Medicolegal Issues

Miscarriages after IUD is missing


 

Miscarriages after IUD is missing: $488,157 verdict

In early 2005, a woman underwent implantation of an intrauterine device (IUD). A month later, the device could not be located on examination or pelvic ultrasonography. The ObGyn believed it had been expelled from the patient's body.

After the patient had miscarriages in 2009 and 2011, she asked her ObGyn if the missing IUD, which she had never seen leave her body, might have contributed to the miscarriages. She was told that the device was not present. No further testing was performed.
 

After the patient switched providers in 2013, an abdominal x-ray located the IUD. The patient became pregnant after the IUD was successfully removed.

PATIENT'S CLAIM:
The patient sued the ObGyn and his clinic for personal injury and wrongful death of the unborn fetuses. She claimed that it is below the standard of care not to perform an abdominal x-ray when a patient's IUD is missing.

The patient's attorney objected to the tests of the miscarried fetuses, contending that the tissues were sent without consent and that misinformation was conveyed on the pathology requisition.

DEFENDANTS' DEFENSE:
The standard of care set by the American College of Obstetricians and Gynecologists (ACOG) did not specify the use of an abdominal x-ray until Practice Bulletin No. 121 in July 2011 stated that the location of a lost IUD should be confirmed by x-ray. 1

The IUD did not produce the miscarriages; testing of remains of 2 miscarried fetuses showed trisomic abnormalities that could not be attributed to the IUD.

The defense countered the patient's attorney that the testing forms had the patient's signed consent and that nothing was misrepresented on the forms.

VERDICT:
A Missouri defense verdict was returned for the wrongful death counts, but the jury awarded the patient $488,157 on the injury claim.

Reference

  1. Espey E, Singh RH; Committee on Practice  Bulletins--Gynecology. American College of Gynecologists and Obstetricians Practice Bulletin No. 121: Long-acting reversible contraception: Implants and intrauterine devices. Obstet  Gynecol. 2011;118(1):184-196.

 

Related article:
Pregnancy test missed before IUD placement? Your liability.

 

Needle left behind during mastectomy reconstruction

After a woman was diagnosed with invasive ductal cancer in her left breast, she underwent a double mastectomy with simple mastectomy reconstruction on the left breast. During the operation, the surgical count could not account for 1 pop-off needle. The surgeon searched for the missing needle and ordered an x-ray but the needle could not be located. The surgeon did not tell the patient that the needle count was incomplete. 

The patient underwent several other breast reconstruction procedures and the needle was never found.

Five years after the initial surgery, the needle was discovered and surgically removed.

PATIENT'S CLAIM:
The surgeon was negligent in not finding the needle on the x-ray and not notifying her that the needle was missing.

PHYSICIAN'S DEFENSE:
The surgeon contended that his search for the needle and reliance on x-ray were in line with the standard of care. Since his actions were within the standard of care, he was not required to inform the patient. 

VERDICT:
A Mississippi defense verdict was returned.

 

Failure to diagnose breast cancer on mammography

A 62-year-old woman started having routine mammographies in 2003. From 2006 to 2010, her annual mammographies were read by the same radiologist (Dr. A), who reported them as normal. Her 2011 mammography was read by a second radiologist (Dr. B), who reported it as normal. A year later, the patient was found to have several breast masses. Testing revealed that the cancer had metastasized. She underwent radical mastectomy and aggressive radiation treatment, but her cancer was deemed incurable.

PATIENT'S CLAIM:
Dr. A misread her mammograms from 2006 to 2010.  There was evidence of asymmetric density suggestive of cancer on the 2006 mammography film.

PHYSICIAN'S DEFENSE:
There was no negligence. His reading of the mammographies was reasonable.

VERDICT:
A Kentucky defense verdict was returned.

 

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.

Share your thoughts!  Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

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