AT 31 2/7 WEEKS' GESTATION, a woman was admitted to the hospital for hypertension. A maternal-fetal medicine specialist determined that a vaginal delivery was reasonable as long as the mother and fetus remained clinically stable; a cesarean delivery would be required if the status changed. An ObGyn and nurse midwife took over the mother’s care. Before dinoprostone and oxytocin were administered the next morning, a second ObGyn conducted a vaginal exam and found the mother’s cervix to be 4-cm dilated. After noon, the fetal heart rate became nonreassuring, with late and prolonged variable decelerations. The baby was born shortly after 5:00 pm with the umbilical cord wrapped around his neck. He was pale, lifeless, and had Apgar scores of 4 and 7 at 1 and 5 minutes, respectively. He required initial positive pressure ventilation due to bradycardia and poor respiratory effort.
The boy has cerebral palsy; although not cognitively impaired, he is severely physically handicapped. He has had several operations because one leg is shorter than the other. He has 65% function of his arms, making it impossible for him to complete normal, daily tasks by himself.
PARENTS' CLAIM A cesarean delivery should have been performed 3 hours earlier.
DEFENDANT' DEFENSE Fetal heart-rate monitoring was reassuring during the last 40 minutes of labor. An Apgar score of 7 at 5 minutes is normal. Blood gases taken at birth were normal (7.3 pH). Ultrasonography of the baby’s head at age 3 days showed normal findings. Problems were not evident on the head ultrasound until the child was 2 weeks of age, showing that the injury occurred after birth and was due to prematurity. Defendants included both ObGyns, the midwife, and the hospital.
VERDICT A $21 million Maryland verdict was returned, including $1 million in noneconomic damages that was reduced to $650,000 under the state cap.
PHYSICIAN APOLOGIZED: DIDN'T READ BIOPSY REPORT BEFORE SURGERY
A 34-YEAR-OLD WOMAN with a family history of breast cancer found a lump in her left breast. After fine-needle aspiration, a general surgeon diagnosed cancer and performed a double mastectomy.
At the first postoperative visit, the surgeon told the patient that she did not have breast cancer, and that the fine-needle aspiration results were negative. The surgeon apologized for never looking at the biopsy report prior to surgery, and admitted that is she had seen the report, she would have cancelled surgery.
PATIENT'S CLAIM The surgeon was negligent in performing bilateral mastectomies without first reading biopsy results.
PHYSICIAN'S DEFENSE The case was settled before trial.
VERDICT Michigan case evaluation delivered an award of $542,000, which both parties accepted.
CYSTOSCOPY BLAMED FOR URETERAL OBSTRUCTION, POOR KIDNEY FUNCTION
WHEN A 59-YEAR-OLD WOMAN underwent gynecologic surgery that included a cystoscopy, her uterers were functioning normally. During the following month, the ObGyn performed several follow-up examinations. A year later, the patient's right ureter was completely obstructed. The obstruction was repaired, but the patient lost function in her right kidney. She must take a drug to improve kidney function for the rest of her life.
PATIENT'S CLAIM The obstruction was caused by ligation that occurred during cystoscopy. The ObGyn should have diagnosed the obstruction during the weeks following surgery.
PHYSICIAN'S DEFENSE The cystoscopy was properly performed. The patient had not reported any symptoms after the procedure that suggested the presence of an obstruction. The obstruction gradually developed and could not have been diagnosed earlier.
VERDICT A New York defense verdict was returned.
INFERIOR VENA CAVA DAMAGED DURING ROBOTIC HYSTERECTOMY
A HYSTERECTOMY AND SALPINGO-OOPHORECTOMY were performed on a 64-year-old woman using the da Vinci Surgical System. The gynecologist also removed a cancerous endometrial mass and dissected the periaortic lymph nodes. When the gynecologist used the robot to lift a lymph fat pad, the inferior vena cava was injured and the patient lost 3 L of blood. After converting the laparotomy, a vascular surgeon implanted an artificial graft to repair the inferior vena cava. The patient fully recovered.
PATIENT'S CLAIM The gynecologist did not perform robotic surgery properly, and the patient was not told of all of the risks associated with robotic surgery. Due to the uncertainty regarding the graft's effectiveness, the patient developed posttraumatic stress disorder.
PHYSICIAN'S DEFENSE The vascular injury was a known risk associated with the procedure. The vena cava was not lacerated or transected: perforator veins that joined the lymph fat pad were unintentionally pulled out. The injury was most likely due to the application of pressure, not laceration by the surgical instrument.
VERDICT A $300,000 New York settlement was reached.
READ: The robot is gaining ground in gynecologic surgery. Should you be using it? A roundtable discussion with Arnold P. Advincula, MD; Cheryl B. Iglesia, MD; Rosanne M. Kho, MD; Jamal Mourad, DO; Marie Fidela R. Paraiso, MD; and Jason D. Wright, MD (April 2013)