PATIENT’S CLAIM Neither physician properly monitored the patient after administration of methotrexate. The ectopic pregnancy continued, and caused rupture of the fallopian tube. Dr. B failed to respond properly to the call from the ED physician.
PHYSICIANS’ DEFENSE Dr. A admitted that the patient had not been properly monitored, but claimed that the lack of monitoring caused no harm. Dr. B denied any negligence.
VERDICT A Georgia defense verdict was returned for both physicians.
Uterine laceration during cesarean
A WOMAN BEGAN TO BLEED excessively in the recovery room after a nonemergent cesarean delivery. Blood pressure and blood oxygen saturation decreased, heart rate increased, and she passed large clots. The recovery room nurse notified the woman’s ObGyn, who ordered medication to constrict the uterus and diminish blood flow, but treatment was unsuccessful.
She was returned to the operating room, where the ObGyn repaired a low-segment uterine laceration. Blood was administered with additional uterotonics. After surgery, the woman was sent to the labor and delivery recovery room. When tests indicated that her hematocrit and hemoglobin level had decreased and she showed signs of a clotting difficulty, the ObGyn ordered additional blood products and fundal massage. Two hours later, the woman suffered cardiac arrest and was revived, but suffered significant brain damage. After six months, mechanical ventilation was withdrawn and she died.
ESTATE’S CLAIM The patient’s vital signs never returned to normal after uterine repair surgery. The ObGyn and anesthesiologist did not stabilize the patient, and failed to perform a hysterectomy to save her life. The nurses did not notify the ObGyn and anesthesiologist of unstable vital signs that signaled blood loss.
DEFENDANTS’ DEFENSE The anesthesiologist found the patient’s vital signs normal after repair of the laceration and left the woman in the care of the nursing staff and ObGyn. The ObGyn was not notified of unstable vital signs. The nurses asserted that they did not tell the ObGyn of the changes because they expected him to look at, review, and interpret the monitor. The physicians claimed that the arrest and death were due to an amniotic fluid embolism or amniotic fluid syndrome that was sudden, unpredictable, and difficult to treat.
VERDICT A $1,350,000 Virginia settlement was reached.
Was she discharged too early?
AN OBGYN PERFORMED total transvaginal hysterectomy on a 54-year-old patient, and discharged her the next day. Several hours later, she began to have severe abdominal pain, and was readmitted. The ObGyn prescribed IV antibiotics and ordered fluid management. When she continued to deteriorate, she was transferred to the ICU.
The next day, the ICU physician ordered diagnostic laparoscopy. A perforation of the sigmoid colon was found and repaired, but the woman continued to deteriorate. Nine days later, she was transferred to another hospital, where she died.
ESTATE’S CLAIM The ObGyn failed to find the perforation during hysterectomy. He did not properly follow-up with the patient after surgery, and improperly discharged her despite abnormal blood work and vital signs; elevated temperature and pulse rate; and an increase in her white blood cell count. Both physicians failed to diagnose and treat the perforation in a timely manner. Delay in diagnosis and treatment led to the woman’s death.
PHYSICIANS’ DEFENSE The physicians denied negligence.
VERDICT A $7 million North Carolina verdict was returned against the ObGyn. A defense verdict was returned for the ICU physician.
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.