Eighteen hours later, she was sent to a university hospital, where an ECG revealed that she had been experiencing a clot-induced heart attack for 44 hours. Approximately 40% of her heart muscle was damaged, and she was counseled to not continue the pregnancy because of cardiac dysfunction.
PATIENT’S CLAIM The perinatologist and Dr. A were negligent in not telling her that she has APAS. With that information, she could have taken medication to prevent a heart attack during her second pregnancy. Dr. B should have tested her for a heart attack when she reported chest pain. She will require at least two heart transplants during her lifetime.
PHYSICIANS’ DEFENSE The perinatologist claimed that messages were left for the patient on both her work and mobile phones, but she did not return the calls. The perinatologist also mailed a pamphlet on APAS and an additional lab form to the patient. Dr. A claimed that the perinatologist was solely responsible for follow-up regarding the test results. Dr. B claimed that a heart attack is very rare in a 24-year-old woman, and was very difficult to identify; several doctors at two hospitals missed the diagnosis.
VERDICT A New Mexico jury found all parties at fault: Dr. B, 47.5%; Dr. A, 35%; perinatologist, 10%; and patient, 7.5%. The jury awarded $9 million in general damages and established a patient compensation fund for future medical expenses. The plaintiff’s actual recovery was $1.8 million due to a state cap.
Bowel injury after hysterectomy
AN OBGYN PERFORMED laparoscopically assisted vaginal hysterectomy on a 55-year-old woman. After surgery, the woman’s condition deteriorated. The ObGyn consulted with a surgeon, who performed an exploratory laparotomy 2 days after initial surgery; he suspected a bowel perforation, but could not find it.
The patient was transferred to another hospital and 4 days later, an imaging study of the bowel revealed the injury and the bowel was repaired. She developed sepsis and necrosis, and a 44-cm section of bowel was resected. Her recovery was complex.
PATIENT’S CLAIM The ObGyn was negligent in not promptly identifying the bowel injury during the initial surgery. The surgeon was negligent for failing to find the bowel injury during exploratory surgery.
PHYSICIAN’S DEFENSE The injury did not occur during the initial surgery; the perforation found at the second hospital was fresh and unrelated to the previous procedures.
VERDICT A Louisiana defense verdict was returned for the ObGyn. The surgeon was found negligent, and the jury awarded $3,314,801.
Zavanelli maneuver; brachial plexus injury
SHOULDER DYSTOCIA was encountered during delivery, and her ObGyn attempted several procedures, including use of a vacuum extractor. Ultimately, he performed a Zavanelli maneuver, in which the fetal head is pushed back into the birth canal in order to deliver the child by cesarean delivery. The child suffered a brachial plexus injury, and does not have use of her right arm.
PATIENT’S CLAIM The mother was administered too much oxytocin by the delivery nurse, causing contractions to be too strong and come too fast, resulting in fetal distress. The ObGyn applied the vacuum extractor when the fetus was too high in the birth canal, resulting in too much traction on the fetus’ brachial nerves.
PHYSICIAN’S DEFENSE The fetus was in grave danger, and was at the proper stage of delivery when the maneuvers were attempted. The child would have suffered significant brain injury or death if the maneuvers had not been attempted.
VERDICT A Georgia defense verdict was returned.
These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska (www.verdictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.