Large prolapsed fibroid left untreated—despite surgery...and more
Large prolapsed fibroid left untreated—despite surgery
A 48-YEAR-OLD WOMAN PRESENTED to the emergency department (ED) with vaginal pain. A large, prolapsed uterine fibroid was diagnosed. Because she was scheduled for an ObGyn visit 2 days later, she was discharged without any treatment.
The next day, she returned to the ED with vaginal bleeding. Ultrasonography (US) showed multiple fibroids. Physical exam confirmed a prolapsed uterine fibroid extending into the vaginal vault. Her ObGyn performed an open myomectomy a few days later.
She called her ObGyn’s office prior to her scheduled postoperative visit because she still felt something in her vagina, and had pelvic pain and vaginal bleeding. She also reported this at the office visit, where she met with a nurse practitioner.
Two months later, she called the ObGyn’s office to complain of vaginal bleeding, and described passing large clots.
A month later, she saw a surgeon, who determined that the large prolapsed fibroid had never been removed. Surgery was scheduled, during which her uterus was removed. The patient was hospitalized for 11 days.
PATIENT’S CLAIM The ObGyn was negligent in failing to surgically remove the fibroid, perform postoperative US, and properly examine, diagnose, and treat her postoperatively. The ObGyn’s office staff failed to relay her telephone and in-person complaints to the physician.
DEFENDANTS’ DEFENSE The ObGyn and his group denied negligence.
VERDICT A $248,160 Georgia verdict was returned against the group.
Woman claims she was never told mammogram results
AFTER MANY NORMAL MAMMOGRAMS, a woman had an abnormal annual result. However, she claimed the physician did not inform her of the reported results. A year later, she was diagnosed with breast cancer.
PATIENT’S CLAIM The physician was negligent in failing to follow-up on the abnormal mammogram and make a correct diagnosis.
PHYSICIAN’S DEFENSE The woman had refused a recommended biopsy after the abnormal mammogram, and later refused mastectomy and radiation therapy. The patient’s outcome would have been the same even if treatment had begun shortly after the abnormal mammogram.
VERDICT A $175,000 verdict was returned in Indiana.
5,386-g newborn has Erb’s palsy
OXYTOCIN WAS ADMINISTERED after a woman’s labor slowed. During vaginal delivery, the ObGyn encountered and managed shoulder dystocia. The 11-lb, 14-oz infant was later given a diagnosis of Erb’s palsy.
PLAINTIFF’S CLAIM Excessive force during the ObGyn’s management of shoulder dystocia caused the Erb’s palsy. US should have been performed prior to delivery to determine fetal weight. Cesarean section may have prevented the injury.
PHYSICIAN’S DEFENSE Fetal weight was calculated at a time when vaginal delivery could not be safely discontinued. Excessive traction was not used; if it had been used, the injury would have been more significant.
VERDICT A New York jury returned a $485,000 verdict.
Was there delay in recognizing necrotizing fasciitis?
PREGNANT WITH TWINS, a 24-year-old woman was hospitalized at 33 weeks’ gestation, and remained there until delivery. There was no clinical evidence of fever or intrauterine infection during her hospitalization. Her anogenital culture for group B Streptococcus was positive. Clindamycin was begun 11 days prior to delivery, and continued after a successful cesarean delivery by her ObGyn.
Three days later, the mother suffered a high fever and marked elevation of her white blood cell count. The ObGyn reopened and drained the wound incision. Surgical debridement was not performed. The woman continued to deteriorate.
She developed extensive necrosis of the tissue around the abdominal wound, extending to the pannus and mons pubis. The ObGyn performed wide excision of the tissue. Necrotizing fasciitis was confirmed by pathology.
The woman was diagnosed with sepsis, multi-system organ failure, disseminated intravascular coagulopathy, and respiratory dependence. She was transferred to another hospital, where she remained until her death 3 months after delivery.
ESTATE’S CLAIM The ObGyn failed to diagnose and treat the necrotizing fasciitis in a timely manner. He failed to perform emergency surgical debridement when the lesions were first identified.
PHYSICIAN’S DEFENSE Antibiotics were ordered at the first sign of the vaginal strep infection and continued due to postsurgical wound infection.
Consultations with infectious disease specialists were obtained because of the patient’s history of extreme medication reaction and numerous antibiotic allergies. Although testing reported negative results for other infection sources, the patient failed to respond to treatment. Surgical debridement was performed when necessary, and as often as the patient was deemed able to tolerate the procedure.
VERDICT A Georgia verdict of $4,317,495 was returned.
ObGyn at fault for child’s brain injury and vision loss?
AT 22 WEEKS’ GESTATION, a woman presented to the ED with cramping and bleeding. A nurse called the woman’s ObGyn, who was not at the hospital; he ordered monitoring and laboratory tests. Two hours later, the bleeding and pain increased. The ObGyn was notified, although whether he was told about the excessive bleeding or not is in dispute. He ordered morphine. The patient was sent home without being seen by a physician, with instructions to follow-up with her ObGyn.
The woman claimed she called the hospital the next morning to report continued pain and bleeding, and was told to take a bath. She returned to the hospital the next evening. US revealed a dilated cervix with hour-glassing membranes. The child was delivered at 23-weeks’ gestation and suffers from a brain injury and vision loss.
PLAINTIFF’S CLAIM Premature delivery was due to an incompetent cervix, which could have been treated with cerclage. Diagnostic US and a physical examination by the ObGyn were never performed.
DEFENDANT’S DEFENSE Postdelivery evaluation of the placenta indicated that the mother had chorioamnionitis. Cerclage would have been contraindicated; delivery would have occurred despite any efforts to prolong the pregnancy.
VERDICT A Utah defense verdict was returned.
Did untreated hypertension cause mother’s blindness?
A 34-YEAR-OLD PREGNANT WOMAN was admitted to the hospital with new onset hypertension. Three days later her BP increased to 170/98 mm Hg; her ObGyn performed an emergent cesarean delivery. During the procedure, the woman’s BP rose to 203/120, and remained high in recovery. When she awoke, she reported blurred vision, and was later declared to be legally blind.
PATIENT’S CLAIM The physician failed to properly monitor her BP. Failure to use antihypertensive drugs led to an ischemic event, resulting in vision loss.
PHYSICIAN’S DEFENSE The woman’s BP was properly monitored at all times. She had been diagnosed with Purtscher’s retinopathy syndrome, which predisposed her to pregnancy-related vision loss. Her blindness was not BP-related.
VERDICT A Tennessee defense verdict was returned.
Ruptured ectopic pregnancy not treated properly in ED
WHEN BROUGHT TO THE EMERGENCY DEPARTMENT, a 25-year-old woman was found to be in hemorrhagic shock following a ruptured ectopic pregnancy. Her BP was 42/19 mm Hg. She was taken to surgery, where the ruptured fallopian tube was removed.
After surgery, she complained of tremors in her legs and torso, and had difficulty walking unassisted. She was diagnosed with hypoxic ischemic encephalopathy and transferred to a rehabilitation facility.
PATIENT’S CLAIM She was not properly resuscitated in the ED; intravenous fluids and transfusions should have been given immediately. Delayed treatment in the ED caused hypoxic ischemic encephalopathy or a conversion disorder.
PHYSICIAN’S DEFENSE Intravenous fluids and transfusions were started appropriately and promptly in the ED. The patient did not suffer hypoxic ischemic encephalopathy; a conversion disorder could have occurred from the stress of the ruptured ectopic pregnancy.
VERDICT An Illinois jury returned a defense verdict.
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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