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Group B strep infection leads to neonatal death
<court>Cook County (Ill) Circuit Court</court>
A woman presented to the hospital at 7:00 AM for labor induction. That night she was given antibiotics for a fever. Shortly after midnight she noted signs of fetal distress, fetal tachycardia, and a failure to progress. Fetal tracings showed a sudden change in the fetus’s condition at 4:30 AM; soon after, the infant was delivered lifeless with zero Apgars.
After the infant was resuscitated, cultures revealed group B strep infection. The infant had multisystem organ failure and died the next day after withdrawal of life support.
In suing, the mother faulted the defendant for failing to offer prenatal screening for group B strep, failing to diagnose macrosomia, and failing to recommend cesarean delivery. She also asserted that earlier antibiotics and delivery would have avoided the infant’s death.
The defense denied any deviation from the standard of care and contended that waiting for maternal fever during labor before administering antibiotics was appropriate. They also denied that the standard of care required advising patients of alternative approaches. They asserted that the standard of care did not require cesarean delivery and that neither earlier administration of antibiotics nor earlier delivery would have prevented the outcome.
- The jury awarded the plaintiff $1.75 million.
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, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
<court>Cook County (Ill) Circuit Court</court>
A woman presented to the hospital at 7:00 AM for labor induction. That night she was given antibiotics for a fever. Shortly after midnight she noted signs of fetal distress, fetal tachycardia, and a failure to progress. Fetal tracings showed a sudden change in the fetus’s condition at 4:30 AM; soon after, the infant was delivered lifeless with zero Apgars.
After the infant was resuscitated, cultures revealed group B strep infection. The infant had multisystem organ failure and died the next day after withdrawal of life support.
In suing, the mother faulted the defendant for failing to offer prenatal screening for group B strep, failing to diagnose macrosomia, and failing to recommend cesarean delivery. She also asserted that earlier antibiotics and delivery would have avoided the infant’s death.
The defense denied any deviation from the standard of care and contended that waiting for maternal fever during labor before administering antibiotics was appropriate. They also denied that the standard of care required advising patients of alternative approaches. They asserted that the standard of care did not require cesarean delivery and that neither earlier administration of antibiotics nor earlier delivery would have prevented the outcome.
- The jury awarded the plaintiff $1.75 million.
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, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
<court>Cook County (Ill) Circuit Court</court>
A woman presented to the hospital at 7:00 AM for labor induction. That night she was given antibiotics for a fever. Shortly after midnight she noted signs of fetal distress, fetal tachycardia, and a failure to progress. Fetal tracings showed a sudden change in the fetus’s condition at 4:30 AM; soon after, the infant was delivered lifeless with zero Apgars.
After the infant was resuscitated, cultures revealed group B strep infection. The infant had multisystem organ failure and died the next day after withdrawal of life support.
In suing, the mother faulted the defendant for failing to offer prenatal screening for group B strep, failing to diagnose macrosomia, and failing to recommend cesarean delivery. She also asserted that earlier antibiotics and delivery would have avoided the infant’s death.
The defense denied any deviation from the standard of care and contended that waiting for maternal fever during labor before administering antibiotics was appropriate. They also denied that the standard of care required advising patients of alternative approaches. They asserted that the standard of care did not require cesarean delivery and that neither earlier administration of antibiotics nor earlier delivery would have prevented the outcome.
- The jury awarded the plaintiff $1.75 million.
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, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
Cancer “cured” despite late discovery?
A 30-year-old woman who had abdominal pain and abnormal vaginal bleeding went to the hospital and was treated by a physician. The next year a Pap smear indicated a low-grade squamous intraepithelial lesion. Three years later, tests revealed the presence of a 3- to 4-cm mass on the cervix that was later diagnosed as stage IIIB cervical cancer. The mass advanced to the pelvic wall, precluding a hysterectomy and necessitating chemotherapy and radiation.
In suing, the woman claimed the physician was negligent for failing to perform a Pap smear, failing to treat the precancerous condition, and failing to diagnose the cancer.
The defense did not contest liability but asserted that the woman had been symptom-free and “cured.”
- The parties settled for $2 million.
A 30-year-old woman who had abdominal pain and abnormal vaginal bleeding went to the hospital and was treated by a physician. The next year a Pap smear indicated a low-grade squamous intraepithelial lesion. Three years later, tests revealed the presence of a 3- to 4-cm mass on the cervix that was later diagnosed as stage IIIB cervical cancer. The mass advanced to the pelvic wall, precluding a hysterectomy and necessitating chemotherapy and radiation.
In suing, the woman claimed the physician was negligent for failing to perform a Pap smear, failing to treat the precancerous condition, and failing to diagnose the cancer.
The defense did not contest liability but asserted that the woman had been symptom-free and “cured.”
- The parties settled for $2 million.
A 30-year-old woman who had abdominal pain and abnormal vaginal bleeding went to the hospital and was treated by a physician. The next year a Pap smear indicated a low-grade squamous intraepithelial lesion. Three years later, tests revealed the presence of a 3- to 4-cm mass on the cervix that was later diagnosed as stage IIIB cervical cancer. The mass advanced to the pelvic wall, precluding a hysterectomy and necessitating chemotherapy and radiation.
In suing, the woman claimed the physician was negligent for failing to perform a Pap smear, failing to treat the precancerous condition, and failing to diagnose the cancer.
The defense did not contest liability but asserted that the woman had been symptom-free and “cured.”
- The parties settled for $2 million.
Postdelivery bleeding results in coma
During cesarean delivery shortly before 9 PM, a 30-year-old woman lost about 500 mL of blood and had a blood pressure of 130/70 mm Hg. Upon transfer to recovery, her blood pressure was 110/70 with a pulse of 142. Her blood pressure was 90/60 at 10:00 PM, 80/40 at 10:10 PM, and 78/30 at 10:25 PM. The nurse notified the anesthesiologist, who arrived at 10:26 PM and called the obstetrician at home.
According to the obstetrician, he was told her pulse was in the 120–130 range and the blood pressure was 90/60. Results from blood drawn at 10:50 PM revealed a hemoglobin of 5.5 and a hematocrit of 15.8.
The obstetrician ordered 4 units of blood and came in for immediate surgery. At 11:10 PM the patient’s blood pressure was 60/30 with a heart rate of 130.
The patient arrested 5 minutes after surgery began at 11:40 PM. After 45 minutes of resuscitation, surgery continued. No source of bleeding was found, but a hysterectomy, gastrostomy, and tracheotomy were performed. Severe brain damage resulted due to a lack of oxygen; the woman remains semicomatose.
The obstetrician was faulted for failing to recognize signs of postoperative bleeding. He denied any deviation from the standard of care.
- The case settled for $3.98 million: $980,000 from the obstetrician, $1 million from the anesthesiologist, and $2 million from the hospital.
During cesarean delivery shortly before 9 PM, a 30-year-old woman lost about 500 mL of blood and had a blood pressure of 130/70 mm Hg. Upon transfer to recovery, her blood pressure was 110/70 with a pulse of 142. Her blood pressure was 90/60 at 10:00 PM, 80/40 at 10:10 PM, and 78/30 at 10:25 PM. The nurse notified the anesthesiologist, who arrived at 10:26 PM and called the obstetrician at home.
According to the obstetrician, he was told her pulse was in the 120–130 range and the blood pressure was 90/60. Results from blood drawn at 10:50 PM revealed a hemoglobin of 5.5 and a hematocrit of 15.8.
The obstetrician ordered 4 units of blood and came in for immediate surgery. At 11:10 PM the patient’s blood pressure was 60/30 with a heart rate of 130.
The patient arrested 5 minutes after surgery began at 11:40 PM. After 45 minutes of resuscitation, surgery continued. No source of bleeding was found, but a hysterectomy, gastrostomy, and tracheotomy were performed. Severe brain damage resulted due to a lack of oxygen; the woman remains semicomatose.
The obstetrician was faulted for failing to recognize signs of postoperative bleeding. He denied any deviation from the standard of care.
- The case settled for $3.98 million: $980,000 from the obstetrician, $1 million from the anesthesiologist, and $2 million from the hospital.
During cesarean delivery shortly before 9 PM, a 30-year-old woman lost about 500 mL of blood and had a blood pressure of 130/70 mm Hg. Upon transfer to recovery, her blood pressure was 110/70 with a pulse of 142. Her blood pressure was 90/60 at 10:00 PM, 80/40 at 10:10 PM, and 78/30 at 10:25 PM. The nurse notified the anesthesiologist, who arrived at 10:26 PM and called the obstetrician at home.
According to the obstetrician, he was told her pulse was in the 120–130 range and the blood pressure was 90/60. Results from blood drawn at 10:50 PM revealed a hemoglobin of 5.5 and a hematocrit of 15.8.
The obstetrician ordered 4 units of blood and came in for immediate surgery. At 11:10 PM the patient’s blood pressure was 60/30 with a heart rate of 130.
The patient arrested 5 minutes after surgery began at 11:40 PM. After 45 minutes of resuscitation, surgery continued. No source of bleeding was found, but a hysterectomy, gastrostomy, and tracheotomy were performed. Severe brain damage resulted due to a lack of oxygen; the woman remains semicomatose.
The obstetrician was faulted for failing to recognize signs of postoperative bleeding. He denied any deviation from the standard of care.
- The case settled for $3.98 million: $980,000 from the obstetrician, $1 million from the anesthesiologist, and $2 million from the hospital.
Defense rebuttal: Child has near-normal IQ
A 28-year-old woman went to the hospital at 8 months’ gestation with uterine contractions. The obstetrician diagnosed premature labor and ordered tocolysis. A sonogram showed no signs of placental abruption. Nevertheless, after the fetal heart monitor showed deep decelerations, an emergency cesarean section was performed.
Not breathing at birth, the infant was given oxygen and intubated. The umbilical cord pH was 6.9. Administration of sodium bicarbonate and epinephrine led to normalization of the heart rate and pH.
The child now has developmental delays with speech and language disabilities.
In suing, the parents claimed placental abruption had occurred and claimed the cesarean section was inappropriately delayed. They also maintained that the neonate had signs of seizure activity, respiratory distress syndrome, and elevated glucose and creatinine levels.
The obstetrician and hospital rebutted that the child had a near-normal IQ and that delaying labor was appropriate.
- The case settled for $5.25 million: $4.25 million from the hospital and $1 million from the obstetrician.
A 28-year-old woman went to the hospital at 8 months’ gestation with uterine contractions. The obstetrician diagnosed premature labor and ordered tocolysis. A sonogram showed no signs of placental abruption. Nevertheless, after the fetal heart monitor showed deep decelerations, an emergency cesarean section was performed.
Not breathing at birth, the infant was given oxygen and intubated. The umbilical cord pH was 6.9. Administration of sodium bicarbonate and epinephrine led to normalization of the heart rate and pH.
The child now has developmental delays with speech and language disabilities.
In suing, the parents claimed placental abruption had occurred and claimed the cesarean section was inappropriately delayed. They also maintained that the neonate had signs of seizure activity, respiratory distress syndrome, and elevated glucose and creatinine levels.
The obstetrician and hospital rebutted that the child had a near-normal IQ and that delaying labor was appropriate.
- The case settled for $5.25 million: $4.25 million from the hospital and $1 million from the obstetrician.
A 28-year-old woman went to the hospital at 8 months’ gestation with uterine contractions. The obstetrician diagnosed premature labor and ordered tocolysis. A sonogram showed no signs of placental abruption. Nevertheless, after the fetal heart monitor showed deep decelerations, an emergency cesarean section was performed.
Not breathing at birth, the infant was given oxygen and intubated. The umbilical cord pH was 6.9. Administration of sodium bicarbonate and epinephrine led to normalization of the heart rate and pH.
The child now has developmental delays with speech and language disabilities.
In suing, the parents claimed placental abruption had occurred and claimed the cesarean section was inappropriately delayed. They also maintained that the neonate had signs of seizure activity, respiratory distress syndrome, and elevated glucose and creatinine levels.
The obstetrician and hospital rebutted that the child had a near-normal IQ and that delaying labor was appropriate.
- The case settled for $5.25 million: $4.25 million from the hospital and $1 million from the obstetrician.
After tubal ligation, child born with problems
A mother underwent a tubal ligation. Seven months later, she became pregnant with her fifth child. At 29 weeks’ gestation, the child was delivered via emergency cesarean section because of complications. During delivery it was determined that the left ovarian ligament had been ligated instead of the left fallopian tube.
The child suffered multiple complications, including growth and development delays.
- The parties reached a confidential settlement.
A mother underwent a tubal ligation. Seven months later, she became pregnant with her fifth child. At 29 weeks’ gestation, the child was delivered via emergency cesarean section because of complications. During delivery it was determined that the left ovarian ligament had been ligated instead of the left fallopian tube.
The child suffered multiple complications, including growth and development delays.
- The parties reached a confidential settlement.
A mother underwent a tubal ligation. Seven months later, she became pregnant with her fifth child. At 29 weeks’ gestation, the child was delivered via emergency cesarean section because of complications. During delivery it was determined that the left ovarian ligament had been ligated instead of the left fallopian tube.
The child suffered multiple complications, including growth and development delays.
- The parties reached a confidential settlement.
Did delay in delivery cause brain softening?
A woman who fell at 34 weeks’ gestation was hospitalized and noted to have irregular contractions but no evidence of preterm labor or abruption. Three weeks later, during a regularly scheduled visit, a decision was made to induce labor based on ultrasound findings suggestive of intrauterine growth restriction.
After a difficult delivery, the infant had Apgar scores of 2, 6, and 7 and a cord blood arterial pH of 7.10. Initially limp with no respiratory effort and poor color, the infant was placed on continuous positive airway pressure and given sodium bicarbonate.
While in the neonatal intensive care unit, the baby had apneic episodes with decreased oxygen saturations and heart rate. He was observed to have increased tone and extension of the arms. A computed tomography scan revealed occipital/parietal and subarachnoid blood along with subdural bleeding. He was later diagnosed with encephalomalacia, a seizure disorder, and severe developmental delays.
In suing, the family blamed the child’s encephalomalacia and seizure disorder on a delay in delivery.
The obstetrician claimed the decision to induce labor was proper, that the infant was properly monitored throughout labor, and that interventions were appropriate.
- The case settled for $1.7 million.
A woman who fell at 34 weeks’ gestation was hospitalized and noted to have irregular contractions but no evidence of preterm labor or abruption. Three weeks later, during a regularly scheduled visit, a decision was made to induce labor based on ultrasound findings suggestive of intrauterine growth restriction.
After a difficult delivery, the infant had Apgar scores of 2, 6, and 7 and a cord blood arterial pH of 7.10. Initially limp with no respiratory effort and poor color, the infant was placed on continuous positive airway pressure and given sodium bicarbonate.
While in the neonatal intensive care unit, the baby had apneic episodes with decreased oxygen saturations and heart rate. He was observed to have increased tone and extension of the arms. A computed tomography scan revealed occipital/parietal and subarachnoid blood along with subdural bleeding. He was later diagnosed with encephalomalacia, a seizure disorder, and severe developmental delays.
In suing, the family blamed the child’s encephalomalacia and seizure disorder on a delay in delivery.
The obstetrician claimed the decision to induce labor was proper, that the infant was properly monitored throughout labor, and that interventions were appropriate.
- The case settled for $1.7 million.
A woman who fell at 34 weeks’ gestation was hospitalized and noted to have irregular contractions but no evidence of preterm labor or abruption. Three weeks later, during a regularly scheduled visit, a decision was made to induce labor based on ultrasound findings suggestive of intrauterine growth restriction.
After a difficult delivery, the infant had Apgar scores of 2, 6, and 7 and a cord blood arterial pH of 7.10. Initially limp with no respiratory effort and poor color, the infant was placed on continuous positive airway pressure and given sodium bicarbonate.
While in the neonatal intensive care unit, the baby had apneic episodes with decreased oxygen saturations and heart rate. He was observed to have increased tone and extension of the arms. A computed tomography scan revealed occipital/parietal and subarachnoid blood along with subdural bleeding. He was later diagnosed with encephalomalacia, a seizure disorder, and severe developmental delays.
In suing, the family blamed the child’s encephalomalacia and seizure disorder on a delay in delivery.
The obstetrician claimed the decision to induce labor was proper, that the infant was properly monitored throughout labor, and that interventions were appropriate.
- The case settled for $1.7 million.
Second twin suffers brain damage
After successful delivery of a first twin, the second twin’s head came to rest on the umbilical cord. He was deprived of oxygen for 15 minutes. The subsequent brain damage left him with little or no cognitive function and no use of his limbs. He will require lifetime care.
In suing, the plaintiff faulted the obstetrician, the nurse, and the hospital and noted that the delivery room had no emergency cesarean section equipment.
- The parties settled for $1.075 million.
After successful delivery of a first twin, the second twin’s head came to rest on the umbilical cord. He was deprived of oxygen for 15 minutes. The subsequent brain damage left him with little or no cognitive function and no use of his limbs. He will require lifetime care.
In suing, the plaintiff faulted the obstetrician, the nurse, and the hospital and noted that the delivery room had no emergency cesarean section equipment.
- The parties settled for $1.075 million.
After successful delivery of a first twin, the second twin’s head came to rest on the umbilical cord. He was deprived of oxygen for 15 minutes. The subsequent brain damage left him with little or no cognitive function and no use of his limbs. He will require lifetime care.
In suing, the plaintiff faulted the obstetrician, the nurse, and the hospital and noted that the delivery room had no emergency cesarean section equipment.
- The parties settled for $1.075 million.
Wrong ovary removed during hysterectomy
A 31-year-old woman had a diseased right ovary that caused severe dysplasia, dysmenorrhea, dyspareunia, and right side pelvic pain. She underwent a total abdominal hysterectomy with right salpingo-oophorectomy. In his postoperative report the physician admitted to removing the wrong ovary; an ultrasound revealed that the diseased ovary remained. Another physician surgically removed the ovary, which contained a benign hemorrhagic cyst and prominent fibrous adhesions.
- A confidential settlement was reached.
A 31-year-old woman had a diseased right ovary that caused severe dysplasia, dysmenorrhea, dyspareunia, and right side pelvic pain. She underwent a total abdominal hysterectomy with right salpingo-oophorectomy. In his postoperative report the physician admitted to removing the wrong ovary; an ultrasound revealed that the diseased ovary remained. Another physician surgically removed the ovary, which contained a benign hemorrhagic cyst and prominent fibrous adhesions.
- A confidential settlement was reached.
A 31-year-old woman had a diseased right ovary that caused severe dysplasia, dysmenorrhea, dyspareunia, and right side pelvic pain. She underwent a total abdominal hysterectomy with right salpingo-oophorectomy. In his postoperative report the physician admitted to removing the wrong ovary; an ultrasound revealed that the diseased ovary remained. Another physician surgically removed the ovary, which contained a benign hemorrhagic cyst and prominent fibrous adhesions.
- A confidential settlement was reached.
C-section complicated by burns and bleeding
While a woman was undergoing a cesarean section, the surgical drape caught on fire as the surgeon used a Bovie cautery unit. To control bleeding the surgeon removed the right fallopian tube and ovary.
In suing, the woman asserted she had burn injuries due to the fire and that removal of the fallopian tube and ovary was unnecessary.
The defense alleged that the surgeon had no role in causing the fire and that removal of the fallopian tube and ovary was necessary to control bleeding and ensure hemostasis.
- The hospital settled for an undisclosed amount prior to the jury returning a verdict in favor of the physician.
While a woman was undergoing a cesarean section, the surgical drape caught on fire as the surgeon used a Bovie cautery unit. To control bleeding the surgeon removed the right fallopian tube and ovary.
In suing, the woman asserted she had burn injuries due to the fire and that removal of the fallopian tube and ovary was unnecessary.
The defense alleged that the surgeon had no role in causing the fire and that removal of the fallopian tube and ovary was necessary to control bleeding and ensure hemostasis.
- The hospital settled for an undisclosed amount prior to the jury returning a verdict in favor of the physician.
While a woman was undergoing a cesarean section, the surgical drape caught on fire as the surgeon used a Bovie cautery unit. To control bleeding the surgeon removed the right fallopian tube and ovary.
In suing, the woman asserted she had burn injuries due to the fire and that removal of the fallopian tube and ovary was unnecessary.
The defense alleged that the surgeon had no role in causing the fire and that removal of the fallopian tube and ovary was necessary to control bleeding and ensure hemostasis.
- The hospital settled for an undisclosed amount prior to the jury returning a verdict in favor of the physician.
Did injuries necessitate cesarean sections?
After a miscarriage at 13 weeks’ gestation, a woman in her late 30s underwent a dilatation and curettage (D&C) by her obstetrician. After 6 months of complications she underwent surgery that included removal of a diseased section of her sigmoid colon and a colostomy. After the colostomy was closed, she underwent a myomectomy and removal of uterine fibroids. Subsequently, the woman gave birth to 3 healthy male infants by cesarean section.
In suing, the woman claimed the obstetrician was negligent in perforating the uterus and bowel during the D&C, which necessitated the colostomy and cesarean deliveries.
The obstetrician argued that the injuries were a known risk of D&C and said the uterine injury did not necessitate the cesarean deliveries, but that the fibroid removal did.
- The jury returned a defense verdict.
After a miscarriage at 13 weeks’ gestation, a woman in her late 30s underwent a dilatation and curettage (D&C) by her obstetrician. After 6 months of complications she underwent surgery that included removal of a diseased section of her sigmoid colon and a colostomy. After the colostomy was closed, she underwent a myomectomy and removal of uterine fibroids. Subsequently, the woman gave birth to 3 healthy male infants by cesarean section.
In suing, the woman claimed the obstetrician was negligent in perforating the uterus and bowel during the D&C, which necessitated the colostomy and cesarean deliveries.
The obstetrician argued that the injuries were a known risk of D&C and said the uterine injury did not necessitate the cesarean deliveries, but that the fibroid removal did.
- The jury returned a defense verdict.
After a miscarriage at 13 weeks’ gestation, a woman in her late 30s underwent a dilatation and curettage (D&C) by her obstetrician. After 6 months of complications she underwent surgery that included removal of a diseased section of her sigmoid colon and a colostomy. After the colostomy was closed, she underwent a myomectomy and removal of uterine fibroids. Subsequently, the woman gave birth to 3 healthy male infants by cesarean section.
In suing, the woman claimed the obstetrician was negligent in perforating the uterus and bowel during the D&C, which necessitated the colostomy and cesarean deliveries.
The obstetrician argued that the injuries were a known risk of D&C and said the uterine injury did not necessitate the cesarean deliveries, but that the fibroid removal did.
- The jury returned a defense verdict.