OBG_12.05_Verdicts_FINAL 11/17/05 3:26 PM Page 51 MEDICAL NOTABLE JUDGMENTS AND SETTLEMENTS IN BRIEF VERDICTS $22 million awarded conjugated estrogens, despite the woman’s history of deep venous thrombosis and the for cerebral palsy “black box warning” against use of conju- Jefferson County (Ky) Circuit Court gated estrogens in such individuals. At more than 40 weeks’ gestation, a woman Shortly thereafter, deep venous throm- was admitted to a hospital for labor induc- bosis developed, leading to permanent par- tion. Oxytocin was administered in increas- tial loss of use of the left leg. ing doses because of slow progress, but 10 In suing, the woman hours after admission the infant was still asserted the physician should not delivered. After failed vaginal delivery not have prescribed the med- with vacuum forceps, the infant was even- ication when it was con- tually delivered by cesarean section. traindicated. The infant has spastic quadriplegia The physician maintained with severe speech and motor deficits, and the woman had not had an is now confined to a wheelchair, requiring episode of deep venous 24-hour care. thrombosis in more than 20 In suing, the woman contended the years, and that the medication Deep venous thrombosis oxytocin caused uterine hyperstimulation was indicated because more and that the nurses failed to note that the than 90% of women who undergo oxytocin was not working. She claimed oophorectomy require hormone treatment. vaginal delivery should not have been The defense added that the woman had no attempted. She asserted the hospital was evidence of permanent injury. negligent in credentialing the physician, • The case settled for $500,000. who was given full privileges without mon- itoring despite having been in practice for only a month at the time of the delivery. Would heparin have The hospital countered that the woman and her infant had responded well to the prevented death? oxytocin and that the hypoxic event result- Hardin County (Ky) Circuit Court ed from unforeseeable and unpreventable A 46-year-old woman underwent a 3-hour- movement by the fetus, which restricted the long vaginal hysterectomy. Before surgery umbilical cord. and during recovery, an intermittent pneu- • The physician settled for a confiden- matic cuff was used to minimize the risk of tial amount prior to trial. The jury deep venous thrombosis. awarded the plaintiff $22 million; A week after the surgery, 2 days after posttrial motions are pending. discharge, she reported extreme fatigue and trouble standing up. Despite the ObGyn’s advice to walk around, she stayed in bed. A Contraindicated drug few hours later she died suddenly of a pul- monary embolus. In suing, the woman’s causes DVT family claimed the physician failed to pre- Roanoke (Va) City Circuit Court scribe heparin in response to the risk of pul- After a 41-year-old woman underwent a monary embolism, given the woman’s age hysterectomy, her physician prescribed and long duration of surgery. CONTINUED www.obgmanagement.com December 2005 • OBG MANAGEMENT 51 OBG_12.05_Verdicts_FINALREV1 11/21/05 4:03 PM Page 52 MEDICAL VERDICTS CONTINUED Although the ObGyn admitted the abnormality and Wolf-Hirschhorn syn- woman was at high risk of pulmonary drome. She was told the infant would embolism, he contended that application of eventually have mental retardation, phys- the pneumatic cuff was sufficient and that ical disfigurement, hearing loss, an inabil- prophylactic heparin was not necessary. ity to speak, and respiratory and feeding • The jury returned a defense verdict. difficulties. The woman remained hospi- talized and under strict bed rest until delivery. The infant was hospitalized for 4 Bladder fistula months and then institutionalized because of the impending profound disabilities. follows hysterectomy The woman filed suit for wrongful Henderson County (Ky) Circuit Court birth, claiming she would have had an During a laparoscopic-assisted vaginal abortion if she had known her infant’s hysterectomy on a 32-year-old woman, prognosis. She claimed her local physi- the surgeon found extensive varicosities cians failed to properly monitor the preg- on the bladder flap. Bleeding was stopped nancy; failed to inform her that first- by cauterization. trimester bleeding indicates a chance of Three weeks later, the woman com- chromosomal damage; inappropriately plained of leaking urine from her bladder. advised her not to have alpha fetoprotein A small hole in her bladder had developed testing; failed to inform her or follow up into a fistula. on the 20-week ultrasound showing a 2- In suing, the woman claimed the week discrepancy between her estimated bladder was damaged during the cauteri- due date and fetal development; and zation and that the surgeon should have failed to obtain fundal heights measure- converted the operation to an open ments. laparotomy to properly handle the vascu- The defendants asserted they had no lar problems. knowledge of the woman as their patient The defense contended cauterization at the time of the trial. They also contend- was not near the bladder, and that fistulas ed that they believed the woman would can occur during hysterectomies without not have aborted the pregnancy under negligence. any condition. • The jury returned a defense verdict. • The jury awarded the plaintiff $3.8 million (the estimated cost of care until age 21). Care costs awarded for wrongful birth Alleged delay in diagnosis Rockland County (NY) Supreme Court A 31-year-old woman had first-trimester of ovarian cancer and third-trimester bleeding, although Rockland County (NY) Supreme Court results from 2 early ultrasounds were nor- After 3 normal visits to her ObGyn over a mal, as was a 20-week ultrasound. span of 8 months, and a negative sono- Out of town about 3 weeks before her gram, a woman presented complaining of delivery date, the woman began profuse pain in the adnexal region. A sonogram at bleeding. Her physician told her to proceed this time led to the diagnosis of ovarian to a local emergency department, which cancer. The woman underwent chemo- transferred her to another facility, where therapy and a hysterectomy. she learned for the first time that the fetus In suing, the woman asserted that her had intrauterine growth retardation. ObGyn should have suspected ovarian Amniocentesis performed at a third cancer and that earlier detection would facility revealed fetal chromosomal have led to less invasive surgery and 52 OBG MANAGEMENT • December 2005 OBG_12.05_Verdicts_FINALREV1 11/21/05 4:03 PM Page 53 MEDICALVERDICTS could have obviated the need for chemo- tears are unrecognizable. therapy. • After 2 mistrials, the jury returned The physician claimed that an earlier a defense verdict. sonogram was unnecessary because the woman had no complaints of pain. The ObGyn also asserted that the treatment Delayed cesarean course would have been the same. • The jury returned a defense verdict. blamed for injuries Essex County (Mass) Superior Court Two weeks past her due date, a woman Was force excessive? underwent artificial rupture of mem- Cook County (Ill) Circuit Court branes in the morning; scant amniotic At 36.5 weeks, a woman was admitted for fluid was noted. Oxytocin was adminis- labor induction. Delivery of the head was tered and late decelerations were noted. followed by shoulder dystocia. The infant Labor progressed slowly and the pos- was born with a severe left brachial plexus sibility of cephalopelvic disproportion was injury and left torticollis. Despite 4 repar- entertained. ative surgeries, the left arm and hand have Later that night the fetal heart rate little useful function. demonstrated tachycardia. The plaintiff In suing, the woman asserted the alleged that the nurses failed to make physician used inappropriate and exces- detailed notes in the patient’s record or sive force to complete the delivery, a claim question the obstetrician’s decision to con- the defense denied. tinue with labor induction in the presence • The hospital settled for $400,000 of a nonreassuring tracing. In the second before the case went to trial. The stage, a vacuum-assisted vaginal delivery jury returned a defense verdict. was attempted due to a prolonged deceler- ation of the fetal heart rate. Nine vacuum extractions were attempted and were unsuccessful. What caused The infant was delivered by emer- fecal incontinence? gency cesarean section with no heart rate, Fulton County (Ga) State Court respirations, muscle tone, or reflex irrita- A 37-year-old woman delivered a healthy tion. After resuscitation, the infant was infant after normal labor and vaginal transferred to another hospital, where delivery. After birth the woman had total seizures developed and cerebral palsy was fecal incontinence, and could no longer diagnosed. work or perform many activities. A The woman sued both the obstetri- sphincteroplasty to repair an anal sphinc- cians and the nurses. The defendants con- ter tear was unsuccessful. tended the fetal monitoring strips showed In suing, the woman asserted her little, if any, signs of nonreassuring pat- physician failed to recognize, treat, or terns. They also claimed the infant’s repair the tear during delivery. injuries had other causes. Her physician countered that a histo- • The case settled for $4 million. ry of hemorrhoidectomy and fistulotomy from 15 years before the birth should have been revealed in the medical history Was lack of cesarean forms completed by the patient. The physician asserted that had he known cause of injury? about this medical history, he would have US District Court, Eastern District of Texas suggested a cesarean section. He also A 33-year-old woman gave birth via forceps contended that some types of muscle delivery to an infant with cerebral palsy. CONTINUED www.obgmanagement.com December 2005 • OBG MANAGEMENT 53 OBG_12.05_Verdicts_FINALREV1 11/21/05 4:03 PM Page 54 MEDICAL VERDICTS CONTINUED In suing, the family claimed an occult that is within ACOG guidelines.