Chronic pain after vaginal wall repair…and more

PHYSICIAN’S DEFENSE The mother was told that tubal ligation had not been performed at the 6-week visit. She was advised to use birth control until she recovered from the cesarean delivery and could undergo a tubal ligation procedure. The ObGyn acknowledged he had forgotten to perform the tubal ligation at delivery, but insisted there was no negligence under the circumstances.

VERDICT A California defense verdict was returned.

Patient claims stomach injury caused GERD

DUE TO PELVIC PAIN, a woman underwent laparoscopy by her ObGyn. During the procedure, a trocar punctured her stomach. The injury was discovered, the procedure converted to a laparotomy with a vertical incision, and the injury repaired.

PATIENT’S CLAIM She developed gastroesophageal reflux disease (GERD) because of the puncture wound, and anxiety because of the scar.

PHYSICIAN’S DEFENSE Gastric perforation is a rare but recognized complication of abdominal laparoscopy, and can occur without negligence. Her GERD is either due to a hiatal hernia or pychosomatic disorder.

VERDICT A Virginia defense verdict was returned.

Physicians not responsible for stroke

SEVERAL DAYS AFTER GIVING BIRTH, a 33-year-old woman visited the ED with chest pain, headache, and abdominal pain. An emergency medicine physician and an ObGyn ordered a chest CT scan and administered anticoagulants. By the time the CT scan was completed, the woman denied having chest pain. No pulmonary emboli (PE) were detected on chest CT, and she was discharged.

The next day, she went to another hospital’s ED with a headache and right-side weakness. A CT scan revealed a large left parietal-lobe intracerebral hematoma. A ventricular catheter was placed and she underwent a stereotactic craniotomy for evacuation of the hematoma. She was transferred to a rehabilitation facility a month later.

She suffers permanent neurologic damage, including short-term memory loss and an inability to lift or walk for any great distance.

PATIENT’S CLAIM The ED physicians failed to diagnose and treat an acute neurologic event in a timely manner, and did not obtain specialist consults. Administration of anticoagulants was negligent; protamine therapy should have been started to reverse the anticoagulant effects. Laboratory testing of clotting times and a ventilation-perfusion lung scan should have been conducted to confirm the presence of PE.

PHYSICIANS’ DEFENSE The patient’s condition was appropriately diagnosed and treated in the ED. Administration of anticoagulants was necessary because of suspected PE. There is no evidence that the heparin given to the plaintiff the day before her stroke was related to the stroke.

VERDICT A Florida defense verdict was returned.

Did failure to diagnose preeclampsia lead to infant’s death?

AT 38-WEEKS’ GESTATION, a 21-year-old woman was seen at a hospital’s obstetric clinic, and sent to the ED with complaints of leaking fluid and lack of fetal movement. She claimed she showed signs of preeclampsia, pregnancy-induced hypertension, and oligohydramnios, but was not admitted to the hospital. The baby was born 2 days later with persistent pulmonary hypertension (PPH), which led to the child’s death at 33 days of age.

PATIENT’S CLAIM There was negligence in failing to diagnose preeclampsia, pregnancy-induced hypertension, and oligohydramnios, which caused the baby to be born with PPH.

PHYSICIAN’S DEFENSE The cause of the infant’s PPH was unknown, and most likely arose in utero prior to birth. An earlier delivery would not have resulted in a different outcome.

VERDICT A Illinois defense verdict was returned.