Medical Verdicts Notable judgments and settlements

Pelvic injury from } VERDICT A $1.25 million New York verdict was returned. the McRoberts maneuver?

During prenatal care, a woman repeatedly com- Abnormal thickness plained of severe discomfort, and requested a of fetal nuchal fold cesarean delivery. The ObGyn’s charts did not note her complaints. When a 31-year-old woman was A first-year resident and nurse covered for 18 weeks’ pregnant, she underwent the ObGyn because he did not arrive at the hospital for hours after the ultrasonography, which was report- mother notified him she was in labor. When was edly normal. The child was born with encountered, the resident used the McRoberts maneuver. The ObGyn Down syndrome. arrived a minute before the birth. The baby weighed 10 lbs. The mother suffered symphysis pubis diastasis, required several surgeries, and now } PATIENT’S CLAIM The ObGyn and uses a cane to walk. radiologist failed to detect an abnormal thickness in the fetal } PATIENT’S CLAIM The ObGyn was negligent in not arriving in time to nuchal fold—often a sign of Down deliver the baby. The mother’s pelvis was injured during the McRob- syndrome. erts maneuver. The baby’s size was not properly estimated. } PHYSICIANS’ DEFENSE The sono- } PHYSICIAN’S DEFENSE The use of the resident’s care was appropriate, as gram was properly analyzed. A thick- this was a teaching hospital. ened fold is an unreliable indicator of } VERDICT A $5.5 million New York verdict was returned. Down syndrome. } VERDICT A $1.7 million New Jersey settlement was returned.

In July 2002, the ObGyn removed Cancer Dx “not timely”; a 3-lb malignant uterine tumor during Ovary retained; additional tx required hysterectomy. A second staging sur- cancer recurs; death gery was performed, and the patient In June 2000, an ObGyn palpated a underwent chemotherapy. A woman underwent surgery for pelvic mass in a postmenopausal ovarian cancer in July 2004. She woman. After ultrasonography (US) } PATIENT’S CLAIM An earlier diagno- died of ovarian cancer in 2008 at in August 2000, the ObGyn told the sis would have reduced the amount age 59. woman that a uterine fibroid had of treatment required. The ObGyn been found but no further testing should have reacted immediately } ESTATE’S CLAIM The gynecologist was needed. In December 2001, US when the mass was first palpated did not tell the patient that only revealed that the mass had enlarged, in June 2000 and found on US in one ovary was removed, or that a but no further testing was done. In August 2000, as postmenopausal pathologist had not found the sec- May 2002, the patient reported fatigue, women do not develop uterine ond ovary in the specimen. Ovarian distention of her abdomen, and an fibroids. A gynecologic oncologist cancer developed in the retained increase in the frequency of urination. should have been present at the ovary a few years later. She would hysterectomy to perform concur- have undergone additional surgery

These cases were selected by the editors of rent staging. had she known the second ovary OBG Management from Medical Malpractice Ver- } PHYSICIAN’S DEFENSE The patient was still there. dicts, Settlements & Experts, with permission of the ck editor, Lewis Laska (www.verdictslaska.com). The failed to report symptoms that sug- } PHYSICIAN’S DEFENSE Both ova- o t s information available to the editors about the cases gested cancer for 10 months; a ries were removed in July 2004. The presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, prompt response was made when left ovary was not found during an these cases represent the types of clinical situations symptoms were revealed. It was autopsy performed on the decedent. : Shutter that typically result in litigation and are meant to o t appropriate to accept the results of } VERDICT A $1.967 million Pennsyl-

o illustrate nationwide variation in jury verdicts

Ph and awards. US regarding a uterine fibroid. vania verdict was returned. continued on page 44

obgmanagement.com Vol. 23 No. 8 | August 2011 | OBG Management 43 5 birth injuries, $54 million in verdicts and settlements

(Apgar scores, all 0). A neonatolo- begin induction and augment 1 Severe birth gist was not available for resuscita- labor. Oxytocin was continued asphyxia: cerebral tion; a neonatal nurse practitioner even though her pattern of con- palsy and seizures arrived 7 minutes after delivery. The tractions showed tachysystole. An baby finally had a heart rate 24 min- intrauterine pressure catheter that After a normal , a utes after delivery. The child suf- had been placed to assess contrac- woman went to the hospital in fered severe birth asphyxia, causing tions was removed. Monitoring labor. Her ObGyn, Dr. A, went off athetoid and spastic cerebral palsy revealed an elevated fetal heart duty at 4 PM and was replaced by and seizures. rate at 170 to 180 bpm. Ten min- Dr. B, a practice partner who deliv- utes before birth, the fetal heart ered five other babies between } PATIENT’S CLAIM The ObGyn failed tracing ended; a sonogram showed 11 PM and 2:15 AM. to deliver the baby in a timely man- fetal bradycardia and prompted an At 9:40 PM, the fetus was ner. The fetus was not continuously emergency . occiput posterior. At 12:31 AM, Dr. monitored with a fetal scalp elec- The baby was floppy at birth, B attempted manual rotation; no trode. The nurse violated several did not cry, and was intubated and exam was recorded in the chart. By hospital policies. transferred to the NICU. Apgar 2:30 AM, the fetus had returned to } DEFENDANTS’ DEFENSE The baby scores were 1, 3, and 5 at 1, 5, and the occiput posterior position, and suffered an acute, total cord occlu- 10 minutes. The umbilical cord gas Dr. B again tried manual rotation. sion minutes before birth; this was had a venous pH of 6.637, indica- Then he left to take a nap while the unpredictable and the injuries tive of profound acidosis. Ongo- mother’s epidural was reinforced. could not have been prevented. ing hypoxia and anoxia resulted There was a delay in achieving a } VERDICT At the end of the discov- in massive and irreversible brain satisfactory epidural, and Dr. B ery period, the defendants’ attorney injury. An EEG at 5 days confirmed was not called back to the bedside withdrew and new attorneys sought the presence of encephalopathy until 4 AM. He decided to perform to name new experts. While these due to perinatal asphyxia. The a cesarean delivery when the fetal issues were pending, the matter was child will require specialized treat- heart monitor showed an increased settled for a Washington total of $20 ment and attendant care for life. baseline with persistent variable million. The mother settled with the decelerations. hospital for $9.85 million. Although } PATIENT’S CLAIM Oxytocin was Although Dr. B had called Dr. the doctors’ group had $5 million never stopped or reduced through- A earlier to elicit her help with in insurance coverage, the plain- out labor and delivery. The ObGyn the cesarean, she had gone back tiff demanded that the insurance failed to promptly deliver the baby. to bed and was not prepared to company pay in excess of limits due No internal scalp electrode was assist. During a 30-minute delay, to potential bad-faith claims. The used to directly monitor the fetus; the electronic fetal monitor was insurance company ultimately paid the intrauterine pressure catheter disconnected and never recon- $10.15 million. was never replaced. nected. A nurse checked the fetal } DEFENDANTS’ DEFENSE The ObGyn heart rate with ultrasonography, and hospital denied negligence or and reported that it was normal; 2 Profound metabolic causation, claiming that there was however, there was no copy in acidosis after a sudden placental abruption 10 the chart. emergent delivery minutes before birth that caused The incision was made at perinatal asphyxia. 4:33 AM, and the baby was deliv- when A woman was 2 cm dilated } VERDICT A $6.95 million District ered at 5:06 AM. The infant was born and 99% effaced, she was given of Columbia settlement was without a heart rate or respiration dinoprostone and oxytocin to returned.

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difficult during labor and delivery. Brain damage did not occur during 3 Breech 2nd twin } VERDICT A $21,573,993 Pennsyl- labor and delivery. has cerebral palsy vania verdict was returned against } VERDICT A $3.55 million Idaho the hospital; a defense verdict was verdict was returned. Pregnant with twins and in early returned for the physician. labor, a woman went to the hospi- tal, where a nurse midwife admin- 5 Fetus transverse; istered dinoprostone. The labor and 4 Shoulder dystocia, oxytocin given delivery nurses only monitored one uterine tachysystole fetal heart rate during most of the complicate vaginal A woman arrived at the hospital labor period. The mother’s contrac- delivery after her membranes ruptured. A tion pattern was indicative of tachy- first-year resident failed to realize systole, and the twin who was being With mild pre-eclampsia and vagi- that the fetus was in a transverse monitored showed a decelerating nal spotting, a woman was admitted position, and, with the attend- heart rate. The ObGyn arrived min- to a hospital’s L&D unit. Dinopros- ing physician’s approval, ordered utes before the birth unprepared tone was administered, but the fetus oxytocin. When vaginal bleeding for delivery, and a nurse delivered a was unengaged. Oxytocin was added began, it was suspected that the pla- healthy first child. to induce labor. Labor was compli- centa had detached. An hour later, The second child’s heart rate cated by repeated tachysystole; pro- after vaginal bleeding increased dropped to 90 bpm, and the baby longed dilation; prolonged descent; and late decelerations were noted shifted to a breech position; the severe, prolonged decelerations; on the fetal heart monitor, cesarean ObGyn tried manual rotation but and tachycardia. Uterine tachysys- delivery was performed. The child was unsuccessful. After 20 minutes, tole continued for extended periods. was given a diagnosis of cerebral cesarean delivery was performed. was complicated palsy and other complications, and The boy was born with signs of by shoulder dystocia, which took 2 died at 16 months of age. metabolic acidosis and suffered a minutes to resolve. The child was seizure 2 hours later. He was given delivered without a heart rate or res- } ESTATE’S CLAIM The use of oxy- a diagnosis of cerebral palsy and is pirations. A heartbeat was obtained tocin is contraindicated for a fed through a tube, cannot speak, a minute after delivery, and Apgar baby in a transverse position. The and requires skilled nursing care. scores were 0, 2, and 2. The child fetus’ position indicated a need was given a diagnosis of hypoxic for a cesarean delivery. Placen- } PATIENT’S CLAIM The ObGyn and ischemic encephalopathy, cerebral tal detachment was not promptly nurses were negligent in only mon- palsy, and a seizure disorder. addressed, leading to fetal oxygen itoring one fetus, and for failing deprivation. to perform cesarean delivery in a } PATIENT’S CLAIM The L&D nurses } DEFENDANTS’ DEFENSE The fetus timely manner. and physicians were negligent appeared to be fine under all objec- } DEFENDANTS’ DEFENSE The ObGyn in failing to properly monitor tive criteria until a “softball-sized” claimed he was not informed of the labor progression, fetal heart clot emerged from the mother’s decelerations shown on the fetal rate, and oxytocin management. vagina. The attending physician monitor, nor of the mother’s rap- They failed to communicate with came to the mother’s bedside at idly progressing labor. The hospi- the woman’s ObGyn, and did not that time. Umbilical cord blood tal maintained that the nurses had exercise the proper chain of com- gases showed no evidence of aci- given the ObGyn proper informa- mand. The physicians failed to dosis. A fetal brain injury occurred tion and that the injuries to the infant recommend a cesarean delivery prior to the mother’s arrival at the had occurred after the ObGyn’s when labor became complicated. hospital. arrival. The mother’s weight of } DEFENDANTS’ DEFENSE The } VERDICT A $2.5 million Pennsylva- 322 pounds made monitoring patient’s treatment was appropriate. nia verdict was returned.

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