Medical Verdicts

Fetal decapitation at 21 weeks … and more


 

References

VERDICT A California defense verdict was returned.

Placental abruption: Child has brain damage

WHEN A LABOR AND DELIVERY NURSE called, Dr. A decided a cesarean delivery was needed. The on-call anesthesiologist was at another cesarean delivery, so the procedure was delayed for longer than an hour. Dr. B delivered the child, who was born severely depressed, was resuscitated, and transferred to the NICU. The child suffered hypoxic encephalopathy, is quadriplegic, and has hypotonia.

PATIENT’S CLAIM The cesarean delivery was not performed in a timely manner. Fetal distress occurred because of placental abruption. The child would not have been injured if 1) the nursing staff had summoned a back-up anesthesiologist and 2) the procedure had started within 30 minutes of the decision.

DEFENDANTS’ DEFENSE The hospital reported that Dr. A arrived at the hospital quickly, but decided to wait for Dr. B. Placental abruption occurred prior to the mother’s arrival at the hospital.

VERDICT The ObGyns settled for an undisclosed amount before trial. A California defense verdict was returned for the hospital.

Necrotizing infection in abdominal hematoma

DYSMENORRHEA and abnormal uterine bleeding developed in a 40-year-old woman. Her gynecologist recommended abdominal hysterectomy because she had undergone two cesarean deliveries. During surgery, bladder injury was recognized and repaired.

After several days, the patient suffered complications and was referred to a urogynecologist, who found a 2-mm vaginal fistula. Three days later, she was found unresponsive at home. During exploratory surgery, the gynecologist found necrotizing infection related to an abdominal hematoma. The patient died 2 weeks later.

ESTATE’S CLAIM The gynecologist was negligent in failing to identify signs of infection at two postoperative visits.

PHYSICIAN’S DEFENSE The patient was properly monitored and referred in a timely manner to the urogynecologist. Death was due to the aggressive nature of the infection, which did not develop until after the last office visit.

VERDICT A Tennessee defense verdict was returned.

C diff infection after antibiotics for cough

AT 34 WEEKS’ GESTATION, an ObGyn prescribed amoxicillin-clavulanate (Augmentin) for a woman’s cough. She developed diarrhea that did not respond to antidiarrheal medication and a change in diet. Another ObGyn prescribed empiric sulfamethoxazole and trimethoprim (Septra), and referred her to an infectious-disease specialist. The specialist prescribed empiric cefpodoxime proxetil (Vantin) and ordered stool cultures.

Before culture results were received, the patient went into labor and delivered by cesarean section. Her illness progressed to fulminant Clostridium difficile pseudomembranous colitis that required total colectomy. Re-anastomosis was accomplished a year later. She continues to have difficulty controlling bowel movements, and reports abdominal pain, frequent dehydration, and weight loss.

PATIENT’S CLAIM Antibiotics should not have been prescribed without a culture-proven bacterial illness. C. difficile should have been suspected and treated when diarrhea first developed. Empiric antibiotic treatment during pregnancy is contraindicated. The group’s practice model of having patients rotate among OBs impeded continuity of care.

PHYSICIANS’ DEFENSE C. difficile infection was difficult to diagnose because it is not known to arise in young, healthy women outside a hospital. Use of antibiotics was proper. The group’s practice model is appropriate; continuity of care was maintained.

VERDICT A Florida defense verdict was returned.

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