Should patient have to ask for testing?
A man was tested by Dr. A and found to be a thalassemia carrier, but his wife was not tested. When she became pregnant and blood work at 6 weeks indicated anemia, no testing for thalassemia was performed by Dr. B. The child was born with thalassemia, a condition that affects the body’s ability to produce hemoglobin, and will need blood transfusions throughout his life.
Patient’s claim The mother would have had an abortion if she had known the baby would have thalassemia.
Doctor’s defense Because the parents knew the father was a carrier, the defendants relied on the mother to be tested if she became pregnant. Also, the parents would not have chosen an abortion.
Verdict $14 million New Jersey verdict against Dr. B only.
Advice to deaf patient is disputed
The parents of a baby girl born with spina bifida were profoundly deaf. The mother’s deafness since birth was due to the genetic disorder Waardenburg syndrome.
Patient’s claim The physician failed to communicate the importance of 1) taking folic acid to prevent birth defects and 2) maternal serum α-fetoprotein (MSAFP) testing to determine if spina bifida was present. The physician also failed to determine what caused the mother’s deafness so she could be referred for genetic counseling. They would have aborted the fetus if they had known of the spina bifida.
Doctor’s defense When the defendant asked about genetic disorders in the family, she was told there were none. She discussed folic acid with the mother, who refused MSAFP testing when it was suggested. The couple also never brought a sign language interpreter with them. The defendant added that there was no scientific evidence that folic acid affects neural tube defects associated with a genetic syndrome such as Waardenburg.
Verdict Kansas defense verdict.
Deaths due to untreated thrombocytopenia?
A 34-year-old woman who was 27½ weeks pregnant presented at the hospital with burning in the chest, diarrhea, nausea, vomiting, and headache. She had protein in her urine, and an OB diagnosed a urinary tract infection and sent her home. In less than 24 hours, she returned by ambulance to the hospital, where she remained for observation. The defendant OBs did not come and no lab tests were ordered.
The following morning, lab results indicated HELLP syndrome or thrombotic thrombocytopenic purpura (TTP). Treatment for HELLP syndrome (delivery of the fetus—a problem because of its prematurity) and TTP (plasma exchange) could not be done at the defendant hospital, but the mother was not transferred to another hospital and consultations were not sought. A day later, an internal medicine physician was consulted, and he urged that a physician specializing in TTP also be consulted, but that was not done. Later, ultrasonography indicated the fetus had died. Fifteen hours after the stillborn baby was delivered, the mother suffered cardiovascular collapse and died.
Patient’s claim The defendants were negligent in treating the woman’s thrombocytopenia and not transferring her to another hospital in a timely manner.
Doctor’s defense Not reported.
Verdict A North Carolina settlement, which included $1,325,000 from the OB defendants and $750,000 from the hospital defendants.
Doctor ignores lump, and patient delays
A patient reported a pea-sized lump in her right breast to her gynecologist after several weeks. When he examined her at a later date, she again reported the lump, but he did not order a sonogram, mammogram, or biopsy. Over a year later, the patient was examined by a family practice physician, who examined the lump and ordered a mammogram. Seven months later, a biopsy showed the presence of cancer. As the cancer had spread to her lymph nodes, she required extensive treatment.
Patient’s claim The gynecologist was negligent for not diagnosing the cancer earlier.
Doctor’s defense Not reported.
Verdict $1,275,647.61 gross verdict in Florida. The woman was found 34% at fault, and the ObGyn, 66% at fault.
Ureteral stricture follows oophorectomy
The cystic ovaries of a 59-year-old woman were removed by an ObGyn in a procedure that was uneventful despite the presence of scarring and adhesions from previous surgeries, including a hysterectomy years earlier. The operative report did not mention that the ureters were visualized, although other structures were noted. The day after surgery, the patient was discharged in satisfactory condition. Two weeks later she returned to her physician with severe left flank pain. She was hospitalized, and a radiologist and urologist were consulted. She was diagnosed with a left ureteral stricture. The urologist placed a nephroureteral stent, and the patient wore a urostomy bag for 1 month until an indwelling stent was placed. Over the next year, she underwent frequent stent changes under general anesthesia.