Medical Verdicts Notable judgmeNts aNd settlemeNts gravida in septic shock; partners during her pregnancy. were signs missed? } physician’s DEFENSE Negative results of a Herpes Select Test 6 months wiTh sEVERE ABDOMINAL PAIN AND VOMITING at 14 before birth made follow-up testing weeks’ gestation, a 30-year-old woman was brought unnecessary. She must have contracted by ambulance to the hospital. After initial evalua- the disease after testing had been per- tion did not reveal a cause of her symptoms, she was formed. She had no symptoms that transferred to the antepartum unit for observation. made the viral disease diagnosable at The mother developed hypotension and a diagnosis of septic shock delivery. The child’s symptoms sug- was made. Fetal cardiac activity ceased and the woman developed intesti- gested transplacental transmission of nal ischemia. She underwent an intestinal transplant several months later. herpes; a cesarean delivery would not have changed the outcome. } paTiEnT’s cLAIM Both treating physicians and the nursing staff failed to } VERDICT A Nevada defense react to her intermittently low blood pressure, and failed to diagnose or verdict was returned. treat septic shock in a timely manner. } defenDanTs’ DEFENSE The patient was properly monitored and treated. } VERDICT A $11,500,000 Illinois verdict was returned against the hospital. home birth A defense verdict was returned for both physicians. emergency DuRing a homE birth managed by severe abdominal pain after surgery. a midwife, the baby was born after Lethal outcome of } defenDanTs’ DEFENSE Bowel perfo- the mother pushed for 2 hours and ovarian cystectomy ration is a known complication of the 47 minutes. The child suffered brain surgery. There was no negligence; it damage. a woman in her 40s underwent was a complicated problem and the ovarian cystectomy. During surgery, staff had progressively attempted to } paTiEnT’s cLAIM The midwife her gynecologist encountered dense rule out various postsurgical issues. was negligent in failing to send the adhesions that required bowel dissec- } VERDICT A $2.5 million Illinois mother to the nearest hospital after tion. Later, the woman complained settlement was reached. she had been pushing for 2 hours. of severe abdominal pain, despite The dangers associated with the taking pain medication. A second lack of fetal heart rate monitoring gynecologist ordered an abdomi- mother’s herpes had never been explained to them. nal scan that showed fluid and pos- infection transmitted } defenDanT’s DEFENSE The parents sible bowel obstruction. Hospital in childbirth agreed to a home birth without use staff ruled out pulmonary embolism. of fetal heart rate monitoring. They When her blood pressure dropped to a baby bEcamE ill wiThin 3 Days of signed a detailed consent form, dangerous levels, a surgeon recom- birth and died several weeks later from which advised them that emergen- mended surgery. Preoperative test- a herpes virus infection. The mother cies could occur during delivery, and ing found punctures in both large had complained of burning pain dur- that the level and type of care would and small intestines. Before she could ing the office visits prior to delivery, be less than at a hospital. be given anesthesia, the woman suf- and during labor and delivery. } VERDICT A $1.9 million New Jersey fered cardiac arrest, and was placed settlement was reached. } on a ventilator. The family asked that paTiEnT’s cLAIM Additional testing These cases were selected by the editors of the ventilator be removed after three should have been performed when OBG Management from Medical Malpractice Ver- dicts, Settlements & Experts, with permission of the days, and she died. the mother complained of symptoms editor, Lewis Laska (www.verdictslaska.com). The prior to birth. The child contracted the information available to the editors about the cases presented here is sometimes incomplete. Moreover, } EsTaTE’s cLAIM The hospital staff herpes virus during vaginal delivery; the cases may or may not have merit. Nevertheless, hutterstock and gynecologists were negligent in proper and timely diagnosis would these cases represent the types of clinical situations s not ruling out bowel perforation as have resulted in a cesarean delivery. that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts soon as the woman complained of The mother denied having sexual and awards. Photo: e1 OBG management | November 2011 | Vol. 23 No. 11 obgmanagement.com taken medication to prevent a heart } paTiEnT’s cLAIM The ObGyn was APAS causes heart attack during her second pregnancy. negligent in not promptly identi- attack; fetal demise Dr. B should have tested her for a fying the bowel injury during the heart attack when she reported chest initial surgery. The surgeon was neg- 7 monThs inTo her FiRsT pregnancy, pain. She will require at least two ligent for failing to find the bowel a woman in her 20s suffered intra- heart transplants during her lifetime. injury during exploratory surgery. uterine fetal demise. A perinatolo- } PHYSICIANS’ DEFENSE The perina- } physician’s DEFENSE The injury did gist determined that the mother has tologist claimed that messages were not occur during the initial surgery; antiphospholipid syndrome (APAS), left for the patient on both her work the perforation found at the second an immune system disorder that can and mobile phones, but she did not hospital was fresh and unrelated to cause excessive blood clotting, pre- return the calls. The perinatologist the previous procedures. mature miscarriage, and heart attack. also mailed a pamphlet on APAS and } VERDICT A Louisiana defense ver- Although the perinatologist and an additional lab form to the patient. dict was returned for the ObGyn. The Dr. A, the woman’s Family Practitio- Dr. A claimed that the perinatologist surgeon was found negligent, and the ner (FP), received the report, neither was solely responsible for follow- jury awarded $3,314,801. told the woman. up regarding the test results. Dr. B When 6-weeks’ pregnant with a claimed that a heart attack is very rare second child, the woman awoke with in a 24-year-old woman, and was very Zavanelli maneuver; severe, crushing chest pain. Dr. B saw difficult to identify; several doctors at brachial plexus injury her in the emergency department, two hospitals missed the diagnosis. but did not order an ECG or cardiac } VERDICT A New Mexico jury found shoulder DysTocia was encoun- enzyme blood test. After 7.5 hours, all parties at fault: Dr. B, 47.5%; Dr. A, tered during delivery, and her ObGyn Dr. B diagnosed morning sickness or 35%; perinatologist, 10%; and patient, attempted several procedures, includ- indigestion, or both, and was ready to 7.5%. The jury awarded $9 million in ing use of a vacuum extractor. Ulti- discharge her. However, the woman, general damages and established a mately, he performed a Zavanelli still in intense pain, expressed con- patient compensation fund for future maneuver, in which the fetal head is cern for her fetus. Dr. B sent her to medical expenses. The plaintiff’s pushed back into the birth canal in another hospital 2 hours away. actual recovery was $1.8 million due order to deliver the child by cesarean Upon arrival, her chest pain had to a state cap. delivery. The child suffered a brachial diminished but she reported radiat- plexus injury, and does not have use ing back and neck pain. Although of her right arm. the hospital’s protocol required ECG bowel injury after within 10 minutes of presentation hysterectomy } PATiEnT’s cLAIM The mother was with chest pain, no ECG was per- administered too much oxytocin by formed. A diagnosis of “gall bladder an obgyn perfoRmed laparoscopi- the delivery nurse, causing contrac- problems” was made. cally assisted vaginal hysterectomy tions to be too strong and come too Eighteen hours later, she was on a 55-year-old woman. After sur- fast, resulting in fetal distress. The sent to a university hospital, where gery, the woman’s condition deterio- ObGyn applied the vacuum extrac- an ECG revealed that she had been rated. The ObGyn consulted with a tor when the fetus was too high in experiencing a clot-induced heart surgeon, who performed an explor- the birth canal, resulting in too much attack for 44 hours. Approximately atory laparotomy 2 days after initial traction on the fetus’ brachial nerves. 40% of her heart muscle was dam- surgery; he suspected a bowel perfo- } PHYSICIAN’s DEFENSE The fetus was aged, and she was counseled to not ration, but could not find it. in grave danger, and was at the proper continue the pregnancy because of The patient was transferred to stage of delivery when the maneu- cardiac dysfunction. another hospital and 4 days later, an vers were attempted. The child would imaging study of the bowel revealed have suffered significant brain injury } paTiEnT’s cLAIM The perinatolo- the injury and the bowel was repaired. or death if the maneuvers had not gist and Dr. A were negligent in not She developed sepsis and necrosis, been attempted. telling her that she has APAS. With and a 44-cm section of bowel was } VERDICT A Georgia defense verdict that information, she could have resected. Her recovery was complex. was returned. obgmanagement.com Vol. 23 No. 11 | November 2011 | OBG management e2.