Circumcision accident: $1.3M verdict

FECAL INCONTINENCE AFTER EPISIOTOMY
A 26-year-old woman gave birth after her ObGyn created an episiotomy to facilitate delivery. The incision was repaired and the ObGyn prescribed docusate (Colace) to soften her stools.
A month later, the patient report-ed fecal incontinence. The ObGyn determined that the incontinence was related to the episiotomy, but did not feel that immediate attention was needed. When the condition did not improve, the patient saw a colorectal surgeon, who diagnosed a significant sphincter defect. The patient underwent a sphincteroplasty, with minor improvement.
PATIENT’S CLAIM The ObGyn failed to properly manage episiotomy healing. The patient remembers being told to stop docusate after she had passed one stool after delivery. A 10-day regimen of docusate and a diet to reduce defecation frequency should have been prescribed. Incontinence should have prompted an immediate referral to a colorectal surgeon.
PHYSICIAN’S DEFENSE Prompt surgical intervention was not necessary. Sphincteroplasty can be delayed until conservative methods have been tried. Episiotomy healing was properly addressed. Permanent incontinence is a known risk of the procedure.
VERDICT A $6 million New York verdict was returned.

Related Article: Does mediolateral episiotomy reduce the risk of anal sphincter injury in operative vaginal delivery? Errol R. Norwitz, MD, PhD (Examining the Evidence, August 2012)

MECONIUM ASPIRATION SYNDROME
A baby stayed in hospital for 3 weeks postdelivery due to meconium aspiration syndrome.
PARENTS’ CLAIM The resident who followed the mother during her pregnancy was negligent in allowing the pregnancy to progress to 46 weeks’ gestation before delivery.
DEFENDANTS’ DEFENSE The estimated date of conception was disputed. The resident claimed that the baby was born at 42 weeks’ gestation. An attending physician reviewed all prenatal visits with the resident. The mother’s cervix was never ripe before induction of labor. Aspiration occurred despite aggressive suctioning. The child has had no further respiratory issues since her neonatal discharge.
VERDICT An Illinois defense verdict was returned.

BOWEL INJURY AFTER HYSTERECTOMY
A woman underwent laparoscopic-assisted vaginal hysterectomy and was discharged the following day. Two days later, she went to an ED in acute distress. A bowel perforation was found during emergency surgery, and her colon was repaired. She made a full recovery.
PATIENT’S CLAIM The ObGyn was negligent in failing to properly evaluate the patient after surgery. The ObGyn also failed to explain the signs of a possible perforation to the patient before she left the hospital.
PHYSICIAN’S DEFENSE The patient’s postoperative course was normal while she was hospitalized. Bowel perforation is a known complication of the procedure. The patient had been informed of all the signs and symptoms of a bowel perforation and had been instructed to call the ObGyn or return to the hospital if she began to have any symptoms.
VERDICT A South Carolina 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.

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