Medical Verdicts

Did delay in delivery cause adverse outcome?

An obstetrician and a perinatologist administered magnesium sulfate to a woman in premature labor, but contractions continued and the plaintiff child was delivered at 29 weeks—limp, cyanotic, and suffering respiratory failure. She was stabilized and diagnosed with periventricular leukomalacia. She suffers from spastic diplegia.

PATIENT’S CLAIM The doctors were negligent for not delivering the child more quickly. Nonreassuring fetal heart monitoring that should have prompted an immediate cesarean section was ignored.

DOCTOR’S DEFENSE Fetal heart monitoring was reassuring, and proper treatment was given.

VERDICT A verdict for the plaintiff found the obstetrician to be 65% at fault and the hospital 35%, with damages assessed at $29.3 million. Settlements recovered $5 million from the hospital and $2.3 million from the obstetrician.

For more on magnesium sulfate tocolysis, see Dr. Barbieri’s Editorial.

Oophorectomy and so much more

A laparoscopic oophorectomy, performed on a 51-year-old woman by 2 gynecologists, included removal of 1 ovary and the lysis of adhesions. The patient was released from the hospital the same day. Four days later, she presented to the emergency room with septic shock. Surgery the following day indicated peritonitis due to perforation of the sigmoid colon. A sigmoid colectomy was performed and an end colostomy created. Following surgery, the patient suffered respiratory failure and required a tracheotomy. She remained hospitalized for 4 weeks. When the colostomy was reversed 2 months later, the patient developed an infection and dehiscence of the surgical wound and was hospitalized for 12 days. Three years later, when she reported abdominal pain and a bowel obstruction was diagnosed, she underwent an appendectomy, oophorectomy of the remaining ovary, and lysis of adhesions. She was hospitalized for 2 days. When she reported abdominal pain 4 days after that, surgery indicated peritonitis resulting from perforation of the sigmoid colon.

PATIENT’S CLAIM The doctors were negligent when they performed the original oophorectomy.

DOCTOR’S DEFENSE The injuries were known risks of the procedure.

VERDICT A $700,000 settlement was reached.

Surprise twin discovered 1 hour after 1st was born

An OB and resident waited 45 minutes after a woman had given birth to 1 baby for the placenta to be expelled. A pelvic exam at that time showed a 2nd fetus. At birth, the 2nd twin had seizure-like activity and was treated with phenobarbital. This child has mild spasticity in the left leg, left foot turning in, moderate language delay, mild to moderate cognitive delay, and mild motor dysfunction.

PATIENT’S CLAIM A radiologist interpreting a prenatal sonogram failed to report findings indicating a 2nd fetus.

DOCTOR’S DEFENSE The radiologist did not misinterpret a prenatal sonogram. Also, hypoxic encephalopathy could have occurred during 2 periods: during the 3rd trimester and immediately before delivery, and the episode prior to delivery was not related to the child’s encephalopathy. As the child’s injuries were not permanent, they would resolve once the child received appropriate medication and underwent physical, occupational, and speech therapy.

VERDICT A $1.85 million settlement was reached.

Tubal ligation—and two bladder perforations

While performing an elective laparoscopic tubal ligation, an ObGyn perforated the patient’s bladder in 2 locations. The next day, the patient presented to the emergency room with abdominal pain and the inability to urinate. She was catheterized and blood was discovered in her urine. Cystoscopy performed by a urologist confirmed the perforations. After repair surgery, the patient developed renal failure, pleural effusions, and respiratory problems. She was discharged 5 days later, but required a catheter in the bladder for a few weeks.

PATIENT’S CLAIM Injury to the bladder should not have occurred.

DOCTOR’S DEFENSE The injury is a known risk of the procedure.

VERDICT Defense verdict.

Did forceps cause brain damage?

Twelve hours after the plaintiff child was delivered with the use of forceps, she began to have seizures. She was diagnosed with an occipital skull fracture, and a hematoma was found near the fracture location. She has suffered seizures and other complications related to a brain injury and is moderately retarded.

PATIENT’S CLAIM The injuries were caused by the ObGyn during use of the forceps, leading to the skull fracture and resulting brain damage.

DOCTOR’S DEFENSE The delivery was properly managed and use of forceps was proper. The defendant questioned whether there really was a fracture and argued that hematoma was a common injury during labor.

VERDICT Defense verdict.

No O₂ to fetus while mother in cardiac arrest

During labor, a woman experienced erratic fluctuations in her blood pressure and went into cardiac arrest. Her child has cerebral palsy and cannot speak or walk.

PATIENT’S CLAIM When the patient went into cardiac arrest, the fetus was deprived of oxygen for 10 minutes, leading to cerebral palsy. The failure to provide adequate oxygen was negligent.

DOCTOR’S DEFENSE Not reported.

VERDICT A $1 million settlement was reached with the delivering physician and hospital, and a $1.5 million settlement with the nurses.

Woman with untreated preeclampsia dies

A 36-year-old woman pregnant with her 2nd child was diagnosed with hypertension by her obstetrician. She was sent to the hospital, where the child was delivered by cesarean section. After suffering convulsions, the mother went into a coma the same day. She was transferred to another hospital and died 6 days later.

PATIENT’S CLAIM Untreated preeclampsia led to eclampsia and death.

DOCTOR’S DEFENSE The patient was monitored properly, but suffered a sudden, unexpected decline.

VERDICT $2.6 million settlement.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn (www.verdictslaska.com). The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.

Did delay in delivery cause adverse outcome?

An obstetrician and a perinatologist administered magnesium sulfate to a woman in premature labor, but contractions continued and the plaintiff child was delivered at 29 weeks—limp, cyanotic, and suffering respiratory failure. She was stabilized and diagnosed with periventricular leukomalacia. She suffers from spastic diplegia.

PATIENT’S CLAIM The doctors were negligent for not delivering the child more quickly. Nonreassuring fetal heart monitoring that should have prompted an immediate cesarean section was ignored.

DOCTOR’S DEFENSE Fetal heart monitoring was reassuring, and proper treatment was given.

VERDICT A verdict for the plaintiff found the obstetrician to be 65% at fault and the hospital 35%, with damages assessed at $29.3 million. Settlements recovered $5 million from the hospital and $2.3 million from the obstetrician.

For more on magnesium sulfate tocolysis, see Dr. Barbieri’s Editorial.

Oophorectomy and so much more

A laparoscopic oophorectomy, performed on a 51-year-old woman by 2 gynecologists, included removal of 1 ovary and the lysis of adhesions. The patient was released from the hospital the same day. Four days later, she presented to the emergency room with septic shock. Surgery the following day indicated peritonitis due to perforation of the sigmoid colon. A sigmoid colectomy was performed and an end colostomy created. Following surgery, the patient suffered respiratory failure and required a tracheotomy. She remained hospitalized for 4 weeks. When the colostomy was reversed 2 months later, the patient developed an infection and dehiscence of the surgical wound and was hospitalized for 12 days. Three years later, when she reported abdominal pain and a bowel obstruction was diagnosed, she underwent an appendectomy, oophorectomy of the remaining ovary, and lysis of adhesions. She was hospitalized for 2 days. When she reported abdominal pain 4 days after that, surgery indicated peritonitis resulting from perforation of the sigmoid colon.

PATIENT’S CLAIM The doctors were negligent when they performed the original oophorectomy.

DOCTOR’S DEFENSE The injuries were known risks of the procedure.

VERDICT A $700,000 settlement was reached.

Surprise twin discovered 1 hour after 1st was born

An OB and resident waited 45 minutes after a woman had given birth to 1 baby for the placenta to be expelled. A pelvic exam at that time showed a 2nd fetus. At birth, the 2nd twin had seizure-like activity and was treated with phenobarbital. This child has mild spasticity in the left leg, left foot turning in, moderate language delay, mild to moderate cognitive delay, and mild motor dysfunction.

PATIENT’S CLAIM A radiologist interpreting a prenatal sonogram failed to report findings indicating a 2nd fetus.

DOCTOR’S DEFENSE The radiologist did not misinterpret a prenatal sonogram. Also, hypoxic encephalopathy could have occurred during 2 periods: during the 3rd trimester and immediately before delivery, and the episode prior to delivery was not related to the child’s encephalopathy. As the child’s injuries were not permanent, they would resolve once the child received appropriate medication and underwent physical, occupational, and speech therapy.

VERDICT A $1.85 million settlement was reached.

Tubal ligation—and two bladder perforations

While performing an elective laparoscopic tubal ligation, an ObGyn perforated the patient’s bladder in 2 locations. The next day, the patient presented to the emergency room with abdominal pain and the inability to urinate. She was catheterized and blood was discovered in her urine. Cystoscopy performed by a urologist confirmed the perforations. After repair surgery, the patient developed renal failure, pleural effusions, and respiratory problems. She was discharged 5 days later, but required a catheter in the bladder for a few weeks.

PATIENT’S CLAIM Injury to the bladder should not have occurred.

DOCTOR’S DEFENSE The injury is a known risk of the procedure.

VERDICT Defense verdict.

Did forceps cause brain damage?

Twelve hours after the plaintiff child was delivered with the use of forceps, she began to have seizures. She was diagnosed with an occipital skull fracture, and a hematoma was found near the fracture location. She has suffered seizures and other complications related to a brain injury and is moderately retarded.

PATIENT’S CLAIM The injuries were caused by the ObGyn during use of the forceps, leading to the skull fracture and resulting brain damage.

DOCTOR’S DEFENSE The delivery was properly managed and use of forceps was proper. The defendant questioned whether there really was a fracture and argued that hematoma was a common injury during labor.

VERDICT Defense verdict.

No O₂ to fetus while mother in cardiac arrest

During labor, a woman experienced erratic fluctuations in her blood pressure and went into cardiac arrest. Her child has cerebral palsy and cannot speak or walk.

PATIENT’S CLAIM When the patient went into cardiac arrest, the fetus was deprived of oxygen for 10 minutes, leading to cerebral palsy. The failure to provide adequate oxygen was negligent.

DOCTOR’S DEFENSE Not reported.

VERDICT A $1 million settlement was reached with the delivering physician and hospital, and a $1.5 million settlement with the nurses.

Woman with untreated preeclampsia dies

A 36-year-old woman pregnant with her 2nd child was diagnosed with hypertension by her obstetrician. She was sent to the hospital, where the child was delivered by cesarean section. After suffering convulsions, the mother went into a coma the same day. She was transferred to another hospital and died 6 days later.

PATIENT’S CLAIM Untreated preeclampsia led to eclampsia and death.

DOCTOR’S DEFENSE The patient was monitored properly, but suffered a sudden, unexpected decline.

VERDICT $2.6 million settlement.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn (www.verdictslaska.com). The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.

Did delay in delivery cause adverse outcome?

An obstetrician and a perinatologist administered magnesium sulfate to a woman in premature labor, but contractions continued and the plaintiff child was delivered at 29 weeks—limp, cyanotic, and suffering respiratory failure. She was stabilized and diagnosed with periventricular leukomalacia. She suffers from spastic diplegia.

PATIENT’S CLAIM The doctors were negligent for not delivering the child more quickly. Nonreassuring fetal heart monitoring that should have prompted an immediate cesarean section was ignored.

DOCTOR’S DEFENSE Fetal heart monitoring was reassuring, and proper treatment was given.

VERDICT A verdict for the plaintiff found the obstetrician to be 65% at fault and the hospital 35%, with damages assessed at $29.3 million. Settlements recovered $5 million from the hospital and $2.3 million from the obstetrician.

For more on magnesium sulfate tocolysis, see Dr. Barbieri’s Editorial.

Oophorectomy and so much more

A laparoscopic oophorectomy, performed on a 51-year-old woman by 2 gynecologists, included removal of 1 ovary and the lysis of adhesions. The patient was released from the hospital the same day. Four days later, she presented to the emergency room with septic shock. Surgery the following day indicated peritonitis due to perforation of the sigmoid colon. A sigmoid colectomy was performed and an end colostomy created. Following surgery, the patient suffered respiratory failure and required a tracheotomy. She remained hospitalized for 4 weeks. When the colostomy was reversed 2 months later, the patient developed an infection and dehiscence of the surgical wound and was hospitalized for 12 days. Three years later, when she reported abdominal pain and a bowel obstruction was diagnosed, she underwent an appendectomy, oophorectomy of the remaining ovary, and lysis of adhesions. She was hospitalized for 2 days. When she reported abdominal pain 4 days after that, surgery indicated peritonitis resulting from perforation of the sigmoid colon.

PATIENT’S CLAIM The doctors were negligent when they performed the original oophorectomy.

DOCTOR’S DEFENSE The injuries were known risks of the procedure.

VERDICT A $700,000 settlement was reached.

Surprise twin discovered 1 hour after 1st was born

An OB and resident waited 45 minutes after a woman had given birth to 1 baby for the placenta to be expelled. A pelvic exam at that time showed a 2nd fetus. At birth, the 2nd twin had seizure-like activity and was treated with phenobarbital. This child has mild spasticity in the left leg, left foot turning in, moderate language delay, mild to moderate cognitive delay, and mild motor dysfunction.

PATIENT’S CLAIM A radiologist interpreting a prenatal sonogram failed to report findings indicating a 2nd fetus.

DOCTOR’S DEFENSE The radiologist did not misinterpret a prenatal sonogram. Also, hypoxic encephalopathy could have occurred during 2 periods: during the 3rd trimester and immediately before delivery, and the episode prior to delivery was not related to the child’s encephalopathy. As the child’s injuries were not permanent, they would resolve once the child received appropriate medication and underwent physical, occupational, and speech therapy.

VERDICT A $1.85 million settlement was reached.

Tubal ligation—and two bladder perforations

While performing an elective laparoscopic tubal ligation, an ObGyn perforated the patient’s bladder in 2 locations. The next day, the patient presented to the emergency room with abdominal pain and the inability to urinate. She was catheterized and blood was discovered in her urine. Cystoscopy performed by a urologist confirmed the perforations. After repair surgery, the patient developed renal failure, pleural effusions, and respiratory problems. She was discharged 5 days later, but required a catheter in the bladder for a few weeks.

PATIENT’S CLAIM Injury to the bladder should not have occurred.

DOCTOR’S DEFENSE The injury is a known risk of the procedure.

VERDICT Defense verdict.

Did forceps cause brain damage?

Twelve hours after the plaintiff child was delivered with the use of forceps, she began to have seizures. She was diagnosed with an occipital skull fracture, and a hematoma was found near the fracture location. She has suffered seizures and other complications related to a brain injury and is moderately retarded.

PATIENT’S CLAIM The injuries were caused by the ObGyn during use of the forceps, leading to the skull fracture and resulting brain damage.

DOCTOR’S DEFENSE The delivery was properly managed and use of forceps was proper. The defendant questioned whether there really was a fracture and argued that hematoma was a common injury during labor.

VERDICT Defense verdict.

No O₂ to fetus while mother in cardiac arrest

During labor, a woman experienced erratic fluctuations in her blood pressure and went into cardiac arrest. Her child has cerebral palsy and cannot speak or walk.

PATIENT’S CLAIM When the patient went into cardiac arrest, the fetus was deprived of oxygen for 10 minutes, leading to cerebral palsy. The failure to provide adequate oxygen was negligent.

DOCTOR’S DEFENSE Not reported.

VERDICT A $1 million settlement was reached with the delivering physician and hospital, and a $1.5 million settlement with the nurses.

Woman with untreated preeclampsia dies

A 36-year-old woman pregnant with her 2nd child was diagnosed with hypertension by her obstetrician. She was sent to the hospital, where the child was delivered by cesarean section. After suffering convulsions, the mother went into a coma the same day. She was transferred to another hospital and died 6 days later.

PATIENT’S CLAIM Untreated preeclampsia led to eclampsia and death.

DOCTOR’S DEFENSE The patient was monitored properly, but suffered a sudden, unexpected decline.

VERDICT $2.6 million settlement.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn (www.verdictslaska.com). The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.

Could hypoxic injury have been avoided?

A woman at full term contacted her ObGyn when she experienced a spontaneous membrane rupture with release of brownish-green fluid. She was advised to go to bed and call back later. Several hours later, she went to the hospital, where a nurse attended to her care. Fetal monitoring showed recurrent late decelerations and reduced variability. Meconium was observed on a pad under the woman, who asked for and received medication for pain. While she was left unattended for 1.5 hours, the fetal monitor continued to indicate different levels of fetal distress. The infant, delivered by cesarean section, required rigorous resuscitation and was placed in the NICU in critical condition. A positive Kleihauer–Betke test significant for fetomaternal bleed indicated the infant had suffered a severe hypoxic injury. The child was diagnosed with multiple neurological deficits.

PATIENT’S CLAIM Failure to promptly respond to signs of fetal distress and perform a timely cesarean section was negligent, and led to hypoxic ischemic encephalopathy, hypotension, hypoglycemia, metabolic acidosis, cerebral palsy, right hemiparesis, and developmental delays. The mother should have been admitted to the hospital when the membranes ruptured; fetal distress was not recognized; fetal well-being was not properly assessed; and emergent c-section should have been performed. Also, the mother should not have been given the pain medication when the heart tracings were nonreassuring.

DOCTOR’S DEFENSE There was no negligence. The child’s injuries were due to anemia resulting from severe chronic fetomaternal hemorrhage that occurred before hospitalization. Also, the child’s Apgar score did not indicate an acute hypoxic event during labor and delivery.

VERDICT $2,747,000 settlement.

Was bowel perforated during or after surgery?

A 35-year-old woman was referred to an ObGyn for an urgent hysterectomy at hospital 1. Three days after the surgery, she had follow-up repair surgery performed at hospital 2. She underwent 4 surgical procedures, including colostomy and colostomy reversal, and was hospitalized for 4 weeks.

PATIENT’S CLAIM The ObGyn negligently perforated her bowel during the initial surgery, and 3 days later fecal matter spilled into her abdomen.

DOCTOR’S DEFENSE The bowel perforation could have occurred either during surgery or afterwards due to the patient’s underlying pathology. Bowel perforation was a known risk of the procedure.

VERDICT Defense verdict.

Maternal hypertension, placental abruption, and brain-damaged newborn

A woman with elevated blood pressure gave birth to a brain-damaged child, who will need lifelong care.

PATIENT’S CLAIM The ObGyn should have admitted the woman to the hospital at 28.5 weeks because of elevated blood pressure and other clinical symptoms.

DOCTOR’S DEFENSE A thorough workup of the patient, including monitoring over a 4-hour period, laboratory studies, and fetal heart monitoring, was done, and the patient was referred for a biophysical profile the next morning. An emergency cesarean section was performed 4 days later because of an acute placental abruption, and earlier hospitalization would have been of no benefit.

VERDICT A defense verdict was returned for the ObGyn. The hospital settled for an undisclosed amount prior to trial, after the court directed a finding of negligence against it for failing to timely monitor for fetal distress.

Gestational diabetes led to macrosomia and permanent Erb’s palsy

A woman with a history of gestational diabetes was diagnosed once again with gestational diabetes 21 weeks into a 2nd pregnancy. Her primary care physician put her on a restricted diet, but did not order insulin therapy. At 42 weeks, the patient was admitted to the hospital for labor induction. The estimated fetal weight was 8 lb. The medical group’s on-call physician, who had never seen the patient, encountered shoulder dystocia while delivering the infant, who actually weighed 10 lb. The child, who had brachial plexus paralysis of the right arm, underwent sural nerve graft surgery.

PATIENT’S CLAIM The on-call doctor performing the delivery did not use the proper maneuvers to safely deliver the child when shoulder dystocia was encountered, resulting in brachial plexus paralysis. Also, the primary care physician did not monitor her gestational diabetes properly, which allowed the infant to become macrosomic, thus increasing the likelihood of shoulder dystocia.

DOCTOR’S DEFENSE There was no negligence.

VERDICT A $1,221,780 present value was returned. A $1,000,000 settlement was reached after the verdict, with the minor’s portion placed in a structured settlement.

Was cesarean section delayed after abnormal biophysical profile?

A diabetic woman with a twin pregnancy had an ultrasound showing twin size discordancy, which was not charted. Near term, she presented in late morning to her prenatal treating office with decreased fetal movement. A nonstress test was nonreactive, with a nonreassuring pattern. In midafternoon, an ultrasound biophysical profile exam performed at the hospital was abnormal. Two repeat tests over the next few hours yielded borderline and abnormal results. A cesarean section was performed in early evening. One twin was born without injury, but the other twin had cerebral palsy and mental retardation.

PATIENT’S CLAIM A bedside ultrasound biophysical profile should have been obtained promptly in the hospital. The initial abnormal results, possible twin discordancy, decreased fetal movement, and nonreactive nonstress test with nonreassuring pattern should have prompted an earlier c-section.

DOCTOR’S DEFENSE Not reported.

VERDICT $1,000,050 settlement.

“Patient knew ureteral injury was a risk”

A 39-year-old woman underwent a hysterectomy, during which a ureteral injury occurred. A urologist was brought in to reimplant the right ureter.

PATIENT’S CLAIM The ObGyn was negligent for causing the ureteral injury.

DOCTOR’S DEFENSE The patient had been informed that bladder tear was a known risk of the surgery.

VERDICT Defense verdict.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn (www.verdictslaska.com). The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.

Could hypoxic injury have been avoided?

A woman at full term contacted her ObGyn when she experienced a spontaneous membrane rupture with release of brownish-green fluid. She was advised to go to bed and call back later. Several hours later, she went to the hospital, where a nurse attended to her care. Fetal monitoring showed recurrent late decelerations and reduced variability. Meconium was observed on a pad under the woman, who asked for and received medication for pain. While she was left unattended for 1.5 hours, the fetal monitor continued to indicate different levels of fetal distress. The infant, delivered by cesarean section, required rigorous resuscitation and was placed in the NICU in critical condition. A positive Kleihauer–Betke test significant for fetomaternal bleed indicated the infant had suffered a severe hypoxic injury. The child was diagnosed with multiple neurological deficits.

PATIENT’S CLAIM Failure to promptly respond to signs of fetal distress and perform a timely cesarean section was negligent, and led to hypoxic ischemic encephalopathy, hypotension, hypoglycemia, metabolic acidosis, cerebral palsy, right hemiparesis, and developmental delays. The mother should have been admitted to the hospital when the membranes ruptured; fetal distress was not recognized; fetal well-being was not properly assessed; and emergent c-section should have been performed. Also, the mother should not have been given the pain medication when the heart tracings were nonreassuring.

DOCTOR’S DEFENSE There was no negligence. The child’s injuries were due to anemia resulting from severe chronic fetomaternal hemorrhage that occurred before hospitalization. Also, the child’s Apgar score did not indicate an acute hypoxic event during labor and delivery.

VERDICT $2,747,000 settlement.

Was bowel perforated during or after surgery?

A 35-year-old woman was referred to an ObGyn for an urgent hysterectomy at hospital 1. Three days after the surgery, she had follow-up repair surgery performed at hospital 2. She underwent 4 surgical procedures, including colostomy and colostomy reversal, and was hospitalized for 4 weeks.

PATIENT’S CLAIM The ObGyn negligently perforated her bowel during the initial surgery, and 3 days later fecal matter spilled into her abdomen.

DOCTOR’S DEFENSE The bowel perforation could have occurred either during surgery or afterwards due to the patient’s underlying pathology. Bowel perforation was a known risk of the procedure.

VERDICT Defense verdict.

Maternal hypertension, placental abruption, and brain-damaged newborn

A woman with elevated blood pressure gave birth to a brain-damaged child, who will need lifelong care.

PATIENT’S CLAIM The ObGyn should have admitted the woman to the hospital at 28.5 weeks because of elevated blood pressure and other clinical symptoms.

DOCTOR’S DEFENSE A thorough workup of the patient, including monitoring over a 4-hour period, laboratory studies, and fetal heart monitoring, was done, and the patient was referred for a biophysical profile the next morning. An emergency cesarean section was performed 4 days later because of an acute placental abruption, and earlier hospitalization would have been of no benefit.

VERDICT A defense verdict was returned for the ObGyn. The hospital settled for an undisclosed amount prior to trial, after the court directed a finding of negligence against it for failing to timely monitor for fetal distress.

Gestational diabetes led to macrosomia and permanent Erb’s palsy

A woman with a history of gestational diabetes was diagnosed once again with gestational diabetes 21 weeks into a 2nd pregnancy. Her primary care physician put her on a restricted diet, but did not order insulin therapy. At 42 weeks, the patient was admitted to the hospital for labor induction. The estimated fetal weight was 8 lb. The medical group’s on-call physician, who had never seen the patient, encountered shoulder dystocia while delivering the infant, who actually weighed 10 lb. The child, who had brachial plexus paralysis of the right arm, underwent sural nerve graft surgery.

PATIENT’S CLAIM The on-call doctor performing the delivery did not use the proper maneuvers to safely deliver the child when shoulder dystocia was encountered, resulting in brachial plexus paralysis. Also, the primary care physician did not monitor her gestational diabetes properly, which allowed the infant to become macrosomic, thus increasing the likelihood of shoulder dystocia.

DOCTOR’S DEFENSE There was no negligence.

VERDICT A $1,221,780 present value was returned. A $1,000,000 settlement was reached after the verdict, with the minor’s portion placed in a structured settlement.

Was cesarean section delayed after abnormal biophysical profile?

A diabetic woman with a twin pregnancy had an ultrasound showing twin size discordancy, which was not charted. Near term, she presented in late morning to her prenatal treating office with decreased fetal movement. A nonstress test was nonreactive, with a nonreassuring pattern. In midafternoon, an ultrasound biophysical profile exam performed at the hospital was abnormal. Two repeat tests over the next few hours yielded borderline and abnormal results. A cesarean section was performed in early evening. One twin was born without injury, but the other twin had cerebral palsy and mental retardation.

PATIENT’S CLAIM A bedside ultrasound biophysical profile should have been obtained promptly in the hospital. The initial abnormal results, possible twin discordancy, decreased fetal movement, and nonreactive nonstress test with nonreassuring pattern should have prompted an earlier c-section.

DOCTOR’S DEFENSE Not reported.

VERDICT $1,000,050 settlement.

“Patient knew ureteral injury was a risk”

A 39-year-old woman underwent a hysterectomy, during which a ureteral injury occurred. A urologist was brought in to reimplant the right ureter.

PATIENT’S CLAIM The ObGyn was negligent for causing the ureteral injury.

DOCTOR’S DEFENSE The patient had been informed that bladder tear was a known risk of the surgery.

VERDICT Defense verdict.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn (www.verdictslaska.com). The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.

Could hypoxic injury have been avoided?

A woman at full term contacted her ObGyn when she experienced a spontaneous membrane rupture with release of brownish-green fluid. She was advised to go to bed and call back later. Several hours later, she went to the hospital, where a nurse attended to her care. Fetal monitoring showed recurrent late decelerations and reduced variability. Meconium was observed on a pad under the woman, who asked for and received medication for pain. While she was left unattended for 1.5 hours, the fetal monitor continued to indicate different levels of fetal distress. The infant, delivered by cesarean section, required rigorous resuscitation and was placed in the NICU in critical condition. A positive Kleihauer–Betke test significant for fetomaternal bleed indicated the infant had suffered a severe hypoxic injury. The child was diagnosed with multiple neurological deficits.

PATIENT’S CLAIM Failure to promptly respond to signs of fetal distress and perform a timely cesarean section was negligent, and led to hypoxic ischemic encephalopathy, hypotension, hypoglycemia, metabolic acidosis, cerebral palsy, right hemiparesis, and developmental delays. The mother should have been admitted to the hospital when the membranes ruptured; fetal distress was not recognized; fetal well-being was not properly assessed; and emergent c-section should have been performed. Also, the mother should not have been given the pain medication when the heart tracings were nonreassuring.

DOCTOR’S DEFENSE There was no negligence. The child’s injuries were due to anemia resulting from severe chronic fetomaternal hemorrhage that occurred before hospitalization. Also, the child’s Apgar score did not indicate an acute hypoxic event during labor and delivery.

VERDICT $2,747,000 settlement.

Was bowel perforated during or after surgery?

A 35-year-old woman was referred to an ObGyn for an urgent hysterectomy at hospital 1. Three days after the surgery, she had follow-up repair surgery performed at hospital 2. She underwent 4 surgical procedures, including colostomy and colostomy reversal, and was hospitalized for 4 weeks.

PATIENT’S CLAIM The ObGyn negligently perforated her bowel during the initial surgery, and 3 days later fecal matter spilled into her abdomen.

DOCTOR’S DEFENSE The bowel perforation could have occurred either during surgery or afterwards due to the patient’s underlying pathology. Bowel perforation was a known risk of the procedure.

VERDICT Defense verdict.

Maternal hypertension, placental abruption, and brain-damaged newborn

A woman with elevated blood pressure gave birth to a brain-damaged child, who will need lifelong care.

PATIENT’S CLAIM The ObGyn should have admitted the woman to the hospital at 28.5 weeks because of elevated blood pressure and other clinical symptoms.

DOCTOR’S DEFENSE A thorough workup of the patient, including monitoring over a 4-hour period, laboratory studies, and fetal heart monitoring, was done, and the patient was referred for a biophysical profile the next morning. An emergency cesarean section was performed 4 days later because of an acute placental abruption, and earlier hospitalization would have been of no benefit.

VERDICT A defense verdict was returned for the ObGyn. The hospital settled for an undisclosed amount prior to trial, after the court directed a finding of negligence against it for failing to timely monitor for fetal distress.

Gestational diabetes led to macrosomia and permanent Erb’s palsy

A woman with a history of gestational diabetes was diagnosed once again with gestational diabetes 21 weeks into a 2nd pregnancy. Her primary care physician put her on a restricted diet, but did not order insulin therapy. At 42 weeks, the patient was admitted to the hospital for labor induction. The estimated fetal weight was 8 lb. The medical group’s on-call physician, who had never seen the patient, encountered shoulder dystocia while delivering the infant, who actually weighed 10 lb. The child, who had brachial plexus paralysis of the right arm, underwent sural nerve graft surgery.

PATIENT’S CLAIM The on-call doctor performing the delivery did not use the proper maneuvers to safely deliver the child when shoulder dystocia was encountered, resulting in brachial plexus paralysis. Also, the primary care physician did not monitor her gestational diabetes properly, which allowed the infant to become macrosomic, thus increasing the likelihood of shoulder dystocia.

DOCTOR’S DEFENSE There was no negligence.

VERDICT A $1,221,780 present value was returned. A $1,000,000 settlement was reached after the verdict, with the minor’s portion placed in a structured settlement.

Was cesarean section delayed after abnormal biophysical profile?

A diabetic woman with a twin pregnancy had an ultrasound showing twin size discordancy, which was not charted. Near term, she presented in late morning to her prenatal treating office with decreased fetal movement. A nonstress test was nonreactive, with a nonreassuring pattern. In midafternoon, an ultrasound biophysical profile exam performed at the hospital was abnormal. Two repeat tests over the next few hours yielded borderline and abnormal results. A cesarean section was performed in early evening. One twin was born without injury, but the other twin had cerebral palsy and mental retardation.

PATIENT’S CLAIM A bedside ultrasound biophysical profile should have been obtained promptly in the hospital. The initial abnormal results, possible twin discordancy, decreased fetal movement, and nonreactive nonstress test with nonreassuring pattern should have prompted an earlier c-section.

DOCTOR’S DEFENSE Not reported.

VERDICT $1,000,050 settlement.

“Patient knew ureteral injury was a risk”

A 39-year-old woman underwent a hysterectomy, during which a ureteral injury occurred. A urologist was brought in to reimplant the right ureter.

PATIENT’S CLAIM The ObGyn was negligent for causing the ureteral injury.

DOCTOR’S DEFENSE The patient had been informed that bladder tear was a known risk of the surgery.

VERDICT Defense verdict.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn (www.verdictslaska.com). The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.

Nurse says OB used misoprostol to avoid working on weekends

A woman’s 4th child, born at 36 weeks’ gestation with lungs not fully developed, was diagnosed with respiratory distress syndrome, apnea, and hypotension. Intubated for 4 or 5 days and in neonatal intensive care for 11 days, the baby required an apnea machine whenever he slept for his first 3 months.

PATIENT’S CLAIM The ObGyn used misoprostol to induce labor prematurely without the mother’s knowledge. A nurse who had worked for the defendant testified that the defendant would use misoprostol on a patient’s cervix the Tuesday before she reached full term and thus avoided working on weekends, and that he had done this for more than a year without telling patients.

DOCTOR’S DEFENSE The doctor denied inducing labor or giving patients misoprostol and claimed the testimony of the former employee nurse was inconsistent. Also, the plaintiff had given birth previously to another baby at 36 weeks, and the younger child’s problems were the result of his prematurity.

VERDICT Defense verdict.

“Doctor is responsible for my divorce”

A 32-year-old woman, whose right fallopian tube had been removed after an ectopic pregnancy, presented to her doctor with abnormal bleeding. She said she had a negative pregnancy test 2 weeks earlier; her doctor diagnosed dysfunctional uterine bleeding. She returned with abdominal pain 2 weeks later. A 2nd ectopic pregnancy was found, plus a ruptured left fallopian tube, which was removed. She was unable to conceive naturally after this.

PATIENT’S CLAIM The doctor should have performed a pregnancy test and was negligent for not diagnosing and treating the 2nd ectopic pregnancy in a timely manner. Her inability to conceive led to divorce.

DOCTOR’S DEFENSE A urine pregnancy test was indeed performed when she presented initially and was found to be negative.

VERDICT Defense verdict.

Was surgeon’s peripheral neuropathy to blame for injury?

Following a vaginal hysterectomy resulting in injury to the urethra, a 35-year-old woman required 2 additional surgeries. She has residual urination frequency that is painful due to scarring.

PATIENT’S CLAIM The gynecologist’s peripheral neuropathy affected control of her hands, and she was negligent in injuring the urethra.

DOCTOR’S DEFENSE There was neither negligence nor a problem with her hand control. Also, the patient did not suffer any significant injury.

VERDICT $200,000 verdict against the doctor; settlement with the hospital for an undisclosed amount.

Did video prove excessive traction?

A pregnant woman, who had limited prenatal care, presented for postterm induction of labor. Shoulder dystocia was encountered. Within 30 seconds the baby was delivered, but the left arm was paralyzed.

PATIENT’S CLAIM Excessive traction was used during delivery. A video of the birth showed the doctor stretching the baby’s head 4 to 5 inches from the shoulders during the delivery.

DOCTOR’S DEFENSE Gentle traction was used to move the baby’s head in the proper direction.

VERDICT Defense verdict. Motion for new trial is pending.

Mother not given chance to change her mind

A woman delivered a baby with a clubfoot by cesarean section, at which time a tubal ligation was also done. Later the baby was found to have a severe congenital heart defect, and eventually died.

PATIENT’S CLAIM The mother claimed lack of informed consent regarding the tubal ligation because the doctor should have known the baby could have other problems. She would not have consented to the ligation if she had known of the baby’s chances of survival.

DOCTOR’S DEFENSE Not reported.

VERDICT Defense verdict. Motion for new trial is pending.

No bowel prep, then permanent incontinence

A 31-year-old woman had an anovaginal fistula surgically repaired by Doctor 1. The following year, Doctor 2 performed follow-up surgery. Five years later, the patient returned to Doctor 2, who determined that a thick band of scar tissue had replaced the external part of the sphincter muscle, causing permanent fecal incontinence. She sued Doctor 1 and the hospital.

PATIENT’S CLAIM Antibiotics should have been prescribed and complete bowel preparation performed before the initial surgery. During surgery, the fistulous tract and scar tissue were not completely resected and the layers were improperly closed. Stool softeners should have been prescribed after surgery.

DOCTOR’S DEFENSE Despite no documentation, Doctor 1 believed stool softeners were probably prescribed. No bowel preparation was needed, the fistulous tract and scar tissue were resected, and closure was done properly. Also, another fistula with rectal abscess formed after Doctor 2’s surgery. This required multiple incisions and drainages and caused the sphincter defect.

VERDICT Defense verdict.

Pregnant woman had cancer in swollen foot

A 24-year-old pregnant woman obtained prenatal care from various residents and supervising physicians at a prenatal clinic. She complained of pain and numbness in her left foot. By the time of delivery, the foot was swollen and she could not walk on it. No imaging studies were done before she was discharged from the hospital. Six months later, a biopsy indicated malignant rhabdomyosarcoma. The patient underwent chemotherapy and radiation, but died 2 years later.

PATIENT’S CLAIM The tumor was not diagnosed in a timely manner. Her complaints should have been investigated during her pregnancy or before discharge from the hospital following delivery.

DOCTOR’S DEFENSE Not reported.

VERDICT A jury awarded $7.7 million. Fault was distributed as follows: the group, 60%; physician 1, 25%; physician 2, 15%.

Urinary leakage, fistula blamed on cystotomy

A 40-year-old woman was diagnosed with uterine prolapse and underwent a vaginal hysterectomy. Dense adhesions found during surgery made the separation and removal of the cervix and uterus from the bladder difficult. An intentional cystotomy was performed and then repaired, but the patient developed a vesicovaginal fistula.

PATIENT’S CLAIM The hysterectomy was not performed properly because the cystotomy was contraindicated and resulted in a vesicovaginal fistula, and the incision for the cystotomy was not properly repaired. The patient also claimed that she suffered occasional urinary leakage during laughing, coughing, straining, and sexual activity.

DOCTOR’S DEFENSE The hysterectomy was performed properly, and the cystotomy helped prevent more serious damage to the urinary tract and bladder. The patient’s urinary leakage was due to overactive bladder, smoking, and age.

VERDICT Defense verdict.

Did the emergency excuse the retained sponge?

A 40-year-old woman underwent an emergency hysterectomy and oophorectomy, during which a surgical sponge was left in her pelvic cavity. The retained sponge, which was not diagnosed on a postoperative x-ray, was discovered when the patient was later admitted to the hospital for chest pain. The sponge and a large mass of purulent material were removed from her pelvic cavity, as was her remaining ovary due to adhesions.

PATIENT’S CLAIM The ObGyn was negligent for leaving a sponge in her pelvic cavity and then for not diagnosing it on postoperative x-ray. The defendant should have consulted the radiologist because the x-ray indicated a vague area of radiopacity. The patient also claimed early-onset menopause due to removal of the ovary.

DOCTOR’S DEFENSE The emergency circumstances of the initial surgery accounted for the retained sponge, and the radiologist never verbally informed him of the questionable x-ray finding.

VERDICT A pretrial settlement was reached with the hospital and assistant surgeon for an undisclosed amount.

Claim: Crash C-section team was tardy

A 21-year-old woman presented to the hospital after experiencing rupture of membranes, and was started on oxytocin. The OB found that labor progress and fetal monitoring strips were normal.

Five hours later, nurses noted signs of prolonged deceleration and began to prepare for an emergency cesarean section.

The anesthesiologist and OB were unavailable at that time, and it took about 34 minutes for a team to be assembled to deliver the infant.

Within 2 minutes, the child was delivered, but his Apgars were 0 at 1, 5, and 10 minutes and 1 at 15 minutes, and he suffered severe brain damage. Cord blood was not analyzed for blood gases.

PATIENT’S CLAIM The defendants were negligent for not anticipating or recognizing developing problems, which were evident as much as 1 hour before the OB’s visit and included hyperstimulation of the uterus and slow progress of labor.

DOCTOR’S DEFENSE The OB would have come in and probably delivered the child if he had been called earlier.

There was no indication of hypoxia or cause for concern until very late in the process, and the brain damage to the child was the result of an unanticipatable event that occurred 30 minutes before delivery.

VERDICT A $3.5 million present-value settlement was reached during trial.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn (www.verdictslaska.com). The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.

Nurse says OB used misoprostol to avoid working on weekends

A woman’s 4th child, born at 36 weeks’ gestation with lungs not fully developed, was diagnosed with respiratory distress syndrome, apnea, and hypotension. Intubated for 4 or 5 days and in neonatal intensive care for 11 days, the baby required an apnea machine whenever he slept for his first 3 months.

PATIENT’S CLAIM The ObGyn used misoprostol to induce labor prematurely without the mother’s knowledge. A nurse who had worked for the defendant testified that the defendant would use misoprostol on a patient’s cervix the Tuesday before she reached full term and thus avoided working on weekends, and that he had done this for more than a year without telling patients.

DOCTOR’S DEFENSE The doctor denied inducing labor or giving patients misoprostol and claimed the testimony of the former employee nurse was inconsistent. Also, the plaintiff had given birth previously to another baby at 36 weeks, and the younger child’s problems were the result of his prematurity.

VERDICT Defense verdict.

“Doctor is responsible for my divorce”

A 32-year-old woman, whose right fallopian tube had been removed after an ectopic pregnancy, presented to her doctor with abnormal bleeding. She said she had a negative pregnancy test 2 weeks earlier; her doctor diagnosed dysfunctional uterine bleeding. She returned with abdominal pain 2 weeks later. A 2nd ectopic pregnancy was found, plus a ruptured left fallopian tube, which was removed. She was unable to conceive naturally after this.

PATIENT’S CLAIM The doctor should have performed a pregnancy test and was negligent for not diagnosing and treating the 2nd ectopic pregnancy in a timely manner. Her inability to conceive led to divorce.

DOCTOR’S DEFENSE A urine pregnancy test was indeed performed when she presented initially and was found to be negative.

VERDICT Defense verdict.

Was surgeon’s peripheral neuropathy to blame for injury?

Following a vaginal hysterectomy resulting in injury to the urethra, a 35-year-old woman required 2 additional surgeries. She has residual urination frequency that is painful due to scarring.

PATIENT’S CLAIM The gynecologist’s peripheral neuropathy affected control of her hands, and she was negligent in injuring the urethra.

DOCTOR’S DEFENSE There was neither negligence nor a problem with her hand control. Also, the patient did not suffer any significant injury.

VERDICT $200,000 verdict against the doctor; settlement with the hospital for an undisclosed amount.

Did video prove excessive traction?

A pregnant woman, who had limited prenatal care, presented for postterm induction of labor. Shoulder dystocia was encountered. Within 30 seconds the baby was delivered, but the left arm was paralyzed.

PATIENT’S CLAIM Excessive traction was used during delivery. A video of the birth showed the doctor stretching the baby’s head 4 to 5 inches from the shoulders during the delivery.

DOCTOR’S DEFENSE Gentle traction was used to move the baby’s head in the proper direction.

VERDICT Defense verdict. Motion for new trial is pending.

Mother not given chance to change her mind

A woman delivered a baby with a clubfoot by cesarean section, at which time a tubal ligation was also done. Later the baby was found to have a severe congenital heart defect, and eventually died.

PATIENT’S CLAIM The mother claimed lack of informed consent regarding the tubal ligation because the doctor should have known the baby could have other problems. She would not have consented to the ligation if she had known of the baby’s chances of survival.

DOCTOR’S DEFENSE Not reported.

VERDICT Defense verdict. Motion for new trial is pending.

No bowel prep, then permanent incontinence

A 31-year-old woman had an anovaginal fistula surgically repaired by Doctor 1. The following year, Doctor 2 performed follow-up surgery. Five years later, the patient returned to Doctor 2, who determined that a thick band of scar tissue had replaced the external part of the sphincter muscle, causing permanent fecal incontinence. She sued Doctor 1 and the hospital.

PATIENT’S CLAIM Antibiotics should have been prescribed and complete bowel preparation performed before the initial surgery. During surgery, the fistulous tract and scar tissue were not completely resected and the layers were improperly closed. Stool softeners should have been prescribed after surgery.

DOCTOR’S DEFENSE Despite no documentation, Doctor 1 believed stool softeners were probably prescribed. No bowel preparation was needed, the fistulous tract and scar tissue were resected, and closure was done properly. Also, another fistula with rectal abscess formed after Doctor 2’s surgery. This required multiple incisions and drainages and caused the sphincter defect.

VERDICT Defense verdict.

Pregnant woman had cancer in swollen foot

A 24-year-old pregnant woman obtained prenatal care from various residents and supervising physicians at a prenatal clinic. She complained of pain and numbness in her left foot. By the time of delivery, the foot was swollen and she could not walk on it. No imaging studies were done before she was discharged from the hospital. Six months later, a biopsy indicated malignant rhabdomyosarcoma. The patient underwent chemotherapy and radiation, but died 2 years later.

PATIENT’S CLAIM The tumor was not diagnosed in a timely manner. Her complaints should have been investigated during her pregnancy or before discharge from the hospital following delivery.

DOCTOR’S DEFENSE Not reported.

VERDICT A jury awarded $7.7 million. Fault was distributed as follows: the group, 60%; physician 1, 25%; physician 2, 15%.

Urinary leakage, fistula blamed on cystotomy

A 40-year-old woman was diagnosed with uterine prolapse and underwent a vaginal hysterectomy. Dense adhesions found during surgery made the separation and removal of the cervix and uterus from the bladder difficult. An intentional cystotomy was performed and then repaired, but the patient developed a vesicovaginal fistula.

PATIENT’S CLAIM The hysterectomy was not performed properly because the cystotomy was contraindicated and resulted in a vesicovaginal fistula, and the incision for the cystotomy was not properly repaired. The patient also claimed that she suffered occasional urinary leakage during laughing, coughing, straining, and sexual activity.

DOCTOR’S DEFENSE The hysterectomy was performed properly, and the cystotomy helped prevent more serious damage to the urinary tract and bladder. The patient’s urinary leakage was due to overactive bladder, smoking, and age.

VERDICT Defense verdict.

Did the emergency excuse the retained sponge?

A 40-year-old woman underwent an emergency hysterectomy and oophorectomy, during which a surgical sponge was left in her pelvic cavity. The retained sponge, which was not diagnosed on a postoperative x-ray, was discovered when the patient was later admitted to the hospital for chest pain. The sponge and a large mass of purulent material were removed from her pelvic cavity, as was her remaining ovary due to adhesions.

PATIENT’S CLAIM The ObGyn was negligent for leaving a sponge in her pelvic cavity and then for not diagnosing it on postoperative x-ray. The defendant should have consulted the radiologist because the x-ray indicated a vague area of radiopacity. The patient also claimed early-onset menopause due to removal of the ovary.

DOCTOR’S DEFENSE The emergency circumstances of the initial surgery accounted for the retained sponge, and the radiologist never verbally informed him of the questionable x-ray finding.

VERDICT A pretrial settlement was reached with the hospital and assistant surgeon for an undisclosed amount.

Claim: Crash C-section team was tardy

A 21-year-old woman presented to the hospital after experiencing rupture of membranes, and was started on oxytocin. The OB found that labor progress and fetal monitoring strips were normal.

Five hours later, nurses noted signs of prolonged deceleration and began to prepare for an emergency cesarean section.

The anesthesiologist and OB were unavailable at that time, and it took about 34 minutes for a team to be assembled to deliver the infant.

Within 2 minutes, the child was delivered, but his Apgars were 0 at 1, 5, and 10 minutes and 1 at 15 minutes, and he suffered severe brain damage. Cord blood was not analyzed for blood gases.

PATIENT’S CLAIM The defendants were negligent for not anticipating or recognizing developing problems, which were evident as much as 1 hour before the OB’s visit and included hyperstimulation of the uterus and slow progress of labor.

DOCTOR’S DEFENSE The OB would have come in and probably delivered the child if he had been called earlier.

There was no indication of hypoxia or cause for concern until very late in the process, and the brain damage to the child was the result of an unanticipatable event that occurred 30 minutes before delivery.

VERDICT A $3.5 million present-value settlement was reached during trial.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn (www.verdictslaska.com). The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.

Nurse says OB used misoprostol to avoid working on weekends

A woman’s 4th child, born at 36 weeks’ gestation with lungs not fully developed, was diagnosed with respiratory distress syndrome, apnea, and hypotension. Intubated for 4 or 5 days and in neonatal intensive care for 11 days, the baby required an apnea machine whenever he slept for his first 3 months.

PATIENT’S CLAIM The ObGyn used misoprostol to induce labor prematurely without the mother’s knowledge. A nurse who had worked for the defendant testified that the defendant would use misoprostol on a patient’s cervix the Tuesday before she reached full term and thus avoided working on weekends, and that he had done this for more than a year without telling patients.

DOCTOR’S DEFENSE The doctor denied inducing labor or giving patients misoprostol and claimed the testimony of the former employee nurse was inconsistent. Also, the plaintiff had given birth previously to another baby at 36 weeks, and the younger child’s problems were the result of his prematurity.

VERDICT Defense verdict.

“Doctor is responsible for my divorce”

A 32-year-old woman, whose right fallopian tube had been removed after an ectopic pregnancy, presented to her doctor with abnormal bleeding. She said she had a negative pregnancy test 2 weeks earlier; her doctor diagnosed dysfunctional uterine bleeding. She returned with abdominal pain 2 weeks later. A 2nd ectopic pregnancy was found, plus a ruptured left fallopian tube, which was removed. She was unable to conceive naturally after this.

PATIENT’S CLAIM The doctor should have performed a pregnancy test and was negligent for not diagnosing and treating the 2nd ectopic pregnancy in a timely manner. Her inability to conceive led to divorce.

DOCTOR’S DEFENSE A urine pregnancy test was indeed performed when she presented initially and was found to be negative.

VERDICT Defense verdict.

Was surgeon’s peripheral neuropathy to blame for injury?

Following a vaginal hysterectomy resulting in injury to the urethra, a 35-year-old woman required 2 additional surgeries. She has residual urination frequency that is painful due to scarring.

PATIENT’S CLAIM The gynecologist’s peripheral neuropathy affected control of her hands, and she was negligent in injuring the urethra.

DOCTOR’S DEFENSE There was neither negligence nor a problem with her hand control. Also, the patient did not suffer any significant injury.

VERDICT $200,000 verdict against the doctor; settlement with the hospital for an undisclosed amount.

Did video prove excessive traction?

A pregnant woman, who had limited prenatal care, presented for postterm induction of labor. Shoulder dystocia was encountered. Within 30 seconds the baby was delivered, but the left arm was paralyzed.

PATIENT’S CLAIM Excessive traction was used during delivery. A video of the birth showed the doctor stretching the baby’s head 4 to 5 inches from the shoulders during the delivery.

DOCTOR’S DEFENSE Gentle traction was used to move the baby’s head in the proper direction.

VERDICT Defense verdict. Motion for new trial is pending.

Mother not given chance to change her mind

A woman delivered a baby with a clubfoot by cesarean section, at which time a tubal ligation was also done. Later the baby was found to have a severe congenital heart defect, and eventually died.

PATIENT’S CLAIM The mother claimed lack of informed consent regarding the tubal ligation because the doctor should have known the baby could have other problems. She would not have consented to the ligation if she had known of the baby’s chances of survival.

DOCTOR’S DEFENSE Not reported.

VERDICT Defense verdict. Motion for new trial is pending.

No bowel prep, then permanent incontinence

A 31-year-old woman had an anovaginal fistula surgically repaired by Doctor 1. The following year, Doctor 2 performed follow-up surgery. Five years later, the patient returned to Doctor 2, who determined that a thick band of scar tissue had replaced the external part of the sphincter muscle, causing permanent fecal incontinence. She sued Doctor 1 and the hospital.

PATIENT’S CLAIM Antibiotics should have been prescribed and complete bowel preparation performed before the initial surgery. During surgery, the fistulous tract and scar tissue were not completely resected and the layers were improperly closed. Stool softeners should have been prescribed after surgery.

DOCTOR’S DEFENSE Despite no documentation, Doctor 1 believed stool softeners were probably prescribed. No bowel preparation was needed, the fistulous tract and scar tissue were resected, and closure was done properly. Also, another fistula with rectal abscess formed after Doctor 2’s surgery. This required multiple incisions and drainages and caused the sphincter defect.

VERDICT Defense verdict.

Pregnant woman had cancer in swollen foot

A 24-year-old pregnant woman obtained prenatal care from various residents and supervising physicians at a prenatal clinic. She complained of pain and numbness in her left foot. By the time of delivery, the foot was swollen and she could not walk on it. No imaging studies were done before she was discharged from the hospital. Six months later, a biopsy indicated malignant rhabdomyosarcoma. The patient underwent chemotherapy and radiation, but died 2 years later.

PATIENT’S CLAIM The tumor was not diagnosed in a timely manner. Her complaints should have been investigated during her pregnancy or before discharge from the hospital following delivery.

DOCTOR’S DEFENSE Not reported.

VERDICT A jury awarded $7.7 million. Fault was distributed as follows: the group, 60%; physician 1, 25%; physician 2, 15%.

Urinary leakage, fistula blamed on cystotomy

A 40-year-old woman was diagnosed with uterine prolapse and underwent a vaginal hysterectomy. Dense adhesions found during surgery made the separation and removal of the cervix and uterus from the bladder difficult. An intentional cystotomy was performed and then repaired, but the patient developed a vesicovaginal fistula.

PATIENT’S CLAIM The hysterectomy was not performed properly because the cystotomy was contraindicated and resulted in a vesicovaginal fistula, and the incision for the cystotomy was not properly repaired. The patient also claimed that she suffered occasional urinary leakage during laughing, coughing, straining, and sexual activity.

DOCTOR’S DEFENSE The hysterectomy was performed properly, and the cystotomy helped prevent more serious damage to the urinary tract and bladder. The patient’s urinary leakage was due to overactive bladder, smoking, and age.

VERDICT Defense verdict.

Did the emergency excuse the retained sponge?

A 40-year-old woman underwent an emergency hysterectomy and oophorectomy, during which a surgical sponge was left in her pelvic cavity. The retained sponge, which was not diagnosed on a postoperative x-ray, was discovered when the patient was later admitted to the hospital for chest pain. The sponge and a large mass of purulent material were removed from her pelvic cavity, as was her remaining ovary due to adhesions.

PATIENT’S CLAIM The ObGyn was negligent for leaving a sponge in her pelvic cavity and then for not diagnosing it on postoperative x-ray. The defendant should have consulted the radiologist because the x-ray indicated a vague area of radiopacity. The patient also claimed early-onset menopause due to removal of the ovary.

DOCTOR’S DEFENSE The emergency circumstances of the initial surgery accounted for the retained sponge, and the radiologist never verbally informed him of the questionable x-ray finding.

VERDICT A pretrial settlement was reached with the hospital and assistant surgeon for an undisclosed amount.

Claim: Crash C-section team was tardy

A 21-year-old woman presented to the hospital after experiencing rupture of membranes, and was started on oxytocin. The OB found that labor progress and fetal monitoring strips were normal.

Five hours later, nurses noted signs of prolonged deceleration and began to prepare for an emergency cesarean section.

The anesthesiologist and OB were unavailable at that time, and it took about 34 minutes for a team to be assembled to deliver the infant.

Within 2 minutes, the child was delivered, but his Apgars were 0 at 1, 5, and 10 minutes and 1 at 15 minutes, and he suffered severe brain damage. Cord blood was not analyzed for blood gases.

PATIENT’S CLAIM The defendants were negligent for not anticipating or recognizing developing problems, which were evident as much as 1 hour before the OB’s visit and included hyperstimulation of the uterus and slow progress of labor.

DOCTOR’S DEFENSE The OB would have come in and probably delivered the child if he had been called earlier.

There was no indication of hypoxia or cause for concern until very late in the process, and the brain damage to the child was the result of an unanticipatable event that occurred 30 minutes before delivery.

VERDICT A $3.5 million present-value settlement was reached during trial.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn (www.verdictslaska.com). The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.

Despite signs of cancer, estrogen is given

After 2 years of mammograms showing signs of breast cancer and the continued administration of estrogen medications, a 55-year-old woman underwent a modified radical left mastectomy and left axillary dissection, followed by extensive radiation therapy and chemotherapy. She suffered extensive radiation burns to her chest wall, chronic arm swelling due to lymphedema, and nerve damage to the hands due to the chemotherapy. She underwent a total of 9 surgeries.

PATIENT’S CLAIM The gynecologist was negligent for not referring her to a surgeon after 2 years of mammograms indicated cancer and for continuing to administer estrogen medications. The delayed diagnosis allowed the cancer to grow to nearly 9 cm and spread to the lymph nodes, thus requiring extensive surgery and treatment, rather than a simple lumpectomy and breast radiation.

DOCTOR’S DEFENSE Not reported.

VERDICT A jury returned a verdict of $5.65 million for the plaintiff and $300,000 for the husband for lost consortium.

Postcoital bleeding fails to alert Gyn to cancer

A 35-year-old woman suffered postcoital bleeding and was diagnosed with cervicitis by her gynecologist. After 10 months with no improvement despite 9 more examinations and antibiotic treatment, a colposcopy performed by a second gynecologist revealed cervical adenocarcinoma. A hysterectomy was performed.

PATIENT’S CLAIM The first gynecologist should have performed a colposcopy and biopsies to diagnose the cancer and start treatment, thus avoiding the hysterectomy and increasing her life expectancy.

DOCTOR’S DEFENSE Cervical cancer is seldom diagnosed at an early stage, and this cancer was located where early detection by colposcopy was impossible. In this case, a hysterectomy would have been necessary anyway.

VERDICT Defense verdict.

Doctor sutures bladder, calls dye spill a “typo”

After having suffered severe pelvic pain and bleeding for years, a 25-year-old woman underwent a total hysterectomy. Following surgery, she began to have bladder problems. When it was discovered that her bladder had been sutured three times during the surgery, she underwent repair surgery, but she remained incontinent.

PATIENT’S CLAIM According to the surgical record, blue dye was observed coming from her bladder during surgery, which should have alerted the doctor to investigate and repair the injury.

DOCTOR’S DEFENSE The physician admitted suturing the bladder, a known complication, but claimed the injury was not immediately apparent. Also, no dye spilled from the bladder - that was just a typographical error.

VERDICT Defense verdict.

Small abdomen worries mother, not doctor

A 24-year-old pregnant woman had monthly visits with her ObGyn from May to November. In October, she indicated that 2 pregnant friends had larger abdomens than she did at similar stages of pregnancy, but she was told everything was fine. In November, she requested an ultrasound on 3 occasions, but was told it was not necessary. In late November, she reported to the clinic complaining of cramps. Fetal demise was diagnosed, she was admitted to the hospital, where delivery was induced, and she went home the next day.

PATIENT’S CLAIM The fetus would not have died if the ObGyn had performed the appropriate tests when she was first concerned about the small size of her abdomen.

DOCTOR’S CLAIM Intrauterine growth retardation is rare and difficult to diagnose, and it has a high morbidity rate. Also, the mother was instructed to report diminished fetal movement, but she had failed to do so.

VERDICT After a trial resulted in a hung jury, a confidential settlement was reached.

Placental abruption or burst fetal blood vessel?

When a pregnant woman at term called her ObGyn after waking in a pool of blood, he questioned her and then sent her to the hospital. Physical assessment, fetal monitoring, and ultrasound were conducted. A cesarean section was performed when vaginal exam revealed that the fetus was remote from a vaginal delivery. After birth the newborn was unstable. She was transferred to another hospital, where she died soon thereafter.

PATIENT’S CLAIM The mother believed she had a placental abruption and claimed the baby would have survived had the delivery been done even 20 minutes earlier.

DOCTOR’S DEFENSE According to information the mother gave on the phone, bleeding was not due to placental abruption. She was no longer bleeding when she arrived at the hospital and had no abdominal pain. A ruptured fetal blood vessel caused the severe blood loss, and the baby would have died even if delivered earlier.

VERDICT A $500,00 verdict was returned.

Referring Gyn: “not responsible” for sponge

A 36-year-old woman’s gynecologist, Doctor 1, referred her to an ObGyn, Doctor 2, to perform a reversal of a tubal ligation. During the procedure, a lap sponge rolled in plastic was left in the patient despite a correct sponge count reported by the nurses. During her hospital stay and 4 office visits with Doctor 2, she reported pain, but a vaginal ultrasound was negative. One year later, she complained of excruciating pain to Doctor 1, who felt a mobile mass. Abdominal ultrasound showed nothing. When a CT tech told her to see her doctor after a CT scan, she was alarmed and immediately had an x-ray done, which indicated a retained foreign body. The patient sought another opinion when Doctor 1 asked her to sign a form for exploratory surgery before he had reviewed the CT results himself. Doctor 3 diagnosed the problem immediately and removed the sponge. She has had few physical problems since then.

The patient sued Doctors 1 and 2, the hospital, and the nurses. The hospital filed a 3rd party action against Doctor 2, claiming he had used a nonradiopaque, noncounted sponge.

PATIENT’S CLAIM The patient claimed the doctor was negligent in leaving the sponge in her and failing to diagnose the problem following surgery.

DOCTOR’S DEFENSE Doctor 1 could not have told the patient about the retained sponge before he had seen the CT films, especially as the records showed a correct sponge count. When he was certain it was a sponge, he called the patient, but she never returned his calls. Also, as the assistant surgeon, he was not responsible for the sponge count.

VERDICT The plaintiff reached a confidential settlement with Doctor 2 and the hospital. The hospital settled with the plaintiff and dismissed its claim against Doctor 2. In the trial against Doctor 1, a defense verdict was returned.

Anesthesiologist, nurses say “not me,” blame OB

An infant later found to be mentally retarded was delivered by cesarean section following fetal distress.

PATIENT’S CLAIM The parents claim the obstetrician, anesthesiologist, and 2 hospital nurses failed to respond quickly to signs of fetal distress, and a 1-hour delay in performing a cesarean section caused the child’s mental retardation. The anesthesiologist should have been prepared for a cesarean section, and the nurses did not report the obstetrician’s delay to superiors.

DOCTOR’S DEFENSE Anesthesiologist and nurses blamed the obstetrician.

VERDICT Prior to trial, the obstetrician settled for $1 million. A $3.69 million verdict was returned against the others, but that was reduced to $45,000 because the jury found the obstetrician to be 90% at fault.

When are drugs, monitoring enough?

A woman pregnant with twins at 29 weeks’ gestation presented to a hospital with vaginal bleeding, but was discharged when maternal-fetal well-being was established. One day after a brown discharge, she reported to the hospital with bleeding and irregular contractions. She was monitored and given tocolytic drugs, then sent home where uterine activity was monitored. She suffered acute bleeding 2 days later and returned to the hospital, where an emergency cesarean section was performed. One twin was born severely depressed due to 75% placental abruption and died 2 days later. The other twin experienced 35% placental abruption, but had no further problems.

PATIENT’S CLAIM If ultrasound had been performed when the mother complained of bleeding, it would have shown the fluid depletion. The mother would have been hospitalized and monitored, allowing the doctors to know of the possibility of abruption.

DOCTOR’S DEFENSE The mother’s symptoms did not require hospitalization. She had a premature rupture of membranes for the one twin, leading to acute severe placental abruption.

VERDICT Defense verdict.

Did she or didn’t she consent to c-section?

A baby weighing over 11 pounds was delivered vaginally in 2001. The child was born with Erb’s palsy and brain damage and has undergone 2 surgeries for the Erb’s palsy. He suffers from language and speech deficits, and requires occupational and speech therapy.

PATIENT’S CLAIM The injury would not have occurred if the doctor, who knew the baby was large, had performed a cesarean section, to which the mother had consented.

DOCTOR’S DEFENSE The plaintiff refused a cesarean section, and a vaginal delivery was proper. Also, the child has no limitation on the range of motion of the left shoulder.

VERDICT A $4 million settlement was reached.

Defense: “Distorted anatomy’s the problem”

A 55-year-old woman had abdominal surgery, during which a ureter was apparently severed. She underwent a second operation to repair the damage.

PATIENT’S CLAIM The doctor was negligent in severing the ureter and in not identifying and repairing the injury in a timely manner.

DOCTOR’S DEFENSE The doctor was not convinced the injury had occurred during surgery, but if it had, then the patient’s distorted anatomy was to blame. Also, when urine leakage was identified, the patient was immediately referred for additional treatment.

VERDICT Defense verdict.

The cases in this column are selected by the editors of Obg Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn (www.verdictslaska.com). The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.

Despite signs of cancer, estrogen is given

After 2 years of mammograms showing signs of breast cancer and the continued administration of estrogen medications, a 55-year-old woman underwent a modified radical left mastectomy and left axillary dissection, followed by extensive radiation therapy and chemotherapy. She suffered extensive radiation burns to her chest wall, chronic arm swelling due to lymphedema, and nerve damage to the hands due to the chemotherapy. She underwent a total of 9 surgeries.

PATIENT’S CLAIM The gynecologist was negligent for not referring her to a surgeon after 2 years of mammograms indicated cancer and for continuing to administer estrogen medications. The delayed diagnosis allowed the cancer to grow to nearly 9 cm and spread to the lymph nodes, thus requiring extensive surgery and treatment, rather than a simple lumpectomy and breast radiation.

DOCTOR’S DEFENSE Not reported.

VERDICT A jury returned a verdict of $5.65 million for the plaintiff and $300,000 for the husband for lost consortium.

Postcoital bleeding fails to alert Gyn to cancer

A 35-year-old woman suffered postcoital bleeding and was diagnosed with cervicitis by her gynecologist. After 10 months with no improvement despite 9 more examinations and antibiotic treatment, a colposcopy performed by a second gynecologist revealed cervical adenocarcinoma. A hysterectomy was performed.

PATIENT’S CLAIM The first gynecologist should have performed a colposcopy and biopsies to diagnose the cancer and start treatment, thus avoiding the hysterectomy and increasing her life expectancy.

DOCTOR’S DEFENSE Cervical cancer is seldom diagnosed at an early stage, and this cancer was located where early detection by colposcopy was impossible. In this case, a hysterectomy would have been necessary anyway.

VERDICT Defense verdict.

Doctor sutures bladder, calls dye spill a “typo”

After having suffered severe pelvic pain and bleeding for years, a 25-year-old woman underwent a total hysterectomy. Following surgery, she began to have bladder problems. When it was discovered that her bladder had been sutured three times during the surgery, she underwent repair surgery, but she remained incontinent.

PATIENT’S CLAIM According to the surgical record, blue dye was observed coming from her bladder during surgery, which should have alerted the doctor to investigate and repair the injury.

DOCTOR’S DEFENSE The physician admitted suturing the bladder, a known complication, but claimed the injury was not immediately apparent. Also, no dye spilled from the bladder - that was just a typographical error.

VERDICT Defense verdict.

Small abdomen worries mother, not doctor

A 24-year-old pregnant woman had monthly visits with her ObGyn from May to November. In October, she indicated that 2 pregnant friends had larger abdomens than she did at similar stages of pregnancy, but she was told everything was fine. In November, she requested an ultrasound on 3 occasions, but was told it was not necessary. In late November, she reported to the clinic complaining of cramps. Fetal demise was diagnosed, she was admitted to the hospital, where delivery was induced, and she went home the next day.

PATIENT’S CLAIM The fetus would not have died if the ObGyn had performed the appropriate tests when she was first concerned about the small size of her abdomen.

DOCTOR’S CLAIM Intrauterine growth retardation is rare and difficult to diagnose, and it has a high morbidity rate. Also, the mother was instructed to report diminished fetal movement, but she had failed to do so.

VERDICT After a trial resulted in a hung jury, a confidential settlement was reached.

Placental abruption or burst fetal blood vessel?

When a pregnant woman at term called her ObGyn after waking in a pool of blood, he questioned her and then sent her to the hospital. Physical assessment, fetal monitoring, and ultrasound were conducted. A cesarean section was performed when vaginal exam revealed that the fetus was remote from a vaginal delivery. After birth the newborn was unstable. She was transferred to another hospital, where she died soon thereafter.

PATIENT’S CLAIM The mother believed she had a placental abruption and claimed the baby would have survived had the delivery been done even 20 minutes earlier.

DOCTOR’S DEFENSE According to information the mother gave on the phone, bleeding was not due to placental abruption. She was no longer bleeding when she arrived at the hospital and had no abdominal pain. A ruptured fetal blood vessel caused the severe blood loss, and the baby would have died even if delivered earlier.

VERDICT A $500,00 verdict was returned.

Referring Gyn: “not responsible” for sponge

A 36-year-old woman’s gynecologist, Doctor 1, referred her to an ObGyn, Doctor 2, to perform a reversal of a tubal ligation. During the procedure, a lap sponge rolled in plastic was left in the patient despite a correct sponge count reported by the nurses. During her hospital stay and 4 office visits with Doctor 2, she reported pain, but a vaginal ultrasound was negative. One year later, she complained of excruciating pain to Doctor 1, who felt a mobile mass. Abdominal ultrasound showed nothing. When a CT tech told her to see her doctor after a CT scan, she was alarmed and immediately had an x-ray done, which indicated a retained foreign body. The patient sought another opinion when Doctor 1 asked her to sign a form for exploratory surgery before he had reviewed the CT results himself. Doctor 3 diagnosed the problem immediately and removed the sponge. She has had few physical problems since then.

The patient sued Doctors 1 and 2, the hospital, and the nurses. The hospital filed a 3rd party action against Doctor 2, claiming he had used a nonradiopaque, noncounted sponge.

PATIENT’S CLAIM The patient claimed the doctor was negligent in leaving the sponge in her and failing to diagnose the problem following surgery.

DOCTOR’S DEFENSE Doctor 1 could not have told the patient about the retained sponge before he had seen the CT films, especially as the records showed a correct sponge count. When he was certain it was a sponge, he called the patient, but she never returned his calls. Also, as the assistant surgeon, he was not responsible for the sponge count.

VERDICT The plaintiff reached a confidential settlement with Doctor 2 and the hospital. The hospital settled with the plaintiff and dismissed its claim against Doctor 2. In the trial against Doctor 1, a defense verdict was returned.

Anesthesiologist, nurses say “not me,” blame OB

An infant later found to be mentally retarded was delivered by cesarean section following fetal distress.

PATIENT’S CLAIM The parents claim the obstetrician, anesthesiologist, and 2 hospital nurses failed to respond quickly to signs of fetal distress, and a 1-hour delay in performing a cesarean section caused the child’s mental retardation. The anesthesiologist should have been prepared for a cesarean section, and the nurses did not report the obstetrician’s delay to superiors.

DOCTOR’S DEFENSE Anesthesiologist and nurses blamed the obstetrician.

VERDICT Prior to trial, the obstetrician settled for $1 million. A $3.69 million verdict was returned against the others, but that was reduced to $45,000 because the jury found the obstetrician to be 90% at fault.

When are drugs, monitoring enough?

A woman pregnant with twins at 29 weeks’ gestation presented to a hospital with vaginal bleeding, but was discharged when maternal-fetal well-being was established. One day after a brown discharge, she reported to the hospital with bleeding and irregular contractions. She was monitored and given tocolytic drugs, then sent home where uterine activity was monitored. She suffered acute bleeding 2 days later and returned to the hospital, where an emergency cesarean section was performed. One twin was born severely depressed due to 75% placental abruption and died 2 days later. The other twin experienced 35% placental abruption, but had no further problems.

PATIENT’S CLAIM If ultrasound had been performed when the mother complained of bleeding, it would have shown the fluid depletion. The mother would have been hospitalized and monitored, allowing the doctors to know of the possibility of abruption.

DOCTOR’S DEFENSE The mother’s symptoms did not require hospitalization. She had a premature rupture of membranes for the one twin, leading to acute severe placental abruption.

VERDICT Defense verdict.

Did she or didn’t she consent to c-section?

A baby weighing over 11 pounds was delivered vaginally in 2001. The child was born with Erb’s palsy and brain damage and has undergone 2 surgeries for the Erb’s palsy. He suffers from language and speech deficits, and requires occupational and speech therapy.

PATIENT’S CLAIM The injury would not have occurred if the doctor, who knew the baby was large, had performed a cesarean section, to which the mother had consented.

DOCTOR’S DEFENSE The plaintiff refused a cesarean section, and a vaginal delivery was proper. Also, the child has no limitation on the range of motion of the left shoulder.

VERDICT A $4 million settlement was reached.

Defense: “Distorted anatomy’s the problem”

A 55-year-old woman had abdominal surgery, during which a ureter was apparently severed. She underwent a second operation to repair the damage.

PATIENT’S CLAIM The doctor was negligent in severing the ureter and in not identifying and repairing the injury in a timely manner.

DOCTOR’S DEFENSE The doctor was not convinced the injury had occurred during surgery, but if it had, then the patient’s distorted anatomy was to blame. Also, when urine leakage was identified, the patient was immediately referred for additional treatment.

VERDICT Defense verdict.

The cases in this column are selected by the editors of Obg Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn (www.verdictslaska.com). The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.

Despite signs of cancer, estrogen is given

After 2 years of mammograms showing signs of breast cancer and the continued administration of estrogen medications, a 55-year-old woman underwent a modified radical left mastectomy and left axillary dissection, followed by extensive radiation therapy and chemotherapy. She suffered extensive radiation burns to her chest wall, chronic arm swelling due to lymphedema, and nerve damage to the hands due to the chemotherapy. She underwent a total of 9 surgeries.

PATIENT’S CLAIM The gynecologist was negligent for not referring her to a surgeon after 2 years of mammograms indicated cancer and for continuing to administer estrogen medications. The delayed diagnosis allowed the cancer to grow to nearly 9 cm and spread to the lymph nodes, thus requiring extensive surgery and treatment, rather than a simple lumpectomy and breast radiation.

DOCTOR’S DEFENSE Not reported.

VERDICT A jury returned a verdict of $5.65 million for the plaintiff and $300,000 for the husband for lost consortium.

Postcoital bleeding fails to alert Gyn to cancer

A 35-year-old woman suffered postcoital bleeding and was diagnosed with cervicitis by her gynecologist. After 10 months with no improvement despite 9 more examinations and antibiotic treatment, a colposcopy performed by a second gynecologist revealed cervical adenocarcinoma. A hysterectomy was performed.

PATIENT’S CLAIM The first gynecologist should have performed a colposcopy and biopsies to diagnose the cancer and start treatment, thus avoiding the hysterectomy and increasing her life expectancy.

DOCTOR’S DEFENSE Cervical cancer is seldom diagnosed at an early stage, and this cancer was located where early detection by colposcopy was impossible. In this case, a hysterectomy would have been necessary anyway.

VERDICT Defense verdict.

Doctor sutures bladder, calls dye spill a “typo”

After having suffered severe pelvic pain and bleeding for years, a 25-year-old woman underwent a total hysterectomy. Following surgery, she began to have bladder problems. When it was discovered that her bladder had been sutured three times during the surgery, she underwent repair surgery, but she remained incontinent.

PATIENT’S CLAIM According to the surgical record, blue dye was observed coming from her bladder during surgery, which should have alerted the doctor to investigate and repair the injury.

DOCTOR’S DEFENSE The physician admitted suturing the bladder, a known complication, but claimed the injury was not immediately apparent. Also, no dye spilled from the bladder - that was just a typographical error.

VERDICT Defense verdict.

Small abdomen worries mother, not doctor

A 24-year-old pregnant woman had monthly visits with her ObGyn from May to November. In October, she indicated that 2 pregnant friends had larger abdomens than she did at similar stages of pregnancy, but she was told everything was fine. In November, she requested an ultrasound on 3 occasions, but was told it was not necessary. In late November, she reported to the clinic complaining of cramps. Fetal demise was diagnosed, she was admitted to the hospital, where delivery was induced, and she went home the next day.

PATIENT’S CLAIM The fetus would not have died if the ObGyn had performed the appropriate tests when she was first concerned about the small size of her abdomen.

DOCTOR’S CLAIM Intrauterine growth retardation is rare and difficult to diagnose, and it has a high morbidity rate. Also, the mother was instructed to report diminished fetal movement, but she had failed to do so.

VERDICT After a trial resulted in a hung jury, a confidential settlement was reached.

Placental abruption or burst fetal blood vessel?

When a pregnant woman at term called her ObGyn after waking in a pool of blood, he questioned her and then sent her to the hospital. Physical assessment, fetal monitoring, and ultrasound were conducted. A cesarean section was performed when vaginal exam revealed that the fetus was remote from a vaginal delivery. After birth the newborn was unstable. She was transferred to another hospital, where she died soon thereafter.

PATIENT’S CLAIM The mother believed she had a placental abruption and claimed the baby would have survived had the delivery been done even 20 minutes earlier.

DOCTOR’S DEFENSE According to information the mother gave on the phone, bleeding was not due to placental abruption. She was no longer bleeding when she arrived at the hospital and had no abdominal pain. A ruptured fetal blood vessel caused the severe blood loss, and the baby would have died even if delivered earlier.

VERDICT A $500,00 verdict was returned.

Referring Gyn: “not responsible” for sponge

A 36-year-old woman’s gynecologist, Doctor 1, referred her to an ObGyn, Doctor 2, to perform a reversal of a tubal ligation. During the procedure, a lap sponge rolled in plastic was left in the patient despite a correct sponge count reported by the nurses. During her hospital stay and 4 office visits with Doctor 2, she reported pain, but a vaginal ultrasound was negative. One year later, she complained of excruciating pain to Doctor 1, who felt a mobile mass. Abdominal ultrasound showed nothing. When a CT tech told her to see her doctor after a CT scan, she was alarmed and immediately had an x-ray done, which indicated a retained foreign body. The patient sought another opinion when Doctor 1 asked her to sign a form for exploratory surgery before he had reviewed the CT results himself. Doctor 3 diagnosed the problem immediately and removed the sponge. She has had few physical problems since then.

The patient sued Doctors 1 and 2, the hospital, and the nurses. The hospital filed a 3rd party action against Doctor 2, claiming he had used a nonradiopaque, noncounted sponge.

PATIENT’S CLAIM The patient claimed the doctor was negligent in leaving the sponge in her and failing to diagnose the problem following surgery.

DOCTOR’S DEFENSE Doctor 1 could not have told the patient about the retained sponge before he had seen the CT films, especially as the records showed a correct sponge count. When he was certain it was a sponge, he called the patient, but she never returned his calls. Also, as the assistant surgeon, he was not responsible for the sponge count.

VERDICT The plaintiff reached a confidential settlement with Doctor 2 and the hospital. The hospital settled with the plaintiff and dismissed its claim against Doctor 2. In the trial against Doctor 1, a defense verdict was returned.

Anesthesiologist, nurses say “not me,” blame OB

An infant later found to be mentally retarded was delivered by cesarean section following fetal distress.

PATIENT’S CLAIM The parents claim the obstetrician, anesthesiologist, and 2 hospital nurses failed to respond quickly to signs of fetal distress, and a 1-hour delay in performing a cesarean section caused the child’s mental retardation. The anesthesiologist should have been prepared for a cesarean section, and the nurses did not report the obstetrician’s delay to superiors.

DOCTOR’S DEFENSE Anesthesiologist and nurses blamed the obstetrician.

VERDICT Prior to trial, the obstetrician settled for $1 million. A $3.69 million verdict was returned against the others, but that was reduced to $45,000 because the jury found the obstetrician to be 90% at fault.

When are drugs, monitoring enough?

A woman pregnant with twins at 29 weeks’ gestation presented to a hospital with vaginal bleeding, but was discharged when maternal-fetal well-being was established. One day after a brown discharge, she reported to the hospital with bleeding and irregular contractions. She was monitored and given tocolytic drugs, then sent home where uterine activity was monitored. She suffered acute bleeding 2 days later and returned to the hospital, where an emergency cesarean section was performed. One twin was born severely depressed due to 75% placental abruption and died 2 days later. The other twin experienced 35% placental abruption, but had no further problems.

PATIENT’S CLAIM If ultrasound had been performed when the mother complained of bleeding, it would have shown the fluid depletion. The mother would have been hospitalized and monitored, allowing the doctors to know of the possibility of abruption.

DOCTOR’S DEFENSE The mother’s symptoms did not require hospitalization. She had a premature rupture of membranes for the one twin, leading to acute severe placental abruption.

VERDICT Defense verdict.

Did she or didn’t she consent to c-section?

A baby weighing over 11 pounds was delivered vaginally in 2001. The child was born with Erb’s palsy and brain damage and has undergone 2 surgeries for the Erb’s palsy. He suffers from language and speech deficits, and requires occupational and speech therapy.

PATIENT’S CLAIM The injury would not have occurred if the doctor, who knew the baby was large, had performed a cesarean section, to which the mother had consented.

DOCTOR’S DEFENSE The plaintiff refused a cesarean section, and a vaginal delivery was proper. Also, the child has no limitation on the range of motion of the left shoulder.

VERDICT A $4 million settlement was reached.

Defense: “Distorted anatomy’s the problem”

A 55-year-old woman had abdominal surgery, during which a ureter was apparently severed. She underwent a second operation to repair the damage.

PATIENT’S CLAIM The doctor was negligent in severing the ureter and in not identifying and repairing the injury in a timely manner.

DOCTOR’S DEFENSE The doctor was not convinced the injury had occurred during surgery, but if it had, then the patient’s distorted anatomy was to blame. Also, when urine leakage was identified, the patient was immediately referred for additional treatment.

VERDICT Defense verdict.

The cases in this column are selected by the editors of Obg Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn (www.verdictslaska.com). The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.

OB blames disability on mother’s language

A woman diagnosed with group B strep at 32 weeks’ gestation had spontaneous rupture of membranes at 36 to 37 weeks and developed a fever during labor and delivery. Several hours into labor, severe variable decelerations were noted and the infant was delivered by cesarean section. Within hours, the infant developed sepsis. The child survived, but suffers from learning disabilities.

PATIENT’S CLAIM The mother should have been given antibiotics before labor.

DOCTOR’S DEFENSE The physicians never received the lab report showing the test result. The child’s learning disability was not caused by any birth event, but by the mother’s use of her native Farsi at home.

VERDICT After mediation, the parties reached a $962,000 settlement.

Did doctors miss signs of chorioamnionitis?

A 30-year-old woman presented to the emergency room at 25 weeks’ gestation, complaining of abdominal pain. After examining her, doctors decided hospitalization was unnecessary. Nine days later, she returned to the hospital and reported vomiting and vaginal spotting. Immediate cesarean section was performed. The child was later diagnosed with mental and physical disabilities, including developmental delays and spastic quadriplegia.

PATIENT’S CLAIM The disabilities and premature birth were caused by an undiagnosed antepartum infection, and the chorioamnionitis should have been detected at the first emergency room visit. Prompt diagnosis and treatment would have prevented the adverse outcome.

DOCTOR’S DEFENSE The child’s injuries were unavoidable.

VERDICT $1.2 million settlement.

“Postop gas, constipation led to divorce”

A 34-year-old woman underwent laparoscopic tubal ligation. After the surgery, she developed a hernia, which was repaired via laparotomy.

PATIENT’S CLAIM The original surgery caused chronic constipation and gas and contributed to the patient’s divorce. The physician caused the hernia by failing to stitch the fascia closed.

DOCTOR’S DEFENSE It was not necessary to suture the fascia closed. The hernia occurred through an adhesion and below the fascia, so a stitch would not have prevented it. The patient’s marriage was in peril before the tubal ligation was performed.

VERDICT Defense verdict.

Missed tubo-ovarian abscess leads to death

A 42-year-old woman with anemia and complaints of generalized abdominal pain and heavy bleeding was referred to an ObGyn, who performed an endometrial biopsy and concluded that her pain and bleeding were caused by fibroids. A hysterectomy was scheduled, and pain medication was prescribed. When ultrasound imaging revealed a cyst, more pain medicine was prescribed, and the date for the hysterectomy was moved up. Blood tests showed extremely elevated white blood cell levels, indicative of infection, but the doctor did not receive results for several days.

The day after the patient visited the ObGyn, she collapsed at home and was taken to a hospital, where she died a few hours later. An autopsy revealed the death was due to sepsis from a right tubo-ovarian abscess. No fibroids were present.

PATIENT’S CLAIM The ObGyn was negligent in failing to examine the patient the day before her death, despite her report of severe pain. Furthermore, the physician caused the tubo-ovarian abscess at the time of the endometrial biopsy.

DOCTOR’S DEFENSE The diagnoses of uterine fibroids, possible ovarian cyst, and urinary tract infection explained all the patient’s symptoms, none of which were consistent with tubo-ovarian abscess.

VERDICT The jury ruled for the defense.

$12 million verdict despite counseling

A woman delivered an infant with spina bifida, who requires lifelong treatment.

PATIENT’S CLAIM The mother was not informed of the need for alpha-fetoprotein testing to detect neural tube defects and Down’s syndrome, and a nurse telephoned her to say the test was unnecessary because the woman was not at risk. As a result, the parents were denied the opportunity to have the pregnancy terminated.

DOCTOR’S DEFENSE The practice group’s records noted that test information was provided during a visit the previous year. The child’s problems were genetic and could not have been avoided.

VERDICT $12 million verdict.

5 operations needed after prolapse repair

A 51-year-old woman suffering from vaginal prolapse underwent pelvic reconstruction in January and continued under the surgeon’s care until May, when she was advised to return to the referring ObGyn. In June, she was found to have grossly distorted vaginal anatomy and infection, necessitating 5 additional operations.

PATIENT’S CLAIM The surgeon was negligent, failed to obtain informed consent, misrepresented the success rate of the procedure, and concealed the true condition of the vagina at the time of discharge. In addition, a mesh used to reinforce the anterior, apical, and posterior compartments of the vagina became infected, causing the distortion. The patient should have been treated with intravenous antibiotics and/or removal of the mesh.

DOCTOR’S DEFENSE Two prior reparative procedures had already been performed by the time he operated. The patient suffered not from infection, but from a reaction to the mesh, a foreign body.

VERDICT Defense verdict.

Did doctors treat UTI properly?

An 18-year-old woman in her 28th week of gestation presented to the hospital reporting decreased fetal movement. Urinary tract infection was diagnosed after leukocytes were detected in the woman’s urine. She was prescribed a 3-day regimen of antibiotics and discharged. Ten days later, she returned to report 2 episodes of vaginal bleeding. After reassuring fetal monitoring, the woman was again discharged.

About 5 days later, the woman returned and was diagnosed with prolonged preterm rupture of membranes, with contractions at 4- to 5-minute intervals. The woman was monitored over 17 hours, and her contractions lessened in frequency. When the fetus showed signs of bradycardia, cesarean section was performed. The child was diagnosed with severe mental retardation, cortical blindness, and spastic quadriplegia. The child is confined to a wheelchair and requires constant medical care and rehabilitation.

PATIENT’S CLAIM The urinary tract infection was not treated properly, and eventually led to ruptured membranes. A cesarean section should have been performed sooner.

DOCTOR’S DEFENSE The urinary tract infection caused the infant’s problems.

VERDICT $5 million settlement.

One twin dies, the other is severely handicapped

A woman pregnant with twins, who was using a fetal monitoring service at home, reported to the hospital at 29 weeks’ gestation because she was experiencing contractions. She was seen by a physician who reported she was less than 2-cm dilated. She was transferred to another facility; upon arrival, she was 4-cm dilated, and was given tocolytics to delay labor.

One child was delivered with respiratory distress syndrome, intracranial hemorrhage, and hydrocephalus, and the other infant died. The surviving twin, who is now 17 years of age, suffers from cerebral palsy, spastic quadriplegia, cortical blindness, and severe mental retardation. She is confined to a wheelchair, requires a feeding tube, and will need lifelong care.

PATIENT’S CLAIM The physician at the initial facility failed to administer tocolytics in time to prevent premature delivery.

DOCTOR’S DEFENSE There were no signs of labor, and administering tocolytics would not have prevented premature labor.

VERDICT $3 million settlement.

Patient delivers after D&C

A woman reported to the emergency room with severe abdominal pain, bleeding, and fever. Testing revealed she was 4 to 5 weeks pregnant. An OB performed a D&C. She gave birth to an unwanted child 7 months later.

PATIENT’S CLAIM The physician failed to tell her she was still pregnant after the D&C and did not provide her with follow-up instructions.

DOCTOR’S DEFENSE The physician performed the D&C not to terminate the pregnancy but to treat pelvic inflammatory disease and to remove remnants from a previous septic miscarriage. Subsequent testing confirmed that products of conception consistent with a nonviable pregnancy had been removed. The physician also claimed the patient was advised to report back to his office in 1 to 2 weeks to seek care for her pregnancy. Initially, the patient claimed she never received instructions to report back to the office for care; however, during testimony, she admitted to receiving instructions but could not recall them.

VERDICT Defense verdict.

Retained placenta leads to hysterectomy

A 40-year-old woman, acting as a surrogate for her brother and sister-in-law, gave birth to twins. Six weeks later, she underwent a hysterectomy.

PATIENT’S CLAIM The obstetrician failed to completely remove the placenta after the cesarean section, resulting in the hysterectomy 6 weeks later.

DOCTOR’S DEFENSE The failure to remove all of the placenta was not negligent, and the woman had placenta increta, which made it difficult to completely remove the placental tissue.

VERDICT The hospital settled for $125,000; the jury awarded the plaintiff $1.2 million against the physician.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn (www.verdictslaska.com).The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.

OB blames disability on mother’s language

A woman diagnosed with group B strep at 32 weeks’ gestation had spontaneous rupture of membranes at 36 to 37 weeks and developed a fever during labor and delivery. Several hours into labor, severe variable decelerations were noted and the infant was delivered by cesarean section. Within hours, the infant developed sepsis. The child survived, but suffers from learning disabilities.

PATIENT’S CLAIM The mother should have been given antibiotics before labor.

DOCTOR’S DEFENSE The physicians never received the lab report showing the test result. The child’s learning disability was not caused by any birth event, but by the mother’s use of her native Farsi at home.

VERDICT After mediation, the parties reached a $962,000 settlement.

Did doctors miss signs of chorioamnionitis?

A 30-year-old woman presented to the emergency room at 25 weeks’ gestation, complaining of abdominal pain. After examining her, doctors decided hospitalization was unnecessary. Nine days later, she returned to the hospital and reported vomiting and vaginal spotting. Immediate cesarean section was performed. The child was later diagnosed with mental and physical disabilities, including developmental delays and spastic quadriplegia.

PATIENT’S CLAIM The disabilities and premature birth were caused by an undiagnosed antepartum infection, and the chorioamnionitis should have been detected at the first emergency room visit. Prompt diagnosis and treatment would have prevented the adverse outcome.

DOCTOR’S DEFENSE The child’s injuries were unavoidable.

VERDICT $1.2 million settlement.

“Postop gas, constipation led to divorce”

A 34-year-old woman underwent laparoscopic tubal ligation. After the surgery, she developed a hernia, which was repaired via laparotomy.

PATIENT’S CLAIM The original surgery caused chronic constipation and gas and contributed to the patient’s divorce. The physician caused the hernia by failing to stitch the fascia closed.

DOCTOR’S DEFENSE It was not necessary to suture the fascia closed. The hernia occurred through an adhesion and below the fascia, so a stitch would not have prevented it. The patient’s marriage was in peril before the tubal ligation was performed.

VERDICT Defense verdict.

Missed tubo-ovarian abscess leads to death

A 42-year-old woman with anemia and complaints of generalized abdominal pain and heavy bleeding was referred to an ObGyn, who performed an endometrial biopsy and concluded that her pain and bleeding were caused by fibroids. A hysterectomy was scheduled, and pain medication was prescribed. When ultrasound imaging revealed a cyst, more pain medicine was prescribed, and the date for the hysterectomy was moved up. Blood tests showed extremely elevated white blood cell levels, indicative of infection, but the doctor did not receive results for several days.

The day after the patient visited the ObGyn, she collapsed at home and was taken to a hospital, where she died a few hours later. An autopsy revealed the death was due to sepsis from a right tubo-ovarian abscess. No fibroids were present.

PATIENT’S CLAIM The ObGyn was negligent in failing to examine the patient the day before her death, despite her report of severe pain. Furthermore, the physician caused the tubo-ovarian abscess at the time of the endometrial biopsy.

DOCTOR’S DEFENSE The diagnoses of uterine fibroids, possible ovarian cyst, and urinary tract infection explained all the patient’s symptoms, none of which were consistent with tubo-ovarian abscess.

VERDICT The jury ruled for the defense.

$12 million verdict despite counseling

A woman delivered an infant with spina bifida, who requires lifelong treatment.

PATIENT’S CLAIM The mother was not informed of the need for alpha-fetoprotein testing to detect neural tube defects and Down’s syndrome, and a nurse telephoned her to say the test was unnecessary because the woman was not at risk. As a result, the parents were denied the opportunity to have the pregnancy terminated.

DOCTOR’S DEFENSE The practice group’s records noted that test information was provided during a visit the previous year. The child’s problems were genetic and could not have been avoided.

VERDICT $12 million verdict.

5 operations needed after prolapse repair

A 51-year-old woman suffering from vaginal prolapse underwent pelvic reconstruction in January and continued under the surgeon’s care until May, when she was advised to return to the referring ObGyn. In June, she was found to have grossly distorted vaginal anatomy and infection, necessitating 5 additional operations.

PATIENT’S CLAIM The surgeon was negligent, failed to obtain informed consent, misrepresented the success rate of the procedure, and concealed the true condition of the vagina at the time of discharge. In addition, a mesh used to reinforce the anterior, apical, and posterior compartments of the vagina became infected, causing the distortion. The patient should have been treated with intravenous antibiotics and/or removal of the mesh.

DOCTOR’S DEFENSE Two prior reparative procedures had already been performed by the time he operated. The patient suffered not from infection, but from a reaction to the mesh, a foreign body.

VERDICT Defense verdict.

Did doctors treat UTI properly?

An 18-year-old woman in her 28th week of gestation presented to the hospital reporting decreased fetal movement. Urinary tract infection was diagnosed after leukocytes were detected in the woman’s urine. She was prescribed a 3-day regimen of antibiotics and discharged. Ten days later, she returned to report 2 episodes of vaginal bleeding. After reassuring fetal monitoring, the woman was again discharged.

About 5 days later, the woman returned and was diagnosed with prolonged preterm rupture of membranes, with contractions at 4- to 5-minute intervals. The woman was monitored over 17 hours, and her contractions lessened in frequency. When the fetus showed signs of bradycardia, cesarean section was performed. The child was diagnosed with severe mental retardation, cortical blindness, and spastic quadriplegia. The child is confined to a wheelchair and requires constant medical care and rehabilitation.

PATIENT’S CLAIM The urinary tract infection was not treated properly, and eventually led to ruptured membranes. A cesarean section should have been performed sooner.

DOCTOR’S DEFENSE The urinary tract infection caused the infant’s problems.

VERDICT $5 million settlement.

One twin dies, the other is severely handicapped

A woman pregnant with twins, who was using a fetal monitoring service at home, reported to the hospital at 29 weeks’ gestation because she was experiencing contractions. She was seen by a physician who reported she was less than 2-cm dilated. She was transferred to another facility; upon arrival, she was 4-cm dilated, and was given tocolytics to delay labor.

One child was delivered with respiratory distress syndrome, intracranial hemorrhage, and hydrocephalus, and the other infant died. The surviving twin, who is now 17 years of age, suffers from cerebral palsy, spastic quadriplegia, cortical blindness, and severe mental retardation. She is confined to a wheelchair, requires a feeding tube, and will need lifelong care.

PATIENT’S CLAIM The physician at the initial facility failed to administer tocolytics in time to prevent premature delivery.

DOCTOR’S DEFENSE There were no signs of labor, and administering tocolytics would not have prevented premature labor.

VERDICT $3 million settlement.

Patient delivers after D&C

A woman reported to the emergency room with severe abdominal pain, bleeding, and fever. Testing revealed she was 4 to 5 weeks pregnant. An OB performed a D&C. She gave birth to an unwanted child 7 months later.

PATIENT’S CLAIM The physician failed to tell her she was still pregnant after the D&C and did not provide her with follow-up instructions.

DOCTOR’S DEFENSE The physician performed the D&C not to terminate the pregnancy but to treat pelvic inflammatory disease and to remove remnants from a previous septic miscarriage. Subsequent testing confirmed that products of conception consistent with a nonviable pregnancy had been removed. The physician also claimed the patient was advised to report back to his office in 1 to 2 weeks to seek care for her pregnancy. Initially, the patient claimed she never received instructions to report back to the office for care; however, during testimony, she admitted to receiving instructions but could not recall them.

VERDICT Defense verdict.

Retained placenta leads to hysterectomy

A 40-year-old woman, acting as a surrogate for her brother and sister-in-law, gave birth to twins. Six weeks later, she underwent a hysterectomy.

PATIENT’S CLAIM The obstetrician failed to completely remove the placenta after the cesarean section, resulting in the hysterectomy 6 weeks later.

DOCTOR’S DEFENSE The failure to remove all of the placenta was not negligent, and the woman had placenta increta, which made it difficult to completely remove the placental tissue.

VERDICT The hospital settled for $125,000; the jury awarded the plaintiff $1.2 million against the physician.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn (www.verdictslaska.com).The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.

OB blames disability on mother’s language

A woman diagnosed with group B strep at 32 weeks’ gestation had spontaneous rupture of membranes at 36 to 37 weeks and developed a fever during labor and delivery. Several hours into labor, severe variable decelerations were noted and the infant was delivered by cesarean section. Within hours, the infant developed sepsis. The child survived, but suffers from learning disabilities.

PATIENT’S CLAIM The mother should have been given antibiotics before labor.

DOCTOR’S DEFENSE The physicians never received the lab report showing the test result. The child’s learning disability was not caused by any birth event, but by the mother’s use of her native Farsi at home.

VERDICT After mediation, the parties reached a $962,000 settlement.

Did doctors miss signs of chorioamnionitis?

A 30-year-old woman presented to the emergency room at 25 weeks’ gestation, complaining of abdominal pain. After examining her, doctors decided hospitalization was unnecessary. Nine days later, she returned to the hospital and reported vomiting and vaginal spotting. Immediate cesarean section was performed. The child was later diagnosed with mental and physical disabilities, including developmental delays and spastic quadriplegia.

PATIENT’S CLAIM The disabilities and premature birth were caused by an undiagnosed antepartum infection, and the chorioamnionitis should have been detected at the first emergency room visit. Prompt diagnosis and treatment would have prevented the adverse outcome.

DOCTOR’S DEFENSE The child’s injuries were unavoidable.

VERDICT $1.2 million settlement.

“Postop gas, constipation led to divorce”

A 34-year-old woman underwent laparoscopic tubal ligation. After the surgery, she developed a hernia, which was repaired via laparotomy.

PATIENT’S CLAIM The original surgery caused chronic constipation and gas and contributed to the patient’s divorce. The physician caused the hernia by failing to stitch the fascia closed.

DOCTOR’S DEFENSE It was not necessary to suture the fascia closed. The hernia occurred through an adhesion and below the fascia, so a stitch would not have prevented it. The patient’s marriage was in peril before the tubal ligation was performed.

VERDICT Defense verdict.

Missed tubo-ovarian abscess leads to death

A 42-year-old woman with anemia and complaints of generalized abdominal pain and heavy bleeding was referred to an ObGyn, who performed an endometrial biopsy and concluded that her pain and bleeding were caused by fibroids. A hysterectomy was scheduled, and pain medication was prescribed. When ultrasound imaging revealed a cyst, more pain medicine was prescribed, and the date for the hysterectomy was moved up. Blood tests showed extremely elevated white blood cell levels, indicative of infection, but the doctor did not receive results for several days.

The day after the patient visited the ObGyn, she collapsed at home and was taken to a hospital, where she died a few hours later. An autopsy revealed the death was due to sepsis from a right tubo-ovarian abscess. No fibroids were present.

PATIENT’S CLAIM The ObGyn was negligent in failing to examine the patient the day before her death, despite her report of severe pain. Furthermore, the physician caused the tubo-ovarian abscess at the time of the endometrial biopsy.

DOCTOR’S DEFENSE The diagnoses of uterine fibroids, possible ovarian cyst, and urinary tract infection explained all the patient’s symptoms, none of which were consistent with tubo-ovarian abscess.

VERDICT The jury ruled for the defense.

$12 million verdict despite counseling

A woman delivered an infant with spina bifida, who requires lifelong treatment.

PATIENT’S CLAIM The mother was not informed of the need for alpha-fetoprotein testing to detect neural tube defects and Down’s syndrome, and a nurse telephoned her to say the test was unnecessary because the woman was not at risk. As a result, the parents were denied the opportunity to have the pregnancy terminated.

DOCTOR’S DEFENSE The practice group’s records noted that test information was provided during a visit the previous year. The child’s problems were genetic and could not have been avoided.

VERDICT $12 million verdict.

5 operations needed after prolapse repair

A 51-year-old woman suffering from vaginal prolapse underwent pelvic reconstruction in January and continued under the surgeon’s care until May, when she was advised to return to the referring ObGyn. In June, she was found to have grossly distorted vaginal anatomy and infection, necessitating 5 additional operations.

PATIENT’S CLAIM The surgeon was negligent, failed to obtain informed consent, misrepresented the success rate of the procedure, and concealed the true condition of the vagina at the time of discharge. In addition, a mesh used to reinforce the anterior, apical, and posterior compartments of the vagina became infected, causing the distortion. The patient should have been treated with intravenous antibiotics and/or removal of the mesh.

DOCTOR’S DEFENSE Two prior reparative procedures had already been performed by the time he operated. The patient suffered not from infection, but from a reaction to the mesh, a foreign body.

VERDICT Defense verdict.

Did doctors treat UTI properly?

An 18-year-old woman in her 28th week of gestation presented to the hospital reporting decreased fetal movement. Urinary tract infection was diagnosed after leukocytes were detected in the woman’s urine. She was prescribed a 3-day regimen of antibiotics and discharged. Ten days later, she returned to report 2 episodes of vaginal bleeding. After reassuring fetal monitoring, the woman was again discharged.

About 5 days later, the woman returned and was diagnosed with prolonged preterm rupture of membranes, with contractions at 4- to 5-minute intervals. The woman was monitored over 17 hours, and her contractions lessened in frequency. When the fetus showed signs of bradycardia, cesarean section was performed. The child was diagnosed with severe mental retardation, cortical blindness, and spastic quadriplegia. The child is confined to a wheelchair and requires constant medical care and rehabilitation.

PATIENT’S CLAIM The urinary tract infection was not treated properly, and eventually led to ruptured membranes. A cesarean section should have been performed sooner.

DOCTOR’S DEFENSE The urinary tract infection caused the infant’s problems.

VERDICT $5 million settlement.

One twin dies, the other is severely handicapped

A woman pregnant with twins, who was using a fetal monitoring service at home, reported to the hospital at 29 weeks’ gestation because she was experiencing contractions. She was seen by a physician who reported she was less than 2-cm dilated. She was transferred to another facility; upon arrival, she was 4-cm dilated, and was given tocolytics to delay labor.

One child was delivered with respiratory distress syndrome, intracranial hemorrhage, and hydrocephalus, and the other infant died. The surviving twin, who is now 17 years of age, suffers from cerebral palsy, spastic quadriplegia, cortical blindness, and severe mental retardation. She is confined to a wheelchair, requires a feeding tube, and will need lifelong care.

PATIENT’S CLAIM The physician at the initial facility failed to administer tocolytics in time to prevent premature delivery.

DOCTOR’S DEFENSE There were no signs of labor, and administering tocolytics would not have prevented premature labor.

VERDICT $3 million settlement.

Patient delivers after D&C

A woman reported to the emergency room with severe abdominal pain, bleeding, and fever. Testing revealed she was 4 to 5 weeks pregnant. An OB performed a D&C. She gave birth to an unwanted child 7 months later.

PATIENT’S CLAIM The physician failed to tell her she was still pregnant after the D&C and did not provide her with follow-up instructions.

DOCTOR’S DEFENSE The physician performed the D&C not to terminate the pregnancy but to treat pelvic inflammatory disease and to remove remnants from a previous septic miscarriage. Subsequent testing confirmed that products of conception consistent with a nonviable pregnancy had been removed. The physician also claimed the patient was advised to report back to his office in 1 to 2 weeks to seek care for her pregnancy. Initially, the patient claimed she never received instructions to report back to the office for care; however, during testimony, she admitted to receiving instructions but could not recall them.

VERDICT Defense verdict.

Retained placenta leads to hysterectomy

A 40-year-old woman, acting as a surrogate for her brother and sister-in-law, gave birth to twins. Six weeks later, she underwent a hysterectomy.

PATIENT’S CLAIM The obstetrician failed to completely remove the placenta after the cesarean section, resulting in the hysterectomy 6 weeks later.

DOCTOR’S DEFENSE The failure to remove all of the placenta was not negligent, and the woman had placenta increta, which made it difficult to completely remove the placental tissue.

VERDICT The hospital settled for $125,000; the jury awarded the plaintiff $1.2 million against the physician.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn (www.verdictslaska.com).The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.

$24.1 million awarded in VBAC gone awry

Seminole County (Fla) Circuit Court

A pregnant woman who desired vaginal delivery for her third child after experiencing 2 successful cesarean sections was induced for 3 days. When the fetus showed signs of distress, the OB used a vacuum extractor for 48 minutes to help deliver the child and ordered the nurses to apply fundal pressure. The woman’s uterus and bladder ruptured, causing oxygen deprivation to the fetus.

The child’s Apgar scores were 2 and 3. She has cerebral palsy, cannot speak, has little use of limbs, and is fed through a stomach tube. The mother required an emergency hysterectomy and surgery to repair her ruptured bladder. Her vocal cords were damaged during intubation, which required another operation.

The woman contended that the OB used the vacuum extractor for too long, failed to perform an emergency cesarean section, and should not have ordered fundal pressure.

• The hospital and senior physician settled for a confidential amount before trial. A $24.1 million verdict was returned against the OB.
  

Home birth, unlicensed midwives, cord prolapse

King County (Wash) Superior Court

A woman who wished to deliver at home, aided by midwives, underwent 2 sonograms during her pregnancy, which revealed multiple large fibroids blocking the birth canal. One of the midwives claimed that 2 consulting OBs were aware of the patient’s condition but claimed she could tolerate a trial of labor at home. One physician argued he never spoke with the midwife about the fibroids and that a consultation never occurred. The doctor also claimed that both midwives were unlicensed and should have referred the woman to an OB for a cesarean section.

After rupture of the membranes, the midwife performed a vaginal examination while the fetal head was not engaged in the pelvis. The midwife tugged on the umbilical cord, causing it to prolapse. The fetus was deprived of oxygen for 45 minutes. The woman was rushed to the hospital for an emergency cesarean section. The baby suffered birth asphyxia, hypoxic ischemic encephalopathy, spastic quadriplegia, and cerebral palsy. Five years later, the child has seizures and severe developmental disabilities, and requires tube feeding.

• The case settled for $3 million.
  

Experts comment on father’s video in shoulder dystocia case

Norfolk (Va) Circuit Court

After giving birth to a child with Erb palsy, the mother argued the OB applied excessive traction and angulation of the head-to-shoulder angle as she twisted and pulled on the infant for more than 50 seconds before shoulder dystocia was relieved. There were no signs of fetal distress.

Neither the physician nor the nursing staff remembered the delivery, but the child’s father made a videotape of the birth. In a pretrial ruling, the judge determined the videotape could not be viewed by the jury, but experts could comment on it. The birth record showed that neither the shoulder dystocia nor paralysis of the right arm was observed by the physician or the nursing staff.

The infant has full use of his hand but has a permanent deformity with inward rotation of the upper arm and elbow and winging of the shoulder blade. The child has had physical therapy, but surgery was considered inappropriate.

• Although judgment was not entered on the verdict, both parties agreed to a structured settlement of $650,000.
  

Oxytocin was increased despite ominous signs

Cook County (III) Circuit Court

A woman was admitted to the hospital for induction of labor. That morning, the fetal monitor tracing was reassuring and oxytocin was initiated. By early afternoon, contraction patterns demonstrated hyperstimulation, with prolonged decelerations. The nurses did not intervene or alert the physician. Oxytocin was continued and increased.

By 1 PM, the fetal monitoring strip showed late decelerations, rising baseline, diminished variability, and lack of accelerations. Oxytocin was continued even though the patient was experiencing extensive contractions. This deteriorating pattern continued until 11:17 PM when the doctor left the room to attend to 2 other deliveries.

At this point, the contraction patterns showed a marked decrease in baseline, severe late decelerations, and absent variability. The nurse continued the oxytocin at more than 24 mU. Upon her return to the delivery room shortly after midnight, the doctor noted a nonreassuring fetal tracing.

At delivery the infant’s Apgar scores were 2, 4, and 5. Initial cord blood gas was 6.98. She was diagnosed with hypoxic ischemic encephalopathy and remained in the NICU for 1 month. She is severely neurologically impaired and nonambulatory, and cannot communicate. She resides in a nursing home where she is fed through a stomach tube.

The mother contended that neither the physician nor the nurse provided adequate intervention. Denying negligence, the defendants argued there was no approximate cause for the infant’s condition and claimed the injury occurred during the last few minutes before delivery.

• The case settled for $21.5 million.
  

Death from ARDS after delivery of twins

Bronx County (NY) Supreme Court

A 22-year-old woman at 34 weeks’ gestation reported to the hospital complaining of intermittent headaches. Her blood pressure was elevated and she was admitted. Six days later, labor was induced and she gave birth to healthy twins. After 12 days in the hospital she was discharged. The following day she returned to the hospital in respiratory distress, and she lost consciousness. She was stabilized with a ventilator but developed adult respiratory distress syndrome and died 10 days later.

The patient’s representatives claimed the physicians failed to diagnose a viral infection, which led to the patient’s death. Claims against several individuals and facilities were discontinued with the exception of 2 hospitals. Representatives for the 2 facilities argued the infection could not have been prevented or treated with antibiotics or any other medication.

• The case settled for $1.4 million.
  

$24.1 million awarded in VBAC gone awry

Seminole County (Fla) Circuit Court

A pregnant woman who desired vaginal delivery for her third child after experiencing 2 successful cesarean sections was induced for 3 days. When the fetus showed signs of distress, the OB used a vacuum extractor for 48 minutes to help deliver the child and ordered the nurses to apply fundal pressure. The woman’s uterus and bladder ruptured, causing oxygen deprivation to the fetus.

The child’s Apgar scores were 2 and 3. She has cerebral palsy, cannot speak, has little use of limbs, and is fed through a stomach tube. The mother required an emergency hysterectomy and surgery to repair her ruptured bladder. Her vocal cords were damaged during intubation, which required another operation.

The woman contended that the OB used the vacuum extractor for too long, failed to perform an emergency cesarean section, and should not have ordered fundal pressure.

• The hospital and senior physician settled for a confidential amount before trial. A $24.1 million verdict was returned against the OB.
  

Home birth, unlicensed midwives, cord prolapse

King County (Wash) Superior Court

A woman who wished to deliver at home, aided by midwives, underwent 2 sonograms during her pregnancy, which revealed multiple large fibroids blocking the birth canal. One of the midwives claimed that 2 consulting OBs were aware of the patient’s condition but claimed she could tolerate a trial of labor at home. One physician argued he never spoke with the midwife about the fibroids and that a consultation never occurred. The doctor also claimed that both midwives were unlicensed and should have referred the woman to an OB for a cesarean section.

After rupture of the membranes, the midwife performed a vaginal examination while the fetal head was not engaged in the pelvis. The midwife tugged on the umbilical cord, causing it to prolapse. The fetus was deprived of oxygen for 45 minutes. The woman was rushed to the hospital for an emergency cesarean section. The baby suffered birth asphyxia, hypoxic ischemic encephalopathy, spastic quadriplegia, and cerebral palsy. Five years later, the child has seizures and severe developmental disabilities, and requires tube feeding.

• The case settled for $3 million.
  

Experts comment on father’s video in shoulder dystocia case

Norfolk (Va) Circuit Court

After giving birth to a child with Erb palsy, the mother argued the OB applied excessive traction and angulation of the head-to-shoulder angle as she twisted and pulled on the infant for more than 50 seconds before shoulder dystocia was relieved. There were no signs of fetal distress.

Neither the physician nor the nursing staff remembered the delivery, but the child’s father made a videotape of the birth. In a pretrial ruling, the judge determined the videotape could not be viewed by the jury, but experts could comment on it. The birth record showed that neither the shoulder dystocia nor paralysis of the right arm was observed by the physician or the nursing staff.

The infant has full use of his hand but has a permanent deformity with inward rotation of the upper arm and elbow and winging of the shoulder blade. The child has had physical therapy, but surgery was considered inappropriate.

• Although judgment was not entered on the verdict, both parties agreed to a structured settlement of $650,000.
  

Oxytocin was increased despite ominous signs

Cook County (III) Circuit Court

A woman was admitted to the hospital for induction of labor. That morning, the fetal monitor tracing was reassuring and oxytocin was initiated. By early afternoon, contraction patterns demonstrated hyperstimulation, with prolonged decelerations. The nurses did not intervene or alert the physician. Oxytocin was continued and increased.

By 1 PM, the fetal monitoring strip showed late decelerations, rising baseline, diminished variability, and lack of accelerations. Oxytocin was continued even though the patient was experiencing extensive contractions. This deteriorating pattern continued until 11:17 PM when the doctor left the room to attend to 2 other deliveries.

At this point, the contraction patterns showed a marked decrease in baseline, severe late decelerations, and absent variability. The nurse continued the oxytocin at more than 24 mU. Upon her return to the delivery room shortly after midnight, the doctor noted a nonreassuring fetal tracing.

At delivery the infant’s Apgar scores were 2, 4, and 5. Initial cord blood gas was 6.98. She was diagnosed with hypoxic ischemic encephalopathy and remained in the NICU for 1 month. She is severely neurologically impaired and nonambulatory, and cannot communicate. She resides in a nursing home where she is fed through a stomach tube.

The mother contended that neither the physician nor the nurse provided adequate intervention. Denying negligence, the defendants argued there was no approximate cause for the infant’s condition and claimed the injury occurred during the last few minutes before delivery.

• The case settled for $21.5 million.
  

Death from ARDS after delivery of twins

Bronx County (NY) Supreme Court

A 22-year-old woman at 34 weeks’ gestation reported to the hospital complaining of intermittent headaches. Her blood pressure was elevated and she was admitted. Six days later, labor was induced and she gave birth to healthy twins. After 12 days in the hospital she was discharged. The following day she returned to the hospital in respiratory distress, and she lost consciousness. She was stabilized with a ventilator but developed adult respiratory distress syndrome and died 10 days later.

The patient’s representatives claimed the physicians failed to diagnose a viral infection, which led to the patient’s death. Claims against several individuals and facilities were discontinued with the exception of 2 hospitals. Representatives for the 2 facilities argued the infection could not have been prevented or treated with antibiotics or any other medication.

• The case settled for $1.4 million.
  

$24.1 million awarded in VBAC gone awry

Seminole County (Fla) Circuit Court

A pregnant woman who desired vaginal delivery for her third child after experiencing 2 successful cesarean sections was induced for 3 days. When the fetus showed signs of distress, the OB used a vacuum extractor for 48 minutes to help deliver the child and ordered the nurses to apply fundal pressure. The woman’s uterus and bladder ruptured, causing oxygen deprivation to the fetus.

The child’s Apgar scores were 2 and 3. She has cerebral palsy, cannot speak, has little use of limbs, and is fed through a stomach tube. The mother required an emergency hysterectomy and surgery to repair her ruptured bladder. Her vocal cords were damaged during intubation, which required another operation.

The woman contended that the OB used the vacuum extractor for too long, failed to perform an emergency cesarean section, and should not have ordered fundal pressure.

• The hospital and senior physician settled for a confidential amount before trial. A $24.1 million verdict was returned against the OB.
  

Home birth, unlicensed midwives, cord prolapse

King County (Wash) Superior Court

A woman who wished to deliver at home, aided by midwives, underwent 2 sonograms during her pregnancy, which revealed multiple large fibroids blocking the birth canal. One of the midwives claimed that 2 consulting OBs were aware of the patient’s condition but claimed she could tolerate a trial of labor at home. One physician argued he never spoke with the midwife about the fibroids and that a consultation never occurred. The doctor also claimed that both midwives were unlicensed and should have referred the woman to an OB for a cesarean section.

After rupture of the membranes, the midwife performed a vaginal examination while the fetal head was not engaged in the pelvis. The midwife tugged on the umbilical cord, causing it to prolapse. The fetus was deprived of oxygen for 45 minutes. The woman was rushed to the hospital for an emergency cesarean section. The baby suffered birth asphyxia, hypoxic ischemic encephalopathy, spastic quadriplegia, and cerebral palsy. Five years later, the child has seizures and severe developmental disabilities, and requires tube feeding.

• The case settled for $3 million.
  

Experts comment on father’s video in shoulder dystocia case

Norfolk (Va) Circuit Court

After giving birth to a child with Erb palsy, the mother argued the OB applied excessive traction and angulation of the head-to-shoulder angle as she twisted and pulled on the infant for more than 50 seconds before shoulder dystocia was relieved. There were no signs of fetal distress.

Neither the physician nor the nursing staff remembered the delivery, but the child’s father made a videotape of the birth. In a pretrial ruling, the judge determined the videotape could not be viewed by the jury, but experts could comment on it. The birth record showed that neither the shoulder dystocia nor paralysis of the right arm was observed by the physician or the nursing staff.

The infant has full use of his hand but has a permanent deformity with inward rotation of the upper arm and elbow and winging of the shoulder blade. The child has had physical therapy, but surgery was considered inappropriate.

• Although judgment was not entered on the verdict, both parties agreed to a structured settlement of $650,000.
  

Oxytocin was increased despite ominous signs

Cook County (III) Circuit Court

A woman was admitted to the hospital for induction of labor. That morning, the fetal monitor tracing was reassuring and oxytocin was initiated. By early afternoon, contraction patterns demonstrated hyperstimulation, with prolonged decelerations. The nurses did not intervene or alert the physician. Oxytocin was continued and increased.

By 1 PM, the fetal monitoring strip showed late decelerations, rising baseline, diminished variability, and lack of accelerations. Oxytocin was continued even though the patient was experiencing extensive contractions. This deteriorating pattern continued until 11:17 PM when the doctor left the room to attend to 2 other deliveries.

At this point, the contraction patterns showed a marked decrease in baseline, severe late decelerations, and absent variability. The nurse continued the oxytocin at more than 24 mU. Upon her return to the delivery room shortly after midnight, the doctor noted a nonreassuring fetal tracing.

At delivery the infant’s Apgar scores were 2, 4, and 5. Initial cord blood gas was 6.98. She was diagnosed with hypoxic ischemic encephalopathy and remained in the NICU for 1 month. She is severely neurologically impaired and nonambulatory, and cannot communicate. She resides in a nursing home where she is fed through a stomach tube.

The mother contended that neither the physician nor the nurse provided adequate intervention. Denying negligence, the defendants argued there was no approximate cause for the infant’s condition and claimed the injury occurred during the last few minutes before delivery.

• The case settled for $21.5 million.
  

Death from ARDS after delivery of twins

Bronx County (NY) Supreme Court

A 22-year-old woman at 34 weeks’ gestation reported to the hospital complaining of intermittent headaches. Her blood pressure was elevated and she was admitted. Six days later, labor was induced and she gave birth to healthy twins. After 12 days in the hospital she was discharged. The following day she returned to the hospital in respiratory distress, and she lost consciousness. She was stabilized with a ventilator but developed adult respiratory distress syndrome and died 10 days later.

The patient’s representatives claimed the physicians failed to diagnose a viral infection, which led to the patient’s death. Claims against several individuals and facilities were discontinued with the exception of 2 hospitals. Representatives for the 2 facilities argued the infection could not have been prevented or treated with antibiotics or any other medication.

• The case settled for $1.4 million.
  

Vocal cord, carpal tunnel damage alleged after cystectomy complications

Bronx County (NY) Supreme Court

A 37-year-old woman underwent laparoscopic surgery for removal of an ovarian cyst. After the cyst was removed, the patient had hypotension and tachycardia. She received 12 blood transfusions but her condition did not improve.

Exploratory surgery after internal bleeding was diagnosed revealed a lacerated abdominal artery. After the artery was repaired, the patient’s condition still did not improve. A dye-injection procedure showed another arterial laceration, which was repaired during a third surgery.

Plaintiff claims. In suing, the woman claimed the lacerations were caused by improper insertion of the trocar. In addition she claimed she had an allergic reaction to the blood transfusions, which caused respiratory distress and the need to be intubated.

According to the patient, the intubation caused permanent paralysis of her vocal cords. Additionally, she contended she developed carpal tunnel syndrome as a result of prolonged bed rest.

The patient maintained that her condition warranted emergency exploratory surgery and that the physician should have repaired both lacerations during the initial surgery.

Defense. The physician argued that arterial lacerations are a well-known risk factor of laparoscopic surgery and that he treated both lacerations appropriately.

He also contended that the patient’s vocal cords were not paralyzed and that she did not have carpal tunnel syndrome.

• The jury returned a defense verdict.
  

Did delayed c-section damage twins’ kidneys?

Queens County (NY) Supreme Court

A 27-year-old woman at 28 weeks’ gestation with a twin pregnancy presented to the hospital complaining of painful vaginal bleeding. Fetal heart monitor tracings revealed a sinusoidal pattern. Fifty minutes later, twin girls were delivered by cesarean section. Both girls were born with kidney problems. One twin died from renal failure 6 weeks later. The other twin survived but suffers from chronic kidney problems.

The mother claimed the girls’ kidney problems were caused by the obstetrician’s delay in performing the cesarean section. The physicians acknowledged that a sinusoidal pattern is an emergency, but contended that the kidney problems were caused by a congenital defect that caused prenatal complications, which resulted in the sinusoidal pattern. The obstetrician claimed the 50-minute delay was caused by the anesthesiologist’s need to perform necessary setup procedures.

• The case settled for $1.5 million, including $250,000 for the wrongful death of the other twin.
  

$3 million in punitive damages follows fatal hysterectomy

Lubbock County (Tex) District Court

A 36-year-old woman with a history of pain and endometriosis underwent laparoscopic hysterectomy. After she was transferred from recovery to the hospital floor, a decrease in her urinary output was noted. A fluid challenge test, hemoglobin, and hematocrit levels were ordered. The patient’s hemoglobin level was 9.8 g/dL, and she remained oliguric after the fluid challenge test. Because the physician was in surgery, the patient’s status was reported to him via his voice mail, which he did not check. When the patient’s blood pressure decreased, the physician was called again.

The patient vomited and aspirated and suffered hypoxic brain injury and organ damage. She was removed from life support a few days later.

In suing, the plaintiff’s representatives claimed the physician did not monitor the tests that were ordered and failed to check the patient after finishing his other surgery. They also claimed that the communication between the physician and hospital staff was deficient and that the nurses had difficulty reaching the doctor.

The physician countered that the nurses failed to properly monitor the patient and report changes in her status.

• The jury awarded the plaintiff $14 million (the physician paid 75% of this amount, which included $3 million in punitive damages; the hospital was responsible for 25%).
  

Trocar angle blamed for perforated bladder

Philadelphia County (Pa) Common Pleas Court

Two days after undergoing laparoscopic tubal ligation, a woman had blood in her urine, abdominal pain, and vomiting. She was admitted to the hospital and diagnosed with a perforated bladder.

Although the patient’s condition seemed to improve after 2 days, she suffered severe respiratory distress and was moved to the ICU. Exploratory laparotomy revealed necrotizing tissue surrounding the perforated bladder. A severe infection ensued and the patient remained unconscious in the ICU for 2 weeks. She eventually recovered and was discharged.

In suing, the woman asserted that the surgeon improperly inserted a second trocar at a downward angle toward the bladder rather than at an upward angle to reach the fallopian tubes.

The physician contended that bladder perforation can occur during tubal ligation and that he had informed the woman of this risk before the operation.

• The jury awarded the plaintiff $5 million.
  

Jury finds oophorectomy was appropriate

Madison (Ky) Circuit Court

A 33-year-old mother of 3 who did not want more children underwent laparoscopic vaginal hysterectomy for heavy menstrual cycles and pelvic pain. Both ovaries were removed and the patient was placed on long-term hormone therapy.

After surgery the woman claimed she did not consent to have her ovaries removed. The patient contended (although the physician denied) that when she confronted the physician about the ovary removal he responded, “I must be senile.”

The physician asserted that he told the patient he would visualize the entire area and repair whatever was necessary. During the procedure, the physician found that both ovaries were severely adherent to the uterus and that one had a cyst. The physician claimed that the decision to remove the ovaries was the appropriate treatment.

• The jury returned a defense verdict.
  

Ureter injury during hysterectomy leads to nephrectomy

Adair County (Mo) Circuit Court

Despite several adjustments in hormone replacement therapy, a 66-year-old woman had vaginal bleeding lasting longer than 1 year. Distressed by the bleeding, she said she would consider hysterectomy.

The physician to whom she was referred discussed a dilatation and curettage (D&C) and a hysterectomy, gave her literature on both procedures, and arranged for her to see an interactive video about the 2 procedures. The woman opted for a hysterectomy. After a history and physical examination the next month, both options were again discussed, and again she chose a hysterectomy.

During laparoscopic vaginal hysterectomy several months later, an inadvertent cystotomy was performed and both ureters avulsed. Another surgeon reimplanted the ureters and placed stents, which were removed after 6 weeks. Three months later the right kidney showed signs of reduced function. The woman declined reimplantation of the right ureter. Thereafter, she had abdominal, flank, low back, and leg pain. Nearly 7 years later, her right kidney was removed.

In suing, the woman claimed the hysterectomy was unnecessary and argued that she should have undergone either a D&C or endometrial ablation. She also asserted the physician performed the operation in the wrong plane, thereby damaging the ureters and bladder.

The physician contended that the surgery was within the standard of care for the woman’s condition and that the injury was a known potential complication that was discovered intraoperatively and repaired. He contended that the injury was caused by a Deaver retractor used during the repair surgery.

• The jury returned a defense verdict.
  

Patient’s request for fetal reduction too late?

San Bernardino County (Calif) Superior Court

At 10 weeks’ gestation, a woman pregnant with quadruplets discussed fetal reduction with her obstetrician to increase her chances of giving birth to a healthy infant(s). Her next appointment was 5 weeks later.

When she returned to the clinic, she was told it was too late to perform selective termination. About 12 weeks later the woman gave birth to quadruplets. One died within 24 hours from hyaline membrane disease and 2 have cerebral palsy. The fourth child is healthy.

In suing, the woman claimed the obstetrician did not inform her that his practice had a policy prohibiting fetal reduction after 14 weeks’ gestation and failed to refer her to a perinatologist who could have performed the procedure.

The health maintenance organization claimed they told the woman about their policy against performing selective termination after 14 weeks and that she had declined to have the procedure before that time.

• The case settled for $2.6 million.
  

Improper diagnosis leads to premature birth

Baltimore County (Md) Circuit Court

A woman reported to the hospital at 25 weeks’ gestation complaining of abdominal pressure and contractions. The physician diagnosed a shortened cervix and discharged her.

Before the woman left the hospital she began to bleed, and an emergency cesarean section was performed.

In suing, the woman charged that the physician failed to properly treat the signs of premature labor. The child, who is now 3 years old, is blind, has cerebral palsy, is unable to communicate, and has limited mental status. The defendants argued that the treatment given was appropriate.

• The jury awarded the plaintiff $6.9 million.
  

Vocal cord, carpal tunnel damage alleged after cystectomy complications

Bronx County (NY) Supreme Court

A 37-year-old woman underwent laparoscopic surgery for removal of an ovarian cyst. After the cyst was removed, the patient had hypotension and tachycardia. She received 12 blood transfusions but her condition did not improve.

Exploratory surgery after internal bleeding was diagnosed revealed a lacerated abdominal artery. After the artery was repaired, the patient’s condition still did not improve. A dye-injection procedure showed another arterial laceration, which was repaired during a third surgery.

Plaintiff claims. In suing, the woman claimed the lacerations were caused by improper insertion of the trocar. In addition she claimed she had an allergic reaction to the blood transfusions, which caused respiratory distress and the need to be intubated.

According to the patient, the intubation caused permanent paralysis of her vocal cords. Additionally, she contended she developed carpal tunnel syndrome as a result of prolonged bed rest.

The patient maintained that her condition warranted emergency exploratory surgery and that the physician should have repaired both lacerations during the initial surgery.

Defense. The physician argued that arterial lacerations are a well-known risk factor of laparoscopic surgery and that he treated both lacerations appropriately.

He also contended that the patient’s vocal cords were not paralyzed and that she did not have carpal tunnel syndrome.

• The jury returned a defense verdict.
  

Did delayed c-section damage twins’ kidneys?

Queens County (NY) Supreme Court

A 27-year-old woman at 28 weeks’ gestation with a twin pregnancy presented to the hospital complaining of painful vaginal bleeding. Fetal heart monitor tracings revealed a sinusoidal pattern. Fifty minutes later, twin girls were delivered by cesarean section. Both girls were born with kidney problems. One twin died from renal failure 6 weeks later. The other twin survived but suffers from chronic kidney problems.

The mother claimed the girls’ kidney problems were caused by the obstetrician’s delay in performing the cesarean section. The physicians acknowledged that a sinusoidal pattern is an emergency, but contended that the kidney problems were caused by a congenital defect that caused prenatal complications, which resulted in the sinusoidal pattern. The obstetrician claimed the 50-minute delay was caused by the anesthesiologist’s need to perform necessary setup procedures.

• The case settled for $1.5 million, including $250,000 for the wrongful death of the other twin.
  

$3 million in punitive damages follows fatal hysterectomy

Lubbock County (Tex) District Court

A 36-year-old woman with a history of pain and endometriosis underwent laparoscopic hysterectomy. After she was transferred from recovery to the hospital floor, a decrease in her urinary output was noted. A fluid challenge test, hemoglobin, and hematocrit levels were ordered. The patient’s hemoglobin level was 9.8 g/dL, and she remained oliguric after the fluid challenge test. Because the physician was in surgery, the patient’s status was reported to him via his voice mail, which he did not check. When the patient’s blood pressure decreased, the physician was called again.

The patient vomited and aspirated and suffered hypoxic brain injury and organ damage. She was removed from life support a few days later.

In suing, the plaintiff’s representatives claimed the physician did not monitor the tests that were ordered and failed to check the patient after finishing his other surgery. They also claimed that the communication between the physician and hospital staff was deficient and that the nurses had difficulty reaching the doctor.

The physician countered that the nurses failed to properly monitor the patient and report changes in her status.

• The jury awarded the plaintiff $14 million (the physician paid 75% of this amount, which included $3 million in punitive damages; the hospital was responsible for 25%).
  

Trocar angle blamed for perforated bladder

Philadelphia County (Pa) Common Pleas Court

Two days after undergoing laparoscopic tubal ligation, a woman had blood in her urine, abdominal pain, and vomiting. She was admitted to the hospital and diagnosed with a perforated bladder.

Although the patient’s condition seemed to improve after 2 days, she suffered severe respiratory distress and was moved to the ICU. Exploratory laparotomy revealed necrotizing tissue surrounding the perforated bladder. A severe infection ensued and the patient remained unconscious in the ICU for 2 weeks. She eventually recovered and was discharged.

In suing, the woman asserted that the surgeon improperly inserted a second trocar at a downward angle toward the bladder rather than at an upward angle to reach the fallopian tubes.

The physician contended that bladder perforation can occur during tubal ligation and that he had informed the woman of this risk before the operation.

• The jury awarded the plaintiff $5 million.
  

Jury finds oophorectomy was appropriate

Madison (Ky) Circuit Court

A 33-year-old mother of 3 who did not want more children underwent laparoscopic vaginal hysterectomy for heavy menstrual cycles and pelvic pain. Both ovaries were removed and the patient was placed on long-term hormone therapy.

After surgery the woman claimed she did not consent to have her ovaries removed. The patient contended (although the physician denied) that when she confronted the physician about the ovary removal he responded, “I must be senile.”

The physician asserted that he told the patient he would visualize the entire area and repair whatever was necessary. During the procedure, the physician found that both ovaries were severely adherent to the uterus and that one had a cyst. The physician claimed that the decision to remove the ovaries was the appropriate treatment.

• The jury returned a defense verdict.
  

Ureter injury during hysterectomy leads to nephrectomy

Adair County (Mo) Circuit Court

Despite several adjustments in hormone replacement therapy, a 66-year-old woman had vaginal bleeding lasting longer than 1 year. Distressed by the bleeding, she said she would consider hysterectomy.

The physician to whom she was referred discussed a dilatation and curettage (D&C) and a hysterectomy, gave her literature on both procedures, and arranged for her to see an interactive video about the 2 procedures. The woman opted for a hysterectomy. After a history and physical examination the next month, both options were again discussed, and again she chose a hysterectomy.

During laparoscopic vaginal hysterectomy several months later, an inadvertent cystotomy was performed and both ureters avulsed. Another surgeon reimplanted the ureters and placed stents, which were removed after 6 weeks. Three months later the right kidney showed signs of reduced function. The woman declined reimplantation of the right ureter. Thereafter, she had abdominal, flank, low back, and leg pain. Nearly 7 years later, her right kidney was removed.

In suing, the woman claimed the hysterectomy was unnecessary and argued that she should have undergone either a D&C or endometrial ablation. She also asserted the physician performed the operation in the wrong plane, thereby damaging the ureters and bladder.

The physician contended that the surgery was within the standard of care for the woman’s condition and that the injury was a known potential complication that was discovered intraoperatively and repaired. He contended that the injury was caused by a Deaver retractor used during the repair surgery.

• The jury returned a defense verdict.
  

Patient’s request for fetal reduction too late?

San Bernardino County (Calif) Superior Court

At 10 weeks’ gestation, a woman pregnant with quadruplets discussed fetal reduction with her obstetrician to increase her chances of giving birth to a healthy infant(s). Her next appointment was 5 weeks later.

When she returned to the clinic, she was told it was too late to perform selective termination. About 12 weeks later the woman gave birth to quadruplets. One died within 24 hours from hyaline membrane disease and 2 have cerebral palsy. The fourth child is healthy.

In suing, the woman claimed the obstetrician did not inform her that his practice had a policy prohibiting fetal reduction after 14 weeks’ gestation and failed to refer her to a perinatologist who could have performed the procedure.

The health maintenance organization claimed they told the woman about their policy against performing selective termination after 14 weeks and that she had declined to have the procedure before that time.

• The case settled for $2.6 million.
  

Improper diagnosis leads to premature birth

Baltimore County (Md) Circuit Court

A woman reported to the hospital at 25 weeks’ gestation complaining of abdominal pressure and contractions. The physician diagnosed a shortened cervix and discharged her.

Before the woman left the hospital she began to bleed, and an emergency cesarean section was performed.

In suing, the woman charged that the physician failed to properly treat the signs of premature labor. The child, who is now 3 years old, is blind, has cerebral palsy, is unable to communicate, and has limited mental status. The defendants argued that the treatment given was appropriate.

• The jury awarded the plaintiff $6.9 million.
  

Vocal cord, carpal tunnel damage alleged after cystectomy complications

Bronx County (NY) Supreme Court

A 37-year-old woman underwent laparoscopic surgery for removal of an ovarian cyst. After the cyst was removed, the patient had hypotension and tachycardia. She received 12 blood transfusions but her condition did not improve.

Exploratory surgery after internal bleeding was diagnosed revealed a lacerated abdominal artery. After the artery was repaired, the patient’s condition still did not improve. A dye-injection procedure showed another arterial laceration, which was repaired during a third surgery.

Plaintiff claims. In suing, the woman claimed the lacerations were caused by improper insertion of the trocar. In addition she claimed she had an allergic reaction to the blood transfusions, which caused respiratory distress and the need to be intubated.

According to the patient, the intubation caused permanent paralysis of her vocal cords. Additionally, she contended she developed carpal tunnel syndrome as a result of prolonged bed rest.

The patient maintained that her condition warranted emergency exploratory surgery and that the physician should have repaired both lacerations during the initial surgery.

Defense. The physician argued that arterial lacerations are a well-known risk factor of laparoscopic surgery and that he treated both lacerations appropriately.

He also contended that the patient’s vocal cords were not paralyzed and that she did not have carpal tunnel syndrome.

• The jury returned a defense verdict.
  

Did delayed c-section damage twins’ kidneys?

Queens County (NY) Supreme Court

A 27-year-old woman at 28 weeks’ gestation with a twin pregnancy presented to the hospital complaining of painful vaginal bleeding. Fetal heart monitor tracings revealed a sinusoidal pattern. Fifty minutes later, twin girls were delivered by cesarean section. Both girls were born with kidney problems. One twin died from renal failure 6 weeks later. The other twin survived but suffers from chronic kidney problems.

The mother claimed the girls’ kidney problems were caused by the obstetrician’s delay in performing the cesarean section. The physicians acknowledged that a sinusoidal pattern is an emergency, but contended that the kidney problems were caused by a congenital defect that caused prenatal complications, which resulted in the sinusoidal pattern. The obstetrician claimed the 50-minute delay was caused by the anesthesiologist’s need to perform necessary setup procedures.

• The case settled for $1.5 million, including $250,000 for the wrongful death of the other twin.
  

$3 million in punitive damages follows fatal hysterectomy

Lubbock County (Tex) District Court

A 36-year-old woman with a history of pain and endometriosis underwent laparoscopic hysterectomy. After she was transferred from recovery to the hospital floor, a decrease in her urinary output was noted. A fluid challenge test, hemoglobin, and hematocrit levels were ordered. The patient’s hemoglobin level was 9.8 g/dL, and she remained oliguric after the fluid challenge test. Because the physician was in surgery, the patient’s status was reported to him via his voice mail, which he did not check. When the patient’s blood pressure decreased, the physician was called again.

The patient vomited and aspirated and suffered hypoxic brain injury and organ damage. She was removed from life support a few days later.

In suing, the plaintiff’s representatives claimed the physician did not monitor the tests that were ordered and failed to check the patient after finishing his other surgery. They also claimed that the communication between the physician and hospital staff was deficient and that the nurses had difficulty reaching the doctor.

The physician countered that the nurses failed to properly monitor the patient and report changes in her status.

• The jury awarded the plaintiff $14 million (the physician paid 75% of this amount, which included $3 million in punitive damages; the hospital was responsible for 25%).
  

Trocar angle blamed for perforated bladder

Philadelphia County (Pa) Common Pleas Court

Two days after undergoing laparoscopic tubal ligation, a woman had blood in her urine, abdominal pain, and vomiting. She was admitted to the hospital and diagnosed with a perforated bladder.

Although the patient’s condition seemed to improve after 2 days, she suffered severe respiratory distress and was moved to the ICU. Exploratory laparotomy revealed necrotizing tissue surrounding the perforated bladder. A severe infection ensued and the patient remained unconscious in the ICU for 2 weeks. She eventually recovered and was discharged.

In suing, the woman asserted that the surgeon improperly inserted a second trocar at a downward angle toward the bladder rather than at an upward angle to reach the fallopian tubes.

The physician contended that bladder perforation can occur during tubal ligation and that he had informed the woman of this risk before the operation.

• The jury awarded the plaintiff $5 million.
  

Jury finds oophorectomy was appropriate

Madison (Ky) Circuit Court

A 33-year-old mother of 3 who did not want more children underwent laparoscopic vaginal hysterectomy for heavy menstrual cycles and pelvic pain. Both ovaries were removed and the patient was placed on long-term hormone therapy.

After surgery the woman claimed she did not consent to have her ovaries removed. The patient contended (although the physician denied) that when she confronted the physician about the ovary removal he responded, “I must be senile.”

The physician asserted that he told the patient he would visualize the entire area and repair whatever was necessary. During the procedure, the physician found that both ovaries were severely adherent to the uterus and that one had a cyst. The physician claimed that the decision to remove the ovaries was the appropriate treatment.

• The jury returned a defense verdict.
  

Ureter injury during hysterectomy leads to nephrectomy

Adair County (Mo) Circuit Court

Despite several adjustments in hormone replacement therapy, a 66-year-old woman had vaginal bleeding lasting longer than 1 year. Distressed by the bleeding, she said she would consider hysterectomy.

The physician to whom she was referred discussed a dilatation and curettage (D&C) and a hysterectomy, gave her literature on both procedures, and arranged for her to see an interactive video about the 2 procedures. The woman opted for a hysterectomy. After a history and physical examination the next month, both options were again discussed, and again she chose a hysterectomy.

During laparoscopic vaginal hysterectomy several months later, an inadvertent cystotomy was performed and both ureters avulsed. Another surgeon reimplanted the ureters and placed stents, which were removed after 6 weeks. Three months later the right kidney showed signs of reduced function. The woman declined reimplantation of the right ureter. Thereafter, she had abdominal, flank, low back, and leg pain. Nearly 7 years later, her right kidney was removed.

In suing, the woman claimed the hysterectomy was unnecessary and argued that she should have undergone either a D&C or endometrial ablation. She also asserted the physician performed the operation in the wrong plane, thereby damaging the ureters and bladder.

The physician contended that the surgery was within the standard of care for the woman’s condition and that the injury was a known potential complication that was discovered intraoperatively and repaired. He contended that the injury was caused by a Deaver retractor used during the repair surgery.

• The jury returned a defense verdict.
  

Patient’s request for fetal reduction too late?

San Bernardino County (Calif) Superior Court

At 10 weeks’ gestation, a woman pregnant with quadruplets discussed fetal reduction with her obstetrician to increase her chances of giving birth to a healthy infant(s). Her next appointment was 5 weeks later.

When she returned to the clinic, she was told it was too late to perform selective termination. About 12 weeks later the woman gave birth to quadruplets. One died within 24 hours from hyaline membrane disease and 2 have cerebral palsy. The fourth child is healthy.

In suing, the woman claimed the obstetrician did not inform her that his practice had a policy prohibiting fetal reduction after 14 weeks’ gestation and failed to refer her to a perinatologist who could have performed the procedure.

The health maintenance organization claimed they told the woman about their policy against performing selective termination after 14 weeks and that she had declined to have the procedure before that time.

• The case settled for $2.6 million.
  

Improper diagnosis leads to premature birth

Baltimore County (Md) Circuit Court

A woman reported to the hospital at 25 weeks’ gestation complaining of abdominal pressure and contractions. The physician diagnosed a shortened cervix and discharged her.

Before the woman left the hospital she began to bleed, and an emergency cesarean section was performed.

In suing, the woman charged that the physician failed to properly treat the signs of premature labor. The child, who is now 3 years old, is blind, has cerebral palsy, is unable to communicate, and has limited mental status. The defendants argued that the treatment given was appropriate.

• The jury awarded the plaintiff $6.9 million.
  

Woman recants request for hysterectomy after she remarries

<court> Harris County (Tex) District Court </court>

Over the course of 12 years, a woman had various obstetric and gynecologic problems, among them adhesions, ovarian cysts, and possible endometriosis. She had ongoing pelvic pain, which was occasionally severe. She was treated with various medications and underwent several surgeries, including removal of her left fallopian tube and ovary due to infection.

After having 2 children, the woman had her remaining tube ligated. Six years later she presented to an emergency department complaining of severe pelvic pain. Three days after a surgical consult suggested the pelvic pain was gynecologic in origin, she requested and underwent a hysterectomy.

In suing, the woman, now divorced and remarried, contended the physician should have obtained more consults, including a psychiatry consult, prior to the hysterectomy to rule out other causes of the pelvic pain. She claimed her request for the hysterectomy did not justify the performance of the procedure. She noted that she had a new marriage and planned to have her tubal ligation reversed because of a desire to have more children.

• The jury returned a defense verdict.

Was Brannon pack “ too big to overlook ” ?

<court> Hillsborough County (Fla) Circuit Court </court>

After a total abdominal hysterectomy with bilateral salpingo-oophorectomy for abdominal pain and postmenstrual spotting, a 43-year-old woman had a temperature as high as 102 ° F and bilious projectile vomiting. An x-ray 3 days after surgery revealed a foreign object in the upper abdomen. During exploratory laparotomy, a lap sponge (Brannon pack) was removed.

In suing, the woman claimed the physician was negligent in failing to remove the Brannon pack. The defense asserted that the physician was entitled to rely on the hospital staff report that the sponge count was correct. The woman claimed the Brannon pack was so large that it should not have been overlooked.

• The hospital settled prior to the filing of the lawsuit for an undisclosed amount. The jury awarded the plaintiff $22,500.

Manifold errors charged in cerebral palsy case

<court> King ’ s County (NY) Supreme Court </court>

At 29 weeks ’ gestation, a woman with diabetes and a history of preterm delivery was admitted for mild-to-moderate contractions. Her physician and the perinatologist on staff ordered magnesium sulfate to stop contractions, but labor progressed. The infant was born with Apgar scores of 4 and 4. She was limp, blue, and not breathing. She was intubated for 4 days and discharged after 3 months, with a diagnosis of periventricular leukomalacia. The child has no use of her legs and little use of her right arm. She is wheel-chair bound and cannot attend to her daily needs. She has full cognition and above-average intelligence and is doing well in school.

In suing the hospital and the physicians, the woman claimed the physicians should have prescribed antibiotics because infection is a known cause of preterm labor. She also asserted that the hospital and the physician improperly reduced the magnesium sulfate, allowing labor to progress. She claimed the hospital staff failed to monitor the fetal heart tracings, which revealed variable decelerations, reduced accelerations, and reduced variability. She claimed failure to perform a cesarean section resulted in cerebral palsy and brain damage.

The hospital maintained the physician was in charge of the labor and delivery, and made all the decisions. The defendants claimed the care given was appropriate.

• The jury awarded the plaintiff $29.3 million, with fault divided 35% to the hospital and 65% to the physician. The plaintiff had agreed to a high/low settlement with the hospital only; a $5 million settlement was reached.

Defense: Consent form warned of dangers

<court> Fresno County (Calif) Superior Court </court>

A 39-year-old woman with a 1-year history of pelvic pressure due to uterine fibroids under-went a hysterectomy. Five days after hospital discharge, she complained of urinary incontinence. A urologist diagnosed a vesicovaginal fistula and recommended surgery.

Ultrasound examination of the kidneys a month later was suggestive of a left ureter injury. The bladder leak and the ureter were repaired soon afterward.

In suing, the woman claimed the physician performed the hysterectomy negligently and failed to perform a postoperative intravenous pyelogram to reveal the bladder and ureter problems.

Denying negligence, the surgeon pointed out that the written consent form explained the risks posed to other organs by the surgery. He noted that the surgical field had substantial adhesions and scar tissue, complicating the procedure. He also claimed the woman would not consent to an intravenous pyelogram because of an iodine allergy.

• The jury returned a defense verdict.

Diabetes undiagnosed until emergency delivery

<court> Kings County (NY) Supreme Court </court>

Because traces of glucose were found in the urine of a 38-year-old pregnant woman, her ObGyn ordered a standard glucose tolerance test. She was unable to drink the liquid necessary for the test, however, and there was no follow-up.

Six months later the woman presented to a hospital complaining of decreased fetal movement, excessive thirst, dry mouth, and vomiting. The hospital physician placed her on a fetal monitor and discharged her several hours later. The next day after reviewing the fetal heart monitor results, her ObGyn asked that she return to the hospital. The hospital physician ordered an emergency cesarean section after an abnormal scalp pH test result.

At birth, the infant weighed 11 lb 14 oz and his Apgar scores were 1, 2, and 5. After a seizure the infant was given anticonvulsants and remained in ICU for 17 days. He was diagnosed with perinatal asphyxia, acidosis, and hypoglycemia. Now 12, the child has mild mental retardation and attention deficit disorder, as well as cognitive and learning disabilities.

The mother claimed the defendants failed to diagnose gestational diabetes in a timely manner, and failed to proceed to immediate cesarean section when the nonreactive and nonreassuring heart rate pattern was noted. The gynecologist asserted he ordered the glucose tolerance test to rule out diabetes, and that the diabetes was not the cause of the fetal distress.

• Damages were set at $4.1 million. The jury assigned fault 55% to the hospital, 25% to the hospital physician, and 20% to the gynecologist.

Abnormal fetal tracing and spastic quadriplegia

<court> Queens County (NY) Supreme Court </court>

In her 37th week of pregnancy, a 19-year-old woman presented to her hospital at 4 cm dilated. She was instructed to ambulate to help induce labor. Two hours later she was given an epidural and placed on a fetal heart monitor. Physicians ruptured her membranes and noticed meconium staining. During the next few hours, fetal distress was recorded; the fetus did not descend into the birth canal, but remained at minus-1 station.

The infant was delivered by cesarean section and had Apgar scores of 2, 4, and 5. After transfer to another facility, the child was diagnosed with microcephaly and spastic quadriplegia.

The woman asserted the delayed cesarean section led to oxygen deprivation that caused the infant ’ s injuries.

• The case settled for $2.95 million.

Unpredictable event to blame, jury agrees

<court> St. Louis County (Mo) Circuit Court </court>

A woman at 41 weeks ’ gestation arrived at the hospital with ruptured membranes and was given oxytocin at 5:25 PM. At about 6 PM the fetal heart rate fell from 130 to 90 and sometimes 70.

Because of difficulties with the fetal monitor, the nurse switched from an external monitor to an internal lead attached to the fetus ’ s scalp. Although the fetal heart rate improved, another deceleration was noted at 6:11 PM. The nurse adjusted the position of the mother, turned off the oxytocin at 6:23 PM, and called the physician 3 minutes later to alert him to the decreased fetal heart rate.

The physician suggested several interventions and told the nurse to call him back with another update. Although the nurse increased IV fluids, administered oxygen, and turned the mother to increase fetal circulation, the deceleration continued. The physician was called again at 6:37 PM; he arrived at the hospital at 6:50 PM for an immediate cesarean section.

The infant was delivered at 7:11 PM with no pulse or respirations. Cerebral palsy due to perinatal hypoxia was diagnosed. The child is confined to a wheelchair, unable to move any part of her body except for one arm. Now age 15, she cannot speak or swallow, and requires a feeding tube. The plaintiff faulted the nurse for failing to recognize signs of fetal distress in a timely manner, and the physician for failing to come to the hospital after the first phone call and failing to recognize the need for cesarean section sooner.

The defense denied any negligence and asserted the injury was caused by an unpredictable, profound, and sudden event.

• The jury returned a defense verdict.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn ( www.verdictslaska.com ).The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.

Woman recants request for hysterectomy after she remarries

<court> Harris County (Tex) District Court </court>

Over the course of 12 years, a woman had various obstetric and gynecologic problems, among them adhesions, ovarian cysts, and possible endometriosis. She had ongoing pelvic pain, which was occasionally severe. She was treated with various medications and underwent several surgeries, including removal of her left fallopian tube and ovary due to infection.

After having 2 children, the woman had her remaining tube ligated. Six years later she presented to an emergency department complaining of severe pelvic pain. Three days after a surgical consult suggested the pelvic pain was gynecologic in origin, she requested and underwent a hysterectomy.

In suing, the woman, now divorced and remarried, contended the physician should have obtained more consults, including a psychiatry consult, prior to the hysterectomy to rule out other causes of the pelvic pain. She claimed her request for the hysterectomy did not justify the performance of the procedure. She noted that she had a new marriage and planned to have her tubal ligation reversed because of a desire to have more children.

• The jury returned a defense verdict.

Was Brannon pack “ too big to overlook ” ?

<court> Hillsborough County (Fla) Circuit Court </court>

After a total abdominal hysterectomy with bilateral salpingo-oophorectomy for abdominal pain and postmenstrual spotting, a 43-year-old woman had a temperature as high as 102 ° F and bilious projectile vomiting. An x-ray 3 days after surgery revealed a foreign object in the upper abdomen. During exploratory laparotomy, a lap sponge (Brannon pack) was removed.

In suing, the woman claimed the physician was negligent in failing to remove the Brannon pack. The defense asserted that the physician was entitled to rely on the hospital staff report that the sponge count was correct. The woman claimed the Brannon pack was so large that it should not have been overlooked.

• The hospital settled prior to the filing of the lawsuit for an undisclosed amount. The jury awarded the plaintiff $22,500.

Manifold errors charged in cerebral palsy case

<court> King ’ s County (NY) Supreme Court </court>

At 29 weeks ’ gestation, a woman with diabetes and a history of preterm delivery was admitted for mild-to-moderate contractions. Her physician and the perinatologist on staff ordered magnesium sulfate to stop contractions, but labor progressed. The infant was born with Apgar scores of 4 and 4. She was limp, blue, and not breathing. She was intubated for 4 days and discharged after 3 months, with a diagnosis of periventricular leukomalacia. The child has no use of her legs and little use of her right arm. She is wheel-chair bound and cannot attend to her daily needs. She has full cognition and above-average intelligence and is doing well in school.

In suing the hospital and the physicians, the woman claimed the physicians should have prescribed antibiotics because infection is a known cause of preterm labor. She also asserted that the hospital and the physician improperly reduced the magnesium sulfate, allowing labor to progress. She claimed the hospital staff failed to monitor the fetal heart tracings, which revealed variable decelerations, reduced accelerations, and reduced variability. She claimed failure to perform a cesarean section resulted in cerebral palsy and brain damage.

The hospital maintained the physician was in charge of the labor and delivery, and made all the decisions. The defendants claimed the care given was appropriate.

• The jury awarded the plaintiff $29.3 million, with fault divided 35% to the hospital and 65% to the physician. The plaintiff had agreed to a high/low settlement with the hospital only; a $5 million settlement was reached.

Defense: Consent form warned of dangers

<court> Fresno County (Calif) Superior Court </court>

A 39-year-old woman with a 1-year history of pelvic pressure due to uterine fibroids under-went a hysterectomy. Five days after hospital discharge, she complained of urinary incontinence. A urologist diagnosed a vesicovaginal fistula and recommended surgery.

Ultrasound examination of the kidneys a month later was suggestive of a left ureter injury. The bladder leak and the ureter were repaired soon afterward.

In suing, the woman claimed the physician performed the hysterectomy negligently and failed to perform a postoperative intravenous pyelogram to reveal the bladder and ureter problems.

Denying negligence, the surgeon pointed out that the written consent form explained the risks posed to other organs by the surgery. He noted that the surgical field had substantial adhesions and scar tissue, complicating the procedure. He also claimed the woman would not consent to an intravenous pyelogram because of an iodine allergy.

• The jury returned a defense verdict.

Diabetes undiagnosed until emergency delivery

<court> Kings County (NY) Supreme Court </court>

Because traces of glucose were found in the urine of a 38-year-old pregnant woman, her ObGyn ordered a standard glucose tolerance test. She was unable to drink the liquid necessary for the test, however, and there was no follow-up.

Six months later the woman presented to a hospital complaining of decreased fetal movement, excessive thirst, dry mouth, and vomiting. The hospital physician placed her on a fetal monitor and discharged her several hours later. The next day after reviewing the fetal heart monitor results, her ObGyn asked that she return to the hospital. The hospital physician ordered an emergency cesarean section after an abnormal scalp pH test result.

At birth, the infant weighed 11 lb 14 oz and his Apgar scores were 1, 2, and 5. After a seizure the infant was given anticonvulsants and remained in ICU for 17 days. He was diagnosed with perinatal asphyxia, acidosis, and hypoglycemia. Now 12, the child has mild mental retardation and attention deficit disorder, as well as cognitive and learning disabilities.

The mother claimed the defendants failed to diagnose gestational diabetes in a timely manner, and failed to proceed to immediate cesarean section when the nonreactive and nonreassuring heart rate pattern was noted. The gynecologist asserted he ordered the glucose tolerance test to rule out diabetes, and that the diabetes was not the cause of the fetal distress.

• Damages were set at $4.1 million. The jury assigned fault 55% to the hospital, 25% to the hospital physician, and 20% to the gynecologist.

Abnormal fetal tracing and spastic quadriplegia

<court> Queens County (NY) Supreme Court </court>

In her 37th week of pregnancy, a 19-year-old woman presented to her hospital at 4 cm dilated. She was instructed to ambulate to help induce labor. Two hours later she was given an epidural and placed on a fetal heart monitor. Physicians ruptured her membranes and noticed meconium staining. During the next few hours, fetal distress was recorded; the fetus did not descend into the birth canal, but remained at minus-1 station.

The infant was delivered by cesarean section and had Apgar scores of 2, 4, and 5. After transfer to another facility, the child was diagnosed with microcephaly and spastic quadriplegia.

The woman asserted the delayed cesarean section led to oxygen deprivation that caused the infant ’ s injuries.

• The case settled for $2.95 million.

Unpredictable event to blame, jury agrees

<court> St. Louis County (Mo) Circuit Court </court>

A woman at 41 weeks ’ gestation arrived at the hospital with ruptured membranes and was given oxytocin at 5:25 PM. At about 6 PM the fetal heart rate fell from 130 to 90 and sometimes 70.

Because of difficulties with the fetal monitor, the nurse switched from an external monitor to an internal lead attached to the fetus ’ s scalp. Although the fetal heart rate improved, another deceleration was noted at 6:11 PM. The nurse adjusted the position of the mother, turned off the oxytocin at 6:23 PM, and called the physician 3 minutes later to alert him to the decreased fetal heart rate.

The physician suggested several interventions and told the nurse to call him back with another update. Although the nurse increased IV fluids, administered oxygen, and turned the mother to increase fetal circulation, the deceleration continued. The physician was called again at 6:37 PM; he arrived at the hospital at 6:50 PM for an immediate cesarean section.

The infant was delivered at 7:11 PM with no pulse or respirations. Cerebral palsy due to perinatal hypoxia was diagnosed. The child is confined to a wheelchair, unable to move any part of her body except for one arm. Now age 15, she cannot speak or swallow, and requires a feeding tube. The plaintiff faulted the nurse for failing to recognize signs of fetal distress in a timely manner, and the physician for failing to come to the hospital after the first phone call and failing to recognize the need for cesarean section sooner.

The defense denied any negligence and asserted the injury was caused by an unpredictable, profound, and sudden event.

• The jury returned a defense verdict.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn ( www.verdictslaska.com ).The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.

Woman recants request for hysterectomy after she remarries

<court> Harris County (Tex) District Court </court>

Over the course of 12 years, a woman had various obstetric and gynecologic problems, among them adhesions, ovarian cysts, and possible endometriosis. She had ongoing pelvic pain, which was occasionally severe. She was treated with various medications and underwent several surgeries, including removal of her left fallopian tube and ovary due to infection.

After having 2 children, the woman had her remaining tube ligated. Six years later she presented to an emergency department complaining of severe pelvic pain. Three days after a surgical consult suggested the pelvic pain was gynecologic in origin, she requested and underwent a hysterectomy.

In suing, the woman, now divorced and remarried, contended the physician should have obtained more consults, including a psychiatry consult, prior to the hysterectomy to rule out other causes of the pelvic pain. She claimed her request for the hysterectomy did not justify the performance of the procedure. She noted that she had a new marriage and planned to have her tubal ligation reversed because of a desire to have more children.

• The jury returned a defense verdict.

Was Brannon pack “ too big to overlook ” ?

<court> Hillsborough County (Fla) Circuit Court </court>

After a total abdominal hysterectomy with bilateral salpingo-oophorectomy for abdominal pain and postmenstrual spotting, a 43-year-old woman had a temperature as high as 102 ° F and bilious projectile vomiting. An x-ray 3 days after surgery revealed a foreign object in the upper abdomen. During exploratory laparotomy, a lap sponge (Brannon pack) was removed.

In suing, the woman claimed the physician was negligent in failing to remove the Brannon pack. The defense asserted that the physician was entitled to rely on the hospital staff report that the sponge count was correct. The woman claimed the Brannon pack was so large that it should not have been overlooked.

• The hospital settled prior to the filing of the lawsuit for an undisclosed amount. The jury awarded the plaintiff $22,500.

Manifold errors charged in cerebral palsy case

<court> King ’ s County (NY) Supreme Court </court>

At 29 weeks ’ gestation, a woman with diabetes and a history of preterm delivery was admitted for mild-to-moderate contractions. Her physician and the perinatologist on staff ordered magnesium sulfate to stop contractions, but labor progressed. The infant was born with Apgar scores of 4 and 4. She was limp, blue, and not breathing. She was intubated for 4 days and discharged after 3 months, with a diagnosis of periventricular leukomalacia. The child has no use of her legs and little use of her right arm. She is wheel-chair bound and cannot attend to her daily needs. She has full cognition and above-average intelligence and is doing well in school.

In suing the hospital and the physicians, the woman claimed the physicians should have prescribed antibiotics because infection is a known cause of preterm labor. She also asserted that the hospital and the physician improperly reduced the magnesium sulfate, allowing labor to progress. She claimed the hospital staff failed to monitor the fetal heart tracings, which revealed variable decelerations, reduced accelerations, and reduced variability. She claimed failure to perform a cesarean section resulted in cerebral palsy and brain damage.

The hospital maintained the physician was in charge of the labor and delivery, and made all the decisions. The defendants claimed the care given was appropriate.

• The jury awarded the plaintiff $29.3 million, with fault divided 35% to the hospital and 65% to the physician. The plaintiff had agreed to a high/low settlement with the hospital only; a $5 million settlement was reached.

Defense: Consent form warned of dangers

<court> Fresno County (Calif) Superior Court </court>

A 39-year-old woman with a 1-year history of pelvic pressure due to uterine fibroids under-went a hysterectomy. Five days after hospital discharge, she complained of urinary incontinence. A urologist diagnosed a vesicovaginal fistula and recommended surgery.

Ultrasound examination of the kidneys a month later was suggestive of a left ureter injury. The bladder leak and the ureter were repaired soon afterward.

In suing, the woman claimed the physician performed the hysterectomy negligently and failed to perform a postoperative intravenous pyelogram to reveal the bladder and ureter problems.

Denying negligence, the surgeon pointed out that the written consent form explained the risks posed to other organs by the surgery. He noted that the surgical field had substantial adhesions and scar tissue, complicating the procedure. He also claimed the woman would not consent to an intravenous pyelogram because of an iodine allergy.

• The jury returned a defense verdict.

Diabetes undiagnosed until emergency delivery

<court> Kings County (NY) Supreme Court </court>

Because traces of glucose were found in the urine of a 38-year-old pregnant woman, her ObGyn ordered a standard glucose tolerance test. She was unable to drink the liquid necessary for the test, however, and there was no follow-up.

Six months later the woman presented to a hospital complaining of decreased fetal movement, excessive thirst, dry mouth, and vomiting. The hospital physician placed her on a fetal monitor and discharged her several hours later. The next day after reviewing the fetal heart monitor results, her ObGyn asked that she return to the hospital. The hospital physician ordered an emergency cesarean section after an abnormal scalp pH test result.

At birth, the infant weighed 11 lb 14 oz and his Apgar scores were 1, 2, and 5. After a seizure the infant was given anticonvulsants and remained in ICU for 17 days. He was diagnosed with perinatal asphyxia, acidosis, and hypoglycemia. Now 12, the child has mild mental retardation and attention deficit disorder, as well as cognitive and learning disabilities.

The mother claimed the defendants failed to diagnose gestational diabetes in a timely manner, and failed to proceed to immediate cesarean section when the nonreactive and nonreassuring heart rate pattern was noted. The gynecologist asserted he ordered the glucose tolerance test to rule out diabetes, and that the diabetes was not the cause of the fetal distress.

• Damages were set at $4.1 million. The jury assigned fault 55% to the hospital, 25% to the hospital physician, and 20% to the gynecologist.

Abnormal fetal tracing and spastic quadriplegia

<court> Queens County (NY) Supreme Court </court>

In her 37th week of pregnancy, a 19-year-old woman presented to her hospital at 4 cm dilated. She was instructed to ambulate to help induce labor. Two hours later she was given an epidural and placed on a fetal heart monitor. Physicians ruptured her membranes and noticed meconium staining. During the next few hours, fetal distress was recorded; the fetus did not descend into the birth canal, but remained at minus-1 station.

The infant was delivered by cesarean section and had Apgar scores of 2, 4, and 5. After transfer to another facility, the child was diagnosed with microcephaly and spastic quadriplegia.

The woman asserted the delayed cesarean section led to oxygen deprivation that caused the infant ’ s injuries.

• The case settled for $2.95 million.

Unpredictable event to blame, jury agrees

<court> St. Louis County (Mo) Circuit Court </court>

A woman at 41 weeks ’ gestation arrived at the hospital with ruptured membranes and was given oxytocin at 5:25 PM. At about 6 PM the fetal heart rate fell from 130 to 90 and sometimes 70.

Because of difficulties with the fetal monitor, the nurse switched from an external monitor to an internal lead attached to the fetus ’ s scalp. Although the fetal heart rate improved, another deceleration was noted at 6:11 PM. The nurse adjusted the position of the mother, turned off the oxytocin at 6:23 PM, and called the physician 3 minutes later to alert him to the decreased fetal heart rate.

The physician suggested several interventions and told the nurse to call him back with another update. Although the nurse increased IV fluids, administered oxygen, and turned the mother to increase fetal circulation, the deceleration continued. The physician was called again at 6:37 PM; he arrived at the hospital at 6:50 PM for an immediate cesarean section.

The infant was delivered at 7:11 PM with no pulse or respirations. Cerebral palsy due to perinatal hypoxia was diagnosed. The child is confined to a wheelchair, unable to move any part of her body except for one arm. Now age 15, she cannot speak or swallow, and requires a feeding tube. The plaintiff faulted the nurse for failing to recognize signs of fetal distress in a timely manner, and the physician for failing to come to the hospital after the first phone call and failing to recognize the need for cesarean section sooner.

The defense denied any negligence and asserted the injury was caused by an unpredictable, profound, and sudden event.

• The jury returned a defense verdict.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn ( www.verdictslaska.com ).The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.

Defense denies dystocia, says baby was “hung up”

Cook County (III) Circuit Court

Shortly after vaginal delivery of a 9 lb 7 oz infant by a 31-year-old woman, the infant was found to have a fractured clavicle, a limp right arm, and bruising on the upper shoulder and back. The physician’s notes stated the delivery was normal, with no shoulder dystocia and no difficulties. The physician allegedly advised the parents that the infant had a “stretched nerve” that would resolve over time, and that nerve injuries took a long time to heal.

After 3 years, the child was diagnosed with brachial plexus injury, arm shortening and weakness, and dexterity problems. The child had had 2 corrective surgeries, and further surgeries and physical therapy were expected to be necessary throughout her life. The plaintiff claimed the shoulder dystocia was a result of excessive traction by the physician, and that the physician failed to recognize the shoulder dystocia and take appropriate action.

The physician insisted the natural propulsive forces of labor caused the injury. He denied encountering shoulder dystocia, although he stated on cross-examination that the baby got “hung up” during delivery.

• The jury awarded the plaintiff $3 million.
  

Resident lacerates infant’s forehead

Queens County (NY) Supreme Court

A 26-year-old woman was admitted with labor pains and was attached to a fetal heart monitor. Because the fetus had mild tachycardia (

The obstetrician made a Pfannenstiel incision and a third-year resident made the uterine incision, lacerating the forehead of the fetus to the bone. The laceration was 5 cm long and required 30 stitches immediately after birth.

The woman asserted she was not advised until moments beforehand that a cesarean section was to be done, and that she was never told that a resident would make the uterine incision. She also claimed negligence on the part of the obstetrician for failing to perform an internal exam to assess the thinness of the uterine wall.

The physician argued the high fetal heart rate necessitated a cesarean section, which became an emergency when general anesthesia was given.

• The jury awarded the plaintiff $550,000.
  

Necrotizing fasciitis after c-section

Suffolk County (Mass) Superior Court

After a 34-year-old primigravida underwent a cesarean section, a surgical incision and deep infection developed. Ten days after delivery, and after several readmissions for the infection, she was transferred to a teaching facility in critical condition, where necrotizing fasciitis was diagnosed immediately. Major debridement of the abdominal wall was repeated several times over the next 5 weeks, and her infected uterus was removed. Reconstruction was necessary to repair the abdominal wall and loss of skin.

The woman claimed negligence in failure to diagnosis postpartum endometritis; she maintained the physician had said the infection was under control just before transfer to the teaching hospital. She faulted the physician for failure to use the standard antibiotic treatment for endometritis, failure to promptly open and drain the surgical wound because of cellulitis, failure to switch antibiotics in the face of progressing infection, prematurely discharging her on 2 occasions, and failure to recognize and treat necrotizing fasciitis despite skin hardening and other classic signs.

The physician contended that necrotizing fasciitis is rare and difficult to diagnose due to its similarity to other infections, and that it developed either just before or during transfer out of his care. The defense maintained the woman was always on antibiotics in consultation with infectious disease and wound care experts.

• The case settled for $500,000.
  

Finger-pointing after high-risk birth

Orange County (Calif) Superior Court

A woman with gestational diabetes, pregnancy-induced hypertension, preeclampsia, fetal prematurity, and intrauterine growth restriction was admitted at 36 weeks’ gestation to a hospital for induction of labor. She was seen by a physician at 5, 14, and 23 hours after admission.

During the induction, fetal monitoring strips became nonreassuring. The on-call OB was allegedly contacted 3 times by the labor-delivery nurse, but he was delivering a series of infants at another hospital. The nurse then contacted the back-up OB, who arrived 40 minutes later.

Delivered by vacuum extraction, the infant had Apgar scores of 6 at 1 minute and 7 at 5 minutes; cord blood pH was 7.15. The infant had seizures in the NICU and brain imaging evidence of subdural and subarachnoid bleeding and an enlarging clot in the transverse sinus and in the superior sagittal sinus. A month later at discharge, the infant was diagnosed with severe cerebral palsy.

In suing, the woman claimed that her complications should have warranted closer monitoring to ensure a safe trial of labor. She also contended the on-call OB should have arranged for the back-up OB to see her.

The nurse testified that she faxed fetal monitor strips twice to the on-call OB and twice asked him to come see the woman. The on-call OB asserted that only 1 fax was received and denied being asked to come to the woman’s bedside before 2:35 AM. The defense denied the standard of care required a physician be at the woman’s bedside prior to 3:00 AM.

• The case settled for $5.25 million ($1 million from the hospital and the rest from the physicians).
  

Drug abuse at fault, not lack of tocolytics

Maricopa County (Ariz) Superior Court

A woman presented at 27 weeks’ gestation with complaints of cramping and spotting. The nurse reported to the physician that the woman stated she was not having contractions and that an hour on a fetal monitor revealed no contractions. Therefore, the physician advised the nurse to discharge the patient.

The woman returned an hour later, however, and vaginal examination revealed that delivery was imminent; she underwent a cesarean section delivery. The infant was noted to have respiratory problems, a bowel perforation, and retinopathy of prematurity. After discharge the infant failed to thrive and was diagnosed with bronchopulmonary dysplasia, cerebral palsy, cortical blindness, and severe mental retardation. The child has required nutrition via a gastrostomy tube since age 3.

In suing, the plaintiff claimed the physicians failed to examine the mother at her first presentation and administer tocolytic agents.

The defense denied the woman was having contractions and asserted that she had an incompetent cervix, and that the infant’s problems were the results of parental neglect and drug abuse.

• The jury returned a defense verdict.
  

Phone call from nurse disputed in fetal injury

Orange County (Calif) Superior Court

A woman admitted in labor had an initial reassuring fetal heart monitor tracing, but as labor progressed, the tracings became nonreassuring. The labor and delivery nurse called the OB at home in the early morning hours. The fetal heart tracings deteriorated further and the OB was called again. He came quickly to the hospital, and by his arrival the fetus was in severe distress. There was an additional delay before the woman was transferred to an operating room for an emergency cesarean section.

The infant was born with hypoxic-ischemic encephalopathy, and cerebral palsy and global developmental delay ensued. The woman claimed the nurse (who worked for a nursing registry apart from the hospital) should have clarified the seriousness of the situation in the first phone call and that the OB should have gone to the hospital sooner. The nurse maintained that she had described the fetal heart tracing accurately in the first phone call. The OB denied hearing such a description.

• The case settled for $3.3 million ($930,000 from the OB, $950,00 from the nursing registry, and $1.45 million from the hospital).
  

Jury agreed ovarian cancer looked like perimenopause

Cook County (III) Circuit Court

A 47-year-old woman with a history of breast cancer at an early age presented to the emergency department complaining of heavy vaginal bleeding for 4 to 5 days, after no menstrual periods for 2 months.

The hospital emergency department physician ruled out neoplasm and diagnosed and treated her for dysfunctional uterine bleeding. She was referred to a gynecologist.

She saw her usual gynecologist the next day, who also diagnosed heavy periods and perimenopause. She also saw her internist several times over the next few months.

She returned to her gynecologist 4 months later with complaints of abdominal pain and urinary symptoms. A pelvic ultrasound, ordered to follow up a tender right ovary, revealed an ovarian cyst. Laparoscopy was recommended, which the woman refused, and she was told to return in 2 weeks. She did not return for 2 months; however, she did visit her internist twice during the interim, with complaints of bilateral lower abdominal pain and bloating. When she returned to her gynecologist, another ultrasound revealed bilateral ovarian cysts that had grown, and the woman was in substantial pain. Prompt surgery was recommended.

Surgery revealed stage IIIC grade III ovarian cancer. After a long course of chemotherapy, the woman died 2 years later.

The suit against the gynecologist and the internist alleged negligence in delayed diagnosis of the ovarian cancer, failure to take a proper history, and failure to have a high index of suspicion due to the woman’s known history of breast cancer. Had earlier ultrasound and a CA 125 blood test been performed, the cancer would have been diagnosed sooner and cure would have been more likely, the plaintiff claimed.

The defense contended the woman’s symptoms were consistent with perimenopause and not cancer, thus no ultrasound or CA 125 tests were necessary. It also argued that the woman did not follow the gynecologist’s recommendation for laparoscopy to examine the cyst when it was first found.

• The internist settled during the trial for $900,000. The jury returned a defense verdict for the gynecologist.
  

OB wins, hospital settles in sepsis, stillbirth case

Bronx County (NY) Supreme Court

When her amniotic membranes began bulging at 17 weeks’ gestation, a 30-year-old woman presented to a hospital, where her physician and a perinatal consultant recommended termination of the pregnancy.

She allegedly declined to terminate the pregnancy. Five days later she had a temperature of 104.4°F, a nosebleed, and bleeding at blood-draw sites. The physician prescribed ampicillin, clindamycin, gentamicin, and fresh frozen plasma. Blood tests revealed disseminated intravascular coagulation.

The fetus was delivered stillborn an hour later, and the mother suffered cardiac arrest 4 hours later and died of septic shock.

The petitioner for the deceased woman claimed the physician delayed delivery of the fetus, failed to administer effective antibiotics, and failed to consult an infectious disease specialist or a hematologist.

The physician contended antibiotics were ordered while culture results were pending.

• The hospital settled before trial for $1.25 million. The jury returned a defense verdict for the physician.
  

Uterine rupture in VBAC with oxytocin

Unknown County (Mich) Circuit Court

After a prior cesarean delivery, a woman and her physician agreed to deliver her second child by cesarean if she did not deliver by a certain date. In the event of earlier labor, she would have a 4-hour trial of labor.

She went into labor before the due date and was given oxytocin. During labor, which extended more than 4 hours, the uterus ruptured, resulting in hypoxic ischemia for the infant, who was born with mild learning disabilities.

In suing, the woman contended the physician should not have given oxytocin, should not have allowed labor to progress beyond 4 hours, and failed to recognize recurrent variable decelerations on the fetal monitor tracings. In addition, she claimed the physician did not examine her during the 5 hours of labor.

The physician countered that the woman was properly examined, monitored, and treated, and denied the child had evidence of cognitive impairment.

• The case settled for $2.25 million.
  

Defense denies dystocia, says baby was “hung up”

Cook County (III) Circuit Court

Shortly after vaginal delivery of a 9 lb 7 oz infant by a 31-year-old woman, the infant was found to have a fractured clavicle, a limp right arm, and bruising on the upper shoulder and back. The physician’s notes stated the delivery was normal, with no shoulder dystocia and no difficulties. The physician allegedly advised the parents that the infant had a “stretched nerve” that would resolve over time, and that nerve injuries took a long time to heal.

After 3 years, the child was diagnosed with brachial plexus injury, arm shortening and weakness, and dexterity problems. The child had had 2 corrective surgeries, and further surgeries and physical therapy were expected to be necessary throughout her life. The plaintiff claimed the shoulder dystocia was a result of excessive traction by the physician, and that the physician failed to recognize the shoulder dystocia and take appropriate action.

The physician insisted the natural propulsive forces of labor caused the injury. He denied encountering shoulder dystocia, although he stated on cross-examination that the baby got “hung up” during delivery.

• The jury awarded the plaintiff $3 million.
  

Resident lacerates infant’s forehead

Queens County (NY) Supreme Court

A 26-year-old woman was admitted with labor pains and was attached to a fetal heart monitor. Because the fetus had mild tachycardia (

The obstetrician made a Pfannenstiel incision and a third-year resident made the uterine incision, lacerating the forehead of the fetus to the bone. The laceration was 5 cm long and required 30 stitches immediately after birth.

The woman asserted she was not advised until moments beforehand that a cesarean section was to be done, and that she was never told that a resident would make the uterine incision. She also claimed negligence on the part of the obstetrician for failing to perform an internal exam to assess the thinness of the uterine wall.

The physician argued the high fetal heart rate necessitated a cesarean section, which became an emergency when general anesthesia was given.

• The jury awarded the plaintiff $550,000.
  

Necrotizing fasciitis after c-section

Suffolk County (Mass) Superior Court

After a 34-year-old primigravida underwent a cesarean section, a surgical incision and deep infection developed. Ten days after delivery, and after several readmissions for the infection, she was transferred to a teaching facility in critical condition, where necrotizing fasciitis was diagnosed immediately. Major debridement of the abdominal wall was repeated several times over the next 5 weeks, and her infected uterus was removed. Reconstruction was necessary to repair the abdominal wall and loss of skin.

The woman claimed negligence in failure to diagnosis postpartum endometritis; she maintained the physician had said the infection was under control just before transfer to the teaching hospital. She faulted the physician for failure to use the standard antibiotic treatment for endometritis, failure to promptly open and drain the surgical wound because of cellulitis, failure to switch antibiotics in the face of progressing infection, prematurely discharging her on 2 occasions, and failure to recognize and treat necrotizing fasciitis despite skin hardening and other classic signs.

The physician contended that necrotizing fasciitis is rare and difficult to diagnose due to its similarity to other infections, and that it developed either just before or during transfer out of his care. The defense maintained the woman was always on antibiotics in consultation with infectious disease and wound care experts.

• The case settled for $500,000.
  

Finger-pointing after high-risk birth

Orange County (Calif) Superior Court

A woman with gestational diabetes, pregnancy-induced hypertension, preeclampsia, fetal prematurity, and intrauterine growth restriction was admitted at 36 weeks’ gestation to a hospital for induction of labor. She was seen by a physician at 5, 14, and 23 hours after admission.

During the induction, fetal monitoring strips became nonreassuring. The on-call OB was allegedly contacted 3 times by the labor-delivery nurse, but he was delivering a series of infants at another hospital. The nurse then contacted the back-up OB, who arrived 40 minutes later.

Delivered by vacuum extraction, the infant had Apgar scores of 6 at 1 minute and 7 at 5 minutes; cord blood pH was 7.15. The infant had seizures in the NICU and brain imaging evidence of subdural and subarachnoid bleeding and an enlarging clot in the transverse sinus and in the superior sagittal sinus. A month later at discharge, the infant was diagnosed with severe cerebral palsy.

In suing, the woman claimed that her complications should have warranted closer monitoring to ensure a safe trial of labor. She also contended the on-call OB should have arranged for the back-up OB to see her.

The nurse testified that she faxed fetal monitor strips twice to the on-call OB and twice asked him to come see the woman. The on-call OB asserted that only 1 fax was received and denied being asked to come to the woman’s bedside before 2:35 AM. The defense denied the standard of care required a physician be at the woman’s bedside prior to 3:00 AM.

• The case settled for $5.25 million ($1 million from the hospital and the rest from the physicians).
  

Drug abuse at fault, not lack of tocolytics

Maricopa County (Ariz) Superior Court

A woman presented at 27 weeks’ gestation with complaints of cramping and spotting. The nurse reported to the physician that the woman stated she was not having contractions and that an hour on a fetal monitor revealed no contractions. Therefore, the physician advised the nurse to discharge the patient.

The woman returned an hour later, however, and vaginal examination revealed that delivery was imminent; she underwent a cesarean section delivery. The infant was noted to have respiratory problems, a bowel perforation, and retinopathy of prematurity. After discharge the infant failed to thrive and was diagnosed with bronchopulmonary dysplasia, cerebral palsy, cortical blindness, and severe mental retardation. The child has required nutrition via a gastrostomy tube since age 3.

In suing, the plaintiff claimed the physicians failed to examine the mother at her first presentation and administer tocolytic agents.

The defense denied the woman was having contractions and asserted that she had an incompetent cervix, and that the infant’s problems were the results of parental neglect and drug abuse.

• The jury returned a defense verdict.
  

Phone call from nurse disputed in fetal injury

Orange County (Calif) Superior Court

A woman admitted in labor had an initial reassuring fetal heart monitor tracing, but as labor progressed, the tracings became nonreassuring. The labor and delivery nurse called the OB at home in the early morning hours. The fetal heart tracings deteriorated further and the OB was called again. He came quickly to the hospital, and by his arrival the fetus was in severe distress. There was an additional delay before the woman was transferred to an operating room for an emergency cesarean section.

The infant was born with hypoxic-ischemic encephalopathy, and cerebral palsy and global developmental delay ensued. The woman claimed the nurse (who worked for a nursing registry apart from the hospital) should have clarified the seriousness of the situation in the first phone call and that the OB should have gone to the hospital sooner. The nurse maintained that she had described the fetal heart tracing accurately in the first phone call. The OB denied hearing such a description.

• The case settled for $3.3 million ($930,000 from the OB, $950,00 from the nursing registry, and $1.45 million from the hospital).
  

Jury agreed ovarian cancer looked like perimenopause

Cook County (III) Circuit Court

A 47-year-old woman with a history of breast cancer at an early age presented to the emergency department complaining of heavy vaginal bleeding for 4 to 5 days, after no menstrual periods for 2 months.

The hospital emergency department physician ruled out neoplasm and diagnosed and treated her for dysfunctional uterine bleeding. She was referred to a gynecologist.

She saw her usual gynecologist the next day, who also diagnosed heavy periods and perimenopause. She also saw her internist several times over the next few months.

She returned to her gynecologist 4 months later with complaints of abdominal pain and urinary symptoms. A pelvic ultrasound, ordered to follow up a tender right ovary, revealed an ovarian cyst. Laparoscopy was recommended, which the woman refused, and she was told to return in 2 weeks. She did not return for 2 months; however, she did visit her internist twice during the interim, with complaints of bilateral lower abdominal pain and bloating. When she returned to her gynecologist, another ultrasound revealed bilateral ovarian cysts that had grown, and the woman was in substantial pain. Prompt surgery was recommended.

Surgery revealed stage IIIC grade III ovarian cancer. After a long course of chemotherapy, the woman died 2 years later.

The suit against the gynecologist and the internist alleged negligence in delayed diagnosis of the ovarian cancer, failure to take a proper history, and failure to have a high index of suspicion due to the woman’s known history of breast cancer. Had earlier ultrasound and a CA 125 blood test been performed, the cancer would have been diagnosed sooner and cure would have been more likely, the plaintiff claimed.

The defense contended the woman’s symptoms were consistent with perimenopause and not cancer, thus no ultrasound or CA 125 tests were necessary. It also argued that the woman did not follow the gynecologist’s recommendation for laparoscopy to examine the cyst when it was first found.

• The internist settled during the trial for $900,000. The jury returned a defense verdict for the gynecologist.
  

OB wins, hospital settles in sepsis, stillbirth case

Bronx County (NY) Supreme Court

When her amniotic membranes began bulging at 17 weeks’ gestation, a 30-year-old woman presented to a hospital, where her physician and a perinatal consultant recommended termination of the pregnancy.

She allegedly declined to terminate the pregnancy. Five days later she had a temperature of 104.4°F, a nosebleed, and bleeding at blood-draw sites. The physician prescribed ampicillin, clindamycin, gentamicin, and fresh frozen plasma. Blood tests revealed disseminated intravascular coagulation.

The fetus was delivered stillborn an hour later, and the mother suffered cardiac arrest 4 hours later and died of septic shock.

The petitioner for the deceased woman claimed the physician delayed delivery of the fetus, failed to administer effective antibiotics, and failed to consult an infectious disease specialist or a hematologist.

The physician contended antibiotics were ordered while culture results were pending.

• The hospital settled before trial for $1.25 million. The jury returned a defense verdict for the physician.
  

Uterine rupture in VBAC with oxytocin

Unknown County (Mich) Circuit Court

After a prior cesarean delivery, a woman and her physician agreed to deliver her second child by cesarean if she did not deliver by a certain date. In the event of earlier labor, she would have a 4-hour trial of labor.

She went into labor before the due date and was given oxytocin. During labor, which extended more than 4 hours, the uterus ruptured, resulting in hypoxic ischemia for the infant, who was born with mild learning disabilities.

In suing, the woman contended the physician should not have given oxytocin, should not have allowed labor to progress beyond 4 hours, and failed to recognize recurrent variable decelerations on the fetal monitor tracings. In addition, she claimed the physician did not examine her during the 5 hours of labor.

The physician countered that the woman was properly examined, monitored, and treated, and denied the child had evidence of cognitive impairment.

• The case settled for $2.25 million.
  

Defense denies dystocia, says baby was “hung up”

Cook County (III) Circuit Court

Shortly after vaginal delivery of a 9 lb 7 oz infant by a 31-year-old woman, the infant was found to have a fractured clavicle, a limp right arm, and bruising on the upper shoulder and back. The physician’s notes stated the delivery was normal, with no shoulder dystocia and no difficulties. The physician allegedly advised the parents that the infant had a “stretched nerve” that would resolve over time, and that nerve injuries took a long time to heal.

After 3 years, the child was diagnosed with brachial plexus injury, arm shortening and weakness, and dexterity problems. The child had had 2 corrective surgeries, and further surgeries and physical therapy were expected to be necessary throughout her life. The plaintiff claimed the shoulder dystocia was a result of excessive traction by the physician, and that the physician failed to recognize the shoulder dystocia and take appropriate action.

The physician insisted the natural propulsive forces of labor caused the injury. He denied encountering shoulder dystocia, although he stated on cross-examination that the baby got “hung up” during delivery.

• The jury awarded the plaintiff $3 million.
  

Resident lacerates infant’s forehead

Queens County (NY) Supreme Court

A 26-year-old woman was admitted with labor pains and was attached to a fetal heart monitor. Because the fetus had mild tachycardia (

The obstetrician made a Pfannenstiel incision and a third-year resident made the uterine incision, lacerating the forehead of the fetus to the bone. The laceration was 5 cm long and required 30 stitches immediately after birth.

The woman asserted she was not advised until moments beforehand that a cesarean section was to be done, and that she was never told that a resident would make the uterine incision. She also claimed negligence on the part of the obstetrician for failing to perform an internal exam to assess the thinness of the uterine wall.

The physician argued the high fetal heart rate necessitated a cesarean section, which became an emergency when general anesthesia was given.

• The jury awarded the plaintiff $550,000.
  

Necrotizing fasciitis after c-section

Suffolk County (Mass) Superior Court

After a 34-year-old primigravida underwent a cesarean section, a surgical incision and deep infection developed. Ten days after delivery, and after several readmissions for the infection, she was transferred to a teaching facility in critical condition, where necrotizing fasciitis was diagnosed immediately. Major debridement of the abdominal wall was repeated several times over the next 5 weeks, and her infected uterus was removed. Reconstruction was necessary to repair the abdominal wall and loss of skin.

The woman claimed negligence in failure to diagnosis postpartum endometritis; she maintained the physician had said the infection was under control just before transfer to the teaching hospital. She faulted the physician for failure to use the standard antibiotic treatment for endometritis, failure to promptly open and drain the surgical wound because of cellulitis, failure to switch antibiotics in the face of progressing infection, prematurely discharging her on 2 occasions, and failure to recognize and treat necrotizing fasciitis despite skin hardening and other classic signs.

The physician contended that necrotizing fasciitis is rare and difficult to diagnose due to its similarity to other infections, and that it developed either just before or during transfer out of his care. The defense maintained the woman was always on antibiotics in consultation with infectious disease and wound care experts.

• The case settled for $500,000.
  

Finger-pointing after high-risk birth

Orange County (Calif) Superior Court

A woman with gestational diabetes, pregnancy-induced hypertension, preeclampsia, fetal prematurity, and intrauterine growth restriction was admitted at 36 weeks’ gestation to a hospital for induction of labor. She was seen by a physician at 5, 14, and 23 hours after admission.

During the induction, fetal monitoring strips became nonreassuring. The on-call OB was allegedly contacted 3 times by the labor-delivery nurse, but he was delivering a series of infants at another hospital. The nurse then contacted the back-up OB, who arrived 40 minutes later.

Delivered by vacuum extraction, the infant had Apgar scores of 6 at 1 minute and 7 at 5 minutes; cord blood pH was 7.15. The infant had seizures in the NICU and brain imaging evidence of subdural and subarachnoid bleeding and an enlarging clot in the transverse sinus and in the superior sagittal sinus. A month later at discharge, the infant was diagnosed with severe cerebral palsy.

In suing, the woman claimed that her complications should have warranted closer monitoring to ensure a safe trial of labor. She also contended the on-call OB should have arranged for the back-up OB to see her.

The nurse testified that she faxed fetal monitor strips twice to the on-call OB and twice asked him to come see the woman. The on-call OB asserted that only 1 fax was received and denied being asked to come to the woman’s bedside before 2:35 AM. The defense denied the standard of care required a physician be at the woman’s bedside prior to 3:00 AM.

• The case settled for $5.25 million ($1 million from the hospital and the rest from the physicians).
  

Drug abuse at fault, not lack of tocolytics

Maricopa County (Ariz) Superior Court

A woman presented at 27 weeks’ gestation with complaints of cramping and spotting. The nurse reported to the physician that the woman stated she was not having contractions and that an hour on a fetal monitor revealed no contractions. Therefore, the physician advised the nurse to discharge the patient.

The woman returned an hour later, however, and vaginal examination revealed that delivery was imminent; she underwent a cesarean section delivery. The infant was noted to have respiratory problems, a bowel perforation, and retinopathy of prematurity. After discharge the infant failed to thrive and was diagnosed with bronchopulmonary dysplasia, cerebral palsy, cortical blindness, and severe mental retardation. The child has required nutrition via a gastrostomy tube since age 3.

In suing, the plaintiff claimed the physicians failed to examine the mother at her first presentation and administer tocolytic agents.

The defense denied the woman was having contractions and asserted that she had an incompetent cervix, and that the infant’s problems were the results of parental neglect and drug abuse.

• The jury returned a defense verdict.
  

Phone call from nurse disputed in fetal injury

Orange County (Calif) Superior Court

A woman admitted in labor had an initial reassuring fetal heart monitor tracing, but as labor progressed, the tracings became nonreassuring. The labor and delivery nurse called the OB at home in the early morning hours. The fetal heart tracings deteriorated further and the OB was called again. He came quickly to the hospital, and by his arrival the fetus was in severe distress. There was an additional delay before the woman was transferred to an operating room for an emergency cesarean section.

The infant was born with hypoxic-ischemic encephalopathy, and cerebral palsy and global developmental delay ensued. The woman claimed the nurse (who worked for a nursing registry apart from the hospital) should have clarified the seriousness of the situation in the first phone call and that the OB should have gone to the hospital sooner. The nurse maintained that she had described the fetal heart tracing accurately in the first phone call. The OB denied hearing such a description.

• The case settled for $3.3 million ($930,000 from the OB, $950,00 from the nursing registry, and $1.45 million from the hospital).
  

Jury agreed ovarian cancer looked like perimenopause

Cook County (III) Circuit Court

A 47-year-old woman with a history of breast cancer at an early age presented to the emergency department complaining of heavy vaginal bleeding for 4 to 5 days, after no menstrual periods for 2 months.

The hospital emergency department physician ruled out neoplasm and diagnosed and treated her for dysfunctional uterine bleeding. She was referred to a gynecologist.

She saw her usual gynecologist the next day, who also diagnosed heavy periods and perimenopause. She also saw her internist several times over the next few months.

She returned to her gynecologist 4 months later with complaints of abdominal pain and urinary symptoms. A pelvic ultrasound, ordered to follow up a tender right ovary, revealed an ovarian cyst. Laparoscopy was recommended, which the woman refused, and she was told to return in 2 weeks. She did not return for 2 months; however, she did visit her internist twice during the interim, with complaints of bilateral lower abdominal pain and bloating. When she returned to her gynecologist, another ultrasound revealed bilateral ovarian cysts that had grown, and the woman was in substantial pain. Prompt surgery was recommended.

Surgery revealed stage IIIC grade III ovarian cancer. After a long course of chemotherapy, the woman died 2 years later.

The suit against the gynecologist and the internist alleged negligence in delayed diagnosis of the ovarian cancer, failure to take a proper history, and failure to have a high index of suspicion due to the woman’s known history of breast cancer. Had earlier ultrasound and a CA 125 blood test been performed, the cancer would have been diagnosed sooner and cure would have been more likely, the plaintiff claimed.

The defense contended the woman’s symptoms were consistent with perimenopause and not cancer, thus no ultrasound or CA 125 tests were necessary. It also argued that the woman did not follow the gynecologist’s recommendation for laparoscopy to examine the cyst when it was first found.

• The internist settled during the trial for $900,000. The jury returned a defense verdict for the gynecologist.
  

OB wins, hospital settles in sepsis, stillbirth case

Bronx County (NY) Supreme Court

When her amniotic membranes began bulging at 17 weeks’ gestation, a 30-year-old woman presented to a hospital, where her physician and a perinatal consultant recommended termination of the pregnancy.

She allegedly declined to terminate the pregnancy. Five days later she had a temperature of 104.4°F, a nosebleed, and bleeding at blood-draw sites. The physician prescribed ampicillin, clindamycin, gentamicin, and fresh frozen plasma. Blood tests revealed disseminated intravascular coagulation.

The fetus was delivered stillborn an hour later, and the mother suffered cardiac arrest 4 hours later and died of septic shock.

The petitioner for the deceased woman claimed the physician delayed delivery of the fetus, failed to administer effective antibiotics, and failed to consult an infectious disease specialist or a hematologist.

The physician contended antibiotics were ordered while culture results were pending.

• The hospital settled before trial for $1.25 million. The jury returned a defense verdict for the physician.
  

Uterine rupture in VBAC with oxytocin

Unknown County (Mich) Circuit Court

After a prior cesarean delivery, a woman and her physician agreed to deliver her second child by cesarean if she did not deliver by a certain date. In the event of earlier labor, she would have a 4-hour trial of labor.

She went into labor before the due date and was given oxytocin. During labor, which extended more than 4 hours, the uterus ruptured, resulting in hypoxic ischemia for the infant, who was born with mild learning disabilities.

In suing, the woman contended the physician should not have given oxytocin, should not have allowed labor to progress beyond 4 hours, and failed to recognize recurrent variable decelerations on the fetal monitor tracings. In addition, she claimed the physician did not examine her during the 5 hours of labor.

The physician countered that the woman was properly examined, monitored, and treated, and denied the child had evidence of cognitive impairment.

• The case settled for $2.25 million.
  

Defense cites child’s medulloblastoma

<court>New York County (NY) Supreme Court</court>

Upon admission for delivery of her first child, a 36-year-old woman was given a small dose of oxytocin. Shortly thereafter the physicians noted fetal tachycardia, followed by bradycardia. Oxygen was given and the infant was delivered by vacuum extraction.

Durifng the next 2 days, the infant had several seizures. She was eventually diagnosed with hypoxic ischemic encephalopathy, resulting in mild retardation with cognitive and learning disabilities.

After claims against the physicians were dismissed, the plaintiffs proceeded to trial against the hospital, claiming it failed to identify nonreassuring signs on the fetal heart monitor and failed to repeat a scalp pH test. The plaintiffs asserted a cesarean section should have been performed as soon as tachycardia occurred.

The defense asserted the arterial blood gas analysis showed a normal pH level and modest base excess, and claimed the infant’s EEG was nonspecific. The defense also claimed the child’s medulloblastoma, which was diagnosed at age 6, was the cause of the cognitive and learning disabilities.

• The hospital settled for $2.75 million.

Incontinence blamed on surgeon sued 20 times

<court>Kings County (NY) Supreme Court</court>

A 45-year-old woman complaining of abdominal pain and bladder pressure was diagnosed with ovarian cysts, and a laparoscopy was planned for their removal. A laparotomy was actually performed, after which the woman had urinary incontinence. During an evaluation, a ureteral obstruction was diagnosed. Despite multiple corrective surgeries, the urinary incontinence persisted.

In suing, the woman alleged the surgeon performed the laparotomy improperly. A $1 million settlement was reached with the physician and the case proceeded to trial against the hospital.

The woman faulted the hospital for failing to supervise the surgeon, who had been sued for medical negligence more than 20 times, which she claimed should have led to mandatory supervision during surgery.

Parties for the hospital claimed the physician was properly credentialed and that most of the suits against him either were dismissed with no payment or resulted in a defense verdict. They noted that none of the prior suits claimed surgical negligence.

• After the jury returned a verdict for the plaintiff, the hospital moved to vacate the verdict, which the judge granted. The matter was dismissed, but an appeal is pending.

Both OBs deferred cesarean

<court>Suffolk County (Mass) Superior Court</court>

A woman was admitted at 41 weeks’ gestation because of a nonreactive nonstress test. The baseline fetal heart rate was in the 160s. A VBAC delivery was planned.

The first OB noted that the fetal heart rate dropped to the 70s for 3 minutes with a contraction, and that the cervix was thick and dilated 1 cm. He noted a plan to use dinoprostone gel and induce labor in the morning. Shortly thereafter the labor nurse noted mild irregular contractions in response to the gel. Intermittent late decelerations were noted before a second OB took over care.

Several hours later a prolonged deceleration to the 70s–90s occurred for 10 minutes. Cesarean section was performed an hour later. The infant was born with neurological and physical deficits.

In suing, the mother claimed the physicians failed to intervene despite signs of fetal distress, and the second OB failed to expedite delivery.

The second physician claimed there was no justifiable basis for proceeding to cesarean section any sooner than he did.

• The outcome of the case against the first physician is unknown. The second defendant settled for $900,000.

Sepsis, renal failure, coma after hysterectomy

<court>Pinellas County (Fla) Circuit Court</court>

A 39-year-old diabetic woman suffering from abdominal pain and excessive uterine bleeding underwent a hysterectomy. An abdominal x-ray was obtained 8 days later by a family physician because the woman continued to experience complications. The patient was discharged 3 days after that, and presented to the emergency department about a week later complaining of abdominal pain.

Exploratory laparotomy revealed a vaginal cuff infection, which was debrided, irrigated, and repaired. Complications developed again over the week, including sepsis, renal insufficiency, respiratory distress syndrome, and coma. Her condition continued to deteriorate during an extended hospitalization. She required a percutaneous endoscopic gastrostomy tube for nutrition, long-term intubation, and daily hemodialysis. An EMG 3 months after the hysterectomy revealed severe peripheral neuropathy in the right leg.

In suing the surgeon and the family physician, the woman claimed the x-ray shortly after the hysterectomy had revealed the vaginal cuff problem, to which she alleged the physician did not respond. She also claimed the physician did not review test results prior to her discharge.

The physician contended the neuropathy resulted from the woman’s preexisting diabetes and noncompliance with her diabetes therapy.

• The surgeon settled with the plaintiff for a confidential sum before trial; the jury returned a defense verdict.

Were maternal and fetal danger signs ignored?

<court>Nassau County (NY) Supreme Court</court>

A 33-year-old woman in the late stages of pregnancy presented to a hospital with nausea and abdominal pain. The examining physician concluded she had dehydration, and released her. The women delivered an infant about 6 weeks later who had severe brain damage, cerebral palsy, cognitive disability, cortical blindness, and seizures.

In suing, the woman alleged the physicians failed to provide proper monitoring during delivery. Specifically, she claimed the fetal monitor revealed nonreassuring, distressed heart rates that were not recognized, resulting in a hypoxic event that caused brain damage.

The woman also asserted the defendants failed to consider that her 2 prior pregnancies were complicated by hypertension and gestational diabetes, so that this pregnancy should have been treated as high risk. According to the plaintiff’s expert, the episode of nausea and abdominal pain should have led to blood, glucose, and urine tests that would have revealed fetal and maternal distress and would have led to immediate cesarean section.

The physician claimed the brain damage occurred before delivery and was unrelated to his actions or inactions. He asserted that the infant had prebirth prolonged protein-S deficiency that caused a dural-sinus thrombosis and hemorrhage. The defense also claimed the infant had prebirth vascular abnormalities and a vascular lesion resulting in disruptions of the circulatory system that led to the brain damage.

• The case settled for $3.7 million.

Was injury due to large infant or inexperience?

<court>Harris County (Tex) District Court</court>

A woman with gestational diabetes gave birth to an infant with a brachial plexus injury. At the time of delivery, some questions were raised about macrosomia and whether the infant would easily pass through the birth canal. Several physicians of varying levels of experience participated in the delivery after the infant became stuck in the birth canal, using various standard manipulations. The shoulder injury was described as a “three-level avulsion,” and the child is unlikely to ever have much use of the arm.

• The case settled for a confidential sum.

Fetal heart rate “sufficiently reassuring”

<court>Unknown Massachusetts venue</court>

Several weeks before she delivered, a pregnant woman fell, requiring hospitalization. Irregular contractions were noted, although no preterm labor or abruption occurred. Three weeks after discharge, at 37 weeks’ gestation, the parents presented to the defendant physician for a regularly scheduled visit. Ultrasound revealed the fetus was in the category of less than 10% for weight. A decision was made to induce labor.

The woman initially had variable decelerations to 90 with recovery to the 140s with moderate beat-to-beat variability. After 20 minutes of the mother pushing, decreased long-term variability during the recovery phase led to a decision to proceed to operative delivery. A vacuum extractor was applied 3 times for 60 seconds each time, bringing the head to +4 station. The fetal heart rate became more reassuring and the mother continued to push.

The infant was delivered with Apgar scores of 2, 6, and 7. The infant was limp with no respiratory effort and poor color. Cord blood arterial pH was 7.1. The infant was placed on CPAP and given bicarbonate. In the NICU the infant had apneic episodes that did not respond to stimulation, and his oxygen saturation levels fell to the 50s with a heart rate of 100.

A CT scan revealed occipital/parietal and subarachnoid blood, along with subdural bleeding. MRI confirmed the bleeding with possible parenchymal ischemia. The infant was eventually diagnosed with gastroesophageal reflux disease, encephalomalacia, and severe developmental delays.

In suing, the mother faulted the defendant for attempting to induce delivery and failing to properly monitor the delivery.

The physician denied any deviation from the standard of care and asserted the fetal heart rate pattern was sufficiently reassuring to allow labor to continue.

• The case settled for $1.7 million.

ObGyn was negligent, but didn’t cause injury

<court>Fayette County (Ky) Circuit Court</court>

A 33-year-old woman with major vaginal bleeding was scheduled for an outpatient dilation and curettage. During the procedure, the physician switched to ablation of the uterus. The physician allegedly did not immediately advise the woman of the change. Complications developed, and ultimately she required a hysterectomy.

In suing, the woman contended the physician mutilated her uterus, in effect sealing the cervix so menstrual flow could not escape. She claimed the physician performed the ablation of the uterus without her consent and did so negligently.

The physician denied negligence, asserting the D&C was insufficient to control the bleeding and that only ablation would provide relief, so that she was justified in continuing without explicit written consent.

• The jury returned a defense verdict. It found that while the physician was negligent, the error was not a substantial factor in causing injury.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn (www.verdictslaska.com). The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.

Defense cites child’s medulloblastoma

<court>New York County (NY) Supreme Court</court>

Upon admission for delivery of her first child, a 36-year-old woman was given a small dose of oxytocin. Shortly thereafter the physicians noted fetal tachycardia, followed by bradycardia. Oxygen was given and the infant was delivered by vacuum extraction.

Durifng the next 2 days, the infant had several seizures. She was eventually diagnosed with hypoxic ischemic encephalopathy, resulting in mild retardation with cognitive and learning disabilities.

After claims against the physicians were dismissed, the plaintiffs proceeded to trial against the hospital, claiming it failed to identify nonreassuring signs on the fetal heart monitor and failed to repeat a scalp pH test. The plaintiffs asserted a cesarean section should have been performed as soon as tachycardia occurred.

The defense asserted the arterial blood gas analysis showed a normal pH level and modest base excess, and claimed the infant’s EEG was nonspecific. The defense also claimed the child’s medulloblastoma, which was diagnosed at age 6, was the cause of the cognitive and learning disabilities.

• The hospital settled for $2.75 million.

Incontinence blamed on surgeon sued 20 times

<court>Kings County (NY) Supreme Court</court>

A 45-year-old woman complaining of abdominal pain and bladder pressure was diagnosed with ovarian cysts, and a laparoscopy was planned for their removal. A laparotomy was actually performed, after which the woman had urinary incontinence. During an evaluation, a ureteral obstruction was diagnosed. Despite multiple corrective surgeries, the urinary incontinence persisted.

In suing, the woman alleged the surgeon performed the laparotomy improperly. A $1 million settlement was reached with the physician and the case proceeded to trial against the hospital.

The woman faulted the hospital for failing to supervise the surgeon, who had been sued for medical negligence more than 20 times, which she claimed should have led to mandatory supervision during surgery.

Parties for the hospital claimed the physician was properly credentialed and that most of the suits against him either were dismissed with no payment or resulted in a defense verdict. They noted that none of the prior suits claimed surgical negligence.

• After the jury returned a verdict for the plaintiff, the hospital moved to vacate the verdict, which the judge granted. The matter was dismissed, but an appeal is pending.

Both OBs deferred cesarean

<court>Suffolk County (Mass) Superior Court</court>

A woman was admitted at 41 weeks’ gestation because of a nonreactive nonstress test. The baseline fetal heart rate was in the 160s. A VBAC delivery was planned.

The first OB noted that the fetal heart rate dropped to the 70s for 3 minutes with a contraction, and that the cervix was thick and dilated 1 cm. He noted a plan to use dinoprostone gel and induce labor in the morning. Shortly thereafter the labor nurse noted mild irregular contractions in response to the gel. Intermittent late decelerations were noted before a second OB took over care.

Several hours later a prolonged deceleration to the 70s–90s occurred for 10 minutes. Cesarean section was performed an hour later. The infant was born with neurological and physical deficits.

In suing, the mother claimed the physicians failed to intervene despite signs of fetal distress, and the second OB failed to expedite delivery.

The second physician claimed there was no justifiable basis for proceeding to cesarean section any sooner than he did.

• The outcome of the case against the first physician is unknown. The second defendant settled for $900,000.

Sepsis, renal failure, coma after hysterectomy

<court>Pinellas County (Fla) Circuit Court</court>

A 39-year-old diabetic woman suffering from abdominal pain and excessive uterine bleeding underwent a hysterectomy. An abdominal x-ray was obtained 8 days later by a family physician because the woman continued to experience complications. The patient was discharged 3 days after that, and presented to the emergency department about a week later complaining of abdominal pain.

Exploratory laparotomy revealed a vaginal cuff infection, which was debrided, irrigated, and repaired. Complications developed again over the week, including sepsis, renal insufficiency, respiratory distress syndrome, and coma. Her condition continued to deteriorate during an extended hospitalization. She required a percutaneous endoscopic gastrostomy tube for nutrition, long-term intubation, and daily hemodialysis. An EMG 3 months after the hysterectomy revealed severe peripheral neuropathy in the right leg.

In suing the surgeon and the family physician, the woman claimed the x-ray shortly after the hysterectomy had revealed the vaginal cuff problem, to which she alleged the physician did not respond. She also claimed the physician did not review test results prior to her discharge.

The physician contended the neuropathy resulted from the woman’s preexisting diabetes and noncompliance with her diabetes therapy.

• The surgeon settled with the plaintiff for a confidential sum before trial; the jury returned a defense verdict.

Were maternal and fetal danger signs ignored?

<court>Nassau County (NY) Supreme Court</court>

A 33-year-old woman in the late stages of pregnancy presented to a hospital with nausea and abdominal pain. The examining physician concluded she had dehydration, and released her. The women delivered an infant about 6 weeks later who had severe brain damage, cerebral palsy, cognitive disability, cortical blindness, and seizures.

In suing, the woman alleged the physicians failed to provide proper monitoring during delivery. Specifically, she claimed the fetal monitor revealed nonreassuring, distressed heart rates that were not recognized, resulting in a hypoxic event that caused brain damage.

The woman also asserted the defendants failed to consider that her 2 prior pregnancies were complicated by hypertension and gestational diabetes, so that this pregnancy should have been treated as high risk. According to the plaintiff’s expert, the episode of nausea and abdominal pain should have led to blood, glucose, and urine tests that would have revealed fetal and maternal distress and would have led to immediate cesarean section.

The physician claimed the brain damage occurred before delivery and was unrelated to his actions or inactions. He asserted that the infant had prebirth prolonged protein-S deficiency that caused a dural-sinus thrombosis and hemorrhage. The defense also claimed the infant had prebirth vascular abnormalities and a vascular lesion resulting in disruptions of the circulatory system that led to the brain damage.

• The case settled for $3.7 million.

Was injury due to large infant or inexperience?

<court>Harris County (Tex) District Court</court>

A woman with gestational diabetes gave birth to an infant with a brachial plexus injury. At the time of delivery, some questions were raised about macrosomia and whether the infant would easily pass through the birth canal. Several physicians of varying levels of experience participated in the delivery after the infant became stuck in the birth canal, using various standard manipulations. The shoulder injury was described as a “three-level avulsion,” and the child is unlikely to ever have much use of the arm.

• The case settled for a confidential sum.

Fetal heart rate “sufficiently reassuring”

<court>Unknown Massachusetts venue</court>

Several weeks before she delivered, a pregnant woman fell, requiring hospitalization. Irregular contractions were noted, although no preterm labor or abruption occurred. Three weeks after discharge, at 37 weeks’ gestation, the parents presented to the defendant physician for a regularly scheduled visit. Ultrasound revealed the fetus was in the category of less than 10% for weight. A decision was made to induce labor.

The woman initially had variable decelerations to 90 with recovery to the 140s with moderate beat-to-beat variability. After 20 minutes of the mother pushing, decreased long-term variability during the recovery phase led to a decision to proceed to operative delivery. A vacuum extractor was applied 3 times for 60 seconds each time, bringing the head to +4 station. The fetal heart rate became more reassuring and the mother continued to push.

The infant was delivered with Apgar scores of 2, 6, and 7. The infant was limp with no respiratory effort and poor color. Cord blood arterial pH was 7.1. The infant was placed on CPAP and given bicarbonate. In the NICU the infant had apneic episodes that did not respond to stimulation, and his oxygen saturation levels fell to the 50s with a heart rate of 100.

A CT scan revealed occipital/parietal and subarachnoid blood, along with subdural bleeding. MRI confirmed the bleeding with possible parenchymal ischemia. The infant was eventually diagnosed with gastroesophageal reflux disease, encephalomalacia, and severe developmental delays.

In suing, the mother faulted the defendant for attempting to induce delivery and failing to properly monitor the delivery.

The physician denied any deviation from the standard of care and asserted the fetal heart rate pattern was sufficiently reassuring to allow labor to continue.

• The case settled for $1.7 million.

ObGyn was negligent, but didn’t cause injury

<court>Fayette County (Ky) Circuit Court</court>

A 33-year-old woman with major vaginal bleeding was scheduled for an outpatient dilation and curettage. During the procedure, the physician switched to ablation of the uterus. The physician allegedly did not immediately advise the woman of the change. Complications developed, and ultimately she required a hysterectomy.

In suing, the woman contended the physician mutilated her uterus, in effect sealing the cervix so menstrual flow could not escape. She claimed the physician performed the ablation of the uterus without her consent and did so negligently.

The physician denied negligence, asserting the D&C was insufficient to control the bleeding and that only ablation would provide relief, so that she was justified in continuing without explicit written consent.

• The jury returned a defense verdict. It found that while the physician was negligent, the error was not a substantial factor in causing injury.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn (www.verdictslaska.com). The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.

Defense cites child’s medulloblastoma

<court>New York County (NY) Supreme Court</court>

Upon admission for delivery of her first child, a 36-year-old woman was given a small dose of oxytocin. Shortly thereafter the physicians noted fetal tachycardia, followed by bradycardia. Oxygen was given and the infant was delivered by vacuum extraction.

Durifng the next 2 days, the infant had several seizures. She was eventually diagnosed with hypoxic ischemic encephalopathy, resulting in mild retardation with cognitive and learning disabilities.

After claims against the physicians were dismissed, the plaintiffs proceeded to trial against the hospital, claiming it failed to identify nonreassuring signs on the fetal heart monitor and failed to repeat a scalp pH test. The plaintiffs asserted a cesarean section should have been performed as soon as tachycardia occurred.

The defense asserted the arterial blood gas analysis showed a normal pH level and modest base excess, and claimed the infant’s EEG was nonspecific. The defense also claimed the child’s medulloblastoma, which was diagnosed at age 6, was the cause of the cognitive and learning disabilities.

• The hospital settled for $2.75 million.

Incontinence blamed on surgeon sued 20 times

<court>Kings County (NY) Supreme Court</court>

A 45-year-old woman complaining of abdominal pain and bladder pressure was diagnosed with ovarian cysts, and a laparoscopy was planned for their removal. A laparotomy was actually performed, after which the woman had urinary incontinence. During an evaluation, a ureteral obstruction was diagnosed. Despite multiple corrective surgeries, the urinary incontinence persisted.

In suing, the woman alleged the surgeon performed the laparotomy improperly. A $1 million settlement was reached with the physician and the case proceeded to trial against the hospital.

The woman faulted the hospital for failing to supervise the surgeon, who had been sued for medical negligence more than 20 times, which she claimed should have led to mandatory supervision during surgery.

Parties for the hospital claimed the physician was properly credentialed and that most of the suits against him either were dismissed with no payment or resulted in a defense verdict. They noted that none of the prior suits claimed surgical negligence.

• After the jury returned a verdict for the plaintiff, the hospital moved to vacate the verdict, which the judge granted. The matter was dismissed, but an appeal is pending.

Both OBs deferred cesarean

<court>Suffolk County (Mass) Superior Court</court>

A woman was admitted at 41 weeks’ gestation because of a nonreactive nonstress test. The baseline fetal heart rate was in the 160s. A VBAC delivery was planned.

The first OB noted that the fetal heart rate dropped to the 70s for 3 minutes with a contraction, and that the cervix was thick and dilated 1 cm. He noted a plan to use dinoprostone gel and induce labor in the morning. Shortly thereafter the labor nurse noted mild irregular contractions in response to the gel. Intermittent late decelerations were noted before a second OB took over care.

Several hours later a prolonged deceleration to the 70s–90s occurred for 10 minutes. Cesarean section was performed an hour later. The infant was born with neurological and physical deficits.

In suing, the mother claimed the physicians failed to intervene despite signs of fetal distress, and the second OB failed to expedite delivery.

The second physician claimed there was no justifiable basis for proceeding to cesarean section any sooner than he did.

• The outcome of the case against the first physician is unknown. The second defendant settled for $900,000.

Sepsis, renal failure, coma after hysterectomy

<court>Pinellas County (Fla) Circuit Court</court>

A 39-year-old diabetic woman suffering from abdominal pain and excessive uterine bleeding underwent a hysterectomy. An abdominal x-ray was obtained 8 days later by a family physician because the woman continued to experience complications. The patient was discharged 3 days after that, and presented to the emergency department about a week later complaining of abdominal pain.

Exploratory laparotomy revealed a vaginal cuff infection, which was debrided, irrigated, and repaired. Complications developed again over the week, including sepsis, renal insufficiency, respiratory distress syndrome, and coma. Her condition continued to deteriorate during an extended hospitalization. She required a percutaneous endoscopic gastrostomy tube for nutrition, long-term intubation, and daily hemodialysis. An EMG 3 months after the hysterectomy revealed severe peripheral neuropathy in the right leg.

In suing the surgeon and the family physician, the woman claimed the x-ray shortly after the hysterectomy had revealed the vaginal cuff problem, to which she alleged the physician did not respond. She also claimed the physician did not review test results prior to her discharge.

The physician contended the neuropathy resulted from the woman’s preexisting diabetes and noncompliance with her diabetes therapy.

• The surgeon settled with the plaintiff for a confidential sum before trial; the jury returned a defense verdict.

Were maternal and fetal danger signs ignored?

<court>Nassau County (NY) Supreme Court</court>

A 33-year-old woman in the late stages of pregnancy presented to a hospital with nausea and abdominal pain. The examining physician concluded she had dehydration, and released her. The women delivered an infant about 6 weeks later who had severe brain damage, cerebral palsy, cognitive disability, cortical blindness, and seizures.

In suing, the woman alleged the physicians failed to provide proper monitoring during delivery. Specifically, she claimed the fetal monitor revealed nonreassuring, distressed heart rates that were not recognized, resulting in a hypoxic event that caused brain damage.

The woman also asserted the defendants failed to consider that her 2 prior pregnancies were complicated by hypertension and gestational diabetes, so that this pregnancy should have been treated as high risk. According to the plaintiff’s expert, the episode of nausea and abdominal pain should have led to blood, glucose, and urine tests that would have revealed fetal and maternal distress and would have led to immediate cesarean section.

The physician claimed the brain damage occurred before delivery and was unrelated to his actions or inactions. He asserted that the infant had prebirth prolonged protein-S deficiency that caused a dural-sinus thrombosis and hemorrhage. The defense also claimed the infant had prebirth vascular abnormalities and a vascular lesion resulting in disruptions of the circulatory system that led to the brain damage.

• The case settled for $3.7 million.

Was injury due to large infant or inexperience?

<court>Harris County (Tex) District Court</court>

A woman with gestational diabetes gave birth to an infant with a brachial plexus injury. At the time of delivery, some questions were raised about macrosomia and whether the infant would easily pass through the birth canal. Several physicians of varying levels of experience participated in the delivery after the infant became stuck in the birth canal, using various standard manipulations. The shoulder injury was described as a “three-level avulsion,” and the child is unlikely to ever have much use of the arm.

• The case settled for a confidential sum.

Fetal heart rate “sufficiently reassuring”

<court>Unknown Massachusetts venue</court>

Several weeks before she delivered, a pregnant woman fell, requiring hospitalization. Irregular contractions were noted, although no preterm labor or abruption occurred. Three weeks after discharge, at 37 weeks’ gestation, the parents presented to the defendant physician for a regularly scheduled visit. Ultrasound revealed the fetus was in the category of less than 10% for weight. A decision was made to induce labor.

The woman initially had variable decelerations to 90 with recovery to the 140s with moderate beat-to-beat variability. After 20 minutes of the mother pushing, decreased long-term variability during the recovery phase led to a decision to proceed to operative delivery. A vacuum extractor was applied 3 times for 60 seconds each time, bringing the head to +4 station. The fetal heart rate became more reassuring and the mother continued to push.

The infant was delivered with Apgar scores of 2, 6, and 7. The infant was limp with no respiratory effort and poor color. Cord blood arterial pH was 7.1. The infant was placed on CPAP and given bicarbonate. In the NICU the infant had apneic episodes that did not respond to stimulation, and his oxygen saturation levels fell to the 50s with a heart rate of 100.

A CT scan revealed occipital/parietal and subarachnoid blood, along with subdural bleeding. MRI confirmed the bleeding with possible parenchymal ischemia. The infant was eventually diagnosed with gastroesophageal reflux disease, encephalomalacia, and severe developmental delays.

In suing, the mother faulted the defendant for attempting to induce delivery and failing to properly monitor the delivery.

The physician denied any deviation from the standard of care and asserted the fetal heart rate pattern was sufficiently reassuring to allow labor to continue.

• The case settled for $1.7 million.

ObGyn was negligent, but didn’t cause injury

<court>Fayette County (Ky) Circuit Court</court>

A 33-year-old woman with major vaginal bleeding was scheduled for an outpatient dilation and curettage. During the procedure, the physician switched to ablation of the uterus. The physician allegedly did not immediately advise the woman of the change. Complications developed, and ultimately she required a hysterectomy.

In suing, the woman contended the physician mutilated her uterus, in effect sealing the cervix so menstrual flow could not escape. She claimed the physician performed the ablation of the uterus without her consent and did so negligently.

The physician denied negligence, asserting the D&C was insufficient to control the bleeding and that only ablation would provide relief, so that she was justified in continuing without explicit written consent.

• The jury returned a defense verdict. It found that while the physician was negligent, the error was not a substantial factor in causing injury.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn (www.verdictslaska.com). The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.