From the Editor
Transfer to the hospital for women planning a home birth: A high-risk obstetrics problem
Do you have a written clinical guideline for pregnant women planning a home birth who are transferred to your hospital?
VERDICT Claims against the hospital resulted in a confidential settlement prior to trial. A Kentucky jury found the hospital 60% at fault and the ObGyn 40% at fault. A verdict totaling $7,440,000 was returned, although no damages were awarded for the death of the fetus. The net verdict was $2,976,000.
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Endometriosis surgery: oophorectomy planned but hysterectomy done
After several weeks of abdominal pain, a 44-year-old woman saw her ObGyn, Dr. A. When the pain increased 4 days later, she saw Dr. B, Dr. A’s partner. Dr. B determined that the patient had endometriosis and scheduled surgery for 3 days later. The surgical plan was to remove one ovary.
Just before surgery, the patient had an anxiety attack. After she signed the consent form, she was administered midazolam (Versed). During the operation, Dr. B decided to perform a total hysterectomy.
PATIENT’S CLAIM Dr. B was negligent in performing total hysterectomy without proper consent. The patient was incapacitated by the anxiety attack and midazolam and was incapable of giving consent. She had hoped to become pregnant.
PHYSICIAN’S DEFENSE Hysterectomy was reasonable due to severe endometriosis. All options had been discussed during the preoperative visit. The consent form the patient signed provided for performance of other procedures as needed. The patient was fully cognizant for consent purposes after administration of midazolam, based on her history of narcotic use.
VERDICT A Tennessee defense verdict was returned.
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Compartment syndrome after childbirth
At 42 weeks’ gestation, a 45-year-old woman was admitted to the hospital in labor after a failed attempt at home birth. The baby was delivered 4.5 hours after her arrival. The next day, the mother reported right shin and leg pain but was able to ambulate and flex her foot. She was offered the choice of staying in the hospital for a neurologic evaluation or being discharged with outpatient follow-up if her symptoms continued. She chose to be released.
At home, her symptoms worsened: the swelling in her leg and foot increased, she could not walk or flex her foot, and there were color changes in her leg. She returned to the ED, was found to have right leg compartment syndrome, and underwent fasciotomy. She continues to have foot drop, irregular gait, and right hip pain.
PATIENT’S CLAIM The ObGyn was negligent in the care of the patient during labor and delivery.
PHYSICIAN’S DEFENSE The case was settled during trial.
VERDICT A $3,500 Washington settlement was reached.
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.
