Medical Verdicts

A mother had given birth to two children with thalamic abnormalities that resulted in seizures, developmental delays, and death. Before getting pregnant again, the parents sought genetic counseling and were told that identifying the specific defective gene would be impossible. The geneticist advised them that a child conceived with a donor egg and father’s sperm would have essentially the same risk as the general population. The parents asked in writing if it would be safer to
use both donor egg and donor sperm; the geneticist responded that the difference in risk was negligible.

The mother gave birth in June 2007 to a child conceived with a donated egg and the father’s sperm. After the child began to show the same symptoms as the others, an MRI of the child’s brain revealed a thalamic abnormality, and testing revealed Alpers syndrome caused by POLG gene mutations. The third child died in September 2008.

PARENTS’ CLAIM The chances of having a child with Alpers syndrome are
about 1:200,000 in the general population; if one parent is a known carrier, the chance is 1:1,000. If the parents had known this risk, they would have used donor egg and donor sperm to conceive or adopted. They were not told about Alpers syndrome and its relationship to the POLG gene until after their third child was born. The geneticist was negligent in failing to provide this information.

PHYSICIAN’S DEFENSE The parents received appropriate and accurate genetic counseling.

VERDICT A $1 million Florida verdict was returned.

What caused a delay in breast cancer diagnosis?
A 39-year-old woman underwent mammography in October 2004. After recommending a spotcompression film of a left-breast lesion, and then ultrasonography, the radiologist concluded that the lesion was benign, and suggested a 1-year follow-up. Reports were sent to the patient and her primary care physician.

In August 2006, when mammography was suspicious for breast cancer, a biopsy diagnosed infiltrating ductal carcinoma of the left breast. After undergoing a mastectomy, radiation therapy, and chemotherapy, the patient was cancer-free at the time of the trial.

patient’s CLAIM The radiologist failed to properly interpret the 2004 mammography.

physician’s DEFENSE The radiologist’s interpretations of the 2004 tests were correct. The patient failed to follow up in 1 year, as recommended, and this delayed the cancer diagnosis. The patient’s survival indicated that she had been cured of her breast cancer.

VERDICT A confidential settlement was reached with the hospital before the trial. An Illinois defense verdict was returned for the radiologist.


Heparin overdose for preemie
At 27 weeks' gestation, a woman went to a clinic with preeclampsia. After she was stabilized, the baby was born by emergency cesarean delivery.

At birth, the baby was thrombocytopenic (platelet count, 37,000/mL) with a heart rate of 60 bpm. The child’s cord blood pH was 7.27, indicating no significant hypoxia. At 1 minute of life, the child’s heart rate had not improved. After trying three times to place an endotracheal tube, chest compressions were begun at 10 minutes of life. An umbilical vein catheter (UVC) was placed at 22 minutes. Heparin was used to flush the UVC. After 40 minutes, the baby’s pH was 6.88, indicating severe acidosis. The infant was transferred to another hospital 3 hours after birth.

Head ultrasonography at 5 days of life revealed hemorrhagic and ischemic changes in the baby’s brain. The child suffered massive brain damage, is ventilator-dependent, and has a G-tube for feeding. She cannot sit up, walk, or speak, and will require specialized care for life.

Parent's claim Emergency resuscitation was not performed at birth: the low heart rate and thrombocytopenia were not treated; the UVC was not immediately placed. Twice, adult doses of heparin were used instead of normal saline to flush the UVC; heparin caused bleeding in the baby’s brain. 

Defendant's Defense The case was settled during trial.

Verdict A $3 million Maryland settlement was reached.

Uterine rupture: $130M verdict

After a woman's first child was born by cesarean delivery, vaginal birth after cesarean (VBAC) was planned for her second pregnancy. When a nurse recognized a ruptured uterus, the ObGyn ordered a cesarean delivery. The newborn suffered severe brain damage, with seizures. She has cerebral palsy with near-normal intelligence, but cannot talk or walk and continues to have seizures.

 Parents' claim The baby’s injuries occurred due to a failure to respond to fetal distress. When the intrauterine pressure catheter (IUPC) stopped working for 27 minutes, the nurse did not notify the ObGyn or apply an external monitor. Fetal heart decelerations occurred, including a prolonged deceleration for 3 minutes; the nurse did not notify the ObGyn, reposition the mother, provide oxygen and extra fluids, or discontinue oxytocin. A cesarean delivery should have occurred 30 to 60 minutes earlier.

Defendants' defense The fetal heart rates were what typically occur during the second stage of labor. The hospital’s accepted practices were followed. When the IUPC failed, the nurse measured contractions by hand and analyzed the fetal heartbeat from audible sounds; therefore, it was not necessary to notify the ObGyn. The physician was promptly called when uterine rupture was suspected. Uterine rupture and placental abruption caused the child’s injury. Uterine rupture cannot be predicted or prevented and is a known complication of VBAC.

Verdict After the parents declined an $8 million settlement, the matter was tried to a defense verdict. That decision was overturned on appeal, and, at a second trial, a $130 million New York verdict was returned against the hospital that employed the ObGyn and nurse.

Uterus, small bowel injured during D&C

A 65-year-old woman underwent dilation and curettage (D&C) to screen for uterine cancer performed by an ObGyn and a general surgeon. Her uterus and small intestine were perforated during the procedure, and a second operation was required to repair the damage.

Patient's claim Both physicians were negligent in performing D&C.

Physician's defense The ObGyn denied negligence and countered that the injuries are known complications of the procedure.

Verdict The surgeon settled for a confidential amount before trial. A New Jersey defense verdict was returned for the ObGyn.

These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska (www.verdictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.

A mother had given birth to two children with thalamic abnormalities that resulted in seizures, developmental delays, and death. Before getting pregnant again, the parents sought genetic counseling and were told that identifying the specific defective gene would be impossible. The geneticist advised them that a child conceived with a donor egg and father’s sperm would have essentially the same risk as the general population. The parents asked in writing if it would be safer to
use both donor egg and donor sperm; the geneticist responded that the difference in risk was negligible.

The mother gave birth in June 2007 to a child conceived with a donated egg and the father’s sperm. After the child began to show the same symptoms as the others, an MRI of the child’s brain revealed a thalamic abnormality, and testing revealed Alpers syndrome caused by POLG gene mutations. The third child died in September 2008.

PARENTS’ CLAIM The chances of having a child with Alpers syndrome are
about 1:200,000 in the general population; if one parent is a known carrier, the chance is 1:1,000. If the parents had known this risk, they would have used donor egg and donor sperm to conceive or adopted. They were not told about Alpers syndrome and its relationship to the POLG gene until after their third child was born. The geneticist was negligent in failing to provide this information.

PHYSICIAN’S DEFENSE The parents received appropriate and accurate genetic counseling.

VERDICT A $1 million Florida verdict was returned.

What caused a delay in breast cancer diagnosis?
A 39-year-old woman underwent mammography in October 2004. After recommending a spotcompression film of a left-breast lesion, and then ultrasonography, the radiologist concluded that the lesion was benign, and suggested a 1-year follow-up. Reports were sent to the patient and her primary care physician.

In August 2006, when mammography was suspicious for breast cancer, a biopsy diagnosed infiltrating ductal carcinoma of the left breast. After undergoing a mastectomy, radiation therapy, and chemotherapy, the patient was cancer-free at the time of the trial.

patient’s CLAIM The radiologist failed to properly interpret the 2004 mammography.

physician’s DEFENSE The radiologist’s interpretations of the 2004 tests were correct. The patient failed to follow up in 1 year, as recommended, and this delayed the cancer diagnosis. The patient’s survival indicated that she had been cured of her breast cancer.

VERDICT A confidential settlement was reached with the hospital before the trial. An Illinois defense verdict was returned for the radiologist.


Heparin overdose for preemie
At 27 weeks' gestation, a woman went to a clinic with preeclampsia. After she was stabilized, the baby was born by emergency cesarean delivery.

At birth, the baby was thrombocytopenic (platelet count, 37,000/mL) with a heart rate of 60 bpm. The child’s cord blood pH was 7.27, indicating no significant hypoxia. At 1 minute of life, the child’s heart rate had not improved. After trying three times to place an endotracheal tube, chest compressions were begun at 10 minutes of life. An umbilical vein catheter (UVC) was placed at 22 minutes. Heparin was used to flush the UVC. After 40 minutes, the baby’s pH was 6.88, indicating severe acidosis. The infant was transferred to another hospital 3 hours after birth.

Head ultrasonography at 5 days of life revealed hemorrhagic and ischemic changes in the baby’s brain. The child suffered massive brain damage, is ventilator-dependent, and has a G-tube for feeding. She cannot sit up, walk, or speak, and will require specialized care for life.

Parent's claim Emergency resuscitation was not performed at birth: the low heart rate and thrombocytopenia were not treated; the UVC was not immediately placed. Twice, adult doses of heparin were used instead of normal saline to flush the UVC; heparin caused bleeding in the baby’s brain. 

Defendant's Defense The case was settled during trial.

Verdict A $3 million Maryland settlement was reached.

Uterine rupture: $130M verdict

After a woman's first child was born by cesarean delivery, vaginal birth after cesarean (VBAC) was planned for her second pregnancy. When a nurse recognized a ruptured uterus, the ObGyn ordered a cesarean delivery. The newborn suffered severe brain damage, with seizures. She has cerebral palsy with near-normal intelligence, but cannot talk or walk and continues to have seizures.

 Parents' claim The baby’s injuries occurred due to a failure to respond to fetal distress. When the intrauterine pressure catheter (IUPC) stopped working for 27 minutes, the nurse did not notify the ObGyn or apply an external monitor. Fetal heart decelerations occurred, including a prolonged deceleration for 3 minutes; the nurse did not notify the ObGyn, reposition the mother, provide oxygen and extra fluids, or discontinue oxytocin. A cesarean delivery should have occurred 30 to 60 minutes earlier.

Defendants' defense The fetal heart rates were what typically occur during the second stage of labor. The hospital’s accepted practices were followed. When the IUPC failed, the nurse measured contractions by hand and analyzed the fetal heartbeat from audible sounds; therefore, it was not necessary to notify the ObGyn. The physician was promptly called when uterine rupture was suspected. Uterine rupture and placental abruption caused the child’s injury. Uterine rupture cannot be predicted or prevented and is a known complication of VBAC.

Verdict After the parents declined an $8 million settlement, the matter was tried to a defense verdict. That decision was overturned on appeal, and, at a second trial, a $130 million New York verdict was returned against the hospital that employed the ObGyn and nurse.

Uterus, small bowel injured during D&C

A 65-year-old woman underwent dilation and curettage (D&C) to screen for uterine cancer performed by an ObGyn and a general surgeon. Her uterus and small intestine were perforated during the procedure, and a second operation was required to repair the damage.

Patient's claim Both physicians were negligent in performing D&C.

Physician's defense The ObGyn denied negligence and countered that the injuries are known complications of the procedure.

Verdict The surgeon settled for a confidential amount before trial. A New Jersey defense verdict was returned for the ObGyn.

These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska (www.verdictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.

A mother had given birth to two children with thalamic abnormalities that resulted in seizures, developmental delays, and death. Before getting pregnant again, the parents sought genetic counseling and were told that identifying the specific defective gene would be impossible. The geneticist advised them that a child conceived with a donor egg and father’s sperm would have essentially the same risk as the general population. The parents asked in writing if it would be safer to
use both donor egg and donor sperm; the geneticist responded that the difference in risk was negligible.

The mother gave birth in June 2007 to a child conceived with a donated egg and the father’s sperm. After the child began to show the same symptoms as the others, an MRI of the child’s brain revealed a thalamic abnormality, and testing revealed Alpers syndrome caused by POLG gene mutations. The third child died in September 2008.

PARENTS’ CLAIM The chances of having a child with Alpers syndrome are
about 1:200,000 in the general population; if one parent is a known carrier, the chance is 1:1,000. If the parents had known this risk, they would have used donor egg and donor sperm to conceive or adopted. They were not told about Alpers syndrome and its relationship to the POLG gene until after their third child was born. The geneticist was negligent in failing to provide this information.

PHYSICIAN’S DEFENSE The parents received appropriate and accurate genetic counseling.

VERDICT A $1 million Florida verdict was returned.

What caused a delay in breast cancer diagnosis?
A 39-year-old woman underwent mammography in October 2004. After recommending a spotcompression film of a left-breast lesion, and then ultrasonography, the radiologist concluded that the lesion was benign, and suggested a 1-year follow-up. Reports were sent to the patient and her primary care physician.

In August 2006, when mammography was suspicious for breast cancer, a biopsy diagnosed infiltrating ductal carcinoma of the left breast. After undergoing a mastectomy, radiation therapy, and chemotherapy, the patient was cancer-free at the time of the trial.

patient’s CLAIM The radiologist failed to properly interpret the 2004 mammography.

physician’s DEFENSE The radiologist’s interpretations of the 2004 tests were correct. The patient failed to follow up in 1 year, as recommended, and this delayed the cancer diagnosis. The patient’s survival indicated that she had been cured of her breast cancer.

VERDICT A confidential settlement was reached with the hospital before the trial. An Illinois defense verdict was returned for the radiologist.


Heparin overdose for preemie
At 27 weeks' gestation, a woman went to a clinic with preeclampsia. After she was stabilized, the baby was born by emergency cesarean delivery.

At birth, the baby was thrombocytopenic (platelet count, 37,000/mL) with a heart rate of 60 bpm. The child’s cord blood pH was 7.27, indicating no significant hypoxia. At 1 minute of life, the child’s heart rate had not improved. After trying three times to place an endotracheal tube, chest compressions were begun at 10 minutes of life. An umbilical vein catheter (UVC) was placed at 22 minutes. Heparin was used to flush the UVC. After 40 minutes, the baby’s pH was 6.88, indicating severe acidosis. The infant was transferred to another hospital 3 hours after birth.

Head ultrasonography at 5 days of life revealed hemorrhagic and ischemic changes in the baby’s brain. The child suffered massive brain damage, is ventilator-dependent, and has a G-tube for feeding. She cannot sit up, walk, or speak, and will require specialized care for life.

Parent's claim Emergency resuscitation was not performed at birth: the low heart rate and thrombocytopenia were not treated; the UVC was not immediately placed. Twice, adult doses of heparin were used instead of normal saline to flush the UVC; heparin caused bleeding in the baby’s brain. 

Defendant's Defense The case was settled during trial.

Verdict A $3 million Maryland settlement was reached.

Uterine rupture: $130M verdict

After a woman's first child was born by cesarean delivery, vaginal birth after cesarean (VBAC) was planned for her second pregnancy. When a nurse recognized a ruptured uterus, the ObGyn ordered a cesarean delivery. The newborn suffered severe brain damage, with seizures. She has cerebral palsy with near-normal intelligence, but cannot talk or walk and continues to have seizures.

 Parents' claim The baby’s injuries occurred due to a failure to respond to fetal distress. When the intrauterine pressure catheter (IUPC) stopped working for 27 minutes, the nurse did not notify the ObGyn or apply an external monitor. Fetal heart decelerations occurred, including a prolonged deceleration for 3 minutes; the nurse did not notify the ObGyn, reposition the mother, provide oxygen and extra fluids, or discontinue oxytocin. A cesarean delivery should have occurred 30 to 60 minutes earlier.

Defendants' defense The fetal heart rates were what typically occur during the second stage of labor. The hospital’s accepted practices were followed. When the IUPC failed, the nurse measured contractions by hand and analyzed the fetal heartbeat from audible sounds; therefore, it was not necessary to notify the ObGyn. The physician was promptly called when uterine rupture was suspected. Uterine rupture and placental abruption caused the child’s injury. Uterine rupture cannot be predicted or prevented and is a known complication of VBAC.

Verdict After the parents declined an $8 million settlement, the matter was tried to a defense verdict. That decision was overturned on appeal, and, at a second trial, a $130 million New York verdict was returned against the hospital that employed the ObGyn and nurse.

Uterus, small bowel injured during D&C

A 65-year-old woman underwent dilation and curettage (D&C) to screen for uterine cancer performed by an ObGyn and a general surgeon. Her uterus and small intestine were perforated during the procedure, and a second operation was required to repair the damage.

Patient's claim Both physicians were negligent in performing D&C.

Physician's defense The ObGyn denied negligence and countered that the injuries are known complications of the procedure.

Verdict The surgeon settled for a confidential amount before trial. A New Jersey defense verdict was returned for the ObGyn.

These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska (www.verdictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.

A 46-year-old woman underwent laparoscopic supracervical hysterectomy to remove her uterus but preserve her cervix. Postsurgically, she had difficulty breathing deeply and reported abdominal pain. The nurses and on-call physician reassured her that she was experiencing “gas pains” due to insufflation. After same-day discharge, she stayed in a motel room to avoid a second-floor bedroom at home.

She called the gynecologist’s office the following day to report continued pain and severe hot flashes and sweats. The gynecologist instructed his nurse to advise the patient to stop taking her birth control pill (ethinyl estradiol/norethindrone, Microgestin) and “to ride out” the hot flashes.

The woman was found dead in her motel room the next morning. An autopsy revealed a perforated small intestine with leakage into the abdominal cavity causing sepsis, multi-organ failure, and death.

ESTATE’S CLAIM The gynecologist reviewed the medical records and found an error in the operative report, but he made no addendum or late entry to correct the operative report. His defense counsel instructed him to draft a letter clarifying the surgery; this clarification was given to defense experts. The description of the procedure in the clarification was different from what was described in the medical records. For example, the clarification reported making 4 incisions for 4 trocars; the operative report indicated using 3 trocars. The pathologist and 2 nurses who treated the patient after surgery confirmed that there were 3 trocar incisions. The pathologist found no tissue necrosis at or around the perforation site, indicating that the perforation likely occurred during surgery.

PHYSICIAN’S DEFENSE Bowel perforation is a known complication of the procedure. The perforation was not present at the time of surgery because leakage of bowel content would have been obvious.

VERDICT A $1.5 million Virginia settlement was reached.

Retained products of conception after D&C
When sonography indicated that a 30-year-old woman was pregnant, she decided to abort the pregnancy and was given mifepristone.

Another sonogram 5 weeks later showed retained products of conception within the uterus. An ObGyn performed dilation and curettage (D&C) at an outpatient clinic. Because he believed the cannula did not remove everything, he used a curette to scrape the uterus. After the patient was dizzy, hypotensive, and in pain for 4 hours, an ambulance transported her to a hospital. Perforations of the uterus and sigmoid colon were discovered and repaired during emergency surgery. The patient has a large scar on her abdomen.

PATIENT'S CLAIM The ObGyn did not perform the D&C properly and perforated the uterus and colon. An earlier response to symptoms could have prevented repair surgery. Damage to the uterus may now preclude her from having a successful pregnancy.

DEFENDANTS’ DEFENSE The ObGyn argued that the aborted pregnancy was ectopic; spontaneous rupture caused the perforations.

VERDICT A $340,000 New York settlement was reached with the ObGyn. By the time of trial, the clinic had closed. 

Wrong-site biopsy; records altered

A 40-year-old woman underwent excisional breast biopsy. The wrong lump was removed and the woman had to have another procedure.

PATIENT'S CLAIM The hospital’s nursing staff failed to properly mark the operative site. The breast surgeon did not confirm that the markings were correct. The surgeon altered the written operative report after the surgery to conceal negligence.

DEFENDANTS’ DEFENSE The nurses properly marked the biopsy site, but the surgeon chose another route. The surgeon edited the original report to reflect events that occurred during surgery that had not been included in the original dictation. The added material gave justification for performing the procedure at a different site than originally intended.  

VERDICT A $15,500 Connecticut verdict was returned.    

Second twin has CP and brain damage: $10M settlement
A woman gave birth to twins at an Army hospital. The first twin was delivered without complications. The second twin developed a prolapsed cord during delivery of the first twin. A resident and the attending physician allowed the mother to continue with vaginal delivery. The heart-rate monitor showed fetal distress, but the medical staff did not respond. After an hour, another physician was consulted, and he ordered immediate delivery. The attending physician decided to continue with vaginal delivery using forceps, but it took 15 minutes to locate forceps in the hospital. The infant suffered severe brain damage and cerebral palsy. She will require 24-hour nursing care for life, including treatment of a tracheostomy.

PARENTS' CLAIM The physicians were negligent for not reacting to non-reassuring monitor strips and for allowing the vaginal delivery to continue. An emergency cesarean delivery should have been performed.

DEFENDANTS’ DEFENSE The case was settled before trial. 

VERDICT A $10 million North Carolina settlement was reached for past medical bills and future care.

Faulty biopsies: breast cancer diagnosis missed
In September 2006, a 40-year-old woman underwent breast sonography. A radiologist, Dr. A, reported finding a mass and a smaller nodule in the right breast, and recommended a biopsy of each area. Two weeks later, a second radiologist, Dr. B, biopsied the larger of the two areas and diagnosed a hyalinized fibroadenoma. He did not biopsy the smaller growth, but reported it as a benign nodule. He recommended more frequent screenings. The patient was referred to a surgeon, who determined that she should be seen in 6 months.

In June 2007, the patient underwent right-breast sonography that revealed cysts and three nodules. The surgeon recommended a biopsy, but the biopsy was performed on only two of three nodules. A third radiologist, Dr. C, determined that the nodules were all benign.

In November 2007, when the patient reported a painful lump in her right breast, her gynecologist ordered mammography, which revealed lesions. A biopsy revealed that one lesion was stage III invasive ductal carcinoma. The patient underwent extensive treatment, including a mastectomy, lymphadenectomy, chemotherapy, and radiation therapy, and prophylactic surgical reduction of the left breast.

PATIENT'S CLAIM The cancer should have been diagnosed in September 2006. Prompt treatment would have decreased the progression of the disease. The September 2006 biopsy should have included both lumps, as recommended by Dr. A.

DEFENDANTS’ DEFENSE There was no indication of cancer in September 2006. Reasonable follow-up care was given. 

VERDICT A New York defense verdict was returned.

Tumor not found during surgery; BSO performed
A 41-year-old woman underwent surgery to remove a pelvic tumor in November 2004. The gynecologist was unable to locate the tumor during surgery. He performed bilateral salpingo-oophorectomy (BSO) because of a visual diagnosis of endometriosis. In August 2005, the patient underwent surgical removal of the tumor by another surgeon. She was hospitalized for several weeks and suffered a large scar that required additional surgery.

PATIENT'S CLAIM BSO was unnecessary, and caused early menopause, with vaginal atrophy and dryness, depression, fatigue, insomnia, loss of hair, and other symptoms.

The patient claimed lack of informed consent. From Ecuador, the patient’s command of English was not sufficient for her to completely understand the consent form; an interpreter should have been provided.

DEFENDANTS’ DEFENSE BSO did not cause a significant acceleration of the onset of menopause. It was necessary to treat the endometriosis.

The patient signed a consent form that included BSO. The patient did not indicate that she did not understand the language on the form; had she asked, an interpreter would have been provided.

VERDICT A $750,000 New York settlement was reached with the gynecologist and medical center.

These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska (www.verdictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.

A 46-year-old woman underwent laparoscopic supracervical hysterectomy to remove her uterus but preserve her cervix. Postsurgically, she had difficulty breathing deeply and reported abdominal pain. The nurses and on-call physician reassured her that she was experiencing “gas pains” due to insufflation. After same-day discharge, she stayed in a motel room to avoid a second-floor bedroom at home.

She called the gynecologist’s office the following day to report continued pain and severe hot flashes and sweats. The gynecologist instructed his nurse to advise the patient to stop taking her birth control pill (ethinyl estradiol/norethindrone, Microgestin) and “to ride out” the hot flashes.

The woman was found dead in her motel room the next morning. An autopsy revealed a perforated small intestine with leakage into the abdominal cavity causing sepsis, multi-organ failure, and death.

ESTATE’S CLAIM The gynecologist reviewed the medical records and found an error in the operative report, but he made no addendum or late entry to correct the operative report. His defense counsel instructed him to draft a letter clarifying the surgery; this clarification was given to defense experts. The description of the procedure in the clarification was different from what was described in the medical records. For example, the clarification reported making 4 incisions for 4 trocars; the operative report indicated using 3 trocars. The pathologist and 2 nurses who treated the patient after surgery confirmed that there were 3 trocar incisions. The pathologist found no tissue necrosis at or around the perforation site, indicating that the perforation likely occurred during surgery.

PHYSICIAN’S DEFENSE Bowel perforation is a known complication of the procedure. The perforation was not present at the time of surgery because leakage of bowel content would have been obvious.

VERDICT A $1.5 million Virginia settlement was reached.

Retained products of conception after D&C
When sonography indicated that a 30-year-old woman was pregnant, she decided to abort the pregnancy and was given mifepristone.

Another sonogram 5 weeks later showed retained products of conception within the uterus. An ObGyn performed dilation and curettage (D&C) at an outpatient clinic. Because he believed the cannula did not remove everything, he used a curette to scrape the uterus. After the patient was dizzy, hypotensive, and in pain for 4 hours, an ambulance transported her to a hospital. Perforations of the uterus and sigmoid colon were discovered and repaired during emergency surgery. The patient has a large scar on her abdomen.

PATIENT'S CLAIM The ObGyn did not perform the D&C properly and perforated the uterus and colon. An earlier response to symptoms could have prevented repair surgery. Damage to the uterus may now preclude her from having a successful pregnancy.

DEFENDANTS’ DEFENSE The ObGyn argued that the aborted pregnancy was ectopic; spontaneous rupture caused the perforations.

VERDICT A $340,000 New York settlement was reached with the ObGyn. By the time of trial, the clinic had closed. 

Wrong-site biopsy; records altered

A 40-year-old woman underwent excisional breast biopsy. The wrong lump was removed and the woman had to have another procedure.

PATIENT'S CLAIM The hospital’s nursing staff failed to properly mark the operative site. The breast surgeon did not confirm that the markings were correct. The surgeon altered the written operative report after the surgery to conceal negligence.

DEFENDANTS’ DEFENSE The nurses properly marked the biopsy site, but the surgeon chose another route. The surgeon edited the original report to reflect events that occurred during surgery that had not been included in the original dictation. The added material gave justification for performing the procedure at a different site than originally intended.  

VERDICT A $15,500 Connecticut verdict was returned.    

Second twin has CP and brain damage: $10M settlement
A woman gave birth to twins at an Army hospital. The first twin was delivered without complications. The second twin developed a prolapsed cord during delivery of the first twin. A resident and the attending physician allowed the mother to continue with vaginal delivery. The heart-rate monitor showed fetal distress, but the medical staff did not respond. After an hour, another physician was consulted, and he ordered immediate delivery. The attending physician decided to continue with vaginal delivery using forceps, but it took 15 minutes to locate forceps in the hospital. The infant suffered severe brain damage and cerebral palsy. She will require 24-hour nursing care for life, including treatment of a tracheostomy.

PARENTS' CLAIM The physicians were negligent for not reacting to non-reassuring monitor strips and for allowing the vaginal delivery to continue. An emergency cesarean delivery should have been performed.

DEFENDANTS’ DEFENSE The case was settled before trial. 

VERDICT A $10 million North Carolina settlement was reached for past medical bills and future care.

Faulty biopsies: breast cancer diagnosis missed
In September 2006, a 40-year-old woman underwent breast sonography. A radiologist, Dr. A, reported finding a mass and a smaller nodule in the right breast, and recommended a biopsy of each area. Two weeks later, a second radiologist, Dr. B, biopsied the larger of the two areas and diagnosed a hyalinized fibroadenoma. He did not biopsy the smaller growth, but reported it as a benign nodule. He recommended more frequent screenings. The patient was referred to a surgeon, who determined that she should be seen in 6 months.

In June 2007, the patient underwent right-breast sonography that revealed cysts and three nodules. The surgeon recommended a biopsy, but the biopsy was performed on only two of three nodules. A third radiologist, Dr. C, determined that the nodules were all benign.

In November 2007, when the patient reported a painful lump in her right breast, her gynecologist ordered mammography, which revealed lesions. A biopsy revealed that one lesion was stage III invasive ductal carcinoma. The patient underwent extensive treatment, including a mastectomy, lymphadenectomy, chemotherapy, and radiation therapy, and prophylactic surgical reduction of the left breast.

PATIENT'S CLAIM The cancer should have been diagnosed in September 2006. Prompt treatment would have decreased the progression of the disease. The September 2006 biopsy should have included both lumps, as recommended by Dr. A.

DEFENDANTS’ DEFENSE There was no indication of cancer in September 2006. Reasonable follow-up care was given. 

VERDICT A New York defense verdict was returned.

Tumor not found during surgery; BSO performed
A 41-year-old woman underwent surgery to remove a pelvic tumor in November 2004. The gynecologist was unable to locate the tumor during surgery. He performed bilateral salpingo-oophorectomy (BSO) because of a visual diagnosis of endometriosis. In August 2005, the patient underwent surgical removal of the tumor by another surgeon. She was hospitalized for several weeks and suffered a large scar that required additional surgery.

PATIENT'S CLAIM BSO was unnecessary, and caused early menopause, with vaginal atrophy and dryness, depression, fatigue, insomnia, loss of hair, and other symptoms.

The patient claimed lack of informed consent. From Ecuador, the patient’s command of English was not sufficient for her to completely understand the consent form; an interpreter should have been provided.

DEFENDANTS’ DEFENSE BSO did not cause a significant acceleration of the onset of menopause. It was necessary to treat the endometriosis.

The patient signed a consent form that included BSO. The patient did not indicate that she did not understand the language on the form; had she asked, an interpreter would have been provided.

VERDICT A $750,000 New York settlement was reached with the gynecologist and medical center.

These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska (www.verdictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.

A 46-year-old woman underwent laparoscopic supracervical hysterectomy to remove her uterus but preserve her cervix. Postsurgically, she had difficulty breathing deeply and reported abdominal pain. The nurses and on-call physician reassured her that she was experiencing “gas pains” due to insufflation. After same-day discharge, she stayed in a motel room to avoid a second-floor bedroom at home.

She called the gynecologist’s office the following day to report continued pain and severe hot flashes and sweats. The gynecologist instructed his nurse to advise the patient to stop taking her birth control pill (ethinyl estradiol/norethindrone, Microgestin) and “to ride out” the hot flashes.

The woman was found dead in her motel room the next morning. An autopsy revealed a perforated small intestine with leakage into the abdominal cavity causing sepsis, multi-organ failure, and death.

ESTATE’S CLAIM The gynecologist reviewed the medical records and found an error in the operative report, but he made no addendum or late entry to correct the operative report. His defense counsel instructed him to draft a letter clarifying the surgery; this clarification was given to defense experts. The description of the procedure in the clarification was different from what was described in the medical records. For example, the clarification reported making 4 incisions for 4 trocars; the operative report indicated using 3 trocars. The pathologist and 2 nurses who treated the patient after surgery confirmed that there were 3 trocar incisions. The pathologist found no tissue necrosis at or around the perforation site, indicating that the perforation likely occurred during surgery.

PHYSICIAN’S DEFENSE Bowel perforation is a known complication of the procedure. The perforation was not present at the time of surgery because leakage of bowel content would have been obvious.

VERDICT A $1.5 million Virginia settlement was reached.

Retained products of conception after D&C
When sonography indicated that a 30-year-old woman was pregnant, she decided to abort the pregnancy and was given mifepristone.

Another sonogram 5 weeks later showed retained products of conception within the uterus. An ObGyn performed dilation and curettage (D&C) at an outpatient clinic. Because he believed the cannula did not remove everything, he used a curette to scrape the uterus. After the patient was dizzy, hypotensive, and in pain for 4 hours, an ambulance transported her to a hospital. Perforations of the uterus and sigmoid colon were discovered and repaired during emergency surgery. The patient has a large scar on her abdomen.

PATIENT'S CLAIM The ObGyn did not perform the D&C properly and perforated the uterus and colon. An earlier response to symptoms could have prevented repair surgery. Damage to the uterus may now preclude her from having a successful pregnancy.

DEFENDANTS’ DEFENSE The ObGyn argued that the aborted pregnancy was ectopic; spontaneous rupture caused the perforations.

VERDICT A $340,000 New York settlement was reached with the ObGyn. By the time of trial, the clinic had closed. 

Wrong-site biopsy; records altered

A 40-year-old woman underwent excisional breast biopsy. The wrong lump was removed and the woman had to have another procedure.

PATIENT'S CLAIM The hospital’s nursing staff failed to properly mark the operative site. The breast surgeon did not confirm that the markings were correct. The surgeon altered the written operative report after the surgery to conceal negligence.

DEFENDANTS’ DEFENSE The nurses properly marked the biopsy site, but the surgeon chose another route. The surgeon edited the original report to reflect events that occurred during surgery that had not been included in the original dictation. The added material gave justification for performing the procedure at a different site than originally intended.  

VERDICT A $15,500 Connecticut verdict was returned.    

Second twin has CP and brain damage: $10M settlement
A woman gave birth to twins at an Army hospital. The first twin was delivered without complications. The second twin developed a prolapsed cord during delivery of the first twin. A resident and the attending physician allowed the mother to continue with vaginal delivery. The heart-rate monitor showed fetal distress, but the medical staff did not respond. After an hour, another physician was consulted, and he ordered immediate delivery. The attending physician decided to continue with vaginal delivery using forceps, but it took 15 minutes to locate forceps in the hospital. The infant suffered severe brain damage and cerebral palsy. She will require 24-hour nursing care for life, including treatment of a tracheostomy.

PARENTS' CLAIM The physicians were negligent for not reacting to non-reassuring monitor strips and for allowing the vaginal delivery to continue. An emergency cesarean delivery should have been performed.

DEFENDANTS’ DEFENSE The case was settled before trial. 

VERDICT A $10 million North Carolina settlement was reached for past medical bills and future care.

Faulty biopsies: breast cancer diagnosis missed
In September 2006, a 40-year-old woman underwent breast sonography. A radiologist, Dr. A, reported finding a mass and a smaller nodule in the right breast, and recommended a biopsy of each area. Two weeks later, a second radiologist, Dr. B, biopsied the larger of the two areas and diagnosed a hyalinized fibroadenoma. He did not biopsy the smaller growth, but reported it as a benign nodule. He recommended more frequent screenings. The patient was referred to a surgeon, who determined that she should be seen in 6 months.

In June 2007, the patient underwent right-breast sonography that revealed cysts and three nodules. The surgeon recommended a biopsy, but the biopsy was performed on only two of three nodules. A third radiologist, Dr. C, determined that the nodules were all benign.

In November 2007, when the patient reported a painful lump in her right breast, her gynecologist ordered mammography, which revealed lesions. A biopsy revealed that one lesion was stage III invasive ductal carcinoma. The patient underwent extensive treatment, including a mastectomy, lymphadenectomy, chemotherapy, and radiation therapy, and prophylactic surgical reduction of the left breast.

PATIENT'S CLAIM The cancer should have been diagnosed in September 2006. Prompt treatment would have decreased the progression of the disease. The September 2006 biopsy should have included both lumps, as recommended by Dr. A.

DEFENDANTS’ DEFENSE There was no indication of cancer in September 2006. Reasonable follow-up care was given. 

VERDICT A New York defense verdict was returned.

Tumor not found during surgery; BSO performed
A 41-year-old woman underwent surgery to remove a pelvic tumor in November 2004. The gynecologist was unable to locate the tumor during surgery. He performed bilateral salpingo-oophorectomy (BSO) because of a visual diagnosis of endometriosis. In August 2005, the patient underwent surgical removal of the tumor by another surgeon. She was hospitalized for several weeks and suffered a large scar that required additional surgery.

PATIENT'S CLAIM BSO was unnecessary, and caused early menopause, with vaginal atrophy and dryness, depression, fatigue, insomnia, loss of hair, and other symptoms.

The patient claimed lack of informed consent. From Ecuador, the patient’s command of English was not sufficient for her to completely understand the consent form; an interpreter should have been provided.

DEFENDANTS’ DEFENSE BSO did not cause a significant acceleration of the onset of menopause. It was necessary to treat the endometriosis.

The patient signed a consent form that included BSO. The patient did not indicate that she did not understand the language on the form; had she asked, an interpreter would have been provided.

VERDICT A $750,000 New York settlement was reached with the gynecologist and medical center.

These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska (www.verdictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.

AT 31 2/7 WEEKS' GESTATION, a woman was admitted to the hospital for hypertension. A maternal-fetal medicine specialist determined that a vaginal delivery was reasonable as long as the mother and fetus remained clinically stable; a cesarean delivery would be required if the status changed. An ObGyn and nurse midwife took over the mother’s care. Before dinoprostone and oxytocin were administered the next morning, a second ObGyn conducted a vaginal exam and found the mother’s cervix to be 4-cm dilated. After noon, the fetal heart rate became nonreassuring, with late and prolonged variable decelerations. The baby was born shortly after 5:00 pm with the umbilical cord wrapped around his neck. He was pale, lifeless, and had Apgar scores of 4 and 7 at 1 and 5 minutes, respectively. He required initial positive pressure ventilation due to bradycardia and poor respiratory effort.
The boy has cerebral palsy; although not cognitively impaired, he is severely physically handicapped. He has had several operations because one leg is shorter than the other. He has 65% function of his arms, making it impossible for him to complete normal, daily tasks by himself.

PARENTS' CLAIM A cesarean delivery should have been performed 3 hours earlier.

DEFENDANT' DEFENSE Fetal heart-rate monitoring was reassuring during the last 40 minutes of labor. An Apgar score of 7 at 5 minutes is normal. Blood gases taken at birth were normal (7.3 pH). Ultrasonography of the baby’s head at age 3 days showed normal findings. Problems were not evident on the head ultrasound until the child was 2 weeks of age, showing that the injury occurred after birth and was due to prematurity. Defendants included both ObGyns, the midwife, and the hospital.

VERDICT A $21 million Maryland verdict was returned, including $1 million in noneconomic damages that was reduced to $650,000 under the state cap.

PHYSICIAN APOLOGIZED: DIDN'T READ BIOPSY REPORT BEFORE SURGERY

A 34-YEAR-OLD WOMAN with a family history of breast cancer found a lump in her left breast. After fine-needle aspiration, a general surgeon diagnosed cancer and performed a double mastectomy.
At the first postoperative visit, the surgeon told the patient that she did not have breast cancer, and that the fine-needle aspiration results were negative. The surgeon apologized for never looking at the biopsy report prior to surgery, and admitted that is she had seen the report, she would have cancelled surgery.

PATIENT'S CLAIM The surgeon was negligent in performing bilateral mastectomies without first reading biopsy results.

PHYSICIAN'S DEFENSE The case was settled before trial.

VERDICT Michigan case evaluation delivered an award of $542,000, which both parties accepted.

CYSTOSCOPY BLAMED FOR URETERAL OBSTRUCTION, POOR KIDNEY FUNCTION

WHEN A 59-YEAR-OLD WOMAN underwent gynecologic surgery that included a cystoscopy, her uterers were functioning normally. During the following month, the ObGyn performed several follow-up examinations. A year later, the patient's right ureter was completely obstructed. The obstruction was repaired, but the patient lost function in her right kidney. She must take a drug to improve kidney function for the rest of her life.

PATIENT'S CLAIM The obstruction was caused by ligation that occurred during cystoscopy. The ObGyn should have diagnosed the obstruction during the weeks following surgery.

PHYSICIAN'S DEFENSE The cystoscopy was properly performed. The patient had not reported any symptoms after the procedure that suggested the presence of an obstruction. The obstruction gradually developed and could not have been diagnosed earlier.

VERDICT A New York defense verdict was returned.


INFERIOR VENA CAVA DAMAGED DURING ROBOTIC HYSTERECTOMY

A HYSTERECTOMY AND SALPINGO-OOPHORECTOMY were performed on a 64-year-old woman using the da Vinci Surgical System. The gynecologist also removed a cancerous endometrial mass and dissected the periaortic lymph nodes. When the gynecologist used the robot to lift a lymph fat pad, the inferior vena cava was injured and the patient lost 3 L of blood. After converting the laparotomy, a vascular surgeon implanted an artificial graft to repair the inferior vena cava. The patient fully recovered.

PATIENT'S CLAIM The gynecologist did not perform robotic surgery properly, and the patient was not told of all of the risks associated with robotic surgery. Due to the uncertainty regarding the graft's effectiveness, the patient developed posttraumatic stress disorder.

PHYSICIAN'S DEFENSE The vascular injury was a known risk associated with the procedure. The vena cava was not lacerated or transected: perforator veins that joined the lymph fat pad were unintentionally pulled out. The injury was most likely due to the application of pressure, not laceration by the surgical instrument.

VERDICT A $300,000 New York settlement was reached.

READ: The robot is gaining ground in gynecologic surgery. Should you be using it? A roundtable discussion with Arnold P. Advincula, MD; Cheryl B. Iglesia, MD; Rosanne M. Kho, MD; Jamal Mourad, DO; Marie Fidela R. Paraiso, MD; and Jason D. Wright, MD (April 2013)

FETAL DISTRESS CAUSED BRAIN INJURY: $13.9M

DURING THE LAST 2 HOURS OF LABOR, the mother was febrile, the baby's heart rate rose to over 160 bpm, and fetal monitoring indicated fetal distress. Oxytocin was administered to hasten delivery, but the mother's uterus became hyperstimulated. After nearly 17 hours of labor, the child was born without respirations. A video of the vaginal birth shows that the child was blue and unresponsive. The baby was resuscitated, and was subsequently found to have cerebral palsy, epilepsy, and mental retardation. At the time of trial, the 10-year-old had the mental capacity of a 3-year-old.

PARENTS' CLAIM The child suffered brain injury due to hypoxic ischemic encephalopathy. A cesarean delivery should have been performed as soon as fetal distress was evident. The doctors and nurses misread the baseline heart rate, and did not react when the baby did not recover well from the mother's contractions. Brain imaging did not show damage caused by infection or meningitis.

PHYSICIAN'S DEFENSE The girl's condition was caused by an infection or meningitis.

VERDICT A confidential settlement was reached with the midwife before the trial. The ObGyn was dismissed because he was never alerted to any problem by the labor and delivery team. A $13.9 million Georgia verdict was returned against the hospital system.

UTERINE ARTERY INJURED DURING CESAREAN DELIVERY

AFTER A SCHEDULED CESAREAN delivery, the 29-year-old mother had low blood pressure and an altered state of consciousness When she returned to the OR several hours later, her ObGyn found a uterine artery hematoma and laceration. After the laceration was clamped and sutured, uterine atony was noted and an emergency hysterectomy was performed

PATIENT'S CLAIM The mother was no longer able to bear children. The ObGyn was negligent in lacerating the uterine artery, failing to recognize the laceration during cesarean surgery, failing to properly monitor the patient after surgery, and failing to repair the artery in a timely manner. The patient's low blood pressure and altered state of consciousness should have been an indication that she had severe blood loss. The hospital's nursing staff failed to properly check her vital signs after surgery, and failed to report the abnormalities in blood pressure and consciousness to the ObGyn.

DEFENDANTS' DEFENSE The ObGyn claimed that a uterine laceration is a known risk of cesarean delivery; it can occur in the absence of negligence. The hospital also denied negligence.

VERDICT A Texas defense verdict was returned.

These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska (www.versictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.

AT 31 2/7 WEEKS' GESTATION, a woman was admitted to the hospital for hypertension. A maternal-fetal medicine specialist determined that a vaginal delivery was reasonable as long as the mother and fetus remained clinically stable; a cesarean delivery would be required if the status changed. An ObGyn and nurse midwife took over the mother’s care. Before dinoprostone and oxytocin were administered the next morning, a second ObGyn conducted a vaginal exam and found the mother’s cervix to be 4-cm dilated. After noon, the fetal heart rate became nonreassuring, with late and prolonged variable decelerations. The baby was born shortly after 5:00 pm with the umbilical cord wrapped around his neck. He was pale, lifeless, and had Apgar scores of 4 and 7 at 1 and 5 minutes, respectively. He required initial positive pressure ventilation due to bradycardia and poor respiratory effort.
The boy has cerebral palsy; although not cognitively impaired, he is severely physically handicapped. He has had several operations because one leg is shorter than the other. He has 65% function of his arms, making it impossible for him to complete normal, daily tasks by himself.

PARENTS' CLAIM A cesarean delivery should have been performed 3 hours earlier.

DEFENDANT' DEFENSE Fetal heart-rate monitoring was reassuring during the last 40 minutes of labor. An Apgar score of 7 at 5 minutes is normal. Blood gases taken at birth were normal (7.3 pH). Ultrasonography of the baby’s head at age 3 days showed normal findings. Problems were not evident on the head ultrasound until the child was 2 weeks of age, showing that the injury occurred after birth and was due to prematurity. Defendants included both ObGyns, the midwife, and the hospital.

VERDICT A $21 million Maryland verdict was returned, including $1 million in noneconomic damages that was reduced to $650,000 under the state cap.

PHYSICIAN APOLOGIZED: DIDN'T READ BIOPSY REPORT BEFORE SURGERY

A 34-YEAR-OLD WOMAN with a family history of breast cancer found a lump in her left breast. After fine-needle aspiration, a general surgeon diagnosed cancer and performed a double mastectomy.
At the first postoperative visit, the surgeon told the patient that she did not have breast cancer, and that the fine-needle aspiration results were negative. The surgeon apologized for never looking at the biopsy report prior to surgery, and admitted that is she had seen the report, she would have cancelled surgery.

PATIENT'S CLAIM The surgeon was negligent in performing bilateral mastectomies without first reading biopsy results.

PHYSICIAN'S DEFENSE The case was settled before trial.

VERDICT Michigan case evaluation delivered an award of $542,000, which both parties accepted.

CYSTOSCOPY BLAMED FOR URETERAL OBSTRUCTION, POOR KIDNEY FUNCTION

WHEN A 59-YEAR-OLD WOMAN underwent gynecologic surgery that included a cystoscopy, her uterers were functioning normally. During the following month, the ObGyn performed several follow-up examinations. A year later, the patient's right ureter was completely obstructed. The obstruction was repaired, but the patient lost function in her right kidney. She must take a drug to improve kidney function for the rest of her life.

PATIENT'S CLAIM The obstruction was caused by ligation that occurred during cystoscopy. The ObGyn should have diagnosed the obstruction during the weeks following surgery.

PHYSICIAN'S DEFENSE The cystoscopy was properly performed. The patient had not reported any symptoms after the procedure that suggested the presence of an obstruction. The obstruction gradually developed and could not have been diagnosed earlier.

VERDICT A New York defense verdict was returned.


INFERIOR VENA CAVA DAMAGED DURING ROBOTIC HYSTERECTOMY

A HYSTERECTOMY AND SALPINGO-OOPHORECTOMY were performed on a 64-year-old woman using the da Vinci Surgical System. The gynecologist also removed a cancerous endometrial mass and dissected the periaortic lymph nodes. When the gynecologist used the robot to lift a lymph fat pad, the inferior vena cava was injured and the patient lost 3 L of blood. After converting the laparotomy, a vascular surgeon implanted an artificial graft to repair the inferior vena cava. The patient fully recovered.

PATIENT'S CLAIM The gynecologist did not perform robotic surgery properly, and the patient was not told of all of the risks associated with robotic surgery. Due to the uncertainty regarding the graft's effectiveness, the patient developed posttraumatic stress disorder.

PHYSICIAN'S DEFENSE The vascular injury was a known risk associated with the procedure. The vena cava was not lacerated or transected: perforator veins that joined the lymph fat pad were unintentionally pulled out. The injury was most likely due to the application of pressure, not laceration by the surgical instrument.

VERDICT A $300,000 New York settlement was reached.

READ: The robot is gaining ground in gynecologic surgery. Should you be using it? A roundtable discussion with Arnold P. Advincula, MD; Cheryl B. Iglesia, MD; Rosanne M. Kho, MD; Jamal Mourad, DO; Marie Fidela R. Paraiso, MD; and Jason D. Wright, MD (April 2013)

FETAL DISTRESS CAUSED BRAIN INJURY: $13.9M

DURING THE LAST 2 HOURS OF LABOR, the mother was febrile, the baby's heart rate rose to over 160 bpm, and fetal monitoring indicated fetal distress. Oxytocin was administered to hasten delivery, but the mother's uterus became hyperstimulated. After nearly 17 hours of labor, the child was born without respirations. A video of the vaginal birth shows that the child was blue and unresponsive. The baby was resuscitated, and was subsequently found to have cerebral palsy, epilepsy, and mental retardation. At the time of trial, the 10-year-old had the mental capacity of a 3-year-old.

PARENTS' CLAIM The child suffered brain injury due to hypoxic ischemic encephalopathy. A cesarean delivery should have been performed as soon as fetal distress was evident. The doctors and nurses misread the baseline heart rate, and did not react when the baby did not recover well from the mother's contractions. Brain imaging did not show damage caused by infection or meningitis.

PHYSICIAN'S DEFENSE The girl's condition was caused by an infection or meningitis.

VERDICT A confidential settlement was reached with the midwife before the trial. The ObGyn was dismissed because he was never alerted to any problem by the labor and delivery team. A $13.9 million Georgia verdict was returned against the hospital system.

UTERINE ARTERY INJURED DURING CESAREAN DELIVERY

AFTER A SCHEDULED CESAREAN delivery, the 29-year-old mother had low blood pressure and an altered state of consciousness When she returned to the OR several hours later, her ObGyn found a uterine artery hematoma and laceration. After the laceration was clamped and sutured, uterine atony was noted and an emergency hysterectomy was performed

PATIENT'S CLAIM The mother was no longer able to bear children. The ObGyn was negligent in lacerating the uterine artery, failing to recognize the laceration during cesarean surgery, failing to properly monitor the patient after surgery, and failing to repair the artery in a timely manner. The patient's low blood pressure and altered state of consciousness should have been an indication that she had severe blood loss. The hospital's nursing staff failed to properly check her vital signs after surgery, and failed to report the abnormalities in blood pressure and consciousness to the ObGyn.

DEFENDANTS' DEFENSE The ObGyn claimed that a uterine laceration is a known risk of cesarean delivery; it can occur in the absence of negligence. The hospital also denied negligence.

VERDICT A Texas defense verdict was returned.

These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska (www.versictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.

AT 31 2/7 WEEKS' GESTATION, a woman was admitted to the hospital for hypertension. A maternal-fetal medicine specialist determined that a vaginal delivery was reasonable as long as the mother and fetus remained clinically stable; a cesarean delivery would be required if the status changed. An ObGyn and nurse midwife took over the mother’s care. Before dinoprostone and oxytocin were administered the next morning, a second ObGyn conducted a vaginal exam and found the mother’s cervix to be 4-cm dilated. After noon, the fetal heart rate became nonreassuring, with late and prolonged variable decelerations. The baby was born shortly after 5:00 pm with the umbilical cord wrapped around his neck. He was pale, lifeless, and had Apgar scores of 4 and 7 at 1 and 5 minutes, respectively. He required initial positive pressure ventilation due to bradycardia and poor respiratory effort.
The boy has cerebral palsy; although not cognitively impaired, he is severely physically handicapped. He has had several operations because one leg is shorter than the other. He has 65% function of his arms, making it impossible for him to complete normal, daily tasks by himself.

PARENTS' CLAIM A cesarean delivery should have been performed 3 hours earlier.

DEFENDANT' DEFENSE Fetal heart-rate monitoring was reassuring during the last 40 minutes of labor. An Apgar score of 7 at 5 minutes is normal. Blood gases taken at birth were normal (7.3 pH). Ultrasonography of the baby’s head at age 3 days showed normal findings. Problems were not evident on the head ultrasound until the child was 2 weeks of age, showing that the injury occurred after birth and was due to prematurity. Defendants included both ObGyns, the midwife, and the hospital.

VERDICT A $21 million Maryland verdict was returned, including $1 million in noneconomic damages that was reduced to $650,000 under the state cap.

PHYSICIAN APOLOGIZED: DIDN'T READ BIOPSY REPORT BEFORE SURGERY

A 34-YEAR-OLD WOMAN with a family history of breast cancer found a lump in her left breast. After fine-needle aspiration, a general surgeon diagnosed cancer and performed a double mastectomy.
At the first postoperative visit, the surgeon told the patient that she did not have breast cancer, and that the fine-needle aspiration results were negative. The surgeon apologized for never looking at the biopsy report prior to surgery, and admitted that is she had seen the report, she would have cancelled surgery.

PATIENT'S CLAIM The surgeon was negligent in performing bilateral mastectomies without first reading biopsy results.

PHYSICIAN'S DEFENSE The case was settled before trial.

VERDICT Michigan case evaluation delivered an award of $542,000, which both parties accepted.

CYSTOSCOPY BLAMED FOR URETERAL OBSTRUCTION, POOR KIDNEY FUNCTION

WHEN A 59-YEAR-OLD WOMAN underwent gynecologic surgery that included a cystoscopy, her uterers were functioning normally. During the following month, the ObGyn performed several follow-up examinations. A year later, the patient's right ureter was completely obstructed. The obstruction was repaired, but the patient lost function in her right kidney. She must take a drug to improve kidney function for the rest of her life.

PATIENT'S CLAIM The obstruction was caused by ligation that occurred during cystoscopy. The ObGyn should have diagnosed the obstruction during the weeks following surgery.

PHYSICIAN'S DEFENSE The cystoscopy was properly performed. The patient had not reported any symptoms after the procedure that suggested the presence of an obstruction. The obstruction gradually developed and could not have been diagnosed earlier.

VERDICT A New York defense verdict was returned.


INFERIOR VENA CAVA DAMAGED DURING ROBOTIC HYSTERECTOMY

A HYSTERECTOMY AND SALPINGO-OOPHORECTOMY were performed on a 64-year-old woman using the da Vinci Surgical System. The gynecologist also removed a cancerous endometrial mass and dissected the periaortic lymph nodes. When the gynecologist used the robot to lift a lymph fat pad, the inferior vena cava was injured and the patient lost 3 L of blood. After converting the laparotomy, a vascular surgeon implanted an artificial graft to repair the inferior vena cava. The patient fully recovered.

PATIENT'S CLAIM The gynecologist did not perform robotic surgery properly, and the patient was not told of all of the risks associated with robotic surgery. Due to the uncertainty regarding the graft's effectiveness, the patient developed posttraumatic stress disorder.

PHYSICIAN'S DEFENSE The vascular injury was a known risk associated with the procedure. The vena cava was not lacerated or transected: perforator veins that joined the lymph fat pad were unintentionally pulled out. The injury was most likely due to the application of pressure, not laceration by the surgical instrument.

VERDICT A $300,000 New York settlement was reached.

READ: The robot is gaining ground in gynecologic surgery. Should you be using it? A roundtable discussion with Arnold P. Advincula, MD; Cheryl B. Iglesia, MD; Rosanne M. Kho, MD; Jamal Mourad, DO; Marie Fidela R. Paraiso, MD; and Jason D. Wright, MD (April 2013)

FETAL DISTRESS CAUSED BRAIN INJURY: $13.9M

DURING THE LAST 2 HOURS OF LABOR, the mother was febrile, the baby's heart rate rose to over 160 bpm, and fetal monitoring indicated fetal distress. Oxytocin was administered to hasten delivery, but the mother's uterus became hyperstimulated. After nearly 17 hours of labor, the child was born without respirations. A video of the vaginal birth shows that the child was blue and unresponsive. The baby was resuscitated, and was subsequently found to have cerebral palsy, epilepsy, and mental retardation. At the time of trial, the 10-year-old had the mental capacity of a 3-year-old.

PARENTS' CLAIM The child suffered brain injury due to hypoxic ischemic encephalopathy. A cesarean delivery should have been performed as soon as fetal distress was evident. The doctors and nurses misread the baseline heart rate, and did not react when the baby did not recover well from the mother's contractions. Brain imaging did not show damage caused by infection or meningitis.

PHYSICIAN'S DEFENSE The girl's condition was caused by an infection or meningitis.

VERDICT A confidential settlement was reached with the midwife before the trial. The ObGyn was dismissed because he was never alerted to any problem by the labor and delivery team. A $13.9 million Georgia verdict was returned against the hospital system.

UTERINE ARTERY INJURED DURING CESAREAN DELIVERY

AFTER A SCHEDULED CESAREAN delivery, the 29-year-old mother had low blood pressure and an altered state of consciousness When she returned to the OR several hours later, her ObGyn found a uterine artery hematoma and laceration. After the laceration was clamped and sutured, uterine atony was noted and an emergency hysterectomy was performed

PATIENT'S CLAIM The mother was no longer able to bear children. The ObGyn was negligent in lacerating the uterine artery, failing to recognize the laceration during cesarean surgery, failing to properly monitor the patient after surgery, and failing to repair the artery in a timely manner. The patient's low blood pressure and altered state of consciousness should have been an indication that she had severe blood loss. The hospital's nursing staff failed to properly check her vital signs after surgery, and failed to report the abnormalities in blood pressure and consciousness to the ObGyn.

DEFENDANTS' DEFENSE The ObGyn claimed that a uterine laceration is a known risk of cesarean delivery; it can occur in the absence of negligence. The hospital also denied negligence.

VERDICT A Texas defense verdict was returned.

These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska (www.versictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.

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AN OBGYN ENCOUNTERED SHOULDER DYSTOCIA. He used fundal pressure and downward lateral traction to free the baby’s shoulder. The child has a brachial plexus injury of the right shoulder, including nerve avulsion, a fractured clavicle, and permanent disfigurement. She underwent surgery; physical and occupational therapy will continue.

PARENTS' CLAIM The standard sequence of maneuvers should have been attempted before fundal pressure and lateral traction were used—the baby was sufficiently oxygenated to allow time for these maneuvers. Excessive lateral traction caused the injury.

DEFENDANTS' DEFENSE The injuries occurred in utero before or while the fetus progressed down the birth canal, and were due to the maternal forces of labor.

VERDICT A $3,070,000 Michigan verdict was returned against the hospital, ObGyn, and ObGyn group.

WHAT IS THE STANDARD SEQUENCE OF MANEUVERS FOR SHOULDER DYSTOCIA?
Read Dr. Robert L. Barbieri’s May Editorial, You are the second responder to a shoulder dystocia emergency. What do you do first? and Dr. Ronald T. Burkman’s March Stop/Start article, Stop all activities that may lead to further shoulder impaction when you suspect possible shoulder dystocia Meconium aspiration leads to brain injury

LATE IN HER PREGNANCY, a woman went to the emergency department (ED) with hypertension; she was discharged the same day. She saw her ObGyns, Dr. A and Dr. B, three times in the next 2 weeks. A day after her last visit, she returned to the ED in active labor. Dr. B assumed her care. Fetal monitoring indicated a nonreassuring heart rate with decelerations. Dr. B administered oxytocin and labor continued.

The baby was born by cesarean delivery after 25 minutes of fetal bradycardia. She was covered in meconium, with a low heart rate and irregular, labored respirations. The baby was transferred to another hospital, where she was treated for pulmonary hypertension, meconium aspiration, and seizures. The child is totally disabled, and will require constant care for life.

PARENTS' CLAIM The mother’s hypertension was not properly treated. Dr. B and the nurse waited too long to perform a cesarean delivery.

DEFENDANTS' DEFENSE Proper prenatal care was provided. There was no reason for additional testing; fetal heart tones at the mother’s last office visit were reactive. There were no clinical signs of a hematoma or cord varix during office visits. An unpredictable, unpreventable umbilical cord hematoma caused ischemia and hypoxia, and the subsequent brain injury. Meconium had been in the amniotic fluid for at least 10 hours due to the ischemic/hypoxic episode. The hematoma formed between her last office visit and when the mother came to the hospital the next day.

VERDICT Settlements were reached with Dr. A and the hospital. An Arkansas defense verdict was returned for Dr. B and the nurse.

14 months' recovery after mass removed

A GYNECOLOGIC ONCOLOGIST operated on a woman in her 50s to remove a large, noncancerous pelvic mass. The patient, discharged on postoperative day 2, was readmitted the next day with a fever (temperature, 103ºF), nausea, vomiting, and abdominal pain. Four days later, the oncologist repaired a perforated bowel and created an ileostomy. Other procedures were needed to drain abscesses and repair fistulas, and resect a large portion of colon due to continuing infection. Treatment lasted 14 months.

PATIENT'S CLAIM The gynecologic oncologist was negligent in failing to timely diagnose and treat the bowel perforation. Earlier repair would have curtailed development of the abscesses and fistulae.

PHYSICIAN'S DEFENSE Any complications the patient experienced were unrelated to any delay in treatment. 

VERDICT A $612,237 Michigan verdict was returned.

Colon perforated during abdominal access

WHEN A MORBIDLY OBESE 37-YEAR-OLD WOMAN reported chronic pelvic pain, her gynecologist suspected endometriosis. Conservative treatment failed and the gynecologist offered laparoscopic hysterectomy.

After abdominal insufflation was unsuccessfully attempted twice using a Veress needle, the gynecologist entered the abdomen with a Visiport optical trocar, and continued the procedure. The gynecologist inspected the abdomen before closing but found no injuries.

The patient did not do well after surgery. CT scan detected a bowel perforation on postoperative day 6. During exploratory laparotomy, a through-and-through “bayonet” colon perforation was repaired. Because of the extensive infection, the patient’s surgical wound was left open and several “washouts” were performed; the wound was closed several weeks later. The patient also underwent two adhesiolysis procedures.

PATIENT'S CLAIM Access to the abdomen was not properly performed and caused colon perforation. The injury should have been found and treated earlier.

PHYSICIAN'S DEFENSE The case was settled before trial.

VERDICT A $750,000 Virginia settlement was reached.

READ How to avoid intestinal and urinary tract injuries during gynecologic laparoscopy, by Michael Baggish, MD (Surgical Techniques, October 2012) What caused this C. diff infection after hysterectomy?

AFTER A HYSTERECTOMY, a 42-year-old woman developed a persistent fever and increased white blood cell count. The gynecologist prescribed ciprofloxacin for a urinary tract infection, and discharged the patient from the hospital on postoperative day 4. She returned to the gynecologist’s office with severe abdominal pain and vomiting 4 days after discharge. The gynecologist prescribed an antacid and told her to continue taking ciprofloxacin.

The patient was taken to the ED by ambulance 3 days later. Testing revealed a Clostridium dificule (C. diff) infection. During emergency surgery, a large portion of her colon was resected, and a colostomy was performed. The colostomy was reversed 6 months later. The patient developed an incisional hernia and has abdominal scarring.

PATIENT'S CLAIM Prophylactic antibiotics should have been prescribed before surgery.

Two possible scenarios were presented: 1) A bowel injury occurred during surgery, and ciprofloxacin likely worsened the infection caused by the bowel injury; or 2) ciprofloxacin triggered the C. diff infection that caused leaking colon perforations and subsequent peritonitis.

The colon perforations could have been avoided if the gynecologist had diagnosed and treated the C. diff infection in a timely manner.

PHYSICIAN'S DEFENSE The patient’s symptoms did not suggest a C. diff infection; testing was not necessary. Ciprofloxacin might have allowed the proliferation of the C. diff infection, but the use of the drug was not negligent. The infection was not preventable and could not have been diagnosed earlier.

VERDICT A $776,000 New York verdict was returned.

Brain injury and cerebral palsy: When did this occur?

DURING LABOR AND DELIVERY, there were periods when the fetal heart-rate tracings were nonreassuring with variable decelerations and fetal tachycardia; some variables were severe. The child suffered anoxic encephalopathy that caused neurologic injury and cerebral palsy.

PARENTS' CLAIM The infant suffered numerous hypoxic incidents before cesarean delivery was performed. An earlier cesarean delivery could have prevented the injury.

PHYSICIAN'S DEFENSE The newborn had a normal blood cord gas level of 7.2 pH and Apgar scores of 9 and 10, at 1 and 5 minutes, respectively. Fetal heart-rate tracings did not show evidence of fetal hypoxia. The brain injury likely occurred prior to the onset of labor and was possibly related to a viral encephalopathy. 

VERDICT A Virginia defense verdict was returned. These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska (www.verdictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.

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AN OBGYN ENCOUNTERED SHOULDER DYSTOCIA. He used fundal pressure and downward lateral traction to free the baby’s shoulder. The child has a brachial plexus injury of the right shoulder, including nerve avulsion, a fractured clavicle, and permanent disfigurement. She underwent surgery; physical and occupational therapy will continue.

PARENTS' CLAIM The standard sequence of maneuvers should have been attempted before fundal pressure and lateral traction were used—the baby was sufficiently oxygenated to allow time for these maneuvers. Excessive lateral traction caused the injury.

DEFENDANTS' DEFENSE The injuries occurred in utero before or while the fetus progressed down the birth canal, and were due to the maternal forces of labor.

VERDICT A $3,070,000 Michigan verdict was returned against the hospital, ObGyn, and ObGyn group.

WHAT IS THE STANDARD SEQUENCE OF MANEUVERS FOR SHOULDER DYSTOCIA?
Read Dr. Robert L. Barbieri’s May Editorial, You are the second responder to a shoulder dystocia emergency. What do you do first? and Dr. Ronald T. Burkman’s March Stop/Start article, Stop all activities that may lead to further shoulder impaction when you suspect possible shoulder dystocia Meconium aspiration leads to brain injury

LATE IN HER PREGNANCY, a woman went to the emergency department (ED) with hypertension; she was discharged the same day. She saw her ObGyns, Dr. A and Dr. B, three times in the next 2 weeks. A day after her last visit, she returned to the ED in active labor. Dr. B assumed her care. Fetal monitoring indicated a nonreassuring heart rate with decelerations. Dr. B administered oxytocin and labor continued.

The baby was born by cesarean delivery after 25 minutes of fetal bradycardia. She was covered in meconium, with a low heart rate and irregular, labored respirations. The baby was transferred to another hospital, where she was treated for pulmonary hypertension, meconium aspiration, and seizures. The child is totally disabled, and will require constant care for life.

PARENTS' CLAIM The mother’s hypertension was not properly treated. Dr. B and the nurse waited too long to perform a cesarean delivery.

DEFENDANTS' DEFENSE Proper prenatal care was provided. There was no reason for additional testing; fetal heart tones at the mother’s last office visit were reactive. There were no clinical signs of a hematoma or cord varix during office visits. An unpredictable, unpreventable umbilical cord hematoma caused ischemia and hypoxia, and the subsequent brain injury. Meconium had been in the amniotic fluid for at least 10 hours due to the ischemic/hypoxic episode. The hematoma formed between her last office visit and when the mother came to the hospital the next day.

VERDICT Settlements were reached with Dr. A and the hospital. An Arkansas defense verdict was returned for Dr. B and the nurse.

14 months' recovery after mass removed

A GYNECOLOGIC ONCOLOGIST operated on a woman in her 50s to remove a large, noncancerous pelvic mass. The patient, discharged on postoperative day 2, was readmitted the next day with a fever (temperature, 103ºF), nausea, vomiting, and abdominal pain. Four days later, the oncologist repaired a perforated bowel and created an ileostomy. Other procedures were needed to drain abscesses and repair fistulas, and resect a large portion of colon due to continuing infection. Treatment lasted 14 months.

PATIENT'S CLAIM The gynecologic oncologist was negligent in failing to timely diagnose and treat the bowel perforation. Earlier repair would have curtailed development of the abscesses and fistulae.

PHYSICIAN'S DEFENSE Any complications the patient experienced were unrelated to any delay in treatment. 

VERDICT A $612,237 Michigan verdict was returned.

Colon perforated during abdominal access

WHEN A MORBIDLY OBESE 37-YEAR-OLD WOMAN reported chronic pelvic pain, her gynecologist suspected endometriosis. Conservative treatment failed and the gynecologist offered laparoscopic hysterectomy.

After abdominal insufflation was unsuccessfully attempted twice using a Veress needle, the gynecologist entered the abdomen with a Visiport optical trocar, and continued the procedure. The gynecologist inspected the abdomen before closing but found no injuries.

The patient did not do well after surgery. CT scan detected a bowel perforation on postoperative day 6. During exploratory laparotomy, a through-and-through “bayonet” colon perforation was repaired. Because of the extensive infection, the patient’s surgical wound was left open and several “washouts” were performed; the wound was closed several weeks later. The patient also underwent two adhesiolysis procedures.

PATIENT'S CLAIM Access to the abdomen was not properly performed and caused colon perforation. The injury should have been found and treated earlier.

PHYSICIAN'S DEFENSE The case was settled before trial.

VERDICT A $750,000 Virginia settlement was reached.

READ How to avoid intestinal and urinary tract injuries during gynecologic laparoscopy, by Michael Baggish, MD (Surgical Techniques, October 2012) What caused this C. diff infection after hysterectomy?

AFTER A HYSTERECTOMY, a 42-year-old woman developed a persistent fever and increased white blood cell count. The gynecologist prescribed ciprofloxacin for a urinary tract infection, and discharged the patient from the hospital on postoperative day 4. She returned to the gynecologist’s office with severe abdominal pain and vomiting 4 days after discharge. The gynecologist prescribed an antacid and told her to continue taking ciprofloxacin.

The patient was taken to the ED by ambulance 3 days later. Testing revealed a Clostridium dificule (C. diff) infection. During emergency surgery, a large portion of her colon was resected, and a colostomy was performed. The colostomy was reversed 6 months later. The patient developed an incisional hernia and has abdominal scarring.

PATIENT'S CLAIM Prophylactic antibiotics should have been prescribed before surgery.

Two possible scenarios were presented: 1) A bowel injury occurred during surgery, and ciprofloxacin likely worsened the infection caused by the bowel injury; or 2) ciprofloxacin triggered the C. diff infection that caused leaking colon perforations and subsequent peritonitis.

The colon perforations could have been avoided if the gynecologist had diagnosed and treated the C. diff infection in a timely manner.

PHYSICIAN'S DEFENSE The patient’s symptoms did not suggest a C. diff infection; testing was not necessary. Ciprofloxacin might have allowed the proliferation of the C. diff infection, but the use of the drug was not negligent. The infection was not preventable and could not have been diagnosed earlier.

VERDICT A $776,000 New York verdict was returned.

Brain injury and cerebral palsy: When did this occur?

DURING LABOR AND DELIVERY, there were periods when the fetal heart-rate tracings were nonreassuring with variable decelerations and fetal tachycardia; some variables were severe. The child suffered anoxic encephalopathy that caused neurologic injury and cerebral palsy.

PARENTS' CLAIM The infant suffered numerous hypoxic incidents before cesarean delivery was performed. An earlier cesarean delivery could have prevented the injury.

PHYSICIAN'S DEFENSE The newborn had a normal blood cord gas level of 7.2 pH and Apgar scores of 9 and 10, at 1 and 5 minutes, respectively. Fetal heart-rate tracings did not show evidence of fetal hypoxia. The brain injury likely occurred prior to the onset of labor and was possibly related to a viral encephalopathy. 

VERDICT A Virginia defense verdict was returned. These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska (www.verdictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.

gb

AN OBGYN ENCOUNTERED SHOULDER DYSTOCIA. He used fundal pressure and downward lateral traction to free the baby’s shoulder. The child has a brachial plexus injury of the right shoulder, including nerve avulsion, a fractured clavicle, and permanent disfigurement. She underwent surgery; physical and occupational therapy will continue.

PARENTS' CLAIM The standard sequence of maneuvers should have been attempted before fundal pressure and lateral traction were used—the baby was sufficiently oxygenated to allow time for these maneuvers. Excessive lateral traction caused the injury.

DEFENDANTS' DEFENSE The injuries occurred in utero before or while the fetus progressed down the birth canal, and were due to the maternal forces of labor.

VERDICT A $3,070,000 Michigan verdict was returned against the hospital, ObGyn, and ObGyn group.

WHAT IS THE STANDARD SEQUENCE OF MANEUVERS FOR SHOULDER DYSTOCIA?
Read Dr. Robert L. Barbieri’s May Editorial, You are the second responder to a shoulder dystocia emergency. What do you do first? and Dr. Ronald T. Burkman’s March Stop/Start article, Stop all activities that may lead to further shoulder impaction when you suspect possible shoulder dystocia Meconium aspiration leads to brain injury

LATE IN HER PREGNANCY, a woman went to the emergency department (ED) with hypertension; she was discharged the same day. She saw her ObGyns, Dr. A and Dr. B, three times in the next 2 weeks. A day after her last visit, she returned to the ED in active labor. Dr. B assumed her care. Fetal monitoring indicated a nonreassuring heart rate with decelerations. Dr. B administered oxytocin and labor continued.

The baby was born by cesarean delivery after 25 minutes of fetal bradycardia. She was covered in meconium, with a low heart rate and irregular, labored respirations. The baby was transferred to another hospital, where she was treated for pulmonary hypertension, meconium aspiration, and seizures. The child is totally disabled, and will require constant care for life.

PARENTS' CLAIM The mother’s hypertension was not properly treated. Dr. B and the nurse waited too long to perform a cesarean delivery.

DEFENDANTS' DEFENSE Proper prenatal care was provided. There was no reason for additional testing; fetal heart tones at the mother’s last office visit were reactive. There were no clinical signs of a hematoma or cord varix during office visits. An unpredictable, unpreventable umbilical cord hematoma caused ischemia and hypoxia, and the subsequent brain injury. Meconium had been in the amniotic fluid for at least 10 hours due to the ischemic/hypoxic episode. The hematoma formed between her last office visit and when the mother came to the hospital the next day.

VERDICT Settlements were reached with Dr. A and the hospital. An Arkansas defense verdict was returned for Dr. B and the nurse.

14 months' recovery after mass removed

A GYNECOLOGIC ONCOLOGIST operated on a woman in her 50s to remove a large, noncancerous pelvic mass. The patient, discharged on postoperative day 2, was readmitted the next day with a fever (temperature, 103ºF), nausea, vomiting, and abdominal pain. Four days later, the oncologist repaired a perforated bowel and created an ileostomy. Other procedures were needed to drain abscesses and repair fistulas, and resect a large portion of colon due to continuing infection. Treatment lasted 14 months.

PATIENT'S CLAIM The gynecologic oncologist was negligent in failing to timely diagnose and treat the bowel perforation. Earlier repair would have curtailed development of the abscesses and fistulae.

PHYSICIAN'S DEFENSE Any complications the patient experienced were unrelated to any delay in treatment. 

VERDICT A $612,237 Michigan verdict was returned.

Colon perforated during abdominal access

WHEN A MORBIDLY OBESE 37-YEAR-OLD WOMAN reported chronic pelvic pain, her gynecologist suspected endometriosis. Conservative treatment failed and the gynecologist offered laparoscopic hysterectomy.

After abdominal insufflation was unsuccessfully attempted twice using a Veress needle, the gynecologist entered the abdomen with a Visiport optical trocar, and continued the procedure. The gynecologist inspected the abdomen before closing but found no injuries.

The patient did not do well after surgery. CT scan detected a bowel perforation on postoperative day 6. During exploratory laparotomy, a through-and-through “bayonet” colon perforation was repaired. Because of the extensive infection, the patient’s surgical wound was left open and several “washouts” were performed; the wound was closed several weeks later. The patient also underwent two adhesiolysis procedures.

PATIENT'S CLAIM Access to the abdomen was not properly performed and caused colon perforation. The injury should have been found and treated earlier.

PHYSICIAN'S DEFENSE The case was settled before trial.

VERDICT A $750,000 Virginia settlement was reached.

READ How to avoid intestinal and urinary tract injuries during gynecologic laparoscopy, by Michael Baggish, MD (Surgical Techniques, October 2012) What caused this C. diff infection after hysterectomy?

AFTER A HYSTERECTOMY, a 42-year-old woman developed a persistent fever and increased white blood cell count. The gynecologist prescribed ciprofloxacin for a urinary tract infection, and discharged the patient from the hospital on postoperative day 4. She returned to the gynecologist’s office with severe abdominal pain and vomiting 4 days after discharge. The gynecologist prescribed an antacid and told her to continue taking ciprofloxacin.

The patient was taken to the ED by ambulance 3 days later. Testing revealed a Clostridium dificule (C. diff) infection. During emergency surgery, a large portion of her colon was resected, and a colostomy was performed. The colostomy was reversed 6 months later. The patient developed an incisional hernia and has abdominal scarring.

PATIENT'S CLAIM Prophylactic antibiotics should have been prescribed before surgery.

Two possible scenarios were presented: 1) A bowel injury occurred during surgery, and ciprofloxacin likely worsened the infection caused by the bowel injury; or 2) ciprofloxacin triggered the C. diff infection that caused leaking colon perforations and subsequent peritonitis.

The colon perforations could have been avoided if the gynecologist had diagnosed and treated the C. diff infection in a timely manner.

PHYSICIAN'S DEFENSE The patient’s symptoms did not suggest a C. diff infection; testing was not necessary. Ciprofloxacin might have allowed the proliferation of the C. diff infection, but the use of the drug was not negligent. The infection was not preventable and could not have been diagnosed earlier.

VERDICT A $776,000 New York verdict was returned.

Brain injury and cerebral palsy: When did this occur?

DURING LABOR AND DELIVERY, there were periods when the fetal heart-rate tracings were nonreassuring with variable decelerations and fetal tachycardia; some variables were severe. The child suffered anoxic encephalopathy that caused neurologic injury and cerebral palsy.

PARENTS' CLAIM The infant suffered numerous hypoxic incidents before cesarean delivery was performed. An earlier cesarean delivery could have prevented the injury.

PHYSICIAN'S DEFENSE The newborn had a normal blood cord gas level of 7.2 pH and Apgar scores of 9 and 10, at 1 and 5 minutes, respectively. Fetal heart-rate tracings did not show evidence of fetal hypoxia. The brain injury likely occurred prior to the onset of labor and was possibly related to a viral encephalopathy. 

VERDICT A Virginia defense verdict was returned. These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska (www.verdictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.

Child’s brain damage blamed on late cesarean

 A MOTHER WANTED A HOME BIRTH with a midwife. When  complications arose and labor stopped progressing, the midwife called an  ambulance. The emergency department (ED) physician ordered an urgent  cesarean delivery, but the procedure did not begin for another 2 hours.  The child was born with brain damage, multiple physical and mental  disabilities, complex seizure disorder, and cerebral palsy.

PARENTS’ CLAIM The child’s injuries occurred because cesarean delivery was delayed for 2 hours. Based on fetal heart-rate monitoring, the injuries most likely occurred in the last 18 minutes before birth, and were probably caused by compression of the umbilical cord. An earlier cesarean delivery would have avoided the injuries.

DEFENDANTS’ DEFENSE All of the injuries occurred prior to the mother’s arrival at the hospital, while she was under the care of the midwife. Fetal distress was present for an hour before the ambulance was called. When the mother arrived at the ED, she was an unknown patient, as the midwife did not have a collaborating physician. While the ED physician determined that a cesarean delivery was required, it was not considered an emergency. The mother was taken to the OR as soon as possible. Fetal monitoring strips at the hospital were reassuring.

VERDICT A $55 million Maryland verdict was returned against the hospital, including $26 million in noneconomic damages. After the court reduced noneconomic damages and future lost wages awards, the net verdict was $28 million.

ARDS after hysterectomy

A MORBIDLY OBESE WOMAN underwent a hysterectomy. The asthmatic, 38-year-old patient vomited after surgery. A pulmonologist undertook her care and determined that she had acute respiratory distress syndrome (ARDS). He prescribed the administration of oxygen. When she vomited again during the early morning hours of the second postsurgical day, he ordered intubation and went to the hospital immediately, but the patient quickly deteriorated. She died from cardiac arrest.

ESTATE’S CLAIM The patient’s death was due to failure to diagnose and treat ARDS in a timely manner. A bronchoscopy and frequent radiographs should have been performed. If the patient had been intubated earlier and steps had been taken to reduce the risk of vomiting, she would have had a better chance of survival. She should have been transferred to another facility when ARDS was diagnosed.

DEFENDANTS’ DEFENSE A bronchoscopy was not necessary. ARDS was diagnosed and treated in a timely manner. She was too unstable to transfer to another hospital.

VERDICT The hospital reached a confidential settlement, and the claim against the anesthesiologist was dismissed. The trial proceeded against the pulmonologist and his group. A New York defense verdict was returned.

Mother’s HELLP syndrome missed; fetus dies

DURING HER PREGNANCY, a 23-year-old woman was monitored for hypertension by her ObGyn and nurse midwife. At her 36-week prenatal visit, she was found to have preeclampsia, including proteinuria. She was sent directly to the ED, where the baby was monitored and laboratory tests were ordered by a nurse and nurse midwife. After 2 hours, she was told she had a urinary tract infection and discharged. Three days later, she returned to the ED in critical condition; she had suffered an intrauterine fetal demise.

PARENTS’ CLAIM Lab results showed critical values and confirmed that the patient had developed HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. The ED nurse and nurse midwife were negligent in their treatment: They never read the lab results or reported the results to the patient or an ObGyn.

DEFENDANTS’ DEFENSE The case was settled before trial.

VERDICT A $950,000 Virginia settlement was reached.

Was this pregnant prisoner in preterm labor ignored?

 A PREGNANT WOMAN WAS AWAITING TRIAL in County jail when she  went into preterm labor. She was taken to the ED but released 2 hours  later, although she was dilated 2–3 cm and having contractions. She was  returned to her locked cell and not monitored—no deputy or nurse was  within sight or sound of the patient. Her water broke and contractions  increased. Despite her screams, and those of other inmates, a nurse  didn’t arrive for 2 hours, when the baby’s head was crowning. EMS services were called and the baby was delivered in the jail cell. The child had no heartbeat or respiration. Mother and baby were transported to the hospital, where the child was resuscitated. She has severe mental impairment and cerebral palsy.

There is no documentation that the mother received any prenatal or postpartum care in jail. The mother is now serving a life sentence after a conviction for felony murder, kidnapping, and conspiracy.

CHILD’S CLAIM The case was brought on behalf of the child, and claimed that deliberate indifference and the failure to provide medical attention caused the child’s impairments.

DEFENDANTS’ DEFENSE The County claimed qualified immunity as a government entity and argued that, when the child was injured, she was still a fetus, and therefore not protected by the Constitution and civil rights laws.

VERDICT The US Circuit Court of Appeals rejected the County’s argument that the child was not protected by the Constitution. An $8 million Michigan settlement was reached.

Dermoid cyst still present after wrong-site surgery

A DERMOID CYST WAS DETECTED on the left ovary of a 28-year-old woman during prenatal ultrasonography (US). A year later, US confirmed the dermoid cyst, and the patient underwent outpatient cystectomy.

At the first postsurgical visit, the patient reported right pelvic pain. When she called the ObGyn’s office a few days later to again report right pelvic pain, her call was not returned.

She then went to the ED, where testing determined that the ObGyn had performed a right salpingo-oophorectomy and that her left ovary and cyst were still intact. She again attempted to contact the ObGyn, without response.

PATIENT’S CLAIM The ObGyn performed wrong-site surgery. The patient was not informed of the error during a postsurgical visit, nor were her attempts at contacting the physician returned. Still at risk for malignancy, she is facing a second surgical procedure to remove the cyst. Her fertility is diminished due to the surgical error, and she suffers anxiety and mental stress as a result of the situation.

At first, the ObGyn refused to provide medical records to the patient’s lawyer. When the records were obtained and compared with records obtained from another physician who treated the patient, it was evident that the ObGyn had altered the records to state that the patient had complained of right-side pain.

PHYSICIAN’S DEFENSE There was no negligence. The patient was properly treated for right-sided pain. The records were not altered.

VERDICT A $1.42 million Maryland verdict was returned. The state cap on noneconomic damages will reduce the verdict to $680,000.

Sponge left behind after vacuum-assisted closure

A WOMAN WENT TO THE ED with abdominal pain. It was determined that she had an abdominal abscess, and a surgeon assumed her care. After surgically draining the abdominal abscess, the surgeon placed a large black sponge into the abdominal cavity and then used vacuum-assisted closure. The patient was discharged 6 days later. She continued to receive treatment for a surgical-site infection that failed to heal. Two weeks later, the patient was readmitted to the hospital for exploratory surgery. The surgeon found and removed the sponge.

PATIENT’S CLAIM The surgeon was negligent for leaving the surgical sponge in the patient’s abdomen. She claimed pain, scarring, wound necrosis, infection, and the need for additional hospitalizations due to retention of the sponge.

PHYSICIAN’S DEFENSE A settlement was reached during the trial.

VERDICT A confidential Florida settlement was reached.

Child’s brain damage blamed on late cesarean

 A MOTHER WANTED A HOME BIRTH with a midwife. When  complications arose and labor stopped progressing, the midwife called an  ambulance. The emergency department (ED) physician ordered an urgent  cesarean delivery, but the procedure did not begin for another 2 hours.  The child was born with brain damage, multiple physical and mental  disabilities, complex seizure disorder, and cerebral palsy.

PARENTS’ CLAIM The child’s injuries occurred because cesarean delivery was delayed for 2 hours. Based on fetal heart-rate monitoring, the injuries most likely occurred in the last 18 minutes before birth, and were probably caused by compression of the umbilical cord. An earlier cesarean delivery would have avoided the injuries.

DEFENDANTS’ DEFENSE All of the injuries occurred prior to the mother’s arrival at the hospital, while she was under the care of the midwife. Fetal distress was present for an hour before the ambulance was called. When the mother arrived at the ED, she was an unknown patient, as the midwife did not have a collaborating physician. While the ED physician determined that a cesarean delivery was required, it was not considered an emergency. The mother was taken to the OR as soon as possible. Fetal monitoring strips at the hospital were reassuring.

VERDICT A $55 million Maryland verdict was returned against the hospital, including $26 million in noneconomic damages. After the court reduced noneconomic damages and future lost wages awards, the net verdict was $28 million.

ARDS after hysterectomy

A MORBIDLY OBESE WOMAN underwent a hysterectomy. The asthmatic, 38-year-old patient vomited after surgery. A pulmonologist undertook her care and determined that she had acute respiratory distress syndrome (ARDS). He prescribed the administration of oxygen. When she vomited again during the early morning hours of the second postsurgical day, he ordered intubation and went to the hospital immediately, but the patient quickly deteriorated. She died from cardiac arrest.

ESTATE’S CLAIM The patient’s death was due to failure to diagnose and treat ARDS in a timely manner. A bronchoscopy and frequent radiographs should have been performed. If the patient had been intubated earlier and steps had been taken to reduce the risk of vomiting, she would have had a better chance of survival. She should have been transferred to another facility when ARDS was diagnosed.

DEFENDANTS’ DEFENSE A bronchoscopy was not necessary. ARDS was diagnosed and treated in a timely manner. She was too unstable to transfer to another hospital.

VERDICT The hospital reached a confidential settlement, and the claim against the anesthesiologist was dismissed. The trial proceeded against the pulmonologist and his group. A New York defense verdict was returned.

Mother’s HELLP syndrome missed; fetus dies

DURING HER PREGNANCY, a 23-year-old woman was monitored for hypertension by her ObGyn and nurse midwife. At her 36-week prenatal visit, she was found to have preeclampsia, including proteinuria. She was sent directly to the ED, where the baby was monitored and laboratory tests were ordered by a nurse and nurse midwife. After 2 hours, she was told she had a urinary tract infection and discharged. Three days later, she returned to the ED in critical condition; she had suffered an intrauterine fetal demise.

PARENTS’ CLAIM Lab results showed critical values and confirmed that the patient had developed HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. The ED nurse and nurse midwife were negligent in their treatment: They never read the lab results or reported the results to the patient or an ObGyn.

DEFENDANTS’ DEFENSE The case was settled before trial.

VERDICT A $950,000 Virginia settlement was reached.

Was this pregnant prisoner in preterm labor ignored?

 A PREGNANT WOMAN WAS AWAITING TRIAL in County jail when she  went into preterm labor. She was taken to the ED but released 2 hours  later, although she was dilated 2–3 cm and having contractions. She was  returned to her locked cell and not monitored—no deputy or nurse was  within sight or sound of the patient. Her water broke and contractions  increased. Despite her screams, and those of other inmates, a nurse  didn’t arrive for 2 hours, when the baby’s head was crowning. EMS services were called and the baby was delivered in the jail cell. The child had no heartbeat or respiration. Mother and baby were transported to the hospital, where the child was resuscitated. She has severe mental impairment and cerebral palsy.

There is no documentation that the mother received any prenatal or postpartum care in jail. The mother is now serving a life sentence after a conviction for felony murder, kidnapping, and conspiracy.

CHILD’S CLAIM The case was brought on behalf of the child, and claimed that deliberate indifference and the failure to provide medical attention caused the child’s impairments.

DEFENDANTS’ DEFENSE The County claimed qualified immunity as a government entity and argued that, when the child was injured, she was still a fetus, and therefore not protected by the Constitution and civil rights laws.

VERDICT The US Circuit Court of Appeals rejected the County’s argument that the child was not protected by the Constitution. An $8 million Michigan settlement was reached.

Dermoid cyst still present after wrong-site surgery

A DERMOID CYST WAS DETECTED on the left ovary of a 28-year-old woman during prenatal ultrasonography (US). A year later, US confirmed the dermoid cyst, and the patient underwent outpatient cystectomy.

At the first postsurgical visit, the patient reported right pelvic pain. When she called the ObGyn’s office a few days later to again report right pelvic pain, her call was not returned.

She then went to the ED, where testing determined that the ObGyn had performed a right salpingo-oophorectomy and that her left ovary and cyst were still intact. She again attempted to contact the ObGyn, without response.

PATIENT’S CLAIM The ObGyn performed wrong-site surgery. The patient was not informed of the error during a postsurgical visit, nor were her attempts at contacting the physician returned. Still at risk for malignancy, she is facing a second surgical procedure to remove the cyst. Her fertility is diminished due to the surgical error, and she suffers anxiety and mental stress as a result of the situation.

At first, the ObGyn refused to provide medical records to the patient’s lawyer. When the records were obtained and compared with records obtained from another physician who treated the patient, it was evident that the ObGyn had altered the records to state that the patient had complained of right-side pain.

PHYSICIAN’S DEFENSE There was no negligence. The patient was properly treated for right-sided pain. The records were not altered.

VERDICT A $1.42 million Maryland verdict was returned. The state cap on noneconomic damages will reduce the verdict to $680,000.

Sponge left behind after vacuum-assisted closure

A WOMAN WENT TO THE ED with abdominal pain. It was determined that she had an abdominal abscess, and a surgeon assumed her care. After surgically draining the abdominal abscess, the surgeon placed a large black sponge into the abdominal cavity and then used vacuum-assisted closure. The patient was discharged 6 days later. She continued to receive treatment for a surgical-site infection that failed to heal. Two weeks later, the patient was readmitted to the hospital for exploratory surgery. The surgeon found and removed the sponge.

PATIENT’S CLAIM The surgeon was negligent for leaving the surgical sponge in the patient’s abdomen. She claimed pain, scarring, wound necrosis, infection, and the need for additional hospitalizations due to retention of the sponge.

PHYSICIAN’S DEFENSE A settlement was reached during the trial.

VERDICT A confidential Florida settlement was reached.

Child’s brain damage blamed on late cesarean

 A MOTHER WANTED A HOME BIRTH with a midwife. When  complications arose and labor stopped progressing, the midwife called an  ambulance. The emergency department (ED) physician ordered an urgent  cesarean delivery, but the procedure did not begin for another 2 hours.  The child was born with brain damage, multiple physical and mental  disabilities, complex seizure disorder, and cerebral palsy.

PARENTS’ CLAIM The child’s injuries occurred because cesarean delivery was delayed for 2 hours. Based on fetal heart-rate monitoring, the injuries most likely occurred in the last 18 minutes before birth, and were probably caused by compression of the umbilical cord. An earlier cesarean delivery would have avoided the injuries.

DEFENDANTS’ DEFENSE All of the injuries occurred prior to the mother’s arrival at the hospital, while she was under the care of the midwife. Fetal distress was present for an hour before the ambulance was called. When the mother arrived at the ED, she was an unknown patient, as the midwife did not have a collaborating physician. While the ED physician determined that a cesarean delivery was required, it was not considered an emergency. The mother was taken to the OR as soon as possible. Fetal monitoring strips at the hospital were reassuring.

VERDICT A $55 million Maryland verdict was returned against the hospital, including $26 million in noneconomic damages. After the court reduced noneconomic damages and future lost wages awards, the net verdict was $28 million.

ARDS after hysterectomy

A MORBIDLY OBESE WOMAN underwent a hysterectomy. The asthmatic, 38-year-old patient vomited after surgery. A pulmonologist undertook her care and determined that she had acute respiratory distress syndrome (ARDS). He prescribed the administration of oxygen. When she vomited again during the early morning hours of the second postsurgical day, he ordered intubation and went to the hospital immediately, but the patient quickly deteriorated. She died from cardiac arrest.

ESTATE’S CLAIM The patient’s death was due to failure to diagnose and treat ARDS in a timely manner. A bronchoscopy and frequent radiographs should have been performed. If the patient had been intubated earlier and steps had been taken to reduce the risk of vomiting, she would have had a better chance of survival. She should have been transferred to another facility when ARDS was diagnosed.

DEFENDANTS’ DEFENSE A bronchoscopy was not necessary. ARDS was diagnosed and treated in a timely manner. She was too unstable to transfer to another hospital.

VERDICT The hospital reached a confidential settlement, and the claim against the anesthesiologist was dismissed. The trial proceeded against the pulmonologist and his group. A New York defense verdict was returned.

Mother’s HELLP syndrome missed; fetus dies

DURING HER PREGNANCY, a 23-year-old woman was monitored for hypertension by her ObGyn and nurse midwife. At her 36-week prenatal visit, she was found to have preeclampsia, including proteinuria. She was sent directly to the ED, where the baby was monitored and laboratory tests were ordered by a nurse and nurse midwife. After 2 hours, she was told she had a urinary tract infection and discharged. Three days later, she returned to the ED in critical condition; she had suffered an intrauterine fetal demise.

PARENTS’ CLAIM Lab results showed critical values and confirmed that the patient had developed HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. The ED nurse and nurse midwife were negligent in their treatment: They never read the lab results or reported the results to the patient or an ObGyn.

DEFENDANTS’ DEFENSE The case was settled before trial.

VERDICT A $950,000 Virginia settlement was reached.

Was this pregnant prisoner in preterm labor ignored?

 A PREGNANT WOMAN WAS AWAITING TRIAL in County jail when she  went into preterm labor. She was taken to the ED but released 2 hours  later, although she was dilated 2–3 cm and having contractions. She was  returned to her locked cell and not monitored—no deputy or nurse was  within sight or sound of the patient. Her water broke and contractions  increased. Despite her screams, and those of other inmates, a nurse  didn’t arrive for 2 hours, when the baby’s head was crowning. EMS services were called and the baby was delivered in the jail cell. The child had no heartbeat or respiration. Mother and baby were transported to the hospital, where the child was resuscitated. She has severe mental impairment and cerebral palsy.

There is no documentation that the mother received any prenatal or postpartum care in jail. The mother is now serving a life sentence after a conviction for felony murder, kidnapping, and conspiracy.

CHILD’S CLAIM The case was brought on behalf of the child, and claimed that deliberate indifference and the failure to provide medical attention caused the child’s impairments.

DEFENDANTS’ DEFENSE The County claimed qualified immunity as a government entity and argued that, when the child was injured, she was still a fetus, and therefore not protected by the Constitution and civil rights laws.

VERDICT The US Circuit Court of Appeals rejected the County’s argument that the child was not protected by the Constitution. An $8 million Michigan settlement was reached.

Dermoid cyst still present after wrong-site surgery

A DERMOID CYST WAS DETECTED on the left ovary of a 28-year-old woman during prenatal ultrasonography (US). A year later, US confirmed the dermoid cyst, and the patient underwent outpatient cystectomy.

At the first postsurgical visit, the patient reported right pelvic pain. When she called the ObGyn’s office a few days later to again report right pelvic pain, her call was not returned.

She then went to the ED, where testing determined that the ObGyn had performed a right salpingo-oophorectomy and that her left ovary and cyst were still intact. She again attempted to contact the ObGyn, without response.

PATIENT’S CLAIM The ObGyn performed wrong-site surgery. The patient was not informed of the error during a postsurgical visit, nor were her attempts at contacting the physician returned. Still at risk for malignancy, she is facing a second surgical procedure to remove the cyst. Her fertility is diminished due to the surgical error, and she suffers anxiety and mental stress as a result of the situation.

At first, the ObGyn refused to provide medical records to the patient’s lawyer. When the records were obtained and compared with records obtained from another physician who treated the patient, it was evident that the ObGyn had altered the records to state that the patient had complained of right-side pain.

PHYSICIAN’S DEFENSE There was no negligence. The patient was properly treated for right-sided pain. The records were not altered.

VERDICT A $1.42 million Maryland verdict was returned. The state cap on noneconomic damages will reduce the verdict to $680,000.

Sponge left behind after vacuum-assisted closure

A WOMAN WENT TO THE ED with abdominal pain. It was determined that she had an abdominal abscess, and a surgeon assumed her care. After surgically draining the abdominal abscess, the surgeon placed a large black sponge into the abdominal cavity and then used vacuum-assisted closure. The patient was discharged 6 days later. She continued to receive treatment for a surgical-site infection that failed to heal. Two weeks later, the patient was readmitted to the hospital for exploratory surgery. The surgeon found and removed the sponge.

PATIENT’S CLAIM The surgeon was negligent for leaving the surgical sponge in the patient’s abdomen. She claimed pain, scarring, wound necrosis, infection, and the need for additional hospitalizations due to retention of the sponge.

PHYSICIAN’S DEFENSE A settlement was reached during the trial.

VERDICT A confidential Florida settlement was reached.

Failure to spot postpartum danger leads to permanent disability

AFTER 2 HOSPITALIZATIONS FOR HYPERTENSION ordered by her physician, a pregnant 41-year-old woman gave birth to a daughter by cesarean section on December 17. She was discharged 2 days later with a blood pressure of 130/90 mm Hg.

On December 21, the woman went to her doctor’s office, complaining that she didn’t feel well and had severe swelling. A nurse took her blood pressure twice, obtaining readings of 170/88 and 168/90 mm Hg. She sent the patient home without an examination by the doctor. On her way out of the office, the patient passed the doctor in the hallway and, she claimed, told him she wasn’t feeling well and that her blood pressure was high. She said he told her to double her blood pressure medication.

That evening the patient had trouble breathing and was taken by paramedics to a hospital, where she was intubated. She didn’t have a pulse for 15 minutes, leading to permanent brain damage.

The patient can’t walk without help and can’t feed herself because her hands are contorted. She’s legally blind, suffers from short-term memory loss, and has difficulty speaking.

PLAINTIFF’S CLAIM The patient had classic signs of postpartum cardiomyopathy. If the doctor had looked at her blood pressure readings and examined her while she was at the office, she would have received appropriate treatment and avoided injury.

THE DEFENSE The patient went to the doctor’s office to show the staff her baby and have her blood pressure checked, not because she was feeling ill. The doctor would have examined the patient if he had been told of the blood pressure readings.

VERDICT $5 million Georgia verdict.

COMMENT For the vast majority of patients, a blood pressure of 170/88 mm Hg is not a medical emergency or even urgent. But for a woman 4 days postpartum with significant edema, it is. This case illustrates the ultimate challenge of family medicine: identifying and treating the dangerous situations among the many mundane ones.

Persistent pain requires more than medication

PAIN IN HER CHEST AND SHOULDERS prompted a 27-year-old woman to seek medical attention. Her physician attributed the pain to muscle strain and prescribed medication. Six months later the patient returned to the doctor complaining of continuing pain. The doctor concluded that the position in which the patient slept was causing the pain and prescribed painkillers.

After 9 months, the pain still had not resolved. The patient was given a diagnosis of stage II Hodgkin’s lymphoma, which went into remission after aggressive treatment.

PLAINTIFF’S CLAIM The pain was caused by the cancer, which had been present at all of the patient’s visits with her doctor. The doctor was negligent in failing to diagnose the cancer promptly, necessitating more aggressive treatment than would otherwise have been required.

THE DEFENSE The patient’s pain was episodic and varied; it didn’t warrant diagnostic testing. The patient failed to follow through on physical therapy that the physician had prescribed. The patient denied that the doctor had prescribed physical therapy.

VERDICT $800,000 New York verdict.

COMMENT Persistence of symptoms dictates persistence of work-up. After 6 months of pain, the patient should have had a more detailed evaluation. On a personal note, I had a patient just like this one several years ago; a chest radiograph revealed her lymphoma.

Failure to spot postpartum danger leads to permanent disability

AFTER 2 HOSPITALIZATIONS FOR HYPERTENSION ordered by her physician, a pregnant 41-year-old woman gave birth to a daughter by cesarean section on December 17. She was discharged 2 days later with a blood pressure of 130/90 mm Hg.

On December 21, the woman went to her doctor’s office, complaining that she didn’t feel well and had severe swelling. A nurse took her blood pressure twice, obtaining readings of 170/88 and 168/90 mm Hg. She sent the patient home without an examination by the doctor. On her way out of the office, the patient passed the doctor in the hallway and, she claimed, told him she wasn’t feeling well and that her blood pressure was high. She said he told her to double her blood pressure medication.

That evening the patient had trouble breathing and was taken by paramedics to a hospital, where she was intubated. She didn’t have a pulse for 15 minutes, leading to permanent brain damage.

The patient can’t walk without help and can’t feed herself because her hands are contorted. She’s legally blind, suffers from short-term memory loss, and has difficulty speaking.

PLAINTIFF’S CLAIM The patient had classic signs of postpartum cardiomyopathy. If the doctor had looked at her blood pressure readings and examined her while she was at the office, she would have received appropriate treatment and avoided injury.

THE DEFENSE The patient went to the doctor’s office to show the staff her baby and have her blood pressure checked, not because she was feeling ill. The doctor would have examined the patient if he had been told of the blood pressure readings.

VERDICT $5 million Georgia verdict.

COMMENT For the vast majority of patients, a blood pressure of 170/88 mm Hg is not a medical emergency or even urgent. But for a woman 4 days postpartum with significant edema, it is. This case illustrates the ultimate challenge of family medicine: identifying and treating the dangerous situations among the many mundane ones.

Persistent pain requires more than medication

PAIN IN HER CHEST AND SHOULDERS prompted a 27-year-old woman to seek medical attention. Her physician attributed the pain to muscle strain and prescribed medication. Six months later the patient returned to the doctor complaining of continuing pain. The doctor concluded that the position in which the patient slept was causing the pain and prescribed painkillers.

After 9 months, the pain still had not resolved. The patient was given a diagnosis of stage II Hodgkin’s lymphoma, which went into remission after aggressive treatment.

PLAINTIFF’S CLAIM The pain was caused by the cancer, which had been present at all of the patient’s visits with her doctor. The doctor was negligent in failing to diagnose the cancer promptly, necessitating more aggressive treatment than would otherwise have been required.

THE DEFENSE The patient’s pain was episodic and varied; it didn’t warrant diagnostic testing. The patient failed to follow through on physical therapy that the physician had prescribed. The patient denied that the doctor had prescribed physical therapy.

VERDICT $800,000 New York verdict.

COMMENT Persistence of symptoms dictates persistence of work-up. After 6 months of pain, the patient should have had a more detailed evaluation. On a personal note, I had a patient just like this one several years ago; a chest radiograph revealed her lymphoma.

Failure to spot postpartum danger leads to permanent disability

AFTER 2 HOSPITALIZATIONS FOR HYPERTENSION ordered by her physician, a pregnant 41-year-old woman gave birth to a daughter by cesarean section on December 17. She was discharged 2 days later with a blood pressure of 130/90 mm Hg.

On December 21, the woman went to her doctor’s office, complaining that she didn’t feel well and had severe swelling. A nurse took her blood pressure twice, obtaining readings of 170/88 and 168/90 mm Hg. She sent the patient home without an examination by the doctor. On her way out of the office, the patient passed the doctor in the hallway and, she claimed, told him she wasn’t feeling well and that her blood pressure was high. She said he told her to double her blood pressure medication.

That evening the patient had trouble breathing and was taken by paramedics to a hospital, where she was intubated. She didn’t have a pulse for 15 minutes, leading to permanent brain damage.

The patient can’t walk without help and can’t feed herself because her hands are contorted. She’s legally blind, suffers from short-term memory loss, and has difficulty speaking.

PLAINTIFF’S CLAIM The patient had classic signs of postpartum cardiomyopathy. If the doctor had looked at her blood pressure readings and examined her while she was at the office, she would have received appropriate treatment and avoided injury.

THE DEFENSE The patient went to the doctor’s office to show the staff her baby and have her blood pressure checked, not because she was feeling ill. The doctor would have examined the patient if he had been told of the blood pressure readings.

VERDICT $5 million Georgia verdict.

COMMENT For the vast majority of patients, a blood pressure of 170/88 mm Hg is not a medical emergency or even urgent. But for a woman 4 days postpartum with significant edema, it is. This case illustrates the ultimate challenge of family medicine: identifying and treating the dangerous situations among the many mundane ones.

Persistent pain requires more than medication

PAIN IN HER CHEST AND SHOULDERS prompted a 27-year-old woman to seek medical attention. Her physician attributed the pain to muscle strain and prescribed medication. Six months later the patient returned to the doctor complaining of continuing pain. The doctor concluded that the position in which the patient slept was causing the pain and prescribed painkillers.

After 9 months, the pain still had not resolved. The patient was given a diagnosis of stage II Hodgkin’s lymphoma, which went into remission after aggressive treatment.

PLAINTIFF’S CLAIM The pain was caused by the cancer, which had been present at all of the patient’s visits with her doctor. The doctor was negligent in failing to diagnose the cancer promptly, necessitating more aggressive treatment than would otherwise have been required.

THE DEFENSE The patient’s pain was episodic and varied; it didn’t warrant diagnostic testing. The patient failed to follow through on physical therapy that the physician had prescribed. The patient denied that the doctor had prescribed physical therapy.

VERDICT $800,000 New York verdict.

COMMENT Persistence of symptoms dictates persistence of work-up. After 6 months of pain, the patient should have had a more detailed evaluation. On a personal note, I had a patient just like this one several years ago; a chest radiograph revealed her lymphoma.

Postpartum high BP; mother suffers brain damage

HOSPITALIZED TWICE FOR HYPERTENSION in the month before her child was born, a 41-year-old woman gave birth to a healthy baby by cesarean delivery. The mother was discharged 2 days later with a blood pressure (BP) of 130/90 mm Hg.

Three days later, she went to her ObGyn’s office because she was not feeling well and had extreme swelling. Her BP, taken twice by a nurse, read 170/88 mm Hg, and 168/90 mm Hg, but she was not examined by the ObGyn.

That evening, the patient had difficulty breathing and was taken to the emergency department (ED), where she was intubated. She went into cardiac arrest and suffered permanent brain damage after being without a pulse for 15 minutes. She was in a coma for 45 days. She is unable to walk without assistance, is legally blind, and her hands are so contorted that she cannot feed herself. She suffers from short-term memory loss and has difficulty speaking.

PATIENT’S CLAIM The ObGyn should have examined her when she was at the office. Her hypertension would have been properly treated and injuries avoided. She had classic signs of postpartum cardiomyopathy.

PHYSICIAN’S DEFENSE The patient had not come to the office because she was feeling ill, but to show off her baby and have her BP checked. If he had been advised of the BP readings, he would have examined her.

VERDICT A $5 million Georgia verdict was returned.

Cervical biopsy results improperly reported

A 44-YEAR-OLD WOMAN UNDERWENT a cervical biopsy in July 2007 performed by a pathologist. A few days later, the pathologist contacted the patient and reported that the biopsy revealed invasive cervical cancer that required immediate surgery. Several procedures were performed without any cancer ever being found.

A second opinion was sought, and it was determined that the cancer diagnosis was incorrect; another patient’s pathology had been reported as the patient’s.

PATIENT’S CLAIM The pathologist and hospital were negligent in reporting incorrect results of the cervical biopsy, which resulted in the patient’s physical and emotional injuries, including unnecessary surgical procedures and depression and anxiety.

DEFENDANTS’ DEFENSE The defendants did not oppose the patient’s motion for summary judgment on liability; the issue of damages was contested.

VERDICT The patient received summary judgment on liability. She then discontinued claims against the pathologist, and the matter proceeded on damages against the hospital. A $46,000 New York verdict was returned. Stipulated medical expenses were added to the verdict for a total recovery of $60,979.

Brachial plexus injury: child has significant functional disability

AT 38 6/7 WEEKS’ GESTATION, a 23-year-old woman went to the ED with contractions. She had pregestational diabetes mellitus. Her admitting glucose level was 143 mg/dL, and she had gained 25 lb during pregnancy. Her fundal height was 40 cm, and estimated fetal weight was 4000 g (8 lb 13 oz). A pelvic examination determined that she was 3 to 4 cm dilated, 100% effaced, and at minus-1 station. She was given oxytocin to aid labor. The ObGyn noted that overall fetal heart-rate tracings were reassuring, and that a pediatrician would be present for delivery due to suspected macrosomia. Shoulder dystocia occurred during delivery, but it was resolved in 40 seconds. The mother sustained a second-degree perineal laceration.

At birth, the baby’s left arm was limp. Apgar scores were 5 and 9 at 1 and 5 minutes, respectively. Her birth weight was 10 lb 2 oz. A brachial plexus injury was diagnosed, and she underwent surgery in October 2008. Despite successful nerve grafts at C5 and C6, the child has significant functional disability in the left arm.

PARENTS’ CLAIM A cesarean delivery should have been scheduled when a macrosomic fetus was suspected.

PHYSICIAN’S DEFENSE The case was settled during trial.

VERDICT A $1,475,000 Maryland settlement was reached.

Breech position and umbilical cord prolapse: Was everything done that could be done?

DURING A MOTHER’S 38-WEEK PRENATAL VISIT, ultrasonography showed the baby was in breech position. The midwife offered two options: to schedule an external cephalic version procedure at 38 weeks or a cesarean delivery at 39 weeks. The parents agreed to schedule a cesarean delivery for 8 days later. The day before the scheduled birth, the mother awoke to find the umbilical cord between her legs. An emergency cesarean delivery was performed. The newborn required resuscitation and mechanical ventilation and suffered permanent brain damage attributed to hypoxia from umbilical cord prolapse.

PARENTS’ CLAIM The midwife’s negligence caused the baby’s injuries. Breech presentation put the pregnancy at high-risk. She did not have a physician examine the patient before scheduling a cesarean delivery and did not attempt to rotate the child back to a head-first position. She did not warn the parents about the risks of breech presentation and umbilical cord prolapse.

DEFENDANTS’ DEFENSE The choices given the parents were reasonable. Scheduling a cesarean delivery at 39 weeks was proper. A prolapsed cord is not predictable or preventable.

VERDICT A $12.6 million Pennsylvania verdict was returned against the midwife and the hospital; a confidential high/low agreement was reached.

Extensive adhesions result in bowel injury

A 58-YEAR-OLD WOMAN UNDERWENT exploratory laparotomy in May 2009. There were extensive adhesions, and the gynecologist used blind, blunt dissection to resect a large pelvic mass adhered to the sidewall. He had difficulty removing the specimen because it was too large to fit through the incision. A left salpingo-oophorectomy was also performed.

On the second postoperative day, the patient reported shortness of breath, intermittent chest pain, and had a fever of 103° F. The next day, she was unable to ambulate due to shortness of breath. CT results ruled out deep vein thrombosis or pulmonary embolism but revealed significantly decreased lung volume. She continued to experience shortness of breath and temperature spikes for 3 more days. She was discharged on the seventh postoperative day despite shortness of breath.

Two days later, she experienced severe abdominal pain and shortness of breath at home and returned to the ED by ambulance. A CT scan revealed free pelvic air, ascites, and extensive inflammatory changes, likely due to bowel perforation. She was intubated and airlifted to a regional trauma center. During exploratory surgery, the surgeon aspirated a foul-smelling fluid and identified a perforation at the rectosigmoid junction; a colostomy was created. The patient stayed in intensive care for 5 days, developed renal failure, and was transfused due to acute blood loss. She was hospitalized for 19 days. The colostomy was reversed in October 2009.

PATIENT’S CLAIM The ObGyn was negligent in injuring the bowel during surgery and in not recognizing the bowel injury and treating it in a timely manner.

PHYSICIAN’S DEFENSE The case was settled during the trial.

VERDICT A $600,000 Virginia settlement was reached.

Pregnant woman stabbed: mother and baby die

A 20-YEAR-OLD WOMAN AT 30 WEEKS’ gestation was treated in the ED for a stab wound to the shoulder. The emergency medicine (EM) physician noted internal bleeding and a possible collapsed lung on radiographs, and began efforts to have the woman transferred. One facility declined because of her pregnancy. The patient was in pain and her ability to breathe declined. An airlift was finally arranged, but she suffered cardiac arrest as the helicopter arrived. A cesarean delivery was performed, but both the mother and baby died.

ESTATE’S CLAIM The EM physician was negligent in failing to perform a thoracotomy and arrange for a more timely transfer. The physician didn’t contact a hospital that was only 8 miles away.

DEFENDANTS’ DEFENSE The federal government, which operated the facility, admitted fault.

VERDICT A $7,267,390 Mississippi verdict included $5.45 million in noneconomic damages.

What caused child’s brain damage?

DURING LABOR AND DELIVERY, electronic fetal heart-rate monitoring indicated fetal distress. Meconium-stained fluid was present. The child was born with brain damage. It is unlikely that he will walk independently, talk in full sentences, or be able to perform daily activities independently.

PARENTS’ CLAIM The fetal heart-rate monitor indicated a need for emergency cesarean delivery. The quality and quantity of meconium should have alerted the caregivers to fetal distress and caused them to perform a cesarean delivery.

DEFENDANTS’ DEFENSE Fetal heart-rate strips did not indicate a need for emergency delivery until shortly before the delivery occurred. The underlying cause of the child’s injuries was an infection that spread to the brain and was irreversible.

VERDICT A $1.71 million Massachusetts verdict was returned.

When did bladder injury occur?

AN 84-YEAR-OLD WOMAN suffered recurrent bladder cancer. She underwent a cystoscopy, and then chemotherapy. Several weeks later, she was diagnosed with a bladder perforation became septic, and died.

ESTATE’S CLAIM The bladder was lacerated during cystoscopy; she would have survived if the laceration had been treated in a timely manner.

PHYSICIAN’S DEFENSE Bladder perforation during cystoscopy is a known risk of the procedure. However, the bladder was not perforated during cystoscopy; chemotherapy may have caused the perforation.

VERDICT A Michigan defense verdict was returned.

Fetal tracings poor: Why wasn’t an internal lead used?

AT 32 WEEKS’ GESTATION, a woman’s membranes ruptured, and she was admitted. Her ObGyn planned to induce labor at 34 weeks’ gestation. She experienced contractions on the morning of the scheduled induction. Although fetal heart-rate monitoring was reassuring, the fetus was in a compound position, with the chin leading. Labor progressed rapidly to 6-cm dilation. The fetal heart rate began to show recurrent mild variable decelerations that became increasingly deeper. Although the technical quality of the external monitoring was poor, no internal lead was applied.

After 3 hours, the tracing showed severe variable decelerations. The mother was fully dilated and began to push. The tracings were of poor quality, but interpretable portions showed minimal variability and significant decelerations during contractions. The fetal baseline heart rate became tachycardic. The obstetric nurse and resident continued to note abnormalities, but there is no evidence that they called the attending ObGyn. The fetal baseline heart rate reached 190 bpm with ongoing decelerations associated with contractions. Variability remained minimal to absent. After 2 hours of pushing, meconium-stained fluid was noted. The infant was born 1 hour later. The attending ObGyn was present for the last 30 minutes of labor.

The newborn’s Apgar scores were 1, 5, and 7, at 1, 5, and 10 minutes, respectively. His arterial cord pH was significantly low. MRI of the head showed subdural and intraventricular hemorrhage and evolving, profound hypoxic ischemic injury. At 1 year of age, the child suffers from a seizure disorder, cortical blindness, and severe developmental delays.

PARENTS’ CLAIM The nurse and resident failed to respond to fetal heart-rate abnormalities and failed to insert an internal lead to obtain better quality heart-rate tracings. They did not expedite delivery when fetal distress was evident.

DEFENDANTS’ DEFENSE The case was settled during trial.

VERDICT A $4.2 million Massachusetts settlement was reached.

Hypoxic ischemic encephalopathy

DUE TO PREECLAMPSIA, a woman was admitted to the hospital 5 weeks before her due date. Her condition was monitored for 2 weeks when it was decided to induce labor with oxytocin. After 3 hours in labor, the fetal heart-rate tracing began to show significant decelerations. The baby was born at 37 weeks’ gestation with severe hypoxic ischemic encephalopathy. The child died 2 years later from severe brain damage.

PARENTS’ CLAIM The ObGyns failed to respond to signs of fetal distress by performing an emergency cesarean. The brain images would have been different if a stroke-like event had occurred.

DEFENDANTS’ DEFENSE The fetus experienced an embolic process due to a compressed umbilical cord, resulting in a stroke-like vascular event, which led to the hypoxic ischemic encephalopathy.

VERDICT A $450,000 Wisconsin settlement was reached.

Postpartum high BP; mother suffers brain damage

HOSPITALIZED TWICE FOR HYPERTENSION in the month before her child was born, a 41-year-old woman gave birth to a healthy baby by cesarean delivery. The mother was discharged 2 days later with a blood pressure (BP) of 130/90 mm Hg.

Three days later, she went to her ObGyn’s office because she was not feeling well and had extreme swelling. Her BP, taken twice by a nurse, read 170/88 mm Hg, and 168/90 mm Hg, but she was not examined by the ObGyn.

That evening, the patient had difficulty breathing and was taken to the emergency department (ED), where she was intubated. She went into cardiac arrest and suffered permanent brain damage after being without a pulse for 15 minutes. She was in a coma for 45 days. She is unable to walk without assistance, is legally blind, and her hands are so contorted that she cannot feed herself. She suffers from short-term memory loss and has difficulty speaking.

PATIENT’S CLAIM The ObGyn should have examined her when she was at the office. Her hypertension would have been properly treated and injuries avoided. She had classic signs of postpartum cardiomyopathy.

PHYSICIAN’S DEFENSE The patient had not come to the office because she was feeling ill, but to show off her baby and have her BP checked. If he had been advised of the BP readings, he would have examined her.

VERDICT A $5 million Georgia verdict was returned.

Cervical biopsy results improperly reported

A 44-YEAR-OLD WOMAN UNDERWENT a cervical biopsy in July 2007 performed by a pathologist. A few days later, the pathologist contacted the patient and reported that the biopsy revealed invasive cervical cancer that required immediate surgery. Several procedures were performed without any cancer ever being found.

A second opinion was sought, and it was determined that the cancer diagnosis was incorrect; another patient’s pathology had been reported as the patient’s.

PATIENT’S CLAIM The pathologist and hospital were negligent in reporting incorrect results of the cervical biopsy, which resulted in the patient’s physical and emotional injuries, including unnecessary surgical procedures and depression and anxiety.

DEFENDANTS’ DEFENSE The defendants did not oppose the patient’s motion for summary judgment on liability; the issue of damages was contested.

VERDICT The patient received summary judgment on liability. She then discontinued claims against the pathologist, and the matter proceeded on damages against the hospital. A $46,000 New York verdict was returned. Stipulated medical expenses were added to the verdict for a total recovery of $60,979.

Brachial plexus injury: child has significant functional disability

AT 38 6/7 WEEKS’ GESTATION, a 23-year-old woman went to the ED with contractions. She had pregestational diabetes mellitus. Her admitting glucose level was 143 mg/dL, and she had gained 25 lb during pregnancy. Her fundal height was 40 cm, and estimated fetal weight was 4000 g (8 lb 13 oz). A pelvic examination determined that she was 3 to 4 cm dilated, 100% effaced, and at minus-1 station. She was given oxytocin to aid labor. The ObGyn noted that overall fetal heart-rate tracings were reassuring, and that a pediatrician would be present for delivery due to suspected macrosomia. Shoulder dystocia occurred during delivery, but it was resolved in 40 seconds. The mother sustained a second-degree perineal laceration.

At birth, the baby’s left arm was limp. Apgar scores were 5 and 9 at 1 and 5 minutes, respectively. Her birth weight was 10 lb 2 oz. A brachial plexus injury was diagnosed, and she underwent surgery in October 2008. Despite successful nerve grafts at C5 and C6, the child has significant functional disability in the left arm.

PARENTS’ CLAIM A cesarean delivery should have been scheduled when a macrosomic fetus was suspected.

PHYSICIAN’S DEFENSE The case was settled during trial.

VERDICT A $1,475,000 Maryland settlement was reached.

Breech position and umbilical cord prolapse: Was everything done that could be done?

DURING A MOTHER’S 38-WEEK PRENATAL VISIT, ultrasonography showed the baby was in breech position. The midwife offered two options: to schedule an external cephalic version procedure at 38 weeks or a cesarean delivery at 39 weeks. The parents agreed to schedule a cesarean delivery for 8 days later. The day before the scheduled birth, the mother awoke to find the umbilical cord between her legs. An emergency cesarean delivery was performed. The newborn required resuscitation and mechanical ventilation and suffered permanent brain damage attributed to hypoxia from umbilical cord prolapse.

PARENTS’ CLAIM The midwife’s negligence caused the baby’s injuries. Breech presentation put the pregnancy at high-risk. She did not have a physician examine the patient before scheduling a cesarean delivery and did not attempt to rotate the child back to a head-first position. She did not warn the parents about the risks of breech presentation and umbilical cord prolapse.

DEFENDANTS’ DEFENSE The choices given the parents were reasonable. Scheduling a cesarean delivery at 39 weeks was proper. A prolapsed cord is not predictable or preventable.

VERDICT A $12.6 million Pennsylvania verdict was returned against the midwife and the hospital; a confidential high/low agreement was reached.

Extensive adhesions result in bowel injury

A 58-YEAR-OLD WOMAN UNDERWENT exploratory laparotomy in May 2009. There were extensive adhesions, and the gynecologist used blind, blunt dissection to resect a large pelvic mass adhered to the sidewall. He had difficulty removing the specimen because it was too large to fit through the incision. A left salpingo-oophorectomy was also performed.

On the second postoperative day, the patient reported shortness of breath, intermittent chest pain, and had a fever of 103° F. The next day, she was unable to ambulate due to shortness of breath. CT results ruled out deep vein thrombosis or pulmonary embolism but revealed significantly decreased lung volume. She continued to experience shortness of breath and temperature spikes for 3 more days. She was discharged on the seventh postoperative day despite shortness of breath.

Two days later, she experienced severe abdominal pain and shortness of breath at home and returned to the ED by ambulance. A CT scan revealed free pelvic air, ascites, and extensive inflammatory changes, likely due to bowel perforation. She was intubated and airlifted to a regional trauma center. During exploratory surgery, the surgeon aspirated a foul-smelling fluid and identified a perforation at the rectosigmoid junction; a colostomy was created. The patient stayed in intensive care for 5 days, developed renal failure, and was transfused due to acute blood loss. She was hospitalized for 19 days. The colostomy was reversed in October 2009.

PATIENT’S CLAIM The ObGyn was negligent in injuring the bowel during surgery and in not recognizing the bowel injury and treating it in a timely manner.

PHYSICIAN’S DEFENSE The case was settled during the trial.

VERDICT A $600,000 Virginia settlement was reached.

Pregnant woman stabbed: mother and baby die

A 20-YEAR-OLD WOMAN AT 30 WEEKS’ gestation was treated in the ED for a stab wound to the shoulder. The emergency medicine (EM) physician noted internal bleeding and a possible collapsed lung on radiographs, and began efforts to have the woman transferred. One facility declined because of her pregnancy. The patient was in pain and her ability to breathe declined. An airlift was finally arranged, but she suffered cardiac arrest as the helicopter arrived. A cesarean delivery was performed, but both the mother and baby died.

ESTATE’S CLAIM The EM physician was negligent in failing to perform a thoracotomy and arrange for a more timely transfer. The physician didn’t contact a hospital that was only 8 miles away.

DEFENDANTS’ DEFENSE The federal government, which operated the facility, admitted fault.

VERDICT A $7,267,390 Mississippi verdict included $5.45 million in noneconomic damages.

What caused child’s brain damage?

DURING LABOR AND DELIVERY, electronic fetal heart-rate monitoring indicated fetal distress. Meconium-stained fluid was present. The child was born with brain damage. It is unlikely that he will walk independently, talk in full sentences, or be able to perform daily activities independently.

PARENTS’ CLAIM The fetal heart-rate monitor indicated a need for emergency cesarean delivery. The quality and quantity of meconium should have alerted the caregivers to fetal distress and caused them to perform a cesarean delivery.

DEFENDANTS’ DEFENSE Fetal heart-rate strips did not indicate a need for emergency delivery until shortly before the delivery occurred. The underlying cause of the child’s injuries was an infection that spread to the brain and was irreversible.

VERDICT A $1.71 million Massachusetts verdict was returned.

When did bladder injury occur?

AN 84-YEAR-OLD WOMAN suffered recurrent bladder cancer. She underwent a cystoscopy, and then chemotherapy. Several weeks later, she was diagnosed with a bladder perforation became septic, and died.

ESTATE’S CLAIM The bladder was lacerated during cystoscopy; she would have survived if the laceration had been treated in a timely manner.

PHYSICIAN’S DEFENSE Bladder perforation during cystoscopy is a known risk of the procedure. However, the bladder was not perforated during cystoscopy; chemotherapy may have caused the perforation.

VERDICT A Michigan defense verdict was returned.

Fetal tracings poor: Why wasn’t an internal lead used?

AT 32 WEEKS’ GESTATION, a woman’s membranes ruptured, and she was admitted. Her ObGyn planned to induce labor at 34 weeks’ gestation. She experienced contractions on the morning of the scheduled induction. Although fetal heart-rate monitoring was reassuring, the fetus was in a compound position, with the chin leading. Labor progressed rapidly to 6-cm dilation. The fetal heart rate began to show recurrent mild variable decelerations that became increasingly deeper. Although the technical quality of the external monitoring was poor, no internal lead was applied.

After 3 hours, the tracing showed severe variable decelerations. The mother was fully dilated and began to push. The tracings were of poor quality, but interpretable portions showed minimal variability and significant decelerations during contractions. The fetal baseline heart rate became tachycardic. The obstetric nurse and resident continued to note abnormalities, but there is no evidence that they called the attending ObGyn. The fetal baseline heart rate reached 190 bpm with ongoing decelerations associated with contractions. Variability remained minimal to absent. After 2 hours of pushing, meconium-stained fluid was noted. The infant was born 1 hour later. The attending ObGyn was present for the last 30 minutes of labor.

The newborn’s Apgar scores were 1, 5, and 7, at 1, 5, and 10 minutes, respectively. His arterial cord pH was significantly low. MRI of the head showed subdural and intraventricular hemorrhage and evolving, profound hypoxic ischemic injury. At 1 year of age, the child suffers from a seizure disorder, cortical blindness, and severe developmental delays.

PARENTS’ CLAIM The nurse and resident failed to respond to fetal heart-rate abnormalities and failed to insert an internal lead to obtain better quality heart-rate tracings. They did not expedite delivery when fetal distress was evident.

DEFENDANTS’ DEFENSE The case was settled during trial.

VERDICT A $4.2 million Massachusetts settlement was reached.

Hypoxic ischemic encephalopathy

DUE TO PREECLAMPSIA, a woman was admitted to the hospital 5 weeks before her due date. Her condition was monitored for 2 weeks when it was decided to induce labor with oxytocin. After 3 hours in labor, the fetal heart-rate tracing began to show significant decelerations. The baby was born at 37 weeks’ gestation with severe hypoxic ischemic encephalopathy. The child died 2 years later from severe brain damage.

PARENTS’ CLAIM The ObGyns failed to respond to signs of fetal distress by performing an emergency cesarean. The brain images would have been different if a stroke-like event had occurred.

DEFENDANTS’ DEFENSE The fetus experienced an embolic process due to a compressed umbilical cord, resulting in a stroke-like vascular event, which led to the hypoxic ischemic encephalopathy.

VERDICT A $450,000 Wisconsin settlement was reached.

Postpartum high BP; mother suffers brain damage

HOSPITALIZED TWICE FOR HYPERTENSION in the month before her child was born, a 41-year-old woman gave birth to a healthy baby by cesarean delivery. The mother was discharged 2 days later with a blood pressure (BP) of 130/90 mm Hg.

Three days later, she went to her ObGyn’s office because she was not feeling well and had extreme swelling. Her BP, taken twice by a nurse, read 170/88 mm Hg, and 168/90 mm Hg, but she was not examined by the ObGyn.

That evening, the patient had difficulty breathing and was taken to the emergency department (ED), where she was intubated. She went into cardiac arrest and suffered permanent brain damage after being without a pulse for 15 minutes. She was in a coma for 45 days. She is unable to walk without assistance, is legally blind, and her hands are so contorted that she cannot feed herself. She suffers from short-term memory loss and has difficulty speaking.

PATIENT’S CLAIM The ObGyn should have examined her when she was at the office. Her hypertension would have been properly treated and injuries avoided. She had classic signs of postpartum cardiomyopathy.

PHYSICIAN’S DEFENSE The patient had not come to the office because she was feeling ill, but to show off her baby and have her BP checked. If he had been advised of the BP readings, he would have examined her.

VERDICT A $5 million Georgia verdict was returned.

Cervical biopsy results improperly reported

A 44-YEAR-OLD WOMAN UNDERWENT a cervical biopsy in July 2007 performed by a pathologist. A few days later, the pathologist contacted the patient and reported that the biopsy revealed invasive cervical cancer that required immediate surgery. Several procedures were performed without any cancer ever being found.

A second opinion was sought, and it was determined that the cancer diagnosis was incorrect; another patient’s pathology had been reported as the patient’s.

PATIENT’S CLAIM The pathologist and hospital were negligent in reporting incorrect results of the cervical biopsy, which resulted in the patient’s physical and emotional injuries, including unnecessary surgical procedures and depression and anxiety.

DEFENDANTS’ DEFENSE The defendants did not oppose the patient’s motion for summary judgment on liability; the issue of damages was contested.

VERDICT The patient received summary judgment on liability. She then discontinued claims against the pathologist, and the matter proceeded on damages against the hospital. A $46,000 New York verdict was returned. Stipulated medical expenses were added to the verdict for a total recovery of $60,979.

Brachial plexus injury: child has significant functional disability

AT 38 6/7 WEEKS’ GESTATION, a 23-year-old woman went to the ED with contractions. She had pregestational diabetes mellitus. Her admitting glucose level was 143 mg/dL, and she had gained 25 lb during pregnancy. Her fundal height was 40 cm, and estimated fetal weight was 4000 g (8 lb 13 oz). A pelvic examination determined that she was 3 to 4 cm dilated, 100% effaced, and at minus-1 station. She was given oxytocin to aid labor. The ObGyn noted that overall fetal heart-rate tracings were reassuring, and that a pediatrician would be present for delivery due to suspected macrosomia. Shoulder dystocia occurred during delivery, but it was resolved in 40 seconds. The mother sustained a second-degree perineal laceration.

At birth, the baby’s left arm was limp. Apgar scores were 5 and 9 at 1 and 5 minutes, respectively. Her birth weight was 10 lb 2 oz. A brachial plexus injury was diagnosed, and she underwent surgery in October 2008. Despite successful nerve grafts at C5 and C6, the child has significant functional disability in the left arm.

PARENTS’ CLAIM A cesarean delivery should have been scheduled when a macrosomic fetus was suspected.

PHYSICIAN’S DEFENSE The case was settled during trial.

VERDICT A $1,475,000 Maryland settlement was reached.

Breech position and umbilical cord prolapse: Was everything done that could be done?

DURING A MOTHER’S 38-WEEK PRENATAL VISIT, ultrasonography showed the baby was in breech position. The midwife offered two options: to schedule an external cephalic version procedure at 38 weeks or a cesarean delivery at 39 weeks. The parents agreed to schedule a cesarean delivery for 8 days later. The day before the scheduled birth, the mother awoke to find the umbilical cord between her legs. An emergency cesarean delivery was performed. The newborn required resuscitation and mechanical ventilation and suffered permanent brain damage attributed to hypoxia from umbilical cord prolapse.

PARENTS’ CLAIM The midwife’s negligence caused the baby’s injuries. Breech presentation put the pregnancy at high-risk. She did not have a physician examine the patient before scheduling a cesarean delivery and did not attempt to rotate the child back to a head-first position. She did not warn the parents about the risks of breech presentation and umbilical cord prolapse.

DEFENDANTS’ DEFENSE The choices given the parents were reasonable. Scheduling a cesarean delivery at 39 weeks was proper. A prolapsed cord is not predictable or preventable.

VERDICT A $12.6 million Pennsylvania verdict was returned against the midwife and the hospital; a confidential high/low agreement was reached.

Extensive adhesions result in bowel injury

A 58-YEAR-OLD WOMAN UNDERWENT exploratory laparotomy in May 2009. There were extensive adhesions, and the gynecologist used blind, blunt dissection to resect a large pelvic mass adhered to the sidewall. He had difficulty removing the specimen because it was too large to fit through the incision. A left salpingo-oophorectomy was also performed.

On the second postoperative day, the patient reported shortness of breath, intermittent chest pain, and had a fever of 103° F. The next day, she was unable to ambulate due to shortness of breath. CT results ruled out deep vein thrombosis or pulmonary embolism but revealed significantly decreased lung volume. She continued to experience shortness of breath and temperature spikes for 3 more days. She was discharged on the seventh postoperative day despite shortness of breath.

Two days later, she experienced severe abdominal pain and shortness of breath at home and returned to the ED by ambulance. A CT scan revealed free pelvic air, ascites, and extensive inflammatory changes, likely due to bowel perforation. She was intubated and airlifted to a regional trauma center. During exploratory surgery, the surgeon aspirated a foul-smelling fluid and identified a perforation at the rectosigmoid junction; a colostomy was created. The patient stayed in intensive care for 5 days, developed renal failure, and was transfused due to acute blood loss. She was hospitalized for 19 days. The colostomy was reversed in October 2009.

PATIENT’S CLAIM The ObGyn was negligent in injuring the bowel during surgery and in not recognizing the bowel injury and treating it in a timely manner.

PHYSICIAN’S DEFENSE The case was settled during the trial.

VERDICT A $600,000 Virginia settlement was reached.

Pregnant woman stabbed: mother and baby die

A 20-YEAR-OLD WOMAN AT 30 WEEKS’ gestation was treated in the ED for a stab wound to the shoulder. The emergency medicine (EM) physician noted internal bleeding and a possible collapsed lung on radiographs, and began efforts to have the woman transferred. One facility declined because of her pregnancy. The patient was in pain and her ability to breathe declined. An airlift was finally arranged, but she suffered cardiac arrest as the helicopter arrived. A cesarean delivery was performed, but both the mother and baby died.

ESTATE’S CLAIM The EM physician was negligent in failing to perform a thoracotomy and arrange for a more timely transfer. The physician didn’t contact a hospital that was only 8 miles away.

DEFENDANTS’ DEFENSE The federal government, which operated the facility, admitted fault.

VERDICT A $7,267,390 Mississippi verdict included $5.45 million in noneconomic damages.

What caused child’s brain damage?

DURING LABOR AND DELIVERY, electronic fetal heart-rate monitoring indicated fetal distress. Meconium-stained fluid was present. The child was born with brain damage. It is unlikely that he will walk independently, talk in full sentences, or be able to perform daily activities independently.

PARENTS’ CLAIM The fetal heart-rate monitor indicated a need for emergency cesarean delivery. The quality and quantity of meconium should have alerted the caregivers to fetal distress and caused them to perform a cesarean delivery.

DEFENDANTS’ DEFENSE Fetal heart-rate strips did not indicate a need for emergency delivery until shortly before the delivery occurred. The underlying cause of the child’s injuries was an infection that spread to the brain and was irreversible.

VERDICT A $1.71 million Massachusetts verdict was returned.

When did bladder injury occur?

AN 84-YEAR-OLD WOMAN suffered recurrent bladder cancer. She underwent a cystoscopy, and then chemotherapy. Several weeks later, she was diagnosed with a bladder perforation became septic, and died.

ESTATE’S CLAIM The bladder was lacerated during cystoscopy; she would have survived if the laceration had been treated in a timely manner.

PHYSICIAN’S DEFENSE Bladder perforation during cystoscopy is a known risk of the procedure. However, the bladder was not perforated during cystoscopy; chemotherapy may have caused the perforation.

VERDICT A Michigan defense verdict was returned.

Fetal tracings poor: Why wasn’t an internal lead used?

AT 32 WEEKS’ GESTATION, a woman’s membranes ruptured, and she was admitted. Her ObGyn planned to induce labor at 34 weeks’ gestation. She experienced contractions on the morning of the scheduled induction. Although fetal heart-rate monitoring was reassuring, the fetus was in a compound position, with the chin leading. Labor progressed rapidly to 6-cm dilation. The fetal heart rate began to show recurrent mild variable decelerations that became increasingly deeper. Although the technical quality of the external monitoring was poor, no internal lead was applied.

After 3 hours, the tracing showed severe variable decelerations. The mother was fully dilated and began to push. The tracings were of poor quality, but interpretable portions showed minimal variability and significant decelerations during contractions. The fetal baseline heart rate became tachycardic. The obstetric nurse and resident continued to note abnormalities, but there is no evidence that they called the attending ObGyn. The fetal baseline heart rate reached 190 bpm with ongoing decelerations associated with contractions. Variability remained minimal to absent. After 2 hours of pushing, meconium-stained fluid was noted. The infant was born 1 hour later. The attending ObGyn was present for the last 30 minutes of labor.

The newborn’s Apgar scores were 1, 5, and 7, at 1, 5, and 10 minutes, respectively. His arterial cord pH was significantly low. MRI of the head showed subdural and intraventricular hemorrhage and evolving, profound hypoxic ischemic injury. At 1 year of age, the child suffers from a seizure disorder, cortical blindness, and severe developmental delays.

PARENTS’ CLAIM The nurse and resident failed to respond to fetal heart-rate abnormalities and failed to insert an internal lead to obtain better quality heart-rate tracings. They did not expedite delivery when fetal distress was evident.

DEFENDANTS’ DEFENSE The case was settled during trial.

VERDICT A $4.2 million Massachusetts settlement was reached.

Hypoxic ischemic encephalopathy

DUE TO PREECLAMPSIA, a woman was admitted to the hospital 5 weeks before her due date. Her condition was monitored for 2 weeks when it was decided to induce labor with oxytocin. After 3 hours in labor, the fetal heart-rate tracing began to show significant decelerations. The baby was born at 37 weeks’ gestation with severe hypoxic ischemic encephalopathy. The child died 2 years later from severe brain damage.

PARENTS’ CLAIM The ObGyns failed to respond to signs of fetal distress by performing an emergency cesarean. The brain images would have been different if a stroke-like event had occurred.

DEFENDANTS’ DEFENSE The fetus experienced an embolic process due to a compressed umbilical cord, resulting in a stroke-like vascular event, which led to the hypoxic ischemic encephalopathy.

VERDICT A $450,000 Wisconsin settlement was reached.

Colon cancer screening comes too late

AFTER 14 YEARS OF TREATMENT by her physician, a 73-year-old woman with a medical history that included chronic obstructive pulmonary disease and major depression underwent her first colonoscopy. It revealed colon cancer. The patient died about a year and a half later.

PLAINTIFF’S CLAIM No information about the plaintiff’s claim is available.

THE DEFENSE The physician claimed that the patient had declined his recommendations for colon cancer screening many times and that she had failed to return stool samples from a home test kit he had given her. The physician’s medical records, which began in 2001, didn’t reflect his screening recommendations. Earlier records had been destroyed in 2007 in accordance with office policy.

VERDICT $500,000 Massachusetts settlement.

COMMENT Do you routinely document refusal of preventive services by your patients? If not, you, too, may fall victim to a plaintiff’s attorney!

A drug reaction with lasting consequences

AN ALLERGIC REACTION to trimethoprim/ sulfamethoxazole caused skin changes in a 44-year-old woman. Nevertheless, her physician prescribed another regimen of the drug 4 years later. This time, the patient had a full-blown allergic reaction, characterized by red, scaly, weepy skin and elevated liver enzymes, among other symptoms.

After several emergency department visits and a hospital admission, the patient was transferred to the burn unit of a regional medical center, with a presumed diagnosis of Stevens-Johnson syndrome (SJS). After evaluating the patient, however, the director of the burn unit concluded that her symptoms were not severe enough to be SJS; he attributed them to a simple drug reaction and had the patient moved to a medical/surgical floor.

At some point, she developed peripheral sensory neuropathy in her hands and feet. The parties involved disagreed about when the neuropathy began and what caused it.

PLAINTIFF’S CLAIM The patient should not have been transferred to the medical/surgical unit; the higher level of care provided on the burn unit would have prevented the peripheral neuropathy. The patient received inadequate nutrition, which contributed to her injuries.

THE DEFENSE Because the patient didn’t actually have SJS, the medical/surgical floor was the appropriate place to treat her. The patient received proper skin care and nutrition. The patient had complained of numbness and tingling in her hands and feet before she was hospitalized, indicating that the drug-related neuropathy had existed before admission to the regional facility.

VERDICT Defense verdict following confidential settlement with the physician who prescribed trimethoprim/sulfamethoxazole.

COMMENT When prescribing any antibiotic, always confirm that the patient isn’t allergic to it. Have your nurses and medical assistants help you maintain accurate medication and allergy lists in your office chart or electronic medical record.

A colonoscopy, then hepatitis C

AFTER UNDERGOING A COLONOSCOPY, a 44-year-old man was diagnosed with hepatitis C. He claimed that the infection had been transmitted by the anesthetic used during the procedure.

PLAINTIFF’S CLAIM The anesthesiologist drew the anesthetic from a multiple-dose vial that had been used during previous procedures; proper sterile techniques weren’t followed.

THE DEFENSE No information about the defense is available.

VERDICT $675,000 New York settlement.

COMMENT I thought this practice had stopped 20 years ago. Review your office procedures and make sure it doesn’t happen. Don’t use single-dose, single-use vials for more than one patient—ever.

Colon cancer screening comes too late

AFTER 14 YEARS OF TREATMENT by her physician, a 73-year-old woman with a medical history that included chronic obstructive pulmonary disease and major depression underwent her first colonoscopy. It revealed colon cancer. The patient died about a year and a half later.

PLAINTIFF’S CLAIM No information about the plaintiff’s claim is available.

THE DEFENSE The physician claimed that the patient had declined his recommendations for colon cancer screening many times and that she had failed to return stool samples from a home test kit he had given her. The physician’s medical records, which began in 2001, didn’t reflect his screening recommendations. Earlier records had been destroyed in 2007 in accordance with office policy.

VERDICT $500,000 Massachusetts settlement.

COMMENT Do you routinely document refusal of preventive services by your patients? If not, you, too, may fall victim to a plaintiff’s attorney!

A drug reaction with lasting consequences

AN ALLERGIC REACTION to trimethoprim/ sulfamethoxazole caused skin changes in a 44-year-old woman. Nevertheless, her physician prescribed another regimen of the drug 4 years later. This time, the patient had a full-blown allergic reaction, characterized by red, scaly, weepy skin and elevated liver enzymes, among other symptoms.

After several emergency department visits and a hospital admission, the patient was transferred to the burn unit of a regional medical center, with a presumed diagnosis of Stevens-Johnson syndrome (SJS). After evaluating the patient, however, the director of the burn unit concluded that her symptoms were not severe enough to be SJS; he attributed them to a simple drug reaction and had the patient moved to a medical/surgical floor.

At some point, she developed peripheral sensory neuropathy in her hands and feet. The parties involved disagreed about when the neuropathy began and what caused it.

PLAINTIFF’S CLAIM The patient should not have been transferred to the medical/surgical unit; the higher level of care provided on the burn unit would have prevented the peripheral neuropathy. The patient received inadequate nutrition, which contributed to her injuries.

THE DEFENSE Because the patient didn’t actually have SJS, the medical/surgical floor was the appropriate place to treat her. The patient received proper skin care and nutrition. The patient had complained of numbness and tingling in her hands and feet before she was hospitalized, indicating that the drug-related neuropathy had existed before admission to the regional facility.

VERDICT Defense verdict following confidential settlement with the physician who prescribed trimethoprim/sulfamethoxazole.

COMMENT When prescribing any antibiotic, always confirm that the patient isn’t allergic to it. Have your nurses and medical assistants help you maintain accurate medication and allergy lists in your office chart or electronic medical record.

A colonoscopy, then hepatitis C

AFTER UNDERGOING A COLONOSCOPY, a 44-year-old man was diagnosed with hepatitis C. He claimed that the infection had been transmitted by the anesthetic used during the procedure.

PLAINTIFF’S CLAIM The anesthesiologist drew the anesthetic from a multiple-dose vial that had been used during previous procedures; proper sterile techniques weren’t followed.

THE DEFENSE No information about the defense is available.

VERDICT $675,000 New York settlement.

COMMENT I thought this practice had stopped 20 years ago. Review your office procedures and make sure it doesn’t happen. Don’t use single-dose, single-use vials for more than one patient—ever.

Colon cancer screening comes too late

AFTER 14 YEARS OF TREATMENT by her physician, a 73-year-old woman with a medical history that included chronic obstructive pulmonary disease and major depression underwent her first colonoscopy. It revealed colon cancer. The patient died about a year and a half later.

PLAINTIFF’S CLAIM No information about the plaintiff’s claim is available.

THE DEFENSE The physician claimed that the patient had declined his recommendations for colon cancer screening many times and that she had failed to return stool samples from a home test kit he had given her. The physician’s medical records, which began in 2001, didn’t reflect his screening recommendations. Earlier records had been destroyed in 2007 in accordance with office policy.

VERDICT $500,000 Massachusetts settlement.

COMMENT Do you routinely document refusal of preventive services by your patients? If not, you, too, may fall victim to a plaintiff’s attorney!

A drug reaction with lasting consequences

AN ALLERGIC REACTION to trimethoprim/ sulfamethoxazole caused skin changes in a 44-year-old woman. Nevertheless, her physician prescribed another regimen of the drug 4 years later. This time, the patient had a full-blown allergic reaction, characterized by red, scaly, weepy skin and elevated liver enzymes, among other symptoms.

After several emergency department visits and a hospital admission, the patient was transferred to the burn unit of a regional medical center, with a presumed diagnosis of Stevens-Johnson syndrome (SJS). After evaluating the patient, however, the director of the burn unit concluded that her symptoms were not severe enough to be SJS; he attributed them to a simple drug reaction and had the patient moved to a medical/surgical floor.

At some point, she developed peripheral sensory neuropathy in her hands and feet. The parties involved disagreed about when the neuropathy began and what caused it.

PLAINTIFF’S CLAIM The patient should not have been transferred to the medical/surgical unit; the higher level of care provided on the burn unit would have prevented the peripheral neuropathy. The patient received inadequate nutrition, which contributed to her injuries.

THE DEFENSE Because the patient didn’t actually have SJS, the medical/surgical floor was the appropriate place to treat her. The patient received proper skin care and nutrition. The patient had complained of numbness and tingling in her hands and feet before she was hospitalized, indicating that the drug-related neuropathy had existed before admission to the regional facility.

VERDICT Defense verdict following confidential settlement with the physician who prescribed trimethoprim/sulfamethoxazole.

COMMENT When prescribing any antibiotic, always confirm that the patient isn’t allergic to it. Have your nurses and medical assistants help you maintain accurate medication and allergy lists in your office chart or electronic medical record.

A colonoscopy, then hepatitis C

AFTER UNDERGOING A COLONOSCOPY, a 44-year-old man was diagnosed with hepatitis C. He claimed that the infection had been transmitted by the anesthetic used during the procedure.

PLAINTIFF’S CLAIM The anesthesiologist drew the anesthetic from a multiple-dose vial that had been used during previous procedures; proper sterile techniques weren’t followed.

THE DEFENSE No information about the defense is available.

VERDICT $675,000 New York settlement.

COMMENT I thought this practice had stopped 20 years ago. Review your office procedures and make sure it doesn’t happen. Don’t use single-dose, single-use vials for more than one patient—ever.

Obese mother gains another 60 lb before delivery

AN OBESE WOMAN with a family history of diabetes had previously given birth to a large baby. Even though she expressed her concern that this fetus would also be macrosomic, the ObGyn planned for spontaneous vaginal delivery. At 39 weeks’ gestation, after gaining 60 lb, she went to the hospital requesting induction of labor; the ObGyn reluctantly agreed. Labor was lengthy, forceps-assisted delivery was performed, and a shoulder dystocia was encountered. The baby was born with respiratory distress, a brachial plexus injury, bruises on his right cheek and both ears, and multiple rib fractures. After transfer to a children’s hospital, surgical exploration revealed avulsion of the C6 root nerve from the spinal cord and damage to C5, C7, and C8 nerve roots. Several surgical repairs and physical therapy have led to some improvement, but the child is permanently injured. His right arm is shorter than the left, his right hand is smaller, and he has less strength and range of motion in the right arm. He also has excessive tearing in the right eye and his right eyelid droops.

PARENTS’ CLAIM The ObGyn failed to recognize the risk of delivering a macrosomic baby and did not consider cesarean delivery. The brachial plexus injury was due to downward traction applied during delivery.

PHYSICIAN’S DEFENSE There was no negligence. The brachial plexus injury was not caused by downward traction.

VERDICT A $4.1 million Indiana verdict was returned, but was reduced to the state cap of $1.25 million.

Failure to follow-up on mass: $1.97M verdict

AFTER STAGE II OVARIAN CANCER was found in 1999, a woman underwent surgery and chemotherapy, and was told she was cancer-free. She had regular visits between 2000 and 2008 with another surgical oncologist after her first surgeon moved. In 2004, the oncologist documented finding a round fullness during a pelvic exam. A CT scan confirmed a mass in the pelvic cul-de-sac.

In August 2008, the patient was treated for deep venous thrombosis in her leg. The attending physician saw the pelvic mass on imaging, and a biopsy indicated a recurrence of ovarian cancer. After chemotherapy, the patient underwent surgery, but the tumor was unresectable. In early 2011, testing revealed metastasis to the spine, sternum, pelvic bone, arm, and lung.

PATIENT’S CLAIM The surgeon did not properly investigate the mass resulting in a delayed diagnosis of cancer recurrence. The patient alleged that the surgical oncologist repeatedly stated that the mass had not changed and was most likely fluid; it was nothing to worry about. Radiology reports indicated a suspicion of cancer.

DEFENDANTS’ DEFENSE The oncologist repeatedly told the patient that the mass should be biopsied, but the patient refused because she was dealing with other medical issues. The radiologist argued that reports to the oncologist included everything needed to diagnose the cancer.

VERDICT A Pennsylvania jury found the surgical oncologist fully at fault and returned a $1,971,455 verdict.

Incomplete tubal ligation

BEFORE DELIVERY OF HER THIRD CHILD, a 26-year-old woman requested sterilization using tubal ligation. After delivery, the ObGyn performed a bilateral tubal ligation. The pathologist’s report indicated that the ligation was incomplete: the left fallopian tube had not been fully removed. The ObGyn failed to note the report’s results in the patient’s record, nor did he advise the patient. Two years later, the patient delivered a fourth child.

PATIENT’S CLAIM The patient alleged wrongful birth against both the ObGyn and pathologist. The ObGyn was negligent for not reacting to the pathologist’s report of incomplete tubal ligation, and for not informing the patient. The pathologist should have verbally confirmed receipt of the report with the ObGyn.

PHYSICIANS’ DEFENSE The ObGyn settled before trial. The pathologist claimed he had properly interpreted the specimen and reported the results.

VERDICT A Louisiana jury found the ObGyn fully at fault and assessed additional damages of $56,252 to the $100,000 settlement.

Where did this foreign body come from?

A WOMAN SUFFERED FROM PELVIC PAIN caused by adhesions following two cesarean deliveries and a hysterectomy. In January 2003, her ObGyn performed laparotomy to reduce adhesions from prior surgeries and place Gore-Tex mesh to prevent future adhesions. In October 2010, the patient reported epigastric pain, and went to a different surgeon (her insurance changed). A CT scan identified a foreign body encapsulated in scar tissue in the patient’s lower abdomen/pelvis. The surgeon removed the foreign body.

PATIENT’S CLAIM The ObGyn and hospital were negligent in conducting the 2003 procedure; the foreign object was a retained surgical sponge.

DEFENDANTS’ DEFENSE The foreign body removed in 2010 was the Gore-Tex mesh placed in 2003. The mesh became encapsulated in scar tissue due to the patient’s propensity to develop adhesions, and then moved within the patient’s body. Surgical sponges have embedded radiopaque tracers; CT scans in 2003 and 2010 did not detect any radiopaque tracers.

VERDICT A California defense verdict was returned.

Massive bleed during sacrocolpopexy

AFTER A 72-YEAR-OLD WOMAN developed pelvic organ prolapse, her urologist performed an abdominal sacrocolpopexy. As the urologist attempted to gain access to the sacral prominence, a tear in the median sacral vein expanded to involve the inferior vena cava and left iliac vein. Massive bleeding occurred and multiple units of blood were transfused. A general surgeon successfully repaired the vascular injuries. The patient was hospitalized for 16 days, received home healthcare, and fully recovered.

PATIENT’S CLAIM The urologist was negligent in overaggressive manipulation of the median sacral vein, causing it to avulse.

PHYSICIAN’S DEFENSE Bleeds of this type are a known complication of the procedure.

VERDICT A Michigan defense verdict was returned.

Was it hypoxia or autism?

AFTER SEVERAL HOURS IN LABOR, a fetal heart-rate monitor indicated decreasing fetal heart rate that led to terminal bradycardia. The ObGyn was called and performed an emergency cesarean delivery. The child was diagnosed with brain damage at 2 years of age.

PARENTS’ CLAIM A cesarean delivery should have been planned because of the fetal weight (8 lb 11 oz). A hypoxic event occurred during labor. Ultrasonography would have shown that the fetus was inverted and that the baby’s face was covered by one of its hands. Delivery was not properly managed, and fetal distress was not reported to the ObGyn in a timely manner.

DEFENDANTS’ DEFENSE The infant’s weight was not sufficient to warrant a cesarean delivery. The infant did not suffer hypoxia. The child’s abnormalities only emerged in the second year of life. An MRI at that time did not indicate brain damage. The child’s development with subsequent regression suggests autism.

VERDICT A New York defense verdict was returned.

Should mammography have been diagnostic?

A 46-YEAR-OLD WOMAN with a family history of breast cancer had regular annual screenings. In December 2006, the patient reported pain, hardness, and burning in her left breast to her gynecologist. A radiologist interpreted the mammography as normal. In May 2007, the patient found a lump in her left breast. Testing indicated she had stage IV breast cancer. She died 2 months after the trial concluded.

PATIENT’S CLAIM The 2006 mammogram was performed as a screening mammography, but should have been diagnostic, considering her family history and reported symptoms. The radiologist improperly interpreted the films.

DEFENDANTS’ DEFENSE The hospital staff testified that the patient did not report pain, hardness, and burning in her left breast when she presented for the 2006 mammography. The radiologist claimed his screening and interpretation were appropriate.

VERDICT The Louisiana court granted the patient’s motion for judgment, and awarded $558,000 in medical costs and $1.3 million in noneconomic damages, totalling $1.808 million. This was reduced to the $500,000 statutory cap.

Obese mother gains another 60 lb before delivery

AN OBESE WOMAN with a family history of diabetes had previously given birth to a large baby. Even though she expressed her concern that this fetus would also be macrosomic, the ObGyn planned for spontaneous vaginal delivery. At 39 weeks’ gestation, after gaining 60 lb, she went to the hospital requesting induction of labor; the ObGyn reluctantly agreed. Labor was lengthy, forceps-assisted delivery was performed, and a shoulder dystocia was encountered. The baby was born with respiratory distress, a brachial plexus injury, bruises on his right cheek and both ears, and multiple rib fractures. After transfer to a children’s hospital, surgical exploration revealed avulsion of the C6 root nerve from the spinal cord and damage to C5, C7, and C8 nerve roots. Several surgical repairs and physical therapy have led to some improvement, but the child is permanently injured. His right arm is shorter than the left, his right hand is smaller, and he has less strength and range of motion in the right arm. He also has excessive tearing in the right eye and his right eyelid droops.

PARENTS’ CLAIM The ObGyn failed to recognize the risk of delivering a macrosomic baby and did not consider cesarean delivery. The brachial plexus injury was due to downward traction applied during delivery.

PHYSICIAN’S DEFENSE There was no negligence. The brachial plexus injury was not caused by downward traction.

VERDICT A $4.1 million Indiana verdict was returned, but was reduced to the state cap of $1.25 million.

Failure to follow-up on mass: $1.97M verdict

AFTER STAGE II OVARIAN CANCER was found in 1999, a woman underwent surgery and chemotherapy, and was told she was cancer-free. She had regular visits between 2000 and 2008 with another surgical oncologist after her first surgeon moved. In 2004, the oncologist documented finding a round fullness during a pelvic exam. A CT scan confirmed a mass in the pelvic cul-de-sac.

In August 2008, the patient was treated for deep venous thrombosis in her leg. The attending physician saw the pelvic mass on imaging, and a biopsy indicated a recurrence of ovarian cancer. After chemotherapy, the patient underwent surgery, but the tumor was unresectable. In early 2011, testing revealed metastasis to the spine, sternum, pelvic bone, arm, and lung.

PATIENT’S CLAIM The surgeon did not properly investigate the mass resulting in a delayed diagnosis of cancer recurrence. The patient alleged that the surgical oncologist repeatedly stated that the mass had not changed and was most likely fluid; it was nothing to worry about. Radiology reports indicated a suspicion of cancer.

DEFENDANTS’ DEFENSE The oncologist repeatedly told the patient that the mass should be biopsied, but the patient refused because she was dealing with other medical issues. The radiologist argued that reports to the oncologist included everything needed to diagnose the cancer.

VERDICT A Pennsylvania jury found the surgical oncologist fully at fault and returned a $1,971,455 verdict.

Incomplete tubal ligation

BEFORE DELIVERY OF HER THIRD CHILD, a 26-year-old woman requested sterilization using tubal ligation. After delivery, the ObGyn performed a bilateral tubal ligation. The pathologist’s report indicated that the ligation was incomplete: the left fallopian tube had not been fully removed. The ObGyn failed to note the report’s results in the patient’s record, nor did he advise the patient. Two years later, the patient delivered a fourth child.

PATIENT’S CLAIM The patient alleged wrongful birth against both the ObGyn and pathologist. The ObGyn was negligent for not reacting to the pathologist’s report of incomplete tubal ligation, and for not informing the patient. The pathologist should have verbally confirmed receipt of the report with the ObGyn.

PHYSICIANS’ DEFENSE The ObGyn settled before trial. The pathologist claimed he had properly interpreted the specimen and reported the results.

VERDICT A Louisiana jury found the ObGyn fully at fault and assessed additional damages of $56,252 to the $100,000 settlement.

Where did this foreign body come from?

A WOMAN SUFFERED FROM PELVIC PAIN caused by adhesions following two cesarean deliveries and a hysterectomy. In January 2003, her ObGyn performed laparotomy to reduce adhesions from prior surgeries and place Gore-Tex mesh to prevent future adhesions. In October 2010, the patient reported epigastric pain, and went to a different surgeon (her insurance changed). A CT scan identified a foreign body encapsulated in scar tissue in the patient’s lower abdomen/pelvis. The surgeon removed the foreign body.

PATIENT’S CLAIM The ObGyn and hospital were negligent in conducting the 2003 procedure; the foreign object was a retained surgical sponge.

DEFENDANTS’ DEFENSE The foreign body removed in 2010 was the Gore-Tex mesh placed in 2003. The mesh became encapsulated in scar tissue due to the patient’s propensity to develop adhesions, and then moved within the patient’s body. Surgical sponges have embedded radiopaque tracers; CT scans in 2003 and 2010 did not detect any radiopaque tracers.

VERDICT A California defense verdict was returned.

Massive bleed during sacrocolpopexy

AFTER A 72-YEAR-OLD WOMAN developed pelvic organ prolapse, her urologist performed an abdominal sacrocolpopexy. As the urologist attempted to gain access to the sacral prominence, a tear in the median sacral vein expanded to involve the inferior vena cava and left iliac vein. Massive bleeding occurred and multiple units of blood were transfused. A general surgeon successfully repaired the vascular injuries. The patient was hospitalized for 16 days, received home healthcare, and fully recovered.

PATIENT’S CLAIM The urologist was negligent in overaggressive manipulation of the median sacral vein, causing it to avulse.

PHYSICIAN’S DEFENSE Bleeds of this type are a known complication of the procedure.

VERDICT A Michigan defense verdict was returned.

Was it hypoxia or autism?

AFTER SEVERAL HOURS IN LABOR, a fetal heart-rate monitor indicated decreasing fetal heart rate that led to terminal bradycardia. The ObGyn was called and performed an emergency cesarean delivery. The child was diagnosed with brain damage at 2 years of age.

PARENTS’ CLAIM A cesarean delivery should have been planned because of the fetal weight (8 lb 11 oz). A hypoxic event occurred during labor. Ultrasonography would have shown that the fetus was inverted and that the baby’s face was covered by one of its hands. Delivery was not properly managed, and fetal distress was not reported to the ObGyn in a timely manner.

DEFENDANTS’ DEFENSE The infant’s weight was not sufficient to warrant a cesarean delivery. The infant did not suffer hypoxia. The child’s abnormalities only emerged in the second year of life. An MRI at that time did not indicate brain damage. The child’s development with subsequent regression suggests autism.

VERDICT A New York defense verdict was returned.

Should mammography have been diagnostic?

A 46-YEAR-OLD WOMAN with a family history of breast cancer had regular annual screenings. In December 2006, the patient reported pain, hardness, and burning in her left breast to her gynecologist. A radiologist interpreted the mammography as normal. In May 2007, the patient found a lump in her left breast. Testing indicated she had stage IV breast cancer. She died 2 months after the trial concluded.

PATIENT’S CLAIM The 2006 mammogram was performed as a screening mammography, but should have been diagnostic, considering her family history and reported symptoms. The radiologist improperly interpreted the films.

DEFENDANTS’ DEFENSE The hospital staff testified that the patient did not report pain, hardness, and burning in her left breast when she presented for the 2006 mammography. The radiologist claimed his screening and interpretation were appropriate.

VERDICT The Louisiana court granted the patient’s motion for judgment, and awarded $558,000 in medical costs and $1.3 million in noneconomic damages, totalling $1.808 million. This was reduced to the $500,000 statutory cap.

Obese mother gains another 60 lb before delivery

AN OBESE WOMAN with a family history of diabetes had previously given birth to a large baby. Even though she expressed her concern that this fetus would also be macrosomic, the ObGyn planned for spontaneous vaginal delivery. At 39 weeks’ gestation, after gaining 60 lb, she went to the hospital requesting induction of labor; the ObGyn reluctantly agreed. Labor was lengthy, forceps-assisted delivery was performed, and a shoulder dystocia was encountered. The baby was born with respiratory distress, a brachial plexus injury, bruises on his right cheek and both ears, and multiple rib fractures. After transfer to a children’s hospital, surgical exploration revealed avulsion of the C6 root nerve from the spinal cord and damage to C5, C7, and C8 nerve roots. Several surgical repairs and physical therapy have led to some improvement, but the child is permanently injured. His right arm is shorter than the left, his right hand is smaller, and he has less strength and range of motion in the right arm. He also has excessive tearing in the right eye and his right eyelid droops.

PARENTS’ CLAIM The ObGyn failed to recognize the risk of delivering a macrosomic baby and did not consider cesarean delivery. The brachial plexus injury was due to downward traction applied during delivery.

PHYSICIAN’S DEFENSE There was no negligence. The brachial plexus injury was not caused by downward traction.

VERDICT A $4.1 million Indiana verdict was returned, but was reduced to the state cap of $1.25 million.

Failure to follow-up on mass: $1.97M verdict

AFTER STAGE II OVARIAN CANCER was found in 1999, a woman underwent surgery and chemotherapy, and was told she was cancer-free. She had regular visits between 2000 and 2008 with another surgical oncologist after her first surgeon moved. In 2004, the oncologist documented finding a round fullness during a pelvic exam. A CT scan confirmed a mass in the pelvic cul-de-sac.

In August 2008, the patient was treated for deep venous thrombosis in her leg. The attending physician saw the pelvic mass on imaging, and a biopsy indicated a recurrence of ovarian cancer. After chemotherapy, the patient underwent surgery, but the tumor was unresectable. In early 2011, testing revealed metastasis to the spine, sternum, pelvic bone, arm, and lung.

PATIENT’S CLAIM The surgeon did not properly investigate the mass resulting in a delayed diagnosis of cancer recurrence. The patient alleged that the surgical oncologist repeatedly stated that the mass had not changed and was most likely fluid; it was nothing to worry about. Radiology reports indicated a suspicion of cancer.

DEFENDANTS’ DEFENSE The oncologist repeatedly told the patient that the mass should be biopsied, but the patient refused because she was dealing with other medical issues. The radiologist argued that reports to the oncologist included everything needed to diagnose the cancer.

VERDICT A Pennsylvania jury found the surgical oncologist fully at fault and returned a $1,971,455 verdict.

Incomplete tubal ligation

BEFORE DELIVERY OF HER THIRD CHILD, a 26-year-old woman requested sterilization using tubal ligation. After delivery, the ObGyn performed a bilateral tubal ligation. The pathologist’s report indicated that the ligation was incomplete: the left fallopian tube had not been fully removed. The ObGyn failed to note the report’s results in the patient’s record, nor did he advise the patient. Two years later, the patient delivered a fourth child.

PATIENT’S CLAIM The patient alleged wrongful birth against both the ObGyn and pathologist. The ObGyn was negligent for not reacting to the pathologist’s report of incomplete tubal ligation, and for not informing the patient. The pathologist should have verbally confirmed receipt of the report with the ObGyn.

PHYSICIANS’ DEFENSE The ObGyn settled before trial. The pathologist claimed he had properly interpreted the specimen and reported the results.

VERDICT A Louisiana jury found the ObGyn fully at fault and assessed additional damages of $56,252 to the $100,000 settlement.

Where did this foreign body come from?

A WOMAN SUFFERED FROM PELVIC PAIN caused by adhesions following two cesarean deliveries and a hysterectomy. In January 2003, her ObGyn performed laparotomy to reduce adhesions from prior surgeries and place Gore-Tex mesh to prevent future adhesions. In October 2010, the patient reported epigastric pain, and went to a different surgeon (her insurance changed). A CT scan identified a foreign body encapsulated in scar tissue in the patient’s lower abdomen/pelvis. The surgeon removed the foreign body.

PATIENT’S CLAIM The ObGyn and hospital were negligent in conducting the 2003 procedure; the foreign object was a retained surgical sponge.

DEFENDANTS’ DEFENSE The foreign body removed in 2010 was the Gore-Tex mesh placed in 2003. The mesh became encapsulated in scar tissue due to the patient’s propensity to develop adhesions, and then moved within the patient’s body. Surgical sponges have embedded radiopaque tracers; CT scans in 2003 and 2010 did not detect any radiopaque tracers.

VERDICT A California defense verdict was returned.

Massive bleed during sacrocolpopexy

AFTER A 72-YEAR-OLD WOMAN developed pelvic organ prolapse, her urologist performed an abdominal sacrocolpopexy. As the urologist attempted to gain access to the sacral prominence, a tear in the median sacral vein expanded to involve the inferior vena cava and left iliac vein. Massive bleeding occurred and multiple units of blood were transfused. A general surgeon successfully repaired the vascular injuries. The patient was hospitalized for 16 days, received home healthcare, and fully recovered.

PATIENT’S CLAIM The urologist was negligent in overaggressive manipulation of the median sacral vein, causing it to avulse.

PHYSICIAN’S DEFENSE Bleeds of this type are a known complication of the procedure.

VERDICT A Michigan defense verdict was returned.

Was it hypoxia or autism?

AFTER SEVERAL HOURS IN LABOR, a fetal heart-rate monitor indicated decreasing fetal heart rate that led to terminal bradycardia. The ObGyn was called and performed an emergency cesarean delivery. The child was diagnosed with brain damage at 2 years of age.

PARENTS’ CLAIM A cesarean delivery should have been planned because of the fetal weight (8 lb 11 oz). A hypoxic event occurred during labor. Ultrasonography would have shown that the fetus was inverted and that the baby’s face was covered by one of its hands. Delivery was not properly managed, and fetal distress was not reported to the ObGyn in a timely manner.

DEFENDANTS’ DEFENSE The infant’s weight was not sufficient to warrant a cesarean delivery. The infant did not suffer hypoxia. The child’s abnormalities only emerged in the second year of life. An MRI at that time did not indicate brain damage. The child’s development with subsequent regression suggests autism.

VERDICT A New York defense verdict was returned.

Should mammography have been diagnostic?

A 46-YEAR-OLD WOMAN with a family history of breast cancer had regular annual screenings. In December 2006, the patient reported pain, hardness, and burning in her left breast to her gynecologist. A radiologist interpreted the mammography as normal. In May 2007, the patient found a lump in her left breast. Testing indicated she had stage IV breast cancer. She died 2 months after the trial concluded.

PATIENT’S CLAIM The 2006 mammogram was performed as a screening mammography, but should have been diagnostic, considering her family history and reported symptoms. The radiologist improperly interpreted the films.

DEFENDANTS’ DEFENSE The hospital staff testified that the patient did not report pain, hardness, and burning in her left breast when she presented for the 2006 mammography. The radiologist claimed his screening and interpretation were appropriate.

VERDICT The Louisiana court granted the patient’s motion for judgment, and awarded $558,000 in medical costs and $1.3 million in noneconomic damages, totalling $1.808 million. This was reduced to the $500,000 statutory cap.

Failure to diagnose preeclampsia

A MOTHER CALLED HER OBGYN at 34 weeks’ gestation with complaints of a headache, swelling, and weight gain. The ObGyn prescribed Tylenol. The next morning, the mother was found unconscious on her kitchen floor. She was taken to the emergency department (ED), where she underwent a cesarean delivery and brain surgery. The child, born prematurely, suffered a stroke that resulted in brain damage and cerebral palsy (CP).

PARENTS’ CLAIM The ObGyn should have immediately evaluated the mother when she called with a headache. Failure to recognize eclampsia led to severe hypertension.

PHYSICIAN’S DEFENSE When the mother called the ObGyn, she reported a headache and diarrhea, and asked if it was all right to take Tylenol. The ObGyn claimed she asked the mother several questions and the mother’s answers included that the headache was not severe and that she’d had it for a few hours. The mother denied blurred vision, abdominal or uterine pain, and reported that she was not vomiting. The ObGyn believed that the mother had a virus and recommended Tylenol. The fetus’ stroke had occurred the day prior to the mother’s eclamptic episode.

VERDICT At first, a Pennsylvania defense verdict was returned. After an appeal, the second trial resulted in a $3.75 million verdict.

Spontaneous home birth goes badly awry

A WOMAN SPONTANEOUSLY DELIVERED her fourth baby at home. An ambulance transported the mother and child to the ED. Upon arrival, the child had depressed breathing. The pediatrician ordered a chest x-ray, which indicated a collapsed lung. A chest tube was inserted. The infant was monitored for the next 2 hours, when transfer to another hospital was arranged because her condition worsened. She sustained brain damage from the respiratory problems and died 2 days after birth.

PARENTS’ CLAIM The pediatrician failed to establish an airway and place a central line.

PHYSICIAN’S DEFENSE The newborn’s breathing difficulties were due to aspiration of meconium. The fetus suffered an in-utero hypoxic event due to a small placenta.

VERDICT A Kentucky defense verdict was returned.

NICU team not called early enough

AN INFANT’S HEART RATE was 100 bpm at birth. She was blue and not breathing, and suffered seizures in the first 24 hours of life. She was found to have brain damage, CP, and spastic quadriplegia. She requires a feeding tube and is unable to speak or walk.

PARENTS’ CLAIM The nurse should have called the NICU team before the baby’s birth because fetal distress was evident. The team arrived and began resuscitation 5 minutes after birth. The delay allowed for a lack of oxygen, which caused brain damage.

DEFENDANTS’ DEFENSE A placental infection caused the baby’s distress.

VERDICT A $8,583,000 Ohio verdict was returned against the hospital.

Woman not told cancer had spread to nodes

A 56-YEAR-OLD WOMAN underwent right breast mastectomy. The surgeon did not remove any lymph nodes despite radiologic evidence of possible nodal involvement. After the mastectomy, the surgeon advised the patient to see an oncologist.

The patient could not get an appointment with the oncologist for 6 months. During that visit, the oncologist told her that cancer had invaded lymph nodes that had not been removed. The cancer metastasized to a lung. Despite surgery, she was told that recurrence was inevitable.

PATIENT’S CLAIM Metastasis could have been avoided if the lymph nodes had been removed at mastectomy. The surgeon had not told her about lymph node involvement, which contributed to the delay in seeing the oncologist.

PHYSICIAN’S DEFENSE Removal of the lymph nodes was not necessary—immediate chemotherapy could have effectively addressed the cancer. The patient was told of the lymph node involvement and clearly advised that prompt chemotherapy was necessary.

VERDICT A $500,000 New York verdict was returned for past pain and suffering. Defense posttrial motions were denied. The judge granted the patient’s motion for future pain and suffering and awarded $500,000.

Brachial plexus injury after emergency surgery

A WOMAN WENT TO THE HOSPITAL FOR THE BIRTH of her eighth child. She had received no prenatal care, although she had a history of preeclampsia. Upon arrival at the ED, she had decreased blood pressure. Two on-call ObGyns delivered the baby. Shoulder dystocia was encountered, and after several unsuccessful attempts were made to dislodge the shoulder, a rescue cesarean delivery was performed. The child has a brachial plexus injury.

PARENTS’ CLAIM The ObGyns failed to perform a cesarean delivery in a timely manner, and used excessive force in attempting to free the baby’s shoulder.

PHYSICIAN’S DEFENSE All appropriate measures were taken in an effort to facilitate a prompt and injury-free delivery.

VERDICT A $1,250,000 Ohio verdict was returned.

Failure to detect fetal growth restriction

A CHILD WAS DELIVERED BY AN OBGYN and a neonatologist. The child has CP with developmental delays and spastic quadriplegia. She requires constant care.

PARENTS’ CLAIM The child’s CP was caused by an hypoxic event that occurred 3 hours before delivery. The fetus was extremely small, which increased the susceptibility to hypoxic events. The ObGyn was negligent in failing to diagnose fetal growth restriction caused by placental insufficiency. The fetal monitor showed an abnormal heart rate during that 3-hour span. Fetal distress should have prompted action by the ObGyn; a cesarean delivery could have avoided the injury.

DEFENDANTS’ DEFENSE Prenatal tests, including ultrasonography, indicated that the fetus had grown appropriately. Fetal heart-rate monitors did not reveal problematic heart function. The child’s CP was due to chronic hypoxia that could not have been detected or prevented.

VERDICT A $6.5 million New York settlement was reached.

Emergency cesarean after fetal distress

AFTER A NORMAL PREGNANCY, an emergency cesarean delivery was performed when the fetal monitor indicated fetal distress. The child suffered hypoxic ischemic encephalopathy resulting in permanent neurologic deficits.

PARENTS’ CLAIM The nurse failed to timely alert the physician of decelerations shown on the fetal heart-rate monitor. A cesarean should have been performed earlier.

DEFENDANT’S DEFENSE The cesarean was performed when fetal distress was evident.

VERDICT A Massachusetts defense verdict was returned.

Pelvic abscess after hysterectomy

A WOMAN UNDERWENT a total vaginal hysterectomy without prophylactic antibiotics. Six days after discharge, she went to the ED with fever, chills, abdominal pain, and diarrhea. She was given antibiotics and admitted after a CT scan and physical examination suggested an infection. At discharge 6 days later, antibiotics were not prescribed because she had been afebrile for over 48 hours. She continued to have abdominal distention, and returned to the hospital the next day with an ultrasound taken elsewhere that revealed a 9-cm pelvic abscess. She underwent bilateral salpingo-oophorectomy and was discharged after 4 days, this time with antibiotics. She continued to have diarrhea, severe abdominal pain, and weight loss for a year.

PATIENT’S CLAIM Prophylactic antibiotics should have been prescribed prior to surgery, and continued when she left the hospital the first time.

DEFENDANTS’ DEFENSE The case was settled before trial.

VERDICT A confidential Utah settlement was reached.

Failure to diagnose preeclampsia

A MOTHER CALLED HER OBGYN at 34 weeks’ gestation with complaints of a headache, swelling, and weight gain. The ObGyn prescribed Tylenol. The next morning, the mother was found unconscious on her kitchen floor. She was taken to the emergency department (ED), where she underwent a cesarean delivery and brain surgery. The child, born prematurely, suffered a stroke that resulted in brain damage and cerebral palsy (CP).

PARENTS’ CLAIM The ObGyn should have immediately evaluated the mother when she called with a headache. Failure to recognize eclampsia led to severe hypertension.

PHYSICIAN’S DEFENSE When the mother called the ObGyn, she reported a headache and diarrhea, and asked if it was all right to take Tylenol. The ObGyn claimed she asked the mother several questions and the mother’s answers included that the headache was not severe and that she’d had it for a few hours. The mother denied blurred vision, abdominal or uterine pain, and reported that she was not vomiting. The ObGyn believed that the mother had a virus and recommended Tylenol. The fetus’ stroke had occurred the day prior to the mother’s eclamptic episode.

VERDICT At first, a Pennsylvania defense verdict was returned. After an appeal, the second trial resulted in a $3.75 million verdict.

Spontaneous home birth goes badly awry

A WOMAN SPONTANEOUSLY DELIVERED her fourth baby at home. An ambulance transported the mother and child to the ED. Upon arrival, the child had depressed breathing. The pediatrician ordered a chest x-ray, which indicated a collapsed lung. A chest tube was inserted. The infant was monitored for the next 2 hours, when transfer to another hospital was arranged because her condition worsened. She sustained brain damage from the respiratory problems and died 2 days after birth.

PARENTS’ CLAIM The pediatrician failed to establish an airway and place a central line.

PHYSICIAN’S DEFENSE The newborn’s breathing difficulties were due to aspiration of meconium. The fetus suffered an in-utero hypoxic event due to a small placenta.

VERDICT A Kentucky defense verdict was returned.

NICU team not called early enough

AN INFANT’S HEART RATE was 100 bpm at birth. She was blue and not breathing, and suffered seizures in the first 24 hours of life. She was found to have brain damage, CP, and spastic quadriplegia. She requires a feeding tube and is unable to speak or walk.

PARENTS’ CLAIM The nurse should have called the NICU team before the baby’s birth because fetal distress was evident. The team arrived and began resuscitation 5 minutes after birth. The delay allowed for a lack of oxygen, which caused brain damage.

DEFENDANTS’ DEFENSE A placental infection caused the baby’s distress.

VERDICT A $8,583,000 Ohio verdict was returned against the hospital.

Woman not told cancer had spread to nodes

A 56-YEAR-OLD WOMAN underwent right breast mastectomy. The surgeon did not remove any lymph nodes despite radiologic evidence of possible nodal involvement. After the mastectomy, the surgeon advised the patient to see an oncologist.

The patient could not get an appointment with the oncologist for 6 months. During that visit, the oncologist told her that cancer had invaded lymph nodes that had not been removed. The cancer metastasized to a lung. Despite surgery, she was told that recurrence was inevitable.

PATIENT’S CLAIM Metastasis could have been avoided if the lymph nodes had been removed at mastectomy. The surgeon had not told her about lymph node involvement, which contributed to the delay in seeing the oncologist.

PHYSICIAN’S DEFENSE Removal of the lymph nodes was not necessary—immediate chemotherapy could have effectively addressed the cancer. The patient was told of the lymph node involvement and clearly advised that prompt chemotherapy was necessary.

VERDICT A $500,000 New York verdict was returned for past pain and suffering. Defense posttrial motions were denied. The judge granted the patient’s motion for future pain and suffering and awarded $500,000.

Brachial plexus injury after emergency surgery

A WOMAN WENT TO THE HOSPITAL FOR THE BIRTH of her eighth child. She had received no prenatal care, although she had a history of preeclampsia. Upon arrival at the ED, she had decreased blood pressure. Two on-call ObGyns delivered the baby. Shoulder dystocia was encountered, and after several unsuccessful attempts were made to dislodge the shoulder, a rescue cesarean delivery was performed. The child has a brachial plexus injury.

PARENTS’ CLAIM The ObGyns failed to perform a cesarean delivery in a timely manner, and used excessive force in attempting to free the baby’s shoulder.

PHYSICIAN’S DEFENSE All appropriate measures were taken in an effort to facilitate a prompt and injury-free delivery.

VERDICT A $1,250,000 Ohio verdict was returned.

Failure to detect fetal growth restriction

A CHILD WAS DELIVERED BY AN OBGYN and a neonatologist. The child has CP with developmental delays and spastic quadriplegia. She requires constant care.

PARENTS’ CLAIM The child’s CP was caused by an hypoxic event that occurred 3 hours before delivery. The fetus was extremely small, which increased the susceptibility to hypoxic events. The ObGyn was negligent in failing to diagnose fetal growth restriction caused by placental insufficiency. The fetal monitor showed an abnormal heart rate during that 3-hour span. Fetal distress should have prompted action by the ObGyn; a cesarean delivery could have avoided the injury.

DEFENDANTS’ DEFENSE Prenatal tests, including ultrasonography, indicated that the fetus had grown appropriately. Fetal heart-rate monitors did not reveal problematic heart function. The child’s CP was due to chronic hypoxia that could not have been detected or prevented.

VERDICT A $6.5 million New York settlement was reached.

Emergency cesarean after fetal distress

AFTER A NORMAL PREGNANCY, an emergency cesarean delivery was performed when the fetal monitor indicated fetal distress. The child suffered hypoxic ischemic encephalopathy resulting in permanent neurologic deficits.

PARENTS’ CLAIM The nurse failed to timely alert the physician of decelerations shown on the fetal heart-rate monitor. A cesarean should have been performed earlier.

DEFENDANT’S DEFENSE The cesarean was performed when fetal distress was evident.

VERDICT A Massachusetts defense verdict was returned.

Pelvic abscess after hysterectomy

A WOMAN UNDERWENT a total vaginal hysterectomy without prophylactic antibiotics. Six days after discharge, she went to the ED with fever, chills, abdominal pain, and diarrhea. She was given antibiotics and admitted after a CT scan and physical examination suggested an infection. At discharge 6 days later, antibiotics were not prescribed because she had been afebrile for over 48 hours. She continued to have abdominal distention, and returned to the hospital the next day with an ultrasound taken elsewhere that revealed a 9-cm pelvic abscess. She underwent bilateral salpingo-oophorectomy and was discharged after 4 days, this time with antibiotics. She continued to have diarrhea, severe abdominal pain, and weight loss for a year.

PATIENT’S CLAIM Prophylactic antibiotics should have been prescribed prior to surgery, and continued when she left the hospital the first time.

DEFENDANTS’ DEFENSE The case was settled before trial.

VERDICT A confidential Utah settlement was reached.

Failure to diagnose preeclampsia

A MOTHER CALLED HER OBGYN at 34 weeks’ gestation with complaints of a headache, swelling, and weight gain. The ObGyn prescribed Tylenol. The next morning, the mother was found unconscious on her kitchen floor. She was taken to the emergency department (ED), where she underwent a cesarean delivery and brain surgery. The child, born prematurely, suffered a stroke that resulted in brain damage and cerebral palsy (CP).

PARENTS’ CLAIM The ObGyn should have immediately evaluated the mother when she called with a headache. Failure to recognize eclampsia led to severe hypertension.

PHYSICIAN’S DEFENSE When the mother called the ObGyn, she reported a headache and diarrhea, and asked if it was all right to take Tylenol. The ObGyn claimed she asked the mother several questions and the mother’s answers included that the headache was not severe and that she’d had it for a few hours. The mother denied blurred vision, abdominal or uterine pain, and reported that she was not vomiting. The ObGyn believed that the mother had a virus and recommended Tylenol. The fetus’ stroke had occurred the day prior to the mother’s eclamptic episode.

VERDICT At first, a Pennsylvania defense verdict was returned. After an appeal, the second trial resulted in a $3.75 million verdict.

Spontaneous home birth goes badly awry

A WOMAN SPONTANEOUSLY DELIVERED her fourth baby at home. An ambulance transported the mother and child to the ED. Upon arrival, the child had depressed breathing. The pediatrician ordered a chest x-ray, which indicated a collapsed lung. A chest tube was inserted. The infant was monitored for the next 2 hours, when transfer to another hospital was arranged because her condition worsened. She sustained brain damage from the respiratory problems and died 2 days after birth.

PARENTS’ CLAIM The pediatrician failed to establish an airway and place a central line.

PHYSICIAN’S DEFENSE The newborn’s breathing difficulties were due to aspiration of meconium. The fetus suffered an in-utero hypoxic event due to a small placenta.

VERDICT A Kentucky defense verdict was returned.

NICU team not called early enough

AN INFANT’S HEART RATE was 100 bpm at birth. She was blue and not breathing, and suffered seizures in the first 24 hours of life. She was found to have brain damage, CP, and spastic quadriplegia. She requires a feeding tube and is unable to speak or walk.

PARENTS’ CLAIM The nurse should have called the NICU team before the baby’s birth because fetal distress was evident. The team arrived and began resuscitation 5 minutes after birth. The delay allowed for a lack of oxygen, which caused brain damage.

DEFENDANTS’ DEFENSE A placental infection caused the baby’s distress.

VERDICT A $8,583,000 Ohio verdict was returned against the hospital.

Woman not told cancer had spread to nodes

A 56-YEAR-OLD WOMAN underwent right breast mastectomy. The surgeon did not remove any lymph nodes despite radiologic evidence of possible nodal involvement. After the mastectomy, the surgeon advised the patient to see an oncologist.

The patient could not get an appointment with the oncologist for 6 months. During that visit, the oncologist told her that cancer had invaded lymph nodes that had not been removed. The cancer metastasized to a lung. Despite surgery, she was told that recurrence was inevitable.

PATIENT’S CLAIM Metastasis could have been avoided if the lymph nodes had been removed at mastectomy. The surgeon had not told her about lymph node involvement, which contributed to the delay in seeing the oncologist.

PHYSICIAN’S DEFENSE Removal of the lymph nodes was not necessary—immediate chemotherapy could have effectively addressed the cancer. The patient was told of the lymph node involvement and clearly advised that prompt chemotherapy was necessary.

VERDICT A $500,000 New York verdict was returned for past pain and suffering. Defense posttrial motions were denied. The judge granted the patient’s motion for future pain and suffering and awarded $500,000.

Brachial plexus injury after emergency surgery

A WOMAN WENT TO THE HOSPITAL FOR THE BIRTH of her eighth child. She had received no prenatal care, although she had a history of preeclampsia. Upon arrival at the ED, she had decreased blood pressure. Two on-call ObGyns delivered the baby. Shoulder dystocia was encountered, and after several unsuccessful attempts were made to dislodge the shoulder, a rescue cesarean delivery was performed. The child has a brachial plexus injury.

PARENTS’ CLAIM The ObGyns failed to perform a cesarean delivery in a timely manner, and used excessive force in attempting to free the baby’s shoulder.

PHYSICIAN’S DEFENSE All appropriate measures were taken in an effort to facilitate a prompt and injury-free delivery.

VERDICT A $1,250,000 Ohio verdict was returned.

Failure to detect fetal growth restriction

A CHILD WAS DELIVERED BY AN OBGYN and a neonatologist. The child has CP with developmental delays and spastic quadriplegia. She requires constant care.

PARENTS’ CLAIM The child’s CP was caused by an hypoxic event that occurred 3 hours before delivery. The fetus was extremely small, which increased the susceptibility to hypoxic events. The ObGyn was negligent in failing to diagnose fetal growth restriction caused by placental insufficiency. The fetal monitor showed an abnormal heart rate during that 3-hour span. Fetal distress should have prompted action by the ObGyn; a cesarean delivery could have avoided the injury.

DEFENDANTS’ DEFENSE Prenatal tests, including ultrasonography, indicated that the fetus had grown appropriately. Fetal heart-rate monitors did not reveal problematic heart function. The child’s CP was due to chronic hypoxia that could not have been detected or prevented.

VERDICT A $6.5 million New York settlement was reached.

Emergency cesarean after fetal distress

AFTER A NORMAL PREGNANCY, an emergency cesarean delivery was performed when the fetal monitor indicated fetal distress. The child suffered hypoxic ischemic encephalopathy resulting in permanent neurologic deficits.

PARENTS’ CLAIM The nurse failed to timely alert the physician of decelerations shown on the fetal heart-rate monitor. A cesarean should have been performed earlier.

DEFENDANT’S DEFENSE The cesarean was performed when fetal distress was evident.

VERDICT A Massachusetts defense verdict was returned.

Pelvic abscess after hysterectomy

A WOMAN UNDERWENT a total vaginal hysterectomy without prophylactic antibiotics. Six days after discharge, she went to the ED with fever, chills, abdominal pain, and diarrhea. She was given antibiotics and admitted after a CT scan and physical examination suggested an infection. At discharge 6 days later, antibiotics were not prescribed because she had been afebrile for over 48 hours. She continued to have abdominal distention, and returned to the hospital the next day with an ultrasound taken elsewhere that revealed a 9-cm pelvic abscess. She underwent bilateral salpingo-oophorectomy and was discharged after 4 days, this time with antibiotics. She continued to have diarrhea, severe abdominal pain, and weight loss for a year.

PATIENT’S CLAIM Prophylactic antibiotics should have been prescribed prior to surgery, and continued when she left the hospital the first time.

DEFENDANTS’ DEFENSE The case was settled before trial.

VERDICT A confidential Utah settlement was reached.