PATIENT’S CLAIM Excessive levels of estrogen caused the DVT. The ObGyn was negligent in disregarding the initial pathologist’s report. It was inappropriate to prescribe HRT if ovarian function was present after surgery.
PHYSICIAN’S DEFENSE There was no negligence. Dense adhesions and a previous bowel perforation did not allow total ovary removal. The remnant is a known risk of the procedure. Estrogen HRT was appropriately administered.
VERDICT A New York defense verdict was returned.
Severing uterosacral ligament relieved pelvic pain, but…
AFTER CONSERVATIVE THERAPY for several months, a 26-year-old woman underwent exploratory laparoscopy to determine the reason for her severe pelvic pain. Findings were negative, but the physician transected the uterosacral ligament to relieve pain. Four days after surgery, a ureteral injury was diagnosed, and a stent was placed. The patient required complex treatment for her urinary tract injury.
PATIENT’S CLAIM Severing the uterosacral ligament was performed without her consent. The ureter injury was caused by negligent use of electrocauterization. Now the patient was at high risk for future pregnancies.
PHYSICIAN’S DEFENSE The patient’s pain warranted surgery; severing the ligament was appropriate. Injury to the ureter is a known complication.
VERDICT A Tennessee defense verdict was returned.
Why did it take so long to stop her bleeding?
AFTER DELIVERING HER THIRD CHILD, a 34-year-old woman reported significant vaginal bleeding to her ObGyn. Two weeks later, a sonogram was performed but the cause of bleeding was undetermined.
Bleeding continued. Sixteen days later, another sonogram revealed a 2-cm-long mass in the uterine cavity. The ObGyn decided to wait 4 or 5 days for another sonogram to make sure the mass wasn’t a fibroid or placental remnant.
The next evening, the patient was admitted to a hospital with excessive bleeding. The ObGyn performed a hysteroscopy and found a fibroid and a placental remnant. After tissue was removed by dilation and curettage (D&C), the ObGyn reinserted the hysteroscope. She encountered severe bleeding but could not find any other suspicious matter. Pathology reported that the excised material was placental tissue. The patient was hospitalized for 2 more days.
Three days later, she returned to the ObGyn with continued bleeding; the ObGyn determined it was post-D&C bleeding.
Two weeks later, the woman suffered severe vaginal hemorrhage. She went to another hospital where the ED physician felt the woman’s life was in jeopardy. A hysterectomy was performed, including the extraction of a placental fragment determined to be the cause of the hemorrhage.
PATIENT’S CLAIM The ObGyn was negligent in not diagnosing and treating the bleeding in a timely way after the first sonogram. The pathology report after D&C confirmed placental accreta, which should have prompted aggressive evaluation. Hysteroscopy and D&C did not effectively remove the deeply implanted placenta. She should not have been discharged from the hospital until the ObGyn had confirmed full removal of any placental remnants. Continued bleeding after D&C should have elicited further evaluation.
PHYSICIAN’S DEFENSE All the patient’s reports of bleeding were quickly and appropriately addressed. The ObGyn denied being told that the patient was still bleeding heavily until 16 days following the first sonogram. It was reasonable to conclude that the D&C had excised all suspicious matters. Post-D&C bleeding was due to an intraoperative laceration of the cervix; medication and a clamp had halted bleeding. Intraoperative bleeding made failure to remove the placental remnant reasonable. Earlier treatment would not have changed the outcome.
VERDICT A New York jury returned a $625,000 verdict.