NOTABLE JUDGMENTS AND SETTLEMENTS IN BRIEF
Despite signs of cancer, estrogen is given
After 2 years of mammograms showing signs of breast cancer and the continued administration of estrogen medications, a 55-year-old woman underwent a modified radical left mastectomy and left axillary dissection, followed by extensive radiation therapy and chemotherapy. She suffered extensive radiation burns to her chest wall, chronic arm swelling due to lymphedema, and nerve damage to the hands due to the chemotherapy. She underwent a total of 9 surgeries.
PATIENT’S CLAIM The gynecologist was negligent for not referring her to a surgeon after 2 years of mammograms indicated cancer and for continuing to administer estrogen medications. The delayed diagnosis allowed the cancer to grow to nearly 9 cm and spread to the lymph nodes, thus requiring extensive surgery and treatment, rather than a simple lumpectomy and breast radiation.
DOCTOR’S DEFENSE Not reported.
VERDICT A jury returned a verdict of $5.65 million for the plaintiff and $300,000 for the husband for lost consortium.
Postcoital bleeding fails to alert Gyn to cancer
A 35-year-old woman suffered postcoital bleeding and was diagnosed with cervicitis by her gynecologist. After 10 months with no improvement despite 9 more examinations and antibiotic treatment, a colposcopy performed by a second gynecologist revealed cervical adenocarcinoma. A hysterectomy was performed.
PATIENT’S CLAIM The first gynecologist should have performed a colposcopy and biopsies to diagnose the cancer and start treatment, thus avoiding the hysterectomy and increasing her life expectancy.
DOCTOR’S DEFENSE Cervical cancer is seldom diagnosed at an early stage, and this cancer was located where early detection by colposcopy was impossible. In this case, a hysterectomy would have been necessary anyway.
VERDICT Defense verdict.
Doctor sutures bladder, calls dye spill a “typo”
After having suffered severe pelvic pain and bleeding for years, a 25-year-old woman underwent a total hysterectomy. Following surgery, she began to have bladder problems. When it was discovered that her bladder had been sutured three times during the surgery, she underwent repair surgery, but she remained incontinent.
PATIENT’S CLAIM According to the surgical record, blue dye was observed coming from her bladder during surgery, which should have alerted the doctor to investigate and repair the injury.
DOCTOR’S DEFENSE The physician admitted suturing the bladder, a known complication, but claimed the injury was not immediately apparent. Also, no dye spilled from the bladder - that was just a typographical error.
VERDICT Defense verdict.
Small abdomen worries mother, not doctor
A 24-year-old pregnant woman had monthly visits with her ObGyn from May to November. In October, she indicated that 2 pregnant friends had larger abdomens than she did at similar stages of pregnancy, but she was told everything was fine. In November, she requested an ultrasound on 3 occasions, but was told it was not necessary. In late November, she reported to the clinic complaining of cramps. Fetal demise was diagnosed, she was admitted to the hospital, where delivery was induced, and she went home the next day.
PATIENT’S CLAIM The fetus would not have died if the ObGyn had performed the appropriate tests when she was first concerned about the small size of her abdomen.
DOCTOR’S CLAIM Intrauterine growth retardation is rare and difficult to diagnose, and it has a high morbidity rate. Also, the mother was instructed to report diminished fetal movement, but she had failed to do so.
VERDICT After a trial resulted in a hung jury, a confidential settlement was reached.
Placental abruption or burst fetal blood vessel?
When a pregnant woman at term called her ObGyn after waking in a pool of blood, he questioned her and then sent her to the hospital. Physical assessment, fetal monitoring, and ultrasound were conducted. A cesarean section was performed when vaginal exam revealed that the fetus was remote from a vaginal delivery. After birth the newborn was unstable. She was transferred to another hospital, where she died soon thereafter.
PATIENT’S CLAIM The mother believed she had a placental abruption and claimed the baby would have survived had the delivery been done even 20 minutes earlier.
DOCTOR’S DEFENSE According to information the mother gave on the phone, bleeding was not due to placental abruption. She was no longer bleeding when she arrived at the hospital and had no abdominal pain. A ruptured fetal blood vessel caused the severe blood loss, and the baby would have died even if delivered earlier.
VERDICT A $500,00 verdict was returned.
Referring Gyn: “not responsible” for sponge
A 36-year-old woman’s gynecologist, Doctor 1, referred her to an ObGyn, Doctor 2, to perform a reversal of a tubal ligation. During the procedure, a lap sponge rolled in plastic was left in the patient despite a correct sponge count reported by the nurses. During her hospital stay and 4 office visits with Doctor 2, she reported pain, but a vaginal ultrasound was negative. One year later, she complained of excruciating pain to Doctor 1, who felt a mobile mass. Abdominal ultrasound showed nothing. When a CT tech told her to see her doctor after a CT scan, she was alarmed and immediately had an x-ray done, which indicated a retained foreign body. The patient sought another opinion when Doctor 1 asked her to sign a form for exploratory surgery before he had reviewed the CT results himself. Doctor 3 diagnosed the problem immediately and removed the sponge. She has had few physical problems since then.
The patient sued Doctors 1 and 2, the hospital, and the nurses. The hospital filed a 3rd party action against Doctor 2, claiming he had used a nonradiopaque, noncounted sponge.
PATIENT’S CLAIM The patient claimed the doctor was negligent in leaving the sponge in her and failing to diagnose the problem following surgery.
DOCTOR’S DEFENSE Doctor 1 could not have told the patient about the retained sponge before he had seen the CT films, especially as the records showed a correct sponge count. When he was certain it was a sponge, he called the patient, but she never returned his calls. Also, as the assistant surgeon, he was not responsible for the sponge count.
VERDICT The plaintiff reached a confidential settlement with Doctor 2 and the hospital. The hospital settled with the plaintiff and dismissed its claim against Doctor 2. In the trial against Doctor 1, a defense verdict was returned.
Anesthesiologist, nurses say “not me,” blame OB
An infant later found to be mentally retarded was delivered by cesarean section following fetal distress.
PATIENT’S CLAIM The parents claim the obstetrician, anesthesiologist, and 2 hospital nurses failed to respond quickly to signs of fetal distress, and a 1-hour delay in performing a cesarean section caused the child’s mental retardation. The anesthesiologist should have been prepared for a cesarean section, and the nurses did not report the obstetrician’s delay to superiors.
DOCTOR’S DEFENSE Anesthesiologist and nurses blamed the obstetrician.
VERDICT Prior to trial, the obstetrician settled for $1 million. A $3.69 million verdict was returned against the others, but that was reduced to $45,000 because the jury found the obstetrician to be 90% at fault.
When are drugs, monitoring enough?
A woman pregnant with twins at 29 weeks’ gestation presented to a hospital with vaginal bleeding, but was discharged when maternal-fetal well-being was established. One day after a brown discharge, she reported to the hospital with bleeding and irregular contractions. She was monitored and given tocolytic drugs, then sent home where uterine activity was monitored. She suffered acute bleeding 2 days later and returned to the hospital, where an emergency cesarean section was performed. One twin was born severely depressed due to 75% placental abruption and died 2 days later. The other twin experienced 35% placental abruption, but had no further problems.
PATIENT’S CLAIM If ultrasound had been performed when the mother complained of bleeding, it would have shown the fluid depletion. The mother would have been hospitalized and monitored, allowing the doctors to know of the possibility of abruption.
DOCTOR’S DEFENSE The mother’s symptoms did not require hospitalization. She had a premature rupture of membranes for the one twin, leading to acute severe placental abruption.
VERDICT Defense verdict.
Did she or didn’t she consent to c-section?
A baby weighing over 11 pounds was delivered vaginally in 2001. The child was born with Erb’s palsy and brain damage and has undergone 2 surgeries for the Erb’s palsy. He suffers from language and speech deficits, and requires occupational and speech therapy.
PATIENT’S CLAIM The injury would not have occurred if the doctor, who knew the baby was large, had performed a cesarean section, to which the mother had consented.
DOCTOR’S DEFENSE The plaintiff refused a cesarean section, and a vaginal delivery was proper. Also, the child has no limitation on the range of motion of the left shoulder.
VERDICT A $4 million settlement was reached.
Defense: “Distorted anatomy’s the problem”
A 55-year-old woman had abdominal surgery, during which a ureter was apparently severed. She underwent a second operation to repair the damage.
PATIENT’S CLAIM The doctor was negligent in severing the ureter and in not identifying and repairing the injury in a timely manner.
DOCTOR’S DEFENSE The doctor was not convinced the injury had occurred during surgery, but if it had, then the patient’s distorted anatomy was to blame. Also, when urine leakage was identified, the patient was immediately referred for additional treatment.
VERDICT Defense verdict.
The cases in this column are selected by the editors of Obg Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, Nashville, Tenn (www.verdictslaska.com). The available information about the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts and awards. Any illustrations are generic and do not represent a specific legal case.