Medical Verdicts

Femoral nerve palsy occurs after hysterectomy

A 39-YEAR-OLD WOMAN was diagnosed with a leiomyomata in her lower uterus. The tissue in the area became necrotic, and prolapse resulted. Surgery was performed. A week later, the patient returned to the hospital because of pain and bleeding. The ObGyn covering for the physician who had performed the surgery recommended—then performed—a hysterectomy. Following the surgery, the woman experienced numbness in the right anterior and lateral thigh. According to a neurological consultation, the femoral nerve was damaged. The patient suffers from persistent femoral nerve palsy, affecting her ability to walk. She has undergone physical therapy and rehabilitation, as well as nerve conduction studies.

• PATIENT’S CLAIM The ObGyn negligently placed the retractor or failed to reposition the retractor blades after they moved during the surgery.
  
• DOCTOR’S DEFENSE There was no negligence. Femoral nerve injury is a known risk of pelvic surgery. The patient suffered only minor sensory and motor palsy immediately following surgery, and her ongoing complaints had no physical basis.
  
• VERDICT California defense verdict.
  

Patient fails to report continued irregular bleeding

AT HER ANNUAL EXAM, a 49-year-old woman told her gynecologist, Dr. A, about cramping and bleeding on day 10 and sometimes day 17 of her menstrual cycle over the previous 6 months. Dr. A noted a normal pelvic exam. She told the patient that the bleeding was a normal perimenopausal symptom and suggested taking Advil for the pain. No further testing was recommended. The patient failed to report continued irregular vaginal bleeding. A year later, Dr. B conducted the next annual exam and found an enlarged uterus in the 7- to 8-week range. Endometrial biopsy showed the left ovary to be tender, slightly enlarged, with a possible mass present. A sonogram 2 days later showed an enlarged right ovary with multiple cystic areas and a large complex mass of the left ovary—findings suspicious for ovarian cancer. Pathology following a D&C 1 month later indicated adenocarcinoma consistent with primary endometrial cancer. The patient was diagnosed with endometrioid type adenocarcinoma involving both ovaries and the uterus, as well as metastatic disease to the omentum and diaphragm. She underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic and periaortic lymph node dissection, omentectomy, and CUSA of the diaphragm. She is not expected to survive long-term.

• PATIENT’S CLAIM Dr. A was negligent for failing to timely diagnose and treat the cancer.
  
• DOCTOR’S DEFENSE As the patient reported irregular vaginal bleeding at one visit only, there was no indication for further testing of a woman her age and no reason to suspect any disease. Most likely, the irregular vaginal bleeding was unrelated to the ovarian cancer, and an endometrial biopsy after the first visit would not have changed the prognosis.
  
• VERDICT $750,000 Massachusetts settlement.