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Foot drop after oophorectomy
After laparoscopic oophorectomy for an ovarian cyst, a woman complained of foot drop. Despite physical therapy, the woman maintained her gait did not improve.
In suing, the woman claimed the oophorectomy was unnecessary because the cyst was benign; that the operation lasted too long; and that the physician positioned her leg poorly during the procedure, leading to compression of the superficial peroneal nerve and the foot drop.
The defense denied negligence and asserted the woman’s condition was a complication of surgery.
- The jury awarded the plaintiff $25,800.
After laparoscopic oophorectomy for an ovarian cyst, a woman complained of foot drop. Despite physical therapy, the woman maintained her gait did not improve.
In suing, the woman claimed the oophorectomy was unnecessary because the cyst was benign; that the operation lasted too long; and that the physician positioned her leg poorly during the procedure, leading to compression of the superficial peroneal nerve and the foot drop.
The defense denied negligence and asserted the woman’s condition was a complication of surgery.
- The jury awarded the plaintiff $25,800.
After laparoscopic oophorectomy for an ovarian cyst, a woman complained of foot drop. Despite physical therapy, the woman maintained her gait did not improve.
In suing, the woman claimed the oophorectomy was unnecessary because the cyst was benign; that the operation lasted too long; and that the physician positioned her leg poorly during the procedure, leading to compression of the superficial peroneal nerve and the foot drop.
The defense denied negligence and asserted the woman’s condition was a complication of surgery.
- The jury awarded the plaintiff $25,800.
Unsupervised resident performed circumcision
A 2-day-old infant underwent circumcision by an unsupervised second-year ObGyn resident. The resident removed a substantial portion of glans tissue. Despite 2 subsequent repair surgeries, the infant was left with a deformed penis and altered urine flow.
In suing, the plaintiff faulted the hospital for failing to adequately supervise the resident. The resident claimed it was reasonable to perform the surgery without supervision after 10 successful proctored procedures and that the result was an acceptable risk. The hospital admitted liability.
- The jury awarded the plaintiff $1.5 million.
A 2-day-old infant underwent circumcision by an unsupervised second-year ObGyn resident. The resident removed a substantial portion of glans tissue. Despite 2 subsequent repair surgeries, the infant was left with a deformed penis and altered urine flow.
In suing, the plaintiff faulted the hospital for failing to adequately supervise the resident. The resident claimed it was reasonable to perform the surgery without supervision after 10 successful proctored procedures and that the result was an acceptable risk. The hospital admitted liability.
- The jury awarded the plaintiff $1.5 million.
A 2-day-old infant underwent circumcision by an unsupervised second-year ObGyn resident. The resident removed a substantial portion of glans tissue. Despite 2 subsequent repair surgeries, the infant was left with a deformed penis and altered urine flow.
In suing, the plaintiff faulted the hospital for failing to adequately supervise the resident. The resident claimed it was reasonable to perform the surgery without supervision after 10 successful proctored procedures and that the result was an acceptable risk. The hospital admitted liability.
- The jury awarded the plaintiff $1.5 million.
Membranes ruptured unintentionally
A 21-year-old woman was admitted to a labor and delivery unit, and the on-call OB was called. Because of abnormal fetal monitor readings, the nurse requested immediate assistance from an available OB. That OB determined that the woman was dilated 5 cm, that her amniotic membrane was intact, and that the fetus was in a vertex position with a probable cord presentation. Upon his arrival, the on-call OB assumed care.
During another vaginal exam the membranes ruptured, necessitating an emergency c-section. The infant was born 18 minutes later with an Apgar score of 1 that remained at that level after 1, 5, 10, and 15 minutes.
The infant was eventually diagnosed with hypoxic ischemic encephalopathy. Now wheelchair-bound, the child has cerebral palsy, quadriparesis, and severe mental retardation, and cannot care for herself.
The mother alleged the birth canal exam ruptured the membranes, causing cord prolapse that resulted in asphyxiation. She claimed a delivery team member should have elevated the infant’s head off the cord.
The defense admitted that the vaginal exam ruptured the membranes, but maintained it was necessary to determine the exact status of the mother’s labor and to investigate for placental abruption.
- The jury returned a defense verdict after the hospital settled for $2 million.
A 21-year-old woman was admitted to a labor and delivery unit, and the on-call OB was called. Because of abnormal fetal monitor readings, the nurse requested immediate assistance from an available OB. That OB determined that the woman was dilated 5 cm, that her amniotic membrane was intact, and that the fetus was in a vertex position with a probable cord presentation. Upon his arrival, the on-call OB assumed care.
During another vaginal exam the membranes ruptured, necessitating an emergency c-section. The infant was born 18 minutes later with an Apgar score of 1 that remained at that level after 1, 5, 10, and 15 minutes.
The infant was eventually diagnosed with hypoxic ischemic encephalopathy. Now wheelchair-bound, the child has cerebral palsy, quadriparesis, and severe mental retardation, and cannot care for herself.
The mother alleged the birth canal exam ruptured the membranes, causing cord prolapse that resulted in asphyxiation. She claimed a delivery team member should have elevated the infant’s head off the cord.
The defense admitted that the vaginal exam ruptured the membranes, but maintained it was necessary to determine the exact status of the mother’s labor and to investigate for placental abruption.
- The jury returned a defense verdict after the hospital settled for $2 million.
A 21-year-old woman was admitted to a labor and delivery unit, and the on-call OB was called. Because of abnormal fetal monitor readings, the nurse requested immediate assistance from an available OB. That OB determined that the woman was dilated 5 cm, that her amniotic membrane was intact, and that the fetus was in a vertex position with a probable cord presentation. Upon his arrival, the on-call OB assumed care.
During another vaginal exam the membranes ruptured, necessitating an emergency c-section. The infant was born 18 minutes later with an Apgar score of 1 that remained at that level after 1, 5, 10, and 15 minutes.
The infant was eventually diagnosed with hypoxic ischemic encephalopathy. Now wheelchair-bound, the child has cerebral palsy, quadriparesis, and severe mental retardation, and cannot care for herself.
The mother alleged the birth canal exam ruptured the membranes, causing cord prolapse that resulted in asphyxiation. She claimed a delivery team member should have elevated the infant’s head off the cord.
The defense admitted that the vaginal exam ruptured the membranes, but maintained it was necessary to determine the exact status of the mother’s labor and to investigate for placental abruption.
- The jury returned a defense verdict after the hospital settled for $2 million.
Was bowel perforation surgical or spontaneous?
A woman was discharged 4 days after a total abdominal hysterectomy and oophorecto-my, during which dense adhesions were encountered between the bowel and left ovary. Six days later she presented to the emergency department with complaints of abdominal pain and stool problems. A CT scan showed accumulation of free gas.
Immediate exploratory surgery revealed a 2.5-cm perforation of the bowel that was repaired. Several more surgeries were required because of massive fecal contamination, including a partial colectomy and a temporary colostomy.
In suing, the woman faulted the surgeon for injuring the bowel and failing to recognize the injury. She maintained that prompt discovery of the injury would have minimized complications.
The defense claimed that the bowel had spontaneously perforated within a day of the repair surgery, and showed pathology slide evidence of a recent event.
- The jury returned a defense verdict.
A woman was discharged 4 days after a total abdominal hysterectomy and oophorecto-my, during which dense adhesions were encountered between the bowel and left ovary. Six days later she presented to the emergency department with complaints of abdominal pain and stool problems. A CT scan showed accumulation of free gas.
Immediate exploratory surgery revealed a 2.5-cm perforation of the bowel that was repaired. Several more surgeries were required because of massive fecal contamination, including a partial colectomy and a temporary colostomy.
In suing, the woman faulted the surgeon for injuring the bowel and failing to recognize the injury. She maintained that prompt discovery of the injury would have minimized complications.
The defense claimed that the bowel had spontaneously perforated within a day of the repair surgery, and showed pathology slide evidence of a recent event.
- The jury returned a defense verdict.
A woman was discharged 4 days after a total abdominal hysterectomy and oophorecto-my, during which dense adhesions were encountered between the bowel and left ovary. Six days later she presented to the emergency department with complaints of abdominal pain and stool problems. A CT scan showed accumulation of free gas.
Immediate exploratory surgery revealed a 2.5-cm perforation of the bowel that was repaired. Several more surgeries were required because of massive fecal contamination, including a partial colectomy and a temporary colostomy.
In suing, the woman faulted the surgeon for injuring the bowel and failing to recognize the injury. She maintained that prompt discovery of the injury would have minimized complications.
The defense claimed that the bowel had spontaneously perforated within a day of the repair surgery, and showed pathology slide evidence of a recent event.
- The jury returned a defense verdict.
Jury faults ObGyns for silence on abortion
A woman gave birth to an infant with rare congenital abnormalities. The parents alleged sonograms indicated abnormalities early on in the course of the pregnancy. In suing, they faulted the obstetrician and the referring maternal-fetal medicine specialist for failing to advise of the option to terminate the pregnancy.
- The jury awarded the plaintiff $5.8 million.
A woman gave birth to an infant with rare congenital abnormalities. The parents alleged sonograms indicated abnormalities early on in the course of the pregnancy. In suing, they faulted the obstetrician and the referring maternal-fetal medicine specialist for failing to advise of the option to terminate the pregnancy.
- The jury awarded the plaintiff $5.8 million.
A woman gave birth to an infant with rare congenital abnormalities. The parents alleged sonograms indicated abnormalities early on in the course of the pregnancy. In suing, they faulted the obstetrician and the referring maternal-fetal medicine specialist for failing to advise of the option to terminate the pregnancy.
- The jury awarded the plaintiff $5.8 million.
How to Read an Income Statement
Last month, I discussed the importance of learning to read and understand financial statements. It is the only way in which you can truly evaluate your practice's financial health.
I named the three barometers of financial strength: liquidity, solvency, and profitability. The first two are measured with the balance sheet, which I covered last month. Measuring profitability requires a separate tool: the income statement.
An income statement summarizes revenue and expenses for a specific time period, usually a year, although reports should be generated more frequently for large or complicated practices. Here are the essential components:
▸ Total sales revenue (TSR). Nicknamed the "top line," TSR represents the practice's gross income for the period. In large offices with multiple "providers" and/or multiple specialized services, TSR will be broken down to identify and track all major revenue producers.
▸ Operating costs. In other words, overhead. For many practices, there is only one category of operating costs, usually called general and administrative expenses (G&A). However, if you offer ancillary services, such as a spa, or sell a lot of products, your income statement should separate the costs of producing these products or services into a separate category called sales costs. Cosmetically oriented practices with large marketing expenses should have a third category to track them.
Many physicians instinctively strive to slash operating costs, but they often fail to distinguish between G&A expenses—which should be kept as low as possible—and sales and marketing costs. The latter often must be maintained or even increased. A practice spending 30% on overhead, for example, is not necessarily doing as well as one spending 60%: Would you rather have 70% of $250,000 or 40% of $1 million?
▸ Gross profit (or loss). In practices with significant sales costs, this is the difference between sales revenue and sales/marketing costs. A positive difference is profit; a negative difference is a loss and is shown in brackets. If you offer ancillary products or services, this category determines if they, by themselves, are making money.
▸ Operating income. What's left when you subtract all the operating expenses from gross profit.
▸ Income before taxes. After subtracting any interest paid on outstanding debt from total operating income, you are left with the amount on which the practice may be liable for taxes.
▸ Taxes. All paid or anticipated taxes during the period, to all jurisdictions.
▸ Net income from continuing operations. After subtracting taxes from its income, this is what is left.
▸ Nonrecurring events. This is the cost of any one-time expenses, such as restructuring the practice or an unreimbursed casualty loss. These are shown on a separate line so as to not confuse the "continuing operations" figure.
▸ Net income. What the practice has left after subtracting all its expenses from its total revenue. If the difference is positive, it is profit. A negative difference is a loss and is shown in brackets. This is a different benchmark for a professional corporation than for most businesses, since professional corporations strive to minimize net income, and thus corporate taxes.
▸ Net income available to shareholders. This is the bottom line, the money left at the end of the period. It is held for future needs, invested as the board directs, or returned to investors in the future.
It takes awhile to become adept at analyzing financial reports, so ask your accountant to walk you through your practice's balance sheet and income statement and point out the important indicators.
Last month, I discussed the importance of learning to read and understand financial statements. It is the only way in which you can truly evaluate your practice's financial health.
I named the three barometers of financial strength: liquidity, solvency, and profitability. The first two are measured with the balance sheet, which I covered last month. Measuring profitability requires a separate tool: the income statement.
An income statement summarizes revenue and expenses for a specific time period, usually a year, although reports should be generated more frequently for large or complicated practices. Here are the essential components:
▸ Total sales revenue (TSR). Nicknamed the "top line," TSR represents the practice's gross income for the period. In large offices with multiple "providers" and/or multiple specialized services, TSR will be broken down to identify and track all major revenue producers.
▸ Operating costs. In other words, overhead. For many practices, there is only one category of operating costs, usually called general and administrative expenses (G&A). However, if you offer ancillary services, such as a spa, or sell a lot of products, your income statement should separate the costs of producing these products or services into a separate category called sales costs. Cosmetically oriented practices with large marketing expenses should have a third category to track them.
Many physicians instinctively strive to slash operating costs, but they often fail to distinguish between G&A expenses—which should be kept as low as possible—and sales and marketing costs. The latter often must be maintained or even increased. A practice spending 30% on overhead, for example, is not necessarily doing as well as one spending 60%: Would you rather have 70% of $250,000 or 40% of $1 million?
▸ Gross profit (or loss). In practices with significant sales costs, this is the difference between sales revenue and sales/marketing costs. A positive difference is profit; a negative difference is a loss and is shown in brackets. If you offer ancillary products or services, this category determines if they, by themselves, are making money.
▸ Operating income. What's left when you subtract all the operating expenses from gross profit.
▸ Income before taxes. After subtracting any interest paid on outstanding debt from total operating income, you are left with the amount on which the practice may be liable for taxes.
▸ Taxes. All paid or anticipated taxes during the period, to all jurisdictions.
▸ Net income from continuing operations. After subtracting taxes from its income, this is what is left.
▸ Nonrecurring events. This is the cost of any one-time expenses, such as restructuring the practice or an unreimbursed casualty loss. These are shown on a separate line so as to not confuse the "continuing operations" figure.
▸ Net income. What the practice has left after subtracting all its expenses from its total revenue. If the difference is positive, it is profit. A negative difference is a loss and is shown in brackets. This is a different benchmark for a professional corporation than for most businesses, since professional corporations strive to minimize net income, and thus corporate taxes.
▸ Net income available to shareholders. This is the bottom line, the money left at the end of the period. It is held for future needs, invested as the board directs, or returned to investors in the future.
It takes awhile to become adept at analyzing financial reports, so ask your accountant to walk you through your practice's balance sheet and income statement and point out the important indicators.
Last month, I discussed the importance of learning to read and understand financial statements. It is the only way in which you can truly evaluate your practice's financial health.
I named the three barometers of financial strength: liquidity, solvency, and profitability. The first two are measured with the balance sheet, which I covered last month. Measuring profitability requires a separate tool: the income statement.
An income statement summarizes revenue and expenses for a specific time period, usually a year, although reports should be generated more frequently for large or complicated practices. Here are the essential components:
▸ Total sales revenue (TSR). Nicknamed the "top line," TSR represents the practice's gross income for the period. In large offices with multiple "providers" and/or multiple specialized services, TSR will be broken down to identify and track all major revenue producers.
▸ Operating costs. In other words, overhead. For many practices, there is only one category of operating costs, usually called general and administrative expenses (G&A). However, if you offer ancillary services, such as a spa, or sell a lot of products, your income statement should separate the costs of producing these products or services into a separate category called sales costs. Cosmetically oriented practices with large marketing expenses should have a third category to track them.
Many physicians instinctively strive to slash operating costs, but they often fail to distinguish between G&A expenses—which should be kept as low as possible—and sales and marketing costs. The latter often must be maintained or even increased. A practice spending 30% on overhead, for example, is not necessarily doing as well as one spending 60%: Would you rather have 70% of $250,000 or 40% of $1 million?
▸ Gross profit (or loss). In practices with significant sales costs, this is the difference between sales revenue and sales/marketing costs. A positive difference is profit; a negative difference is a loss and is shown in brackets. If you offer ancillary products or services, this category determines if they, by themselves, are making money.
▸ Operating income. What's left when you subtract all the operating expenses from gross profit.
▸ Income before taxes. After subtracting any interest paid on outstanding debt from total operating income, you are left with the amount on which the practice may be liable for taxes.
▸ Taxes. All paid or anticipated taxes during the period, to all jurisdictions.
▸ Net income from continuing operations. After subtracting taxes from its income, this is what is left.
▸ Nonrecurring events. This is the cost of any one-time expenses, such as restructuring the practice or an unreimbursed casualty loss. These are shown on a separate line so as to not confuse the "continuing operations" figure.
▸ Net income. What the practice has left after subtracting all its expenses from its total revenue. If the difference is positive, it is profit. A negative difference is a loss and is shown in brackets. This is a different benchmark for a professional corporation than for most businesses, since professional corporations strive to minimize net income, and thus corporate taxes.
▸ Net income available to shareholders. This is the bottom line, the money left at the end of the period. It is held for future needs, invested as the board directs, or returned to investors in the future.
It takes awhile to become adept at analyzing financial reports, so ask your accountant to walk you through your practice's balance sheet and income statement and point out the important indicators.
Delivery linked to disability
More than a week overdue, a woman was admitted for labor induction at 7 AM. At 12:30 PM the physician ruptured her membranes. By 4:45 PM labor had progressed slowly and the fetal heart rate tracing was intermittently abnormal. The physician placed the mother on her side and administered oxygen.
The next time a physician saw the woman was nearly 3 hours later, but that physician allegedly did not offer cesarean as an option. Another 2 hours later the physician made several attempts at vacuum extraction delivery, and the mother eventually pushed the fetus out on her own. The infant was depressed and had signs of bruising around her head. MRI and CT scans showed cerebral hemorrhage.
Now 9 years old, the child has severe learning disabilities and wears braces. She sometimes uses a walker because she is prone to falling down.
- The jury awarded the plaintiff $23.8 million.
More than a week overdue, a woman was admitted for labor induction at 7 AM. At 12:30 PM the physician ruptured her membranes. By 4:45 PM labor had progressed slowly and the fetal heart rate tracing was intermittently abnormal. The physician placed the mother on her side and administered oxygen.
The next time a physician saw the woman was nearly 3 hours later, but that physician allegedly did not offer cesarean as an option. Another 2 hours later the physician made several attempts at vacuum extraction delivery, and the mother eventually pushed the fetus out on her own. The infant was depressed and had signs of bruising around her head. MRI and CT scans showed cerebral hemorrhage.
Now 9 years old, the child has severe learning disabilities and wears braces. She sometimes uses a walker because she is prone to falling down.
- The jury awarded the plaintiff $23.8 million.
More than a week overdue, a woman was admitted for labor induction at 7 AM. At 12:30 PM the physician ruptured her membranes. By 4:45 PM labor had progressed slowly and the fetal heart rate tracing was intermittently abnormal. The physician placed the mother on her side and administered oxygen.
The next time a physician saw the woman was nearly 3 hours later, but that physician allegedly did not offer cesarean as an option. Another 2 hours later the physician made several attempts at vacuum extraction delivery, and the mother eventually pushed the fetus out on her own. The infant was depressed and had signs of bruising around her head. MRI and CT scans showed cerebral hemorrhage.
Now 9 years old, the child has severe learning disabilities and wears braces. She sometimes uses a walker because she is prone to falling down.
- The jury awarded the plaintiff $23.8 million.
Fetal demise leads to award
Prenatal care for a 2nd pregnancy was uneventful until 35 weeks, when preterm labor began. The woman reported rhythmic cramping and increased vaginal pressure. Examination revealed she was dilated to 4 cm and the fetus was at the –1 station with 80% cervical effacement. She was sent home, but was later called and asked to return to the hospital for further examination, at which time she was admitted.
Preterm labor was confirmed and the fetal status was reassuring. She was given 2 doses of steroids during the hospitalization to increase lung maturity in case of early delivery. At discharge she was told to contact her physician’s office in case of decreased fetal movement or fluid leakage.
Two days later she called the office because of decreased fetal movement. The medical assistant told the mother that this change was normal as the infant moved down the birth canal and that as long as there was any movement, she did not have to follow up. (Experts for both the defense and the plaintiff testified that this statement was incorrect.) Another 2 days later the woman called the office again to report fluid leakage. The same medical assistant told her to stay home and that these symptoms were normal.
The woman came into the office for a routine visit the next day. Although the chart notes indicated a decrease in movement and regular contractions, during the case the physician claimed the woman reported adequate fetal movement and the woman claimed she was not having contractions. The woman was sent home; 4 days later she called back to report no fetal movement.
Fetal demise was diagnosed. Upon delivery, a nuchal cord was found.
In suing, the woman claimed that earlier intervention or continued monitoring would have resulted in a healthy infant.
- The jury awarded the plaintiff $2.5 million.
Prenatal care for a 2nd pregnancy was uneventful until 35 weeks, when preterm labor began. The woman reported rhythmic cramping and increased vaginal pressure. Examination revealed she was dilated to 4 cm and the fetus was at the –1 station with 80% cervical effacement. She was sent home, but was later called and asked to return to the hospital for further examination, at which time she was admitted.
Preterm labor was confirmed and the fetal status was reassuring. She was given 2 doses of steroids during the hospitalization to increase lung maturity in case of early delivery. At discharge she was told to contact her physician’s office in case of decreased fetal movement or fluid leakage.
Two days later she called the office because of decreased fetal movement. The medical assistant told the mother that this change was normal as the infant moved down the birth canal and that as long as there was any movement, she did not have to follow up. (Experts for both the defense and the plaintiff testified that this statement was incorrect.) Another 2 days later the woman called the office again to report fluid leakage. The same medical assistant told her to stay home and that these symptoms were normal.
The woman came into the office for a routine visit the next day. Although the chart notes indicated a decrease in movement and regular contractions, during the case the physician claimed the woman reported adequate fetal movement and the woman claimed she was not having contractions. The woman was sent home; 4 days later she called back to report no fetal movement.
Fetal demise was diagnosed. Upon delivery, a nuchal cord was found.
In suing, the woman claimed that earlier intervention or continued monitoring would have resulted in a healthy infant.
- The jury awarded the plaintiff $2.5 million.
Prenatal care for a 2nd pregnancy was uneventful until 35 weeks, when preterm labor began. The woman reported rhythmic cramping and increased vaginal pressure. Examination revealed she was dilated to 4 cm and the fetus was at the –1 station with 80% cervical effacement. She was sent home, but was later called and asked to return to the hospital for further examination, at which time she was admitted.
Preterm labor was confirmed and the fetal status was reassuring. She was given 2 doses of steroids during the hospitalization to increase lung maturity in case of early delivery. At discharge she was told to contact her physician’s office in case of decreased fetal movement or fluid leakage.
Two days later she called the office because of decreased fetal movement. The medical assistant told the mother that this change was normal as the infant moved down the birth canal and that as long as there was any movement, she did not have to follow up. (Experts for both the defense and the plaintiff testified that this statement was incorrect.) Another 2 days later the woman called the office again to report fluid leakage. The same medical assistant told her to stay home and that these symptoms were normal.
The woman came into the office for a routine visit the next day. Although the chart notes indicated a decrease in movement and regular contractions, during the case the physician claimed the woman reported adequate fetal movement and the woman claimed she was not having contractions. The woman was sent home; 4 days later she called back to report no fetal movement.
Fetal demise was diagnosed. Upon delivery, a nuchal cord was found.
In suing, the woman claimed that earlier intervention or continued monitoring would have resulted in a healthy infant.
- The jury awarded the plaintiff $2.5 million.
How was cervical cancer missed?
A woman in her early 50s had irregular vaginal bleeding attributed to fibroids. A hysterectomy was recommended on 2 different occasions a year apart, but the woman declined the procedure each time. The following year she was admitted to a hospital with fever, vomiting, and abdominal pain.
Three days later an exploratory laparotomy revealed a complex mass extending from the bladder peritoneum to the cul-de-sac and involving the lower uterine segment. The anterior mass was removed but not the posterior mass, because the colon was also adhered to the posterior portion of the uterus. The posterior mass was drained. Biopsy results of the anterior mass were negative. After discharge, 2 subsequent Pap smears 3 months apart were negative, but 4 months later a gynecological consultant diagnosed stage IVa cervical cancer. The woman underwent chemotherapy and radiation, and had a colostomy.
In suing, the woman faulted the defendants for failing to discover the cancer during her hospitalization. The defense countered that the woman failed to agree to a hysterectomy when recommended on 2 separate occasions and that the cancer was not discoverable during her hospitalization based on negative Pap smear results.
- The jury returned a defense verdict.
A woman in her early 50s had irregular vaginal bleeding attributed to fibroids. A hysterectomy was recommended on 2 different occasions a year apart, but the woman declined the procedure each time. The following year she was admitted to a hospital with fever, vomiting, and abdominal pain.
Three days later an exploratory laparotomy revealed a complex mass extending from the bladder peritoneum to the cul-de-sac and involving the lower uterine segment. The anterior mass was removed but not the posterior mass, because the colon was also adhered to the posterior portion of the uterus. The posterior mass was drained. Biopsy results of the anterior mass were negative. After discharge, 2 subsequent Pap smears 3 months apart were negative, but 4 months later a gynecological consultant diagnosed stage IVa cervical cancer. The woman underwent chemotherapy and radiation, and had a colostomy.
In suing, the woman faulted the defendants for failing to discover the cancer during her hospitalization. The defense countered that the woman failed to agree to a hysterectomy when recommended on 2 separate occasions and that the cancer was not discoverable during her hospitalization based on negative Pap smear results.
- The jury returned a defense verdict.
A woman in her early 50s had irregular vaginal bleeding attributed to fibroids. A hysterectomy was recommended on 2 different occasions a year apart, but the woman declined the procedure each time. The following year she was admitted to a hospital with fever, vomiting, and abdominal pain.
Three days later an exploratory laparotomy revealed a complex mass extending from the bladder peritoneum to the cul-de-sac and involving the lower uterine segment. The anterior mass was removed but not the posterior mass, because the colon was also adhered to the posterior portion of the uterus. The posterior mass was drained. Biopsy results of the anterior mass were negative. After discharge, 2 subsequent Pap smears 3 months apart were negative, but 4 months later a gynecological consultant diagnosed stage IVa cervical cancer. The woman underwent chemotherapy and radiation, and had a colostomy.
In suing, the woman faulted the defendants for failing to discover the cancer during her hospitalization. The defense countered that the woman failed to agree to a hysterectomy when recommended on 2 separate occasions and that the cancer was not discoverable during her hospitalization based on negative Pap smear results.
- The jury returned a defense verdict.
Jury: Patient at fault for skipping follow-up
A 42-year-old woman with a 4×6 cm mass on her left ovary was given hormone suppression therapy and told to return in a month. She did not return for a year, at which time the mass was found to have enlarged to 9×11 cm and surgery was recommended.
Because of adhesions, a laparotomy was performed. The next day the woman complained of back pain, and it was discovered that a ureter had been cut. The woman underwent surgery to repair the ureter.
In suing, the woman asserted the physician was negligent in failing to protect the ureter from injury during the laparotomy. She claimed she had back pain, chronic depression, loss of bladder control, and disfigurement as a result of the injury.
The physician contended the ureter was injured during clamping of deep pelvic blood vessels to control bleeding and that the ureter had been visualized as intact prior to closure. The physician also claimed negligence on the part of the woman, for failing to return for a follow-up examination when recommended, leading to the growth of the mass, which complicated the surgery.
- The jury returned a defense verdict.
A 42-year-old woman with a 4×6 cm mass on her left ovary was given hormone suppression therapy and told to return in a month. She did not return for a year, at which time the mass was found to have enlarged to 9×11 cm and surgery was recommended.
Because of adhesions, a laparotomy was performed. The next day the woman complained of back pain, and it was discovered that a ureter had been cut. The woman underwent surgery to repair the ureter.
In suing, the woman asserted the physician was negligent in failing to protect the ureter from injury during the laparotomy. She claimed she had back pain, chronic depression, loss of bladder control, and disfigurement as a result of the injury.
The physician contended the ureter was injured during clamping of deep pelvic blood vessels to control bleeding and that the ureter had been visualized as intact prior to closure. The physician also claimed negligence on the part of the woman, for failing to return for a follow-up examination when recommended, leading to the growth of the mass, which complicated the surgery.
- The jury returned a defense verdict.
A 42-year-old woman with a 4×6 cm mass on her left ovary was given hormone suppression therapy and told to return in a month. She did not return for a year, at which time the mass was found to have enlarged to 9×11 cm and surgery was recommended.
Because of adhesions, a laparotomy was performed. The next day the woman complained of back pain, and it was discovered that a ureter had been cut. The woman underwent surgery to repair the ureter.
In suing, the woman asserted the physician was negligent in failing to protect the ureter from injury during the laparotomy. She claimed she had back pain, chronic depression, loss of bladder control, and disfigurement as a result of the injury.
The physician contended the ureter was injured during clamping of deep pelvic blood vessels to control bleeding and that the ureter had been visualized as intact prior to closure. The physician also claimed negligence on the part of the woman, for failing to return for a follow-up examination when recommended, leading to the growth of the mass, which complicated the surgery.
- The jury returned a defense verdict.