plans with a family physician to undergo a tubal ligation the day after delivery. During the procedure, performed under general anesthesia, the woman’s bladder was lacerated and a sudden gush of fluid contaminated the surgical site. A urologist was called immediately and repaired the damage successfully. After 2 days, the patient was discharged, but she returned 5 hours later with intense abdominal pain, the result of a ruptured bladder. Another repair was followed by further complications and more hospital visits.

Patient’s claim Because of a lack of bladder control, she requires ongoing treatment, including the use of catheters to drain her bladder.

Doctor’s defense A lacerated bladder is a known complication of tubal ligation. Because the patient did not urinate before the surgery as he instructed her, the bladder was distended and discharged an unexpected gush of fluid when it was lacerated. Her ongoing problems, however, are not a result of the laceration or repair.

Verdict Indiana defense verdict.

Sex impossible after too much surgery?

A 52-year-old woman underwent a hysterectomy, bladder neck suspension to repair a cystocele, and implantation of a synthetic suburethral sling, all performed by an ObGyn. Following surgery, the patient suffered erosion of the sling into the vagina, causing a chronic infection with discharge and pain. After undergoing further procedures, including debridement and resection of the vagina, she has vaginal scar tissue, muscle myalgia, chronic vaginal pain or irritation and discharge, and the loss of her vagina due to scarring and foreshortening. She and her husband can no longer have sexual intercourse.

Patient’s claim The sling procedure was unnecessary. Also the physician mishandled the postoperative complications resulting from the sling, and he did not refer her to a specialist in a timely manner.

Doctor’s defense The patient had complained of stress urinary incontinence, and the sling procedure was indicated because of a hypermobile urethra. Also the complications were handled properly.

Verdict $5 million Illinois verdict, including $1 million for the woman’s husband for loss of consortium.

IUD in place while pregnant with twins

A month after giving birth to her first child, a 19-year-old woman underwent a Pap smear and had an IUD inserted for birth control. After reviewing the Pap results, the physician asked the patient to return for a cervical biopsy. During the colposcopy, the physician removed the IUD because it was partially expelled from her cervix. A week later he inserted a new IUD, but neither he nor the patient knew she was 2 weeks pregnant. When she suffered severe bleeding and cramping 2 months later, a pregnancy test indicated she was pregnant, and a sonogram revealed twins with the IUD in place. The string was not visible, so the IUD could not be removed. The patient was put on bed rest to avoid a threatened miscarriage. At a second facility, it was confirmed that the IUD could not be removed. The patient was diagnosed with an incompetent cervix and, following placement of a cervical cerclage, was told to remain on rest. Within a month, she miscarried.

Patient’s claim The physician was negligent for inserting an IUD without determining if she was pregnant, and the IUD caused the miscarriage.

Doctor’s defense A pregnancy test prior to insertion of an IUD is not the standard of care, especially when the patient reports regular periods. Also, the miscarriage was not related to the IUD.

Verdict Missouri defense verdict.

Was mother’s brain damage avoidable?

A 27-year-old pregnant woman at full term presented at the hospital for labor augmentation. Her OB was Dr. A. Dr. B, the anesthesiologist, was called a few hours later to place an epidural. Later, the patient began vomiting and experiencing seizures and became unresponsive. Neither Dr. A nor Dr. B was present. Fetal bradycardia was diagnosed and an emergency cesarean section was performed. During the delivery, the mother experienced cardiac arrest, uterine atony, and disseminated intravascular coagulation. She was resuscitated, but suffered severe brain damage. She must use a wheelchair because of cognitive and neurological impairments.

Patient’s claim Three things should have been done: earlier cesarean section, suctioning after the vomiting, and intubation.

Doctor’s defense The patient had an unpredictable and untreatable amniotic fluid embolism.

Verdict New York defense verdict, but posttrial motions were pending.

Depo-Provera is given to pregnant woman

When a 28-year-old woman with a history of alcohol and drug abuse requested contraceptive medication, she was prescribed 3 injections of Depo-Provera over 6 months. At each exam, she reported a weight gain, breast tenderness, and swelling of her breasts. The ObGyn said those were side effects of the medication. When she went to another physician 7 months after the first injection, it was determined that she was late in her seventh month of pregnancy. Unable to terminate the pregnancy, she delivered a child with significant, permanent disabilities. To care for the child, she quit her job and moved in with her parents.

Patient’s claim The physician failed to rule out pregnancy before the first injection.

Doctor’s defense The plaintiff had no damages.

Verdict $400,000 Massachusetts settlement.

Video supports claims of negligence

Shoulder dystocia occurred during delivery of the plaintiff’s child. Because of brachial plexus damage, the child suffers from Erb’s palsy and has undergone surgery to try to restore function to her arm, hand, and fingers.

Patient’s claim The defendants did not tell her to stop pushing when shoulder dystocia was discovered, and were negligent for using the McRoberts maneuver, suprapubic pressure, and excessive traction. The plaintiff provided video documentation of the delivery.

Doctor’s defense Negligence was denied.

Verdict $1 million Maryland verdict.

Should patient have to ask for testing?

A man was tested by Dr. A and found to be a thalassemia carrier, but his wife was not tested. When she became pregnant and blood work at 6 weeks indicated anemia, no testing for thalassemia was performed by Dr. B. The child was born with thalassemia, a condition that affects the body’s ability to produce hemoglobin, and will need blood transfusions throughout his life.

Patient’s claim The mother would have had an abortion if she had known the baby would have thalassemia.

Doctor’s defense Because the parents knew the father was a carrier, the defendants relied on the mother to be tested if she became pregnant. Also, the parents would not have chosen an abortion.

Verdict $14 million New Jersey verdict against Dr. B only.

Advice to deaf patient is disputed

The parents of a baby girl born with spina bifida were profoundly deaf. The mother’s deafness since birth was due to the genetic disorder Waardenburg syndrome.

Patient’s claim The physician failed to communicate the importance of 1) taking folic acid to prevent birth defects and 2) maternal serum α-fetoprotein (MSAFP) testing to determine if spina bifida was present. The physician also failed to determine what caused the mother’s deafness so she could be referred for genetic counseling. They would have aborted the fetus if they had known of the spina bifida.

Doctor’s defense When the defendant asked about genetic disorders in the family, she was told there were none. She discussed folic acid with the mother, who refused MSAFP testing when it was suggested. The couple also never brought a sign language interpreter with them. The defendant added that there was no scientific evidence that folic acid affects neural tube defects associated with a genetic syndrome such as Waardenburg.

Verdict Kansas defense verdict.

Deaths due to untreated thrombocytopenia?

A 34-year-old woman who was 27½ weeks pregnant presented at the hospital with burning in the chest, diarrhea, nausea, vomiting, and headache. She had protein in her urine, and an OB diagnosed a urinary tract infection and sent her home. In less than 24 hours, she returned by ambulance to the hospital, where she remained for observation. The defendant OBs did not come and no lab tests were ordered.

The following morning, lab results indicated HELLP syndrome or thrombotic thrombocytopenic purpura (TTP). Treatment for HELLP syndrome (delivery of the fetus—a problem because of its prematurity) and TTP (plasma exchange) could not be done at the defendant hospital, but the mother was not transferred to another hospital and consultations were not sought. A day later, an internal medicine physician was consulted, and he urged that a physician specializing in TTP also be consulted, but that was not done. Later, ultrasonography indicated the fetus had died. Fifteen hours after the stillborn baby was delivered, the mother suffered cardiovascular collapse and died.

Patient’s claim The defendants were negligent in treating the woman’s thrombocytopenia and not transferring her to another hospital in a timely manner.

Doctor’s defense Not reported.

Verdict A North Carolina settlement, which included $1,325,000 from the OB defendants and $750,000 from the hospital defendants.

Doctor ignores lump, and patient delays

A patient reported a pea-sized lump in her right breast to her gynecologist after several weeks. When he examined her at a later date, she again reported the lump, but he did not order a sonogram, mammogram, or biopsy. Over a year later, the patient was examined by a family practice physician, who examined the lump and ordered a mammogram. Seven months later, a biopsy showed the presence of cancer. As the cancer had spread to her lymph nodes, she required extensive treatment.

Patient’s claim The gynecologist was negligent for not diagnosing the cancer earlier.

Doctor’s defense Not reported.

Verdict $1,275,647.61 gross verdict in Florida. The woman was found 34% at fault, and the ObGyn, 66% at fault.

Ureteral stricture follows oophorectomy

The cystic ovaries of a 59-year-old woman were removed by an ObGyn in a procedure that was uneventful despite the presence of scarring and adhesions from previous surgeries, including a hysterectomy years earlier. The operative report did not mention that the ureters were visualized, although other structures were noted. The day after surgery, the patient was discharged in satisfactory condition. Two weeks later she returned to her physician with severe left flank pain. She was hospitalized, and a radiologist and urologist were consulted. She was diagnosed with a left ureteral stricture. The urologist placed a nephroureteral stent, and the patient wore a urostomy bag for 1 month until an indwelling stent was placed. Over the next year, she underwent frequent stent changes under general anesthesia.

Patient’s claim The physician failed to visualize the ureter during the surgery and was negligent in placing a staple in it, thus causing the injury.

Doctor’s defense He had visualized the ureter and properly placed the staples. The stricture was due to scar tissue.

Verdict Three Virginia trials resulted in a hung jury, a mistrial, and finally a defense verdict.

Bladder injury during tubal ligation

A 25-year-old woman pregnant with her first child made plans with a family physician to undergo a tubal ligation the day after delivery. During the procedure, performed under general anesthesia, the woman’s bladder was lacerated and a sudden gush of fluid contaminated the surgical site. A urologist was called immediately and repaired the damage successfully. After 2 days, the patient was discharged, but she returned 5 hours later with intense abdominal pain, the result of a ruptured bladder. Another repair was followed by further complications and more hospital visits.

Patient’s claim Because of a lack of bladder control, she requires ongoing treatment, including the use of catheters to drain her bladder.

Doctor’s defense A lacerated bladder is a known complication of tubal ligation. Because the patient did not urinate before the surgery as he instructed her, the bladder was distended and discharged an unexpected gush of fluid when it was lacerated. Her ongoing problems, however, are not a result of the laceration or repair.

Verdict Indiana defense verdict.

Sex impossible after too much surgery?

A 52-year-old woman underwent a hysterectomy, bladder neck suspension to repair a cystocele, and implantation of a synthetic suburethral sling, all performed by an ObGyn. Following surgery, the patient suffered erosion of the sling into the vagina, causing a chronic infection with discharge and pain. After undergoing further procedures, including debridement and resection of the vagina, she has vaginal scar tissue, muscle myalgia, chronic vaginal pain or irritation and discharge, and the loss of her vagina due to scarring and foreshortening. She and her husband can no longer have sexual intercourse.

Patient’s claim The sling procedure was unnecessary. Also the physician mishandled the postoperative complications resulting from the sling, and he did not refer her to a specialist in a timely manner.

Doctor’s defense The patient had complained of stress urinary incontinence, and the sling procedure was indicated because of a hypermobile urethra. Also the complications were handled properly.

Verdict $5 million Illinois verdict, including $1 million for the woman’s husband for loss of consortium.

IUD in place while pregnant with twins

A month after giving birth to her first child, a 19-year-old woman underwent a Pap smear and had an IUD inserted for birth control. After reviewing the Pap results, the physician asked the patient to return for a cervical biopsy. During the colposcopy, the physician removed the IUD because it was partially expelled from her cervix. A week later he inserted a new IUD, but neither he nor the patient knew she was 2 weeks pregnant. When she suffered severe bleeding and cramping 2 months later, a pregnancy test indicated she was pregnant, and a sonogram revealed twins with the IUD in place. The string was not visible, so the IUD could not be removed. The patient was put on bed rest to avoid a threatened miscarriage. At a second facility, it was confirmed that the IUD could not be removed. The patient was diagnosed with an incompetent cervix and, following placement of a cervical cerclage, was told to remain on rest. Within a month, she miscarried.

Patient’s claim The physician was negligent for inserting an IUD without determining if she was pregnant, and the IUD caused the miscarriage.

Doctor’s defense A pregnancy test prior to insertion of an IUD is not the standard of care, especially when the patient reports regular periods. Also, the miscarriage was not related to the IUD.

Verdict Missouri defense verdict.

Was mother’s brain damage avoidable?

A 27-year-old pregnant woman at full term presented at the hospital for labor augmentation. Her OB was Dr. A. Dr. B, the anesthesiologist, was called a few hours later to place an epidural. Later, the patient began vomiting and experiencing seizures and became unresponsive. Neither Dr. A nor Dr. B was present. Fetal bradycardia was diagnosed and an emergency cesarean section was performed. During the delivery, the mother experienced cardiac arrest, uterine atony, and disseminated intravascular coagulation. She was resuscitated, but suffered severe brain damage. She must use a wheelchair because of cognitive and neurological impairments.

Patient’s claim Three things should have been done: earlier cesarean section, suctioning after the vomiting, and intubation.

Doctor’s defense The patient had an unpredictable and untreatable amniotic fluid embolism.

Verdict New York defense verdict, but posttrial motions were pending.

Depo-Provera is given to pregnant woman

When a 28-year-old woman with a history of alcohol and drug abuse requested contraceptive medication, she was prescribed 3 injections of Depo-Provera over 6 months. At each exam, she reported a weight gain, breast tenderness, and swelling of her breasts. The ObGyn said those were side effects of the medication. When she went to another physician 7 months after the first injection, it was determined that she was late in her seventh month of pregnancy. Unable to terminate the pregnancy, she delivered a child with significant, permanent disabilities. To care for the child, she quit her job and moved in with her parents.

Patient’s claim The physician failed to rule out pregnancy before the first injection.

Doctor’s defense The plaintiff had no damages.

Verdict $400,000 Massachusetts settlement.

Video supports claims of negligence

Shoulder dystocia occurred during delivery of the plaintiff’s child. Because of brachial plexus damage, the child suffers from Erb’s palsy and has undergone surgery to try to restore function to her arm, hand, and fingers.

Patient’s claim The defendants did not tell her to stop pushing when shoulder dystocia was discovered, and were negligent for using the McRoberts maneuver, suprapubic pressure, and excessive traction. The plaintiff provided video documentation of the delivery.

Doctor’s defense Negligence was denied.

Verdict $1 million Maryland verdict.

Should patient have to ask for testing?

A man was tested by Dr. A and found to be a thalassemia carrier, but his wife was not tested. When she became pregnant and blood work at 6 weeks indicated anemia, no testing for thalassemia was performed by Dr. B. The child was born with thalassemia, a condition that affects the body’s ability to produce hemoglobin, and will need blood transfusions throughout his life.

Patient’s claim The mother would have had an abortion if she had known the baby would have thalassemia.

Doctor’s defense Because the parents knew the father was a carrier, the defendants relied on the mother to be tested if she became pregnant. Also, the parents would not have chosen an abortion.

Verdict $14 million New Jersey verdict against Dr. B only.

Advice to deaf patient is disputed

The parents of a baby girl born with spina bifida were profoundly deaf. The mother’s deafness since birth was due to the genetic disorder Waardenburg syndrome.

Patient’s claim The physician failed to communicate the importance of 1) taking folic acid to prevent birth defects and 2) maternal serum α-fetoprotein (MSAFP) testing to determine if spina bifida was present. The physician also failed to determine what caused the mother’s deafness so she could be referred for genetic counseling. They would have aborted the fetus if they had known of the spina bifida.

Doctor’s defense When the defendant asked about genetic disorders in the family, she was told there were none. She discussed folic acid with the mother, who refused MSAFP testing when it was suggested. The couple also never brought a sign language interpreter with them. The defendant added that there was no scientific evidence that folic acid affects neural tube defects associated with a genetic syndrome such as Waardenburg.

Verdict Kansas defense verdict.

Deaths due to untreated thrombocytopenia?

A 34-year-old woman who was 27½ weeks pregnant presented at the hospital with burning in the chest, diarrhea, nausea, vomiting, and headache. She had protein in her urine, and an OB diagnosed a urinary tract infection and sent her home. In less than 24 hours, she returned by ambulance to the hospital, where she remained for observation. The defendant OBs did not come and no lab tests were ordered.

The following morning, lab results indicated HELLP syndrome or thrombotic thrombocytopenic purpura (TTP). Treatment for HELLP syndrome (delivery of the fetus—a problem because of its prematurity) and TTP (plasma exchange) could not be done at the defendant hospital, but the mother was not transferred to another hospital and consultations were not sought. A day later, an internal medicine physician was consulted, and he urged that a physician specializing in TTP also be consulted, but that was not done. Later, ultrasonography indicated the fetus had died. Fifteen hours after the stillborn baby was delivered, the mother suffered cardiovascular collapse and died.

Patient’s claim The defendants were negligent in treating the woman’s thrombocytopenia and not transferring her to another hospital in a timely manner.

Doctor’s defense Not reported.

Verdict A North Carolina settlement, which included $1,325,000 from the OB defendants and $750,000 from the hospital defendants.

Doctor ignores lump, and patient delays

A patient reported a pea-sized lump in her right breast to her gynecologist after several weeks. When he examined her at a later date, she again reported the lump, but he did not order a sonogram, mammogram, or biopsy. Over a year later, the patient was examined by a family practice physician, who examined the lump and ordered a mammogram. Seven months later, a biopsy showed the presence of cancer. As the cancer had spread to her lymph nodes, she required extensive treatment.

Patient’s claim The gynecologist was negligent for not diagnosing the cancer earlier.

Doctor’s defense Not reported.

Verdict $1,275,647.61 gross verdict in Florida. The woman was found 34% at fault, and the ObGyn, 66% at fault.

Ureteral stricture follows oophorectomy

The cystic ovaries of a 59-year-old woman were removed by an ObGyn in a procedure that was uneventful despite the presence of scarring and adhesions from previous surgeries, including a hysterectomy years earlier. The operative report did not mention that the ureters were visualized, although other structures were noted. The day after surgery, the patient was discharged in satisfactory condition. Two weeks later she returned to her physician with severe left flank pain. She was hospitalized, and a radiologist and urologist were consulted. She was diagnosed with a left ureteral stricture. The urologist placed a nephroureteral stent, and the patient wore a urostomy bag for 1 month until an indwelling stent was placed. Over the next year, she underwent frequent stent changes under general anesthesia.

Patient’s claim The physician failed to visualize the ureter during the surgery and was negligent in placing a staple in it, thus causing the injury.

Doctor’s defense He had visualized the ureter and properly placed the staples. The stricture was due to scar tissue.

Verdict Three Virginia trials resulted in a hung jury, a mistrial, and finally a defense verdict.

Bladder injury during tubal ligation

A 25-year-old woman pregnant with her first child made plans with a family physician to undergo a tubal ligation the day after delivery. During the procedure, performed under general anesthesia, the woman’s bladder was lacerated and a sudden gush of fluid contaminated the surgical site. A urologist was called immediately and repaired the damage successfully. After 2 days, the patient was discharged, but she returned 5 hours later with intense abdominal pain, the result of a ruptured bladder. Another repair was followed by further complications and more hospital visits.

Patient’s claim Because of a lack of bladder control, she requires ongoing treatment, including the use of catheters to drain her bladder.

Doctor’s defense A lacerated bladder is a known complication of tubal ligation. Because the patient did not urinate before the surgery as he instructed her, the bladder was distended and discharged an unexpected gush of fluid when it was lacerated. Her ongoing problems, however, are not a result of the laceration or repair.

Verdict Indiana defense verdict.

Sex impossible after too much surgery?

A 52-year-old woman underwent a hysterectomy, bladder neck suspension to repair a cystocele, and implantation of a synthetic suburethral sling, all performed by an ObGyn. Following surgery, the patient suffered erosion of the sling into the vagina, causing a chronic infection with discharge and pain. After undergoing further procedures, including debridement and resection of the vagina, she has vaginal scar tissue, muscle myalgia, chronic vaginal pain or irritation and discharge, and the loss of her vagina due to scarring and foreshortening. She and her husband can no longer have sexual intercourse.

Patient’s claim The sling procedure was unnecessary. Also the physician mishandled the postoperative complications resulting from the sling, and he did not refer her to a specialist in a timely manner.

Doctor’s defense The patient had complained of stress urinary incontinence, and the sling procedure was indicated because of a hypermobile urethra. Also the complications were handled properly.

Verdict $5 million Illinois verdict, including $1 million for the woman’s husband for loss of consortium.

IUD in place while pregnant with twins

A month after giving birth to her first child, a 19-year-old woman underwent a Pap smear and had an IUD inserted for birth control. After reviewing the Pap results, the physician asked the patient to return for a cervical biopsy. During the colposcopy, the physician removed the IUD because it was partially expelled from her cervix. A week later he inserted a new IUD, but neither he nor the patient knew she was 2 weeks pregnant. When she suffered severe bleeding and cramping 2 months later, a pregnancy test indicated she was pregnant, and a sonogram revealed twins with the IUD in place. The string was not visible, so the IUD could not be removed. The patient was put on bed rest to avoid a threatened miscarriage. At a second facility, it was confirmed that the IUD could not be removed. The patient was diagnosed with an incompetent cervix and, following placement of a cervical cerclage, was told to remain on rest. Within a month, she miscarried.

Patient’s claim The physician was negligent for inserting an IUD without determining if she was pregnant, and the IUD caused the miscarriage.

Doctor’s defense A pregnancy test prior to insertion of an IUD is not the standard of care, especially when the patient reports regular periods. Also, the miscarriage was not related to the IUD.

Verdict Missouri defense verdict.

Was mother’s brain damage avoidable?

A 27-year-old pregnant woman at full term presented at the hospital for labor augmentation. Her OB was Dr. A. Dr. B, the anesthesiologist, was called a few hours later to place an epidural. Later, the patient began vomiting and experiencing seizures and became unresponsive. Neither Dr. A nor Dr. B was present. Fetal bradycardia was diagnosed and an emergency cesarean section was performed. During the delivery, the mother experienced cardiac arrest, uterine atony, and disseminated intravascular coagulation. She was resuscitated, but suffered severe brain damage. She must use a wheelchair because of cognitive and neurological impairments.

Patient’s claim Three things should have been done: earlier cesarean section, suctioning after the vomiting, and intubation.

Doctor’s defense The patient had an unpredictable and untreatable amniotic fluid embolism.

Verdict New York defense verdict, but posttrial motions were pending.

Depo-Provera is given to pregnant woman

When a 28-year-old woman with a history of alcohol and drug abuse requested contraceptive medication, she was prescribed 3 injections of Depo-Provera over 6 months. At each exam, she reported a weight gain, breast tenderness, and swelling of her breasts. The ObGyn said those were side effects of the medication. When she went to another physician 7 months after the first injection, it was determined that she was late in her seventh month of pregnancy. Unable to terminate the pregnancy, she delivered a child with significant, permanent disabilities. To care for the child, she quit her job and moved in with her parents.

Patient’s claim The physician failed to rule out pregnancy before the first injection.

Doctor’s defense The plaintiff had no damages.

Verdict $400,000 Massachusetts settlement.

Video supports claims of negligence

Shoulder dystocia occurred during delivery of the plaintiff’s child. Because of brachial plexus damage, the child suffers from Erb’s palsy and has undergone surgery to try to restore function to her arm, hand, and fingers.

Patient’s claim The defendants did not tell her to stop pushing when shoulder dystocia was discovered, and were negligent for using the McRoberts maneuver, suprapubic pressure, and excessive traction. The plaintiff provided video documentation of the delivery.

Doctor’s defense Negligence was denied.

Verdict $1 million Maryland verdict.

Pain, oophorectomy, then bowel perforation

Following an abdominal hysterectomy and bladder suspension, a 42-year-old woman began to have pain in the right suprapubic area. During laparoscopy to determine the cause of the pain, an ObGyn removed the patient’s ovaries. The patient began to experience severe abdominal pain and was found to have a perforated bowel. A colostomy was performed—and then reversed 2 months later.

Patient’s claim The laparoscopy, during which the bowel perforation occurred, should have been converted to an open laparotomy because of adhesions and the ovaries adhering with scar tissue to the bowel.

Doctor’s defense Bowel perforations are a known risk of laparoscopy, and the bowel perforation occurred after the surgery.

Verdict Defense verdict.

8 repair surgeries harm career

A 35-year-old country music entertainer who had complained of persistent abdominal pain underwent a hysterectomy and oophorectomy. During the procedure, the ureter and colon were transected, although this was not diagnosed until 5 days later. Nearly 4 L of urine was found when repair surgery was begun, and the patient’s chance of survival was uncertain. She had a total of 8 repair surgeries, which left residual scarring.

Patient’s claim As a result of the injuries, she could no longer perform on tours.

Doctor’s defense The problems were a known complication of the surgery.

Verdict A $500,000 verdict was returned. A post-trial motion by the defendant was pending.

Pain, oophorectomy, then bowel perforation

Following an abdominal hysterectomy and bladder suspension, a 42-year-old woman began to have pain in the right suprapubic area. During laparoscopy to determine the cause of the pain, an ObGyn removed the patient’s ovaries. The patient began to experience severe abdominal pain and was found to have a perforated bowel. A colostomy was performed—and then reversed 2 months later.

Patient’s claim The laparoscopy, during which the bowel perforation occurred, should have been converted to an open laparotomy because of adhesions and the ovaries adhering with scar tissue to the bowel.

Doctor’s defense Bowel perforations are a known risk of laparoscopy, and the bowel perforation occurred after the surgery.

Verdict Defense verdict.

8 repair surgeries harm career

A 35-year-old country music entertainer who had complained of persistent abdominal pain underwent a hysterectomy and oophorectomy. During the procedure, the ureter and colon were transected, although this was not diagnosed until 5 days later. Nearly 4 L of urine was found when repair surgery was begun, and the patient’s chance of survival was uncertain. She had a total of 8 repair surgeries, which left residual scarring.

Patient’s claim As a result of the injuries, she could no longer perform on tours.

Doctor’s defense The problems were a known complication of the surgery.

Verdict A $500,000 verdict was returned. A post-trial motion by the defendant was pending.

Pain, oophorectomy, then bowel perforation

Following an abdominal hysterectomy and bladder suspension, a 42-year-old woman began to have pain in the right suprapubic area. During laparoscopy to determine the cause of the pain, an ObGyn removed the patient’s ovaries. The patient began to experience severe abdominal pain and was found to have a perforated bowel. A colostomy was performed—and then reversed 2 months later.

Patient’s claim The laparoscopy, during which the bowel perforation occurred, should have been converted to an open laparotomy because of adhesions and the ovaries adhering with scar tissue to the bowel.

Doctor’s defense Bowel perforations are a known risk of laparoscopy, and the bowel perforation occurred after the surgery.

Verdict Defense verdict.

8 repair surgeries harm career

A 35-year-old country music entertainer who had complained of persistent abdominal pain underwent a hysterectomy and oophorectomy. During the procedure, the ureter and colon were transected, although this was not diagnosed until 5 days later. Nearly 4 L of urine was found when repair surgery was begun, and the patient’s chance of survival was uncertain. She had a total of 8 repair surgeries, which left residual scarring.

Patient’s claim As a result of the injuries, she could no longer perform on tours.

Doctor’s defense The problems were a known complication of the surgery.

Verdict A $500,000 verdict was returned. A post-trial motion by the defendant was pending.

Too-early birth of twins follows mother’s UTI

A woman in the 26th week of pregnancy with twins (the plaintiffs in the case) called her OB, Dr. A, to report she had a 102° fever. He advised her to take Tylenol, drink fluids, and call back in 2 hours. In the early morning of the next day, the woman presented at the hospital with a temperature of 101°, where Dr. B, another OB, saw her. She underwent testing, and the following day amniocentesis was performed. That afternoon the twins were delivered by emergency cesarean section. Each weighed less than 2 lb. The boy, born with multiple defects, has undergone numerous surgeries on his eyes and legs, but will always be wheelchair-bound. The girl can see after 2 surgeries, but suffers from physical and mental delays.

Patient’s claim The mother had a urinary tract infection, which was not properly diagnosed when she called Dr. A. Also, the amniocentesis should have been performed earlier.

Doctor’s defense They denied receiving further calls from the mother. Also, there was no indication of significant problems.

Verdict A $13.2 million verdict was returned against Dr. B only. Post-trial motions were pending.

MD removes ovaries, cyst—and part of ureter

A physician-employee of the defendant group performed surgery on a 44-year-old woman to remove her ovaries, fallopian tubes, and a cyst the size of an orange on the left ovary. The pathology report confirmed that the physician had removed part of the patient’s left ureter during the surgery. She required emergency reconstructive surgery and remained in the hospital for 2 weeks. A stent was put in place for 4 to 6 weeks. The repair surgery required an iliopsoas hitch. The patient continues to have left flank pain.

Patient’s claim Injury to the ureter was negligent. As the same physician had delivered her third child as well as performed her hysterectomy, he should have been aware of her condition.

Doctor’s defense The patient had complicated anatomy and adhesions because of the hysterectomy done the previous year.

Verdict A $400,000 verdict was returned.

Audible pop at delivery signals diastasis

A 36-year-old woman pregnant with her first child was admitted to the hospital in labor. The next morning she was completely dilated and effaced. She started pushing and, after 2 hours, forceps were used. An audible popping sound occurred at delivery and was noted in the records as a possible fracture of the coccyx. The patient, in great pain after the delivery, had suffered a 3-cm pubic symphysis diastasis (PSD) as shown on a pelvic CT scan. She was discharged after 6 days, and home treatment was arranged. The PSD healed before the trial.

Patient’s claim Inadequate fetal descent during the second stage of labor should have prompted a cesarean section. Cephalopelvic disproportion was present, and excessive force was used during the forceps delivery.

Doctor’s defense There was no cephalopelvic disproportion, and excessive force was not used. Also, PSD is a known risk factor of pregnancy.

Verdict Defense verdict.

Hysterectomy for postpartum hemorrhage

Following a cesarean section, a 39-year-old woman suffered postpartum internal bleeding and then developed disseminated intravascular coagulopathy. To stop the bleeding, a hysterectomy was performed.

Patient’s claim If the medical staff had reacted properly to her drop in blood pressure, which occurred shortly after she arrived in the recovery room following the cesarean section, the bleeding problem could have been prevented.

Doctor’s defense The bleeding problem was not a result of negligence. Also, a doctor was not required to go to the patient when her blood pressure dropped.

Verdict Defense verdict.

Misplaced sutures, then multiple surgeries

A 45-year-old woman underwent a hysterectomy, during which the ObGyn placed several sutures in her bladder. During a subsequent cystoscopy, a urologist identified and removed 2 of the sutures. A third procedure was performed when the woman developed symptoms of a fistula, and a third suture that had not fully penetrated the bladder was discovered. She required multiple surgeries to repair the vesicovaginal fistula.

Patient’s claim The ObGyn was negligent for placing the sutures in the bladder, and the urologist was negligent for not finding all 3 sutures during the initial cystoscopy.

Doctor’s defense Placing sutures in the bladder is a known risk of hysterectomy. The urologist also argued that the third suture could not be seen during the first cystoscopy.

Verdict Defense verdict.

Baby with entrapped head, occluded cord dies at 21 months

A 23-year-old woman in the 35th week of her second pregnancy, believing she was in labor, presented at the hospital, but monitoring equipment detected no sign of contractions. She claimed that the OB examined her, but no one checked her cervix to see if she was dilated. Although she demonstrated no organized contraction pattern, she was fully dilated 18 hours later. The OB attempted a vaginal delivery. The fetus presented in a breech position, and during delivery the head and umbilical cord became stuck in the birth canal. Physically and neurologically impaired at birth, the baby died at 21 months of age.

Patient’s claim The failure to diagnose labor led to the baby’s injuries. As the woman’s first pregnancy had resulted in labor at 36 weeks, there was a very good chance that she’d have a second preterm delivery. Also, the baby was deprived of oxygen for 6 minutes because of the head entrapment and umbilical cord occlusion, which caused hemorrhaging in the brain.

Doctor’s defense There was no negligence. The baby’s problems developed before birth.

Verdict A $2,890,000 verdict.

Too-early birth of twins follows mother’s UTI

A woman in the 26th week of pregnancy with twins (the plaintiffs in the case) called her OB, Dr. A, to report she had a 102° fever. He advised her to take Tylenol, drink fluids, and call back in 2 hours. In the early morning of the next day, the woman presented at the hospital with a temperature of 101°, where Dr. B, another OB, saw her. She underwent testing, and the following day amniocentesis was performed. That afternoon the twins were delivered by emergency cesarean section. Each weighed less than 2 lb. The boy, born with multiple defects, has undergone numerous surgeries on his eyes and legs, but will always be wheelchair-bound. The girl can see after 2 surgeries, but suffers from physical and mental delays.

Patient’s claim The mother had a urinary tract infection, which was not properly diagnosed when she called Dr. A. Also, the amniocentesis should have been performed earlier.

Doctor’s defense They denied receiving further calls from the mother. Also, there was no indication of significant problems.

Verdict A $13.2 million verdict was returned against Dr. B only. Post-trial motions were pending.

MD removes ovaries, cyst—and part of ureter

A physician-employee of the defendant group performed surgery on a 44-year-old woman to remove her ovaries, fallopian tubes, and a cyst the size of an orange on the left ovary. The pathology report confirmed that the physician had removed part of the patient’s left ureter during the surgery. She required emergency reconstructive surgery and remained in the hospital for 2 weeks. A stent was put in place for 4 to 6 weeks. The repair surgery required an iliopsoas hitch. The patient continues to have left flank pain.

Patient’s claim Injury to the ureter was negligent. As the same physician had delivered her third child as well as performed her hysterectomy, he should have been aware of her condition.

Doctor’s defense The patient had complicated anatomy and adhesions because of the hysterectomy done the previous year.

Verdict A $400,000 verdict was returned.

Audible pop at delivery signals diastasis

A 36-year-old woman pregnant with her first child was admitted to the hospital in labor. The next morning she was completely dilated and effaced. She started pushing and, after 2 hours, forceps were used. An audible popping sound occurred at delivery and was noted in the records as a possible fracture of the coccyx. The patient, in great pain after the delivery, had suffered a 3-cm pubic symphysis diastasis (PSD) as shown on a pelvic CT scan. She was discharged after 6 days, and home treatment was arranged. The PSD healed before the trial.

Patient’s claim Inadequate fetal descent during the second stage of labor should have prompted a cesarean section. Cephalopelvic disproportion was present, and excessive force was used during the forceps delivery.

Doctor’s defense There was no cephalopelvic disproportion, and excessive force was not used. Also, PSD is a known risk factor of pregnancy.

Verdict Defense verdict.

Hysterectomy for postpartum hemorrhage

Following a cesarean section, a 39-year-old woman suffered postpartum internal bleeding and then developed disseminated intravascular coagulopathy. To stop the bleeding, a hysterectomy was performed.

Patient’s claim If the medical staff had reacted properly to her drop in blood pressure, which occurred shortly after she arrived in the recovery room following the cesarean section, the bleeding problem could have been prevented.

Doctor’s defense The bleeding problem was not a result of negligence. Also, a doctor was not required to go to the patient when her blood pressure dropped.

Verdict Defense verdict.

Misplaced sutures, then multiple surgeries

A 45-year-old woman underwent a hysterectomy, during which the ObGyn placed several sutures in her bladder. During a subsequent cystoscopy, a urologist identified and removed 2 of the sutures. A third procedure was performed when the woman developed symptoms of a fistula, and a third suture that had not fully penetrated the bladder was discovered. She required multiple surgeries to repair the vesicovaginal fistula.

Patient’s claim The ObGyn was negligent for placing the sutures in the bladder, and the urologist was negligent for not finding all 3 sutures during the initial cystoscopy.

Doctor’s defense Placing sutures in the bladder is a known risk of hysterectomy. The urologist also argued that the third suture could not be seen during the first cystoscopy.

Verdict Defense verdict.

Baby with entrapped head, occluded cord dies at 21 months

A 23-year-old woman in the 35th week of her second pregnancy, believing she was in labor, presented at the hospital, but monitoring equipment detected no sign of contractions. She claimed that the OB examined her, but no one checked her cervix to see if she was dilated. Although she demonstrated no organized contraction pattern, she was fully dilated 18 hours later. The OB attempted a vaginal delivery. The fetus presented in a breech position, and during delivery the head and umbilical cord became stuck in the birth canal. Physically and neurologically impaired at birth, the baby died at 21 months of age.

Patient’s claim The failure to diagnose labor led to the baby’s injuries. As the woman’s first pregnancy had resulted in labor at 36 weeks, there was a very good chance that she’d have a second preterm delivery. Also, the baby was deprived of oxygen for 6 minutes because of the head entrapment and umbilical cord occlusion, which caused hemorrhaging in the brain.

Doctor’s defense There was no negligence. The baby’s problems developed before birth.

Verdict A $2,890,000 verdict.

Too-early birth of twins follows mother’s UTI

A woman in the 26th week of pregnancy with twins (the plaintiffs in the case) called her OB, Dr. A, to report she had a 102° fever. He advised her to take Tylenol, drink fluids, and call back in 2 hours. In the early morning of the next day, the woman presented at the hospital with a temperature of 101°, where Dr. B, another OB, saw her. She underwent testing, and the following day amniocentesis was performed. That afternoon the twins were delivered by emergency cesarean section. Each weighed less than 2 lb. The boy, born with multiple defects, has undergone numerous surgeries on his eyes and legs, but will always be wheelchair-bound. The girl can see after 2 surgeries, but suffers from physical and mental delays.

Patient’s claim The mother had a urinary tract infection, which was not properly diagnosed when she called Dr. A. Also, the amniocentesis should have been performed earlier.

Doctor’s defense They denied receiving further calls from the mother. Also, there was no indication of significant problems.

Verdict A $13.2 million verdict was returned against Dr. B only. Post-trial motions were pending.

MD removes ovaries, cyst—and part of ureter

A physician-employee of the defendant group performed surgery on a 44-year-old woman to remove her ovaries, fallopian tubes, and a cyst the size of an orange on the left ovary. The pathology report confirmed that the physician had removed part of the patient’s left ureter during the surgery. She required emergency reconstructive surgery and remained in the hospital for 2 weeks. A stent was put in place for 4 to 6 weeks. The repair surgery required an iliopsoas hitch. The patient continues to have left flank pain.

Patient’s claim Injury to the ureter was negligent. As the same physician had delivered her third child as well as performed her hysterectomy, he should have been aware of her condition.

Doctor’s defense The patient had complicated anatomy and adhesions because of the hysterectomy done the previous year.

Verdict A $400,000 verdict was returned.

Audible pop at delivery signals diastasis

A 36-year-old woman pregnant with her first child was admitted to the hospital in labor. The next morning she was completely dilated and effaced. She started pushing and, after 2 hours, forceps were used. An audible popping sound occurred at delivery and was noted in the records as a possible fracture of the coccyx. The patient, in great pain after the delivery, had suffered a 3-cm pubic symphysis diastasis (PSD) as shown on a pelvic CT scan. She was discharged after 6 days, and home treatment was arranged. The PSD healed before the trial.

Patient’s claim Inadequate fetal descent during the second stage of labor should have prompted a cesarean section. Cephalopelvic disproportion was present, and excessive force was used during the forceps delivery.

Doctor’s defense There was no cephalopelvic disproportion, and excessive force was not used. Also, PSD is a known risk factor of pregnancy.

Verdict Defense verdict.

Hysterectomy for postpartum hemorrhage

Following a cesarean section, a 39-year-old woman suffered postpartum internal bleeding and then developed disseminated intravascular coagulopathy. To stop the bleeding, a hysterectomy was performed.

Patient’s claim If the medical staff had reacted properly to her drop in blood pressure, which occurred shortly after she arrived in the recovery room following the cesarean section, the bleeding problem could have been prevented.

Doctor’s defense The bleeding problem was not a result of negligence. Also, a doctor was not required to go to the patient when her blood pressure dropped.

Verdict Defense verdict.

Misplaced sutures, then multiple surgeries

A 45-year-old woman underwent a hysterectomy, during which the ObGyn placed several sutures in her bladder. During a subsequent cystoscopy, a urologist identified and removed 2 of the sutures. A third procedure was performed when the woman developed symptoms of a fistula, and a third suture that had not fully penetrated the bladder was discovered. She required multiple surgeries to repair the vesicovaginal fistula.

Patient’s claim The ObGyn was negligent for placing the sutures in the bladder, and the urologist was negligent for not finding all 3 sutures during the initial cystoscopy.

Doctor’s defense Placing sutures in the bladder is a known risk of hysterectomy. The urologist also argued that the third suture could not be seen during the first cystoscopy.

Verdict Defense verdict.

Baby with entrapped head, occluded cord dies at 21 months

A 23-year-old woman in the 35th week of her second pregnancy, believing she was in labor, presented at the hospital, but monitoring equipment detected no sign of contractions. She claimed that the OB examined her, but no one checked her cervix to see if she was dilated. Although she demonstrated no organized contraction pattern, she was fully dilated 18 hours later. The OB attempted a vaginal delivery. The fetus presented in a breech position, and during delivery the head and umbilical cord became stuck in the birth canal. Physically and neurologically impaired at birth, the baby died at 21 months of age.

Patient’s claim The failure to diagnose labor led to the baby’s injuries. As the woman’s first pregnancy had resulted in labor at 36 weeks, there was a very good chance that she’d have a second preterm delivery. Also, the baby was deprived of oxygen for 6 minutes because of the head entrapment and umbilical cord occlusion, which caused hemorrhaging in the brain.

Doctor’s defense There was no negligence. The baby’s problems developed before birth.

Verdict A $2,890,000 verdict.

Patient not told of STD infects (then loses) beau

A Pap smear taken by an ObGyn was reported to the patient as normal. Four months later, the woman’s boyfriend ended their relationship because, he said, she had infected him with a sexually transmitted disease. When she called the ObGyn’s office, she was informed that, in fact, the Pap smear did show a Trichomonas vaginalis infection, but that she was not told so as not to worry her prior to unspecified surgery. The patient was treated successfully by another physician.

Patient’s claim By not telling her about the infection in a timely manner, the defendant caused her to transmit the infection unknowingly. Had she been told, she would have undergone immediate treatment.

Doctor’s defense He planned to treat the patient for the infection on a follow-up visit after surgery, but she did not keep the appointment. Also, the delay in treatment did not cause her any harm.

Verdict A jury found that there was negligence, but awarded no damages.

Who’s at fault in late delivery?

A morbidly obese woman who had diabetes was scheduled for a cesarean delivery several days after ultrasonography showed her full-term fetus to weigh 11 pounds. When she arrived for the delivery, fetal monitoring showed no fetal movement or heart tones. A stillborn baby was delivered.

Patient’s claim The delivery should have been done at the time of the sonogram.

Doctor’s defense The mother failed to report that she noticed decreased fetal movement days before scheduled delivery. She also failed to keep doctors’ appointments and follow prenatal advice.

Verdict Defense verdict.

Retained IUD blamed for infection, prematurity, and child’s problems

A woman received an IUD from her ObGyn. Later, when she thought she was pregnant, and a home pregnancy test confirmed it, she reported to her ObGyn that she was pregnant with an IUD in place. She underwent a sonogram that same day, but the sonographer reportedly saw no IUD in the uterus. Although no physician examined her to look for the IUD’s string, she was assured that the IUD had probably fallen out. Again no vaginal examination was done at her first prenatal visit.

At 30 weeks, her water broke. She was hospitalized in labor, but attempts to stop the labor failed. A significant uterine infection was discovered, and vaginal examination showed the IUD covered in purulent material inside the cervix. Cultures indicated methicillin-resistant Staphylococcus aureus.

Following emergency cesarean section, the baby was hospitalized for 6 weeks. Because of the infection, the mother suffered prolonged wound healing and was unable to work for 6 months. The child was hospitalized 9 times before the age of 4 years because of lung problems due to bronchopulmonary dysplasia. In the 12 months preceding settlement of the case, however, the child required no hospitalization.

Patient’s claim The defendants should have done more to find and remove the IUD during early pregnancy, so it could have progressed to term. The IUD caused the infection, which resulted in premature delivery and damaged the child’s lungs.

Doctor’s defense Not reported.

Verdict A $750,000 settlement was reached.

Tears to the perineum require 2 repairs

When a 35-year-old woman gave birth, she suffered tears to the perineum. The doctor who performed the delivery also repaired the tears after birth. A skin bridge formed and was repaired by another doctor.

Patient’s claim The tears were not repaired properly, causing the skin bridge.

Doctor’s defense The tears were repaired properly. Also scar tissue is a known risk of such a repair.

Verdict Defense verdict.

Foreshortened vagina hinders sex

Following recovery from a vaginal hysterectomy, a woman in her mid-30s suffered unbearable physical pain and discomfort in her vagina during sexual intercourse. Repair surgery, followed by full recovery, allowed her to have sexual activity without pain or discomfort.

Patient’s claim The physician was negligent in foreshortening her vaginal canal, necessitating further surgery.

Doctor’s defense The problems were caused by unusual postoperative scarring in the vaginal canal.

Verdict Defense verdict.

Patient not told of STD infects (then loses) beau

A Pap smear taken by an ObGyn was reported to the patient as normal. Four months later, the woman’s boyfriend ended their relationship because, he said, she had infected him with a sexually transmitted disease. When she called the ObGyn’s office, she was informed that, in fact, the Pap smear did show a Trichomonas vaginalis infection, but that she was not told so as not to worry her prior to unspecified surgery. The patient was treated successfully by another physician.

Patient’s claim By not telling her about the infection in a timely manner, the defendant caused her to transmit the infection unknowingly. Had she been told, she would have undergone immediate treatment.

Doctor’s defense He planned to treat the patient for the infection on a follow-up visit after surgery, but she did not keep the appointment. Also, the delay in treatment did not cause her any harm.

Verdict A jury found that there was negligence, but awarded no damages.

Who’s at fault in late delivery?

A morbidly obese woman who had diabetes was scheduled for a cesarean delivery several days after ultrasonography showed her full-term fetus to weigh 11 pounds. When she arrived for the delivery, fetal monitoring showed no fetal movement or heart tones. A stillborn baby was delivered.

Patient’s claim The delivery should have been done at the time of the sonogram.

Doctor’s defense The mother failed to report that she noticed decreased fetal movement days before scheduled delivery. She also failed to keep doctors’ appointments and follow prenatal advice.

Verdict Defense verdict.

Retained IUD blamed for infection, prematurity, and child’s problems

A woman received an IUD from her ObGyn. Later, when she thought she was pregnant, and a home pregnancy test confirmed it, she reported to her ObGyn that she was pregnant with an IUD in place. She underwent a sonogram that same day, but the sonographer reportedly saw no IUD in the uterus. Although no physician examined her to look for the IUD’s string, she was assured that the IUD had probably fallen out. Again no vaginal examination was done at her first prenatal visit.

At 30 weeks, her water broke. She was hospitalized in labor, but attempts to stop the labor failed. A significant uterine infection was discovered, and vaginal examination showed the IUD covered in purulent material inside the cervix. Cultures indicated methicillin-resistant Staphylococcus aureus.

Following emergency cesarean section, the baby was hospitalized for 6 weeks. Because of the infection, the mother suffered prolonged wound healing and was unable to work for 6 months. The child was hospitalized 9 times before the age of 4 years because of lung problems due to bronchopulmonary dysplasia. In the 12 months preceding settlement of the case, however, the child required no hospitalization.

Patient’s claim The defendants should have done more to find and remove the IUD during early pregnancy, so it could have progressed to term. The IUD caused the infection, which resulted in premature delivery and damaged the child’s lungs.

Doctor’s defense Not reported.

Verdict A $750,000 settlement was reached.

Tears to the perineum require 2 repairs

When a 35-year-old woman gave birth, she suffered tears to the perineum. The doctor who performed the delivery also repaired the tears after birth. A skin bridge formed and was repaired by another doctor.

Patient’s claim The tears were not repaired properly, causing the skin bridge.

Doctor’s defense The tears were repaired properly. Also scar tissue is a known risk of such a repair.

Verdict Defense verdict.

Foreshortened vagina hinders sex

Following recovery from a vaginal hysterectomy, a woman in her mid-30s suffered unbearable physical pain and discomfort in her vagina during sexual intercourse. Repair surgery, followed by full recovery, allowed her to have sexual activity without pain or discomfort.

Patient’s claim The physician was negligent in foreshortening her vaginal canal, necessitating further surgery.

Doctor’s defense The problems were caused by unusual postoperative scarring in the vaginal canal.

Verdict Defense verdict.

Patient not told of STD infects (then loses) beau

A Pap smear taken by an ObGyn was reported to the patient as normal. Four months later, the woman’s boyfriend ended their relationship because, he said, she had infected him with a sexually transmitted disease. When she called the ObGyn’s office, she was informed that, in fact, the Pap smear did show a Trichomonas vaginalis infection, but that she was not told so as not to worry her prior to unspecified surgery. The patient was treated successfully by another physician.

Patient’s claim By not telling her about the infection in a timely manner, the defendant caused her to transmit the infection unknowingly. Had she been told, she would have undergone immediate treatment.

Doctor’s defense He planned to treat the patient for the infection on a follow-up visit after surgery, but she did not keep the appointment. Also, the delay in treatment did not cause her any harm.

Verdict A jury found that there was negligence, but awarded no damages.

Who’s at fault in late delivery?

A morbidly obese woman who had diabetes was scheduled for a cesarean delivery several days after ultrasonography showed her full-term fetus to weigh 11 pounds. When she arrived for the delivery, fetal monitoring showed no fetal movement or heart tones. A stillborn baby was delivered.

Patient’s claim The delivery should have been done at the time of the sonogram.

Doctor’s defense The mother failed to report that she noticed decreased fetal movement days before scheduled delivery. She also failed to keep doctors’ appointments and follow prenatal advice.

Verdict Defense verdict.

Retained IUD blamed for infection, prematurity, and child’s problems

A woman received an IUD from her ObGyn. Later, when she thought she was pregnant, and a home pregnancy test confirmed it, she reported to her ObGyn that she was pregnant with an IUD in place. She underwent a sonogram that same day, but the sonographer reportedly saw no IUD in the uterus. Although no physician examined her to look for the IUD’s string, she was assured that the IUD had probably fallen out. Again no vaginal examination was done at her first prenatal visit.

At 30 weeks, her water broke. She was hospitalized in labor, but attempts to stop the labor failed. A significant uterine infection was discovered, and vaginal examination showed the IUD covered in purulent material inside the cervix. Cultures indicated methicillin-resistant Staphylococcus aureus.

Following emergency cesarean section, the baby was hospitalized for 6 weeks. Because of the infection, the mother suffered prolonged wound healing and was unable to work for 6 months. The child was hospitalized 9 times before the age of 4 years because of lung problems due to bronchopulmonary dysplasia. In the 12 months preceding settlement of the case, however, the child required no hospitalization.

Patient’s claim The defendants should have done more to find and remove the IUD during early pregnancy, so it could have progressed to term. The IUD caused the infection, which resulted in premature delivery and damaged the child’s lungs.

Doctor’s defense Not reported.

Verdict A $750,000 settlement was reached.

Tears to the perineum require 2 repairs

When a 35-year-old woman gave birth, she suffered tears to the perineum. The doctor who performed the delivery also repaired the tears after birth. A skin bridge formed and was repaired by another doctor.

Patient’s claim The tears were not repaired properly, causing the skin bridge.

Doctor’s defense The tears were repaired properly. Also scar tissue is a known risk of such a repair.

Verdict Defense verdict.

Foreshortened vagina hinders sex

Following recovery from a vaginal hysterectomy, a woman in her mid-30s suffered unbearable physical pain and discomfort in her vagina during sexual intercourse. Repair surgery, followed by full recovery, allowed her to have sexual activity without pain or discomfort.

Patient’s claim The physician was negligent in foreshortening her vaginal canal, necessitating further surgery.

Doctor’s defense The problems were caused by unusual postoperative scarring in the vaginal canal.

Verdict Defense verdict.

Severe brain damage follows slow response to fetal distress

When a woman was admitted to the hospital for delivery, oxytocin was administered to induce labor; fetal monitoring was reportedly reassuring. Moderate decelerations in the fetal monitoring occurred and, after several hours, the monitor indicated severe variable decelerations. The infant was delivered by vacuum extraction and required resuscitation. Apgar score was 1 at 1 minute and 5 at 5 minutes. He was diagnosed with hypoxia and severe brain damage and requires 24-hour care.

PATIENT’S CLAIM Cesarean section should have been performed, oxytocin should have been discontinued when the nonreassuring fetal heart rate pattern occurred, and a neonatologist should have been present at delivery to resuscitate the infant immediately.

DOCTOR’S DEFENSE Not reported.

VERDICT A $14.25 million settlement was reached, which included $250,000 for the mother.

From a search for 1 cyst … to complete hysterectomy

A 37-year-old woman went for a laparoscopic evaluation. The ObGyn believed she might have a cyst on 1 ovary and advised her there was a remote chance the ovary might have to be removed. The doctor found the cyst was large and removed the ovary, and then found a small cyst on the other ovary and removed that ovary also. As the patient had no ovaries, the doctor removed the uterus to make the procedure a complete hysterectomy.

PATIENT’S CLAIM She alleged lack of informed consent.

DOCTOR’S DEFENSE Not reported.

VERDICT A $71,621 verdict was returned.

Repair surgery leaves unwanted scars

A 39-year-old woman underwent an elective postpartum tubal ligation by minilaparotomy. In the pelvic cavity, multiple adhesions of the small bowel prevented the physician from accessing the fallopian tubes, so he stopped the procedure instead of converting to a full laparotomy procedure. Two days later, the patient was discharged, but she returned to the emergency room the next day with fecal material leaking from the minilaparotomy incision. General surgery was consulted to repair a suspected perforation of the bowel, which led to 7 inches of small bowel being removed and hospitalization for about a week.

PATIENT’S CLAIM The doctor had caught part of the small bowel with his suture, which caused the perforation, and the second procedure left her with scars.

DOCTOR’S DEFENSE At the time of closure, the injured loop of bowel was adherent to the abdominal wall and lateral to his incision, so that it was outside his field of vision.

VERDICT Defense verdict.

Severe brain damage follows slow response to fetal distress

When a woman was admitted to the hospital for delivery, oxytocin was administered to induce labor; fetal monitoring was reportedly reassuring. Moderate decelerations in the fetal monitoring occurred and, after several hours, the monitor indicated severe variable decelerations. The infant was delivered by vacuum extraction and required resuscitation. Apgar score was 1 at 1 minute and 5 at 5 minutes. He was diagnosed with hypoxia and severe brain damage and requires 24-hour care.

PATIENT’S CLAIM Cesarean section should have been performed, oxytocin should have been discontinued when the nonreassuring fetal heart rate pattern occurred, and a neonatologist should have been present at delivery to resuscitate the infant immediately.

DOCTOR’S DEFENSE Not reported.

VERDICT A $14.25 million settlement was reached, which included $250,000 for the mother.

From a search for 1 cyst … to complete hysterectomy

A 37-year-old woman went for a laparoscopic evaluation. The ObGyn believed she might have a cyst on 1 ovary and advised her there was a remote chance the ovary might have to be removed. The doctor found the cyst was large and removed the ovary, and then found a small cyst on the other ovary and removed that ovary also. As the patient had no ovaries, the doctor removed the uterus to make the procedure a complete hysterectomy.

PATIENT’S CLAIM She alleged lack of informed consent.

DOCTOR’S DEFENSE Not reported.

VERDICT A $71,621 verdict was returned.

Repair surgery leaves unwanted scars

A 39-year-old woman underwent an elective postpartum tubal ligation by minilaparotomy. In the pelvic cavity, multiple adhesions of the small bowel prevented the physician from accessing the fallopian tubes, so he stopped the procedure instead of converting to a full laparotomy procedure. Two days later, the patient was discharged, but she returned to the emergency room the next day with fecal material leaking from the minilaparotomy incision. General surgery was consulted to repair a suspected perforation of the bowel, which led to 7 inches of small bowel being removed and hospitalization for about a week.

PATIENT’S CLAIM The doctor had caught part of the small bowel with his suture, which caused the perforation, and the second procedure left her with scars.

DOCTOR’S DEFENSE At the time of closure, the injured loop of bowel was adherent to the abdominal wall and lateral to his incision, so that it was outside his field of vision.

VERDICT Defense verdict.

Severe brain damage follows slow response to fetal distress

When a woman was admitted to the hospital for delivery, oxytocin was administered to induce labor; fetal monitoring was reportedly reassuring. Moderate decelerations in the fetal monitoring occurred and, after several hours, the monitor indicated severe variable decelerations. The infant was delivered by vacuum extraction and required resuscitation. Apgar score was 1 at 1 minute and 5 at 5 minutes. He was diagnosed with hypoxia and severe brain damage and requires 24-hour care.

PATIENT’S CLAIM Cesarean section should have been performed, oxytocin should have been discontinued when the nonreassuring fetal heart rate pattern occurred, and a neonatologist should have been present at delivery to resuscitate the infant immediately.

DOCTOR’S DEFENSE Not reported.

VERDICT A $14.25 million settlement was reached, which included $250,000 for the mother.

From a search for 1 cyst … to complete hysterectomy

A 37-year-old woman went for a laparoscopic evaluation. The ObGyn believed she might have a cyst on 1 ovary and advised her there was a remote chance the ovary might have to be removed. The doctor found the cyst was large and removed the ovary, and then found a small cyst on the other ovary and removed that ovary also. As the patient had no ovaries, the doctor removed the uterus to make the procedure a complete hysterectomy.

PATIENT’S CLAIM She alleged lack of informed consent.

DOCTOR’S DEFENSE Not reported.

VERDICT A $71,621 verdict was returned.

Repair surgery leaves unwanted scars

A 39-year-old woman underwent an elective postpartum tubal ligation by minilaparotomy. In the pelvic cavity, multiple adhesions of the small bowel prevented the physician from accessing the fallopian tubes, so he stopped the procedure instead of converting to a full laparotomy procedure. Two days later, the patient was discharged, but she returned to the emergency room the next day with fecal material leaking from the minilaparotomy incision. General surgery was consulted to repair a suspected perforation of the bowel, which led to 7 inches of small bowel being removed and hospitalization for about a week.

PATIENT’S CLAIM The doctor had caught part of the small bowel with his suture, which caused the perforation, and the second procedure left her with scars.

DOCTOR’S DEFENSE At the time of closure, the injured loop of bowel was adherent to the abdominal wall and lateral to his incision, so that it was outside his field of vision.

VERDICT Defense verdict.