Massive bleed during sacrocolpopexy
AFTER A 72-YEAR-OLD WOMAN developed pelvic organ prolapse, her urologist performed an abdominal sacrocolpopexy. As the urologist attempted to gain access to the sacral prominence, a tear in the median sacral vein expanded to involve the inferior vena cava and left iliac vein. Massive bleeding occurred and multiple units of blood were transfused. A general surgeon successfully repaired the vascular injuries. The patient was hospitalized for 16 days, received home healthcare, and fully recovered.
PATIENT’S CLAIM The urologist was negligent in overaggressive manipulation of the median sacral vein, causing it to avulse.
PHYSICIAN’S DEFENSE Bleeds of this type are a known complication of the procedure.
VERDICT A Michigan defense verdict was returned.
Was it hypoxia or autism?
AFTER SEVERAL HOURS IN LABOR, a fetal heart-rate monitor indicated decreasing fetal heart rate that led to terminal bradycardia. The ObGyn was called and performed an emergency cesarean delivery. The child was diagnosed with brain damage at 2 years of age.
PARENTS’ CLAIM A cesarean delivery should have been planned because of the fetal weight (8 lb 11 oz). A hypoxic event occurred during labor. Ultrasonography would have shown that the fetus was inverted and that the baby’s face was covered by one of its hands. Delivery was not properly managed, and fetal distress was not reported to the ObGyn in a timely manner.
DEFENDANTS’ DEFENSE The infant’s weight was not sufficient to warrant a cesarean delivery. The infant did not suffer hypoxia. The child’s abnormalities only emerged in the second year of life. An MRI at that time did not indicate brain damage. The child’s development with subsequent regression suggests autism.
VERDICT A New York defense verdict was returned.
Should mammography have been diagnostic?
A 46-YEAR-OLD WOMAN with a family history of breast cancer had regular annual screenings. In December 2006, the patient reported pain, hardness, and burning in her left breast to her gynecologist. A radiologist interpreted the mammography as normal. In May 2007, the patient found a lump in her left breast. Testing indicated she had stage IV breast cancer. She died 2 months after the trial concluded.
PATIENT’S CLAIM The 2006 mammogram was performed as a screening mammography, but should have been diagnostic, considering her family history and reported symptoms. The radiologist improperly interpreted the films.
DEFENDANTS’ DEFENSE The hospital staff testified that the patient did not report pain, hardness, and burning in her left breast when she presented for the 2006 mammography. The radiologist claimed his screening and interpretation were appropriate.
VERDICT The Louisiana court granted the patient’s motion for judgment, and awarded $558,000 in medical costs and $1.3 million in noneconomic damages, totalling $1.808 million. This was reduced to the $500,000 statutory cap.