Medical Verdicts Notable judgments and settlements

Blocked intestine after when the stitch migrated through the anterior wall of the vagina. cesarean—a nonsurgical cause?

A 34-year-old woman gave to a healthy } patient’s CLAIM The gynecologist baby by cesarean delivery. Several weeks later, the was at fault for injuring the bladder mother reported abdominal pain, distention, and during surgery, and repairing it with nausea. Her ObGyn suspected it was related to a a nondissolving suture. somatic disorder. } physician’s DEFENSE Injury to the Two months after delivery, the mother came bladder and ureters is a known risk to the emergency department with increasingly severe symptoms. One of the procedure. The correct type of month later, at another hospital, physicians diagnosed a bowel obstruc- suture was used; it was supposed to tion. During emergency surgery, a lap sponge was found within the lumen dissolve. The gynecologist tested the of the patient’s small intestine. bladder and ureters using Indigo car- mine-based dye before closing. } patient’s CLAIM The ObGyn left the lap sponge in her abdomen during Over time, as the suture failed cesarean delivery. to dissolve, scar tissue occluded the } physician’s DEFENSE The sponge count from the cesarean delivery was ureter. Subsequent surgery returned correct. The ObGyn suggested that the patient had swallowed the sponge, the patient to baseline health. because it was found within the lumen of the intestine, not in free space. } VERDICT A Pennsylvania defense The surgeon who removed the sponge agreed with the ObGyn, and rec- verdict was returned. ommended a psychiatric consult. } VERDICT A Louisiana defense verdict was returned. Baby stillborn. Vasa previa missed? } PHYSICIAN’S DEFENSE Vacuum Did extraction was necessary because ultrasonography revealed that the baby was not progressing down the patient probably had a vasa pre- cause developmental the birth canal and was beginning via. Her ObGyn referred her to an delays? to show signs of distress. Vacuum OB specialist, who ordered a second extraction did not cause the child’s scan, which ruled out vasa previa. A successful delivery was per- injuries. month later, the patient was taken to formed using vacuum extraction. } VERDICT A confidential South Caro- the hospital with vaginal bleeding. It Later, mild balance and coordination lina settlement was reached during was determined that she was in labor, issues, cognitive deficits, and speech jury deliberations. and her ObGyn performed a cesar- delay were diagnosed in the child. ean delivery. The baby was stillborn.

} patient’s CLAIM Use of the vacuum Suture fails to dissolve; } PATIENT’S CLAIM Both ObGyns failed extractor was unnecessary; the fistula develops to diagnose a vasa previa, which instrument caused a subdural bleed caused the stillbirth. Proper diagno- that resulted in the child’s develop- a woman underwent surgery for sis would have allowed for cesarean mental delays. uterine fibroids, during which injury delivery before labor began, result- to the bladder was repaired with a ing in a successful birth.

These cases were selected by the editors of single suture. } physicians’ DEFENSE The preg- OBG Management from Medical Malpractice Ver- A few weeks later, she devel- nancy was properly managed. Vasa dicts, Settlements & Experts, with permission of the editor, Lewis Laska (www.verdictslaska.com). The oped abdominal pain, blood in her previa had been ruled out by ultra- information available to the editors about the cases urine, and urinary incontinence. It sonography. Placental abruption or presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, was determined that the suture had a fetal-maternal hemorrhage was these cases represent the types of clinical situations hutterstock not dissolved, and caused obstruc- responsible for the stillbirth. S that typically result in litigation and are meant to } VERDICT illustrate nationwide variation in jury verdicts tion of the right ureter and kidney. A Kentucky defense verdict

and awards. A vesicovaginal fistula developed was returned. Photo:

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The child cannot swallow and wand perforated the bowel. The Delay in delivery, receives nutrition through a feeding gynecologist was negligent in his use then uterine infection, tube. She cannot speak, is confined of the wand; the wand manufacturer to a wheelchair, and has the cognitive and the electrosurgical generator then hysterectomy function of an 18-month old. manufacturer were negligent in the equipment’s design; and the hospital a 29-year-old woman was 34 weeks’ } patient’s CLAIM The child suffered a was negligent in its maintenance of pregnant with her third child when she hypoxic event caused by meconium the equipment. suspected that her water broke, and aspiration, resulting in encephalop- } defendants’ DEFENSE The instru- went to the hospital. Testing revealed athy and cerebral palsy. The finding ment manufacturer denied any the membranes had ruptured, but the of stained amniotic fluid should have design defect and argued that the ObGyn elected to delay delivery. prompted the ObGyn to perform an injury was not a burn but was caused Amniotic fluid continued to leak emergency cesarean delivery. by the coagulator wand making con- for 5 days when suddenly the wom- } physician’s DEFENSE Electronic tact with another surgical instru- an’s temperature spiked. A healthy fetal monitoring never indicated fetal ment. The physician, generator baby was delivered by cesarean sec- distress. cleared the manufacturer, and hospital denied tion 24 hours later. amniotic fluid, making a cesarean negligence. After delivery, an intrauter- delivery unnecessary. The child’s } VERDICT The claim against the ine infection was diagnosed in the condition resulted from preexist- gynecologist was dismissed by sum- mother. She was transferred to ing neurological problems and/or a mary judgment. The hospital and the another hospital, where she under- genetic condition that also caused generator manufacturer settled for went a hysterectomy. microcephaly, a heart defect, and an undisclosed amount. A $2.2 mil- polydactylism. lion California verdict was reached } patient’s CLAIM The ObGyn was } VERDICT A New York defense verdict against the wand manufacturer. negligent in failing to deliver the was returned. child when membranes initially broke. Leaking amniotic fluid con- Child has spina bifida tributed to the uterine infection. Bowel is perforated: despite evaluation } PHYSICIAN’S DEFENSE It was appro- “Now I can’t conceive” priate to allow the to ultrasonography results indi- continue because the fetus was a woman was given a diagnosis of cated normal fetal growth during a premature. Infection could have endometriosis. During laparoscopic woman’s pregnancy. However, the occurred regardless of when delivery surgery to treat the condition, the child was born with spina bifida and was performed. gynecologist used a unipolar laparo- required back and brain surgery } VERDICT A $25,000 Mississippi scopic coagulator wand. shortly after birth. She wears ankle verdict was returned. Eighteen days later, the patient and foot orthotics and is incontinent. went to the emergency department with severe lower abdominal pain. } patient’s CLAIM The ObGyn failed to What caused this Peritonitis, caused by bowel perfora- perform a prenatal alpha-fetoprotein child’s brain damage? tion, was diagnosed, and she under- test. The radiologist misinterpreted went surgery. A portion of bowel was the sonogram. during prolonged delivery, the phy- removed. A colostomy was created, } physicians’ DEFENSE The ObGyn sician assistant and residents in charge which was later reversed. believes that most spina bifida condi- of labor and delivery noted meconium- She developed adhesions from tions are detectable by ultrasonogra- stained amniotic fluid discharge. When the peritonitis and required addi- phy, and the radiologist’s report did advised, the mother’s ObGyn directed tional surgeries that, she alleged, not indicate spina bifida. the hospital staff to perform amnioinfu- caused subsequent fertility treat- } VERDICT The radiologist settled for sion. The child was born vaginally sev- ments to be unsuccessful. $1 million before the trial. A $2.5 mil- eral hours later and determined to have lion New Jersey verdict was returned suffered brain damage. } PATIENT’S CLAIM The coagulator against the ObGyn.

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