Large prolapsed fibroid left untreated—despite surgery
A 48-YEAR-OLD WOMAN PRESENTED to the emergency department (ED) with vaginal pain. A large, prolapsed uterine fibroid was diagnosed. Because she was scheduled for an ObGyn visit 2 days later, she was discharged without any treatment.
The next day, she returned to the ED with vaginal bleeding. Ultrasonography (US) showed multiple fibroids. Physical exam confirmed a prolapsed uterine fibroid extending into the vaginal vault. Her ObGyn performed an open myomectomy a few days later.
She called her ObGyn’s office prior to her scheduled postoperative visit because she still felt something in her vagina, and had pelvic pain and vaginal bleeding. She also reported this at the office visit, where she met with a nurse practitioner.
Two months later, she called the ObGyn’s office to complain of vaginal bleeding, and described passing large clots.
A month later, she saw a surgeon, who determined that the large prolapsed fibroid had never been removed. Surgery was scheduled, during which her uterus was removed. The patient was hospitalized for 11 days.
PATIENT’S CLAIM The ObGyn was negligent in failing to surgically remove the fibroid, perform postoperative US, and properly examine, diagnose, and treat her postoperatively. The ObGyn’s office staff failed to relay her telephone and in-person complaints to the physician.
DEFENDANTS’ DEFENSE The ObGyn and his group denied negligence.
VERDICT A $248,160 Georgia verdict was returned against the group.
Woman claims she was never told mammogram results
AFTER MANY NORMAL MAMMOGRAMS, a woman had an abnormal annual result. However, she claimed the physician did not inform her of the reported results. A year later, she was diagnosed with breast cancer.
PATIENT’S CLAIM The physician was negligent in failing to follow-up on the abnormal mammogram and make a correct diagnosis.
PHYSICIAN’S DEFENSE The woman had refused a recommended biopsy after the abnormal mammogram, and later refused mastectomy and radiation therapy. The patient’s outcome would have been the same even if treatment had begun shortly after the abnormal mammogram.
VERDICT A $175,000 verdict was returned in Indiana.
5,386-g newborn has Erb’s palsy
OXYTOCIN WAS ADMINISTERED after a woman’s labor slowed. During vaginal delivery, the ObGyn encountered and managed shoulder dystocia. The 11-lb, 14-oz infant was later given a diagnosis of Erb’s palsy.
PLAINTIFF’S CLAIM Excessive force during the ObGyn’s management of shoulder dystocia caused the Erb’s palsy. US should have been performed prior to delivery to determine fetal weight. Cesarean section may have prevented the injury.
PHYSICIAN’S DEFENSE Fetal weight was calculated at a time when vaginal delivery could not be safely discontinued. Excessive traction was not used; if it had been used, the injury would have been more significant.
VERDICT A New York jury returned a $485,000 verdict.
Was there delay in recognizing necrotizing fasciitis?
PREGNANT WITH TWINS, a 24-year-old woman was hospitalized at 33 weeks’ gestation, and remained there until delivery. There was no clinical evidence of fever or intrauterine infection during her hospitalization. Her anogenital culture for group B Streptococcus was positive. Clindamycin was begun 11 days prior to delivery, and continued after a successful cesarean delivery by her ObGyn.
Three days later, the mother suffered a high fever and marked elevation of her white blood cell count. The ObGyn reopened and drained the wound incision. Surgical debridement was not performed. The woman continued to deteriorate.
She developed extensive necrosis of the tissue around the abdominal wound, extending to the pannus and mons pubis. The ObGyn performed wide excision of the tissue. Necrotizing fasciitis was confirmed by pathology.
The woman was diagnosed with sepsis, multi-system organ failure, disseminated intravascular coagulopathy, and respiratory dependence. She was transferred to another hospital, where she remained until her death 3 months after delivery.
ESTATE’S CLAIM The ObGyn failed to diagnose and treat the necrotizing fasciitis in a timely manner. He failed to perform emergency surgical debridement when the lesions were first identified.
PHYSICIAN’S DEFENSE Antibiotics were ordered at the first sign of the vaginal strep infection and continued due to postsurgical wound infection.
Consultations with infectious disease specialists were obtained because of the patient’s history of extreme medication reaction and numerous antibiotic allergies. Although testing reported negative results for other infection sources, the patient failed to respond to treatment. Surgical debridement was performed when necessary, and as often as the patient was deemed able to tolerate the procedure.
VERDICT A Georgia verdict of $4,317,495 was returned.
ObGyn at fault for child’s brain injury and vision loss?
AT 22 WEEKS’ GESTATION, a woman presented to the ED with cramping and bleeding. A nurse called the woman’s ObGyn, who was not at the hospital; he ordered monitoring and laboratory tests. Two hours later, the bleeding and pain increased. The ObGyn was notified, although whether he was told about the excessive bleeding or not is in dispute. He ordered morphine. The patient was sent home without being seen by a physician, with instructions to follow-up with her ObGyn.