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Excessive force used on fetal head?
A woman experienced a normal pregnancy and an uneventful labor through delivery of the fetal head, at which time shoulder dystocia was encountered.
Delivery notes indicate that the obstetrician used suprapubic pressure, the McRoberts maneuver, and minimal traction on the fetal head to dislodge the shoulder. The child, 8 lb 9 oz at birth, was noted to have bruising to his head and scalp, a molded head, and limited movement of his left arm and hand. He was diagnosed with Erb’s palsy, and claims to have permanent damage to his left biceps, left triceps, and middle deltoid, despite 3 surgeries and extensive physical therapy.
In suing, the child claimed that the defendant used excessive force when pulling on his head during delivery.
The obstetrician admitted she had pulled continuously on the fetal head for 20 to 30 seconds, and did not know how much force she used.
She claimed, however, that it was impossible to determine the cause of the child’s injury, which may have occurred prior to delivery. Further, she noted the injury was minor and did not greatly impede the plaintiff’s quality of life.
- The jury awarded the plaintiff $1.8 million.
A woman experienced a normal pregnancy and an uneventful labor through delivery of the fetal head, at which time shoulder dystocia was encountered.
Delivery notes indicate that the obstetrician used suprapubic pressure, the McRoberts maneuver, and minimal traction on the fetal head to dislodge the shoulder. The child, 8 lb 9 oz at birth, was noted to have bruising to his head and scalp, a molded head, and limited movement of his left arm and hand. He was diagnosed with Erb’s palsy, and claims to have permanent damage to his left biceps, left triceps, and middle deltoid, despite 3 surgeries and extensive physical therapy.
In suing, the child claimed that the defendant used excessive force when pulling on his head during delivery.
The obstetrician admitted she had pulled continuously on the fetal head for 20 to 30 seconds, and did not know how much force she used.
She claimed, however, that it was impossible to determine the cause of the child’s injury, which may have occurred prior to delivery. Further, she noted the injury was minor and did not greatly impede the plaintiff’s quality of life.
- The jury awarded the plaintiff $1.8 million.
A woman experienced a normal pregnancy and an uneventful labor through delivery of the fetal head, at which time shoulder dystocia was encountered.
Delivery notes indicate that the obstetrician used suprapubic pressure, the McRoberts maneuver, and minimal traction on the fetal head to dislodge the shoulder. The child, 8 lb 9 oz at birth, was noted to have bruising to his head and scalp, a molded head, and limited movement of his left arm and hand. He was diagnosed with Erb’s palsy, and claims to have permanent damage to his left biceps, left triceps, and middle deltoid, despite 3 surgeries and extensive physical therapy.
In suing, the child claimed that the defendant used excessive force when pulling on his head during delivery.
The obstetrician admitted she had pulled continuously on the fetal head for 20 to 30 seconds, and did not know how much force she used.
She claimed, however, that it was impossible to determine the cause of the child’s injury, which may have occurred prior to delivery. Further, she noted the injury was minor and did not greatly impede the plaintiff’s quality of life.
- The jury awarded the plaintiff $1.8 million.
Hysterectomy defies patient’s wish
A 47-year-old woman with a strong belief in holistic medicine presented to an Ob/Gyn with abdominal complaints. Suspecting ovarian cysts, the physician scheduled an exploratory procedure.
Prior to surgery, the woman expressly stated in writing that a hysterectomy was not to be performed, since this procedure went against her beliefs. At surgery, however, the physician encountered excessive bleeding and performed an abdominal hysterectomy.
In suing, the woman noted that the physician had defied her wishes, and claimed the hysterectomy caused her emotional distress.
The defendant maintained that his decision was appropriate given the bleeding he discovered.
- The parties settled for $210,000.
A 47-year-old woman with a strong belief in holistic medicine presented to an Ob/Gyn with abdominal complaints. Suspecting ovarian cysts, the physician scheduled an exploratory procedure.
Prior to surgery, the woman expressly stated in writing that a hysterectomy was not to be performed, since this procedure went against her beliefs. At surgery, however, the physician encountered excessive bleeding and performed an abdominal hysterectomy.
In suing, the woman noted that the physician had defied her wishes, and claimed the hysterectomy caused her emotional distress.
The defendant maintained that his decision was appropriate given the bleeding he discovered.
- The parties settled for $210,000.
A 47-year-old woman with a strong belief in holistic medicine presented to an Ob/Gyn with abdominal complaints. Suspecting ovarian cysts, the physician scheduled an exploratory procedure.
Prior to surgery, the woman expressly stated in writing that a hysterectomy was not to be performed, since this procedure went against her beliefs. At surgery, however, the physician encountered excessive bleeding and performed an abdominal hysterectomy.
In suing, the woman noted that the physician had defied her wishes, and claimed the hysterectomy caused her emotional distress.
The defendant maintained that his decision was appropriate given the bleeding he discovered.
- The parties settled for $210,000.
EMR—A Primer
The day will come—and probably soon—when you will have to seriously consider switching from paper to electronic medical records.
Most physicians dread that day, and with good reason: Choosing the right EMR system for your practice is difficult at best, and once you make the choice, conversion is often a nightmare. But unless you'll be retiring soon, it will become virtually inevitable.
There are two good reasons for this.
First, EMR is long overdue. If you compare how medicine was practiced in 1905 with how it is practiced today, virtually nothing is the same—except the way we keep records.
Several studies suggest that EMR does make a difference in health care outcomes, by shortening inpatient stays, decreasing risk of adverse drug interactions, improving the consistency and content of records, and improving continuity of care and follow-up, among other things.
But there is a second reason why EMR's time has come: Our government has decreed that it has, whether we are ready or not.
The Bush administration has outlined a plan to ensure that most Americans have electronic health records within the next 10 years. “By computerizing health records,” the president said in his 2004 State of the Union address, “we can avoid dangerous medical mistakes, reduce costs, and improve care.” And in January, in one of his first speeches following his second inauguration, President Bush reaffirmed his commitment to that goal.
This, of course, is easier said than done.
For one thing, EMR is still by and large slower than pen and paper because direct data entry is still primarily done by keyboard. Voice recognition, handheld devices, and wireless devices have been tried and have largely failed except for specialized tasks. For another thing, physicians have been slow to warm to a system that slows them down and forces them to change the way they think and work. In addition, many fear that EMR will interfere with clinical decision making and intrude on physician-patient communication. The prospect of a malfunction bringing an entire clinic to a grinding halt is not particularly inviting either.
The special needs of dermatology—high patient volumes, multiple diagnoses and prescriptions per patient, the wide variety of procedures we perform, and especially digital image storage—present further hurdles. Nevertheless, many of us will be looking to install EMR systems in the not-too-distant future. And when you start looking, be careful.
The key phrase to keep in mind is caveat emptor. There is as yet no regulatory body to test vendor claims or certify system behaviors. And vaporware is still as common as real software; beware the “feature in the next release” if it is a feature you need right now. Avoid the temptation to buy a flashy new system and then try to adapt it to your needs; figure out your needs first, then find a system that meets them.
Unfortunately, there is no easy way around doing the work of comparing one system with another—or 20 systems against each other.
The most important information a vendor can give you is the names and addresses of two or more sites where you can go watch their system in action. Site visits are tedious and time consuming, but they are the only way to pick the best system for your practice the first time around.
Never be the first dermatology office with that particular system. Let the vendor work the bugs out with somebody else.
Above all, if you have disorganized paper records, don't count on EMR to automatically solve your problems. If your paper system is in disarray, solve that problem before considering EMR.
With all of its problems and hurdles, EMR soon will be a part of most of our lives. And for those who take the time to do it right, it will be an improvement.
The day will come—and probably soon—when you will have to seriously consider switching from paper to electronic medical records.
Most physicians dread that day, and with good reason: Choosing the right EMR system for your practice is difficult at best, and once you make the choice, conversion is often a nightmare. But unless you'll be retiring soon, it will become virtually inevitable.
There are two good reasons for this.
First, EMR is long overdue. If you compare how medicine was practiced in 1905 with how it is practiced today, virtually nothing is the same—except the way we keep records.
Several studies suggest that EMR does make a difference in health care outcomes, by shortening inpatient stays, decreasing risk of adverse drug interactions, improving the consistency and content of records, and improving continuity of care and follow-up, among other things.
But there is a second reason why EMR's time has come: Our government has decreed that it has, whether we are ready or not.
The Bush administration has outlined a plan to ensure that most Americans have electronic health records within the next 10 years. “By computerizing health records,” the president said in his 2004 State of the Union address, “we can avoid dangerous medical mistakes, reduce costs, and improve care.” And in January, in one of his first speeches following his second inauguration, President Bush reaffirmed his commitment to that goal.
This, of course, is easier said than done.
For one thing, EMR is still by and large slower than pen and paper because direct data entry is still primarily done by keyboard. Voice recognition, handheld devices, and wireless devices have been tried and have largely failed except for specialized tasks. For another thing, physicians have been slow to warm to a system that slows them down and forces them to change the way they think and work. In addition, many fear that EMR will interfere with clinical decision making and intrude on physician-patient communication. The prospect of a malfunction bringing an entire clinic to a grinding halt is not particularly inviting either.
The special needs of dermatology—high patient volumes, multiple diagnoses and prescriptions per patient, the wide variety of procedures we perform, and especially digital image storage—present further hurdles. Nevertheless, many of us will be looking to install EMR systems in the not-too-distant future. And when you start looking, be careful.
The key phrase to keep in mind is caveat emptor. There is as yet no regulatory body to test vendor claims or certify system behaviors. And vaporware is still as common as real software; beware the “feature in the next release” if it is a feature you need right now. Avoid the temptation to buy a flashy new system and then try to adapt it to your needs; figure out your needs first, then find a system that meets them.
Unfortunately, there is no easy way around doing the work of comparing one system with another—or 20 systems against each other.
The most important information a vendor can give you is the names and addresses of two or more sites where you can go watch their system in action. Site visits are tedious and time consuming, but they are the only way to pick the best system for your practice the first time around.
Never be the first dermatology office with that particular system. Let the vendor work the bugs out with somebody else.
Above all, if you have disorganized paper records, don't count on EMR to automatically solve your problems. If your paper system is in disarray, solve that problem before considering EMR.
With all of its problems and hurdles, EMR soon will be a part of most of our lives. And for those who take the time to do it right, it will be an improvement.
The day will come—and probably soon—when you will have to seriously consider switching from paper to electronic medical records.
Most physicians dread that day, and with good reason: Choosing the right EMR system for your practice is difficult at best, and once you make the choice, conversion is often a nightmare. But unless you'll be retiring soon, it will become virtually inevitable.
There are two good reasons for this.
First, EMR is long overdue. If you compare how medicine was practiced in 1905 with how it is practiced today, virtually nothing is the same—except the way we keep records.
Several studies suggest that EMR does make a difference in health care outcomes, by shortening inpatient stays, decreasing risk of adverse drug interactions, improving the consistency and content of records, and improving continuity of care and follow-up, among other things.
But there is a second reason why EMR's time has come: Our government has decreed that it has, whether we are ready or not.
The Bush administration has outlined a plan to ensure that most Americans have electronic health records within the next 10 years. “By computerizing health records,” the president said in his 2004 State of the Union address, “we can avoid dangerous medical mistakes, reduce costs, and improve care.” And in January, in one of his first speeches following his second inauguration, President Bush reaffirmed his commitment to that goal.
This, of course, is easier said than done.
For one thing, EMR is still by and large slower than pen and paper because direct data entry is still primarily done by keyboard. Voice recognition, handheld devices, and wireless devices have been tried and have largely failed except for specialized tasks. For another thing, physicians have been slow to warm to a system that slows them down and forces them to change the way they think and work. In addition, many fear that EMR will interfere with clinical decision making and intrude on physician-patient communication. The prospect of a malfunction bringing an entire clinic to a grinding halt is not particularly inviting either.
The special needs of dermatology—high patient volumes, multiple diagnoses and prescriptions per patient, the wide variety of procedures we perform, and especially digital image storage—present further hurdles. Nevertheless, many of us will be looking to install EMR systems in the not-too-distant future. And when you start looking, be careful.
The key phrase to keep in mind is caveat emptor. There is as yet no regulatory body to test vendor claims or certify system behaviors. And vaporware is still as common as real software; beware the “feature in the next release” if it is a feature you need right now. Avoid the temptation to buy a flashy new system and then try to adapt it to your needs; figure out your needs first, then find a system that meets them.
Unfortunately, there is no easy way around doing the work of comparing one system with another—or 20 systems against each other.
The most important information a vendor can give you is the names and addresses of two or more sites where you can go watch their system in action. Site visits are tedious and time consuming, but they are the only way to pick the best system for your practice the first time around.
Never be the first dermatology office with that particular system. Let the vendor work the bugs out with somebody else.
Above all, if you have disorganized paper records, don't count on EMR to automatically solve your problems. If your paper system is in disarray, solve that problem before considering EMR.
With all of its problems and hurdles, EMR soon will be a part of most of our lives. And for those who take the time to do it right, it will be an improvement.
Was viable pregnancy negligently terminated?
A 28-year-old woman presented to an Ob/Gyn reporting several days of vaginal spotting after a positive pregnancy test. No intrauterine pregnancy could be found on transvaginal ultrasound. Suspecting an ectopic pregnancy, the physician advised termination.
The plaintiff agreed, but later sued the doctor, alleging the pregnancy was actually intrauterine. She further claimed lack of informed consent and an inability to become pregnant.
The defendant maintained that the diagnosis was accurate, and noted that termination was necessary, since the condition’s consequences can be fatal. He also claimed informed consent was granted, and noted that the termination offered the woman the greatest chance of future fertility.
- The jury returned a defense verdict.
A 28-year-old woman presented to an Ob/Gyn reporting several days of vaginal spotting after a positive pregnancy test. No intrauterine pregnancy could be found on transvaginal ultrasound. Suspecting an ectopic pregnancy, the physician advised termination.
The plaintiff agreed, but later sued the doctor, alleging the pregnancy was actually intrauterine. She further claimed lack of informed consent and an inability to become pregnant.
The defendant maintained that the diagnosis was accurate, and noted that termination was necessary, since the condition’s consequences can be fatal. He also claimed informed consent was granted, and noted that the termination offered the woman the greatest chance of future fertility.
- The jury returned a defense verdict.
A 28-year-old woman presented to an Ob/Gyn reporting several days of vaginal spotting after a positive pregnancy test. No intrauterine pregnancy could be found on transvaginal ultrasound. Suspecting an ectopic pregnancy, the physician advised termination.
The plaintiff agreed, but later sued the doctor, alleging the pregnancy was actually intrauterine. She further claimed lack of informed consent and an inability to become pregnant.
The defendant maintained that the diagnosis was accurate, and noted that termination was necessary, since the condition’s consequences can be fatal. He also claimed informed consent was granted, and noted that the termination offered the woman the greatest chance of future fertility.
- The jury returned a defense verdict.
Covering physician encounters dystocia
<court>Essex County (NJ) Superior Court</court>
An Ob/Gyn, filling in for a vacationing obstetrician, induced labor in a woman at 36 weeks’ gestation with gestational diabetes and ruptured membranes.
Despite signs of fetal distress, the defendant opted for a forceps delivery. The child suffered Erb’s palsy, which required 3 surgeries by the time of trial.
In suing, the plaintiff argued that the defendant did not review the woman’s medical records. Had he done so, he would have learned that a prior sonogram showed a disproportionally large torso (stemming from the mother’s gestational diabetes), which would have alerted him that a cesarean delivery might be necessary.
- The jury returned a verdict for the plaintiff in the amount of $2.3 million.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
<court>Essex County (NJ) Superior Court</court>
An Ob/Gyn, filling in for a vacationing obstetrician, induced labor in a woman at 36 weeks’ gestation with gestational diabetes and ruptured membranes.
Despite signs of fetal distress, the defendant opted for a forceps delivery. The child suffered Erb’s palsy, which required 3 surgeries by the time of trial.
In suing, the plaintiff argued that the defendant did not review the woman’s medical records. Had he done so, he would have learned that a prior sonogram showed a disproportionally large torso (stemming from the mother’s gestational diabetes), which would have alerted him that a cesarean delivery might be necessary.
- The jury returned a verdict for the plaintiff in the amount of $2.3 million.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
<court>Essex County (NJ) Superior Court</court>
An Ob/Gyn, filling in for a vacationing obstetrician, induced labor in a woman at 36 weeks’ gestation with gestational diabetes and ruptured membranes.
Despite signs of fetal distress, the defendant opted for a forceps delivery. The child suffered Erb’s palsy, which required 3 surgeries by the time of trial.
In suing, the plaintiff argued that the defendant did not review the woman’s medical records. Had he done so, he would have learned that a prior sonogram showed a disproportionally large torso (stemming from the mother’s gestational diabetes), which would have alerted him that a cesarean delivery might be necessary.
- The jury returned a verdict for the plaintiff in the amount of $2.3 million.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
McRoberts maneuver not recorded
Following a delivery complicated by shoulder dystocia, a child was diagnosed with Erb’s palsy. In suing, the plaintiffs argued the obstetrician did not employ proper maneuvers to dislodge the shoulder.
The defendant claimed that the McRoberts maneuver was used, but never recorded on the chart. Further, it was argued that labor progressed quickly after the dystocia was recognized.
- The jury awarded the plaintiffs $750,000.
Following a delivery complicated by shoulder dystocia, a child was diagnosed with Erb’s palsy. In suing, the plaintiffs argued the obstetrician did not employ proper maneuvers to dislodge the shoulder.
The defendant claimed that the McRoberts maneuver was used, but never recorded on the chart. Further, it was argued that labor progressed quickly after the dystocia was recognized.
- The jury awarded the plaintiffs $750,000.
Following a delivery complicated by shoulder dystocia, a child was diagnosed with Erb’s palsy. In suing, the plaintiffs argued the obstetrician did not employ proper maneuvers to dislodge the shoulder.
The defendant claimed that the McRoberts maneuver was used, but never recorded on the chart. Further, it was argued that labor progressed quickly after the dystocia was recognized.
- The jury awarded the plaintiffs $750,000.
Cesarean ordered late, no OR available
Approximately 1 half-hour after admission, fetal monitoring of a woman presenting with ruptured membranes revealed 2 periods of brief deceleration. In the half-hour that followed, however, no decelerations were reported.
The obstetrician left to see other patients, and instructed the nurse to continue fetal monitoring and report any changes. Several periods of decelerations followed, but the nurse never informed the physician. Instead, approximately 1 hour after the first of these decelerations, she reported to the doctor that both mother and fetus were fine.
Following this conversation, the child’s heart rate again dropped, at one point reaching 39 beats per minute. A new nurse contacted the doctor, noting the woman was 8 cm dilated but never conveying the extent of the decelerations.
An emergency cesarean was ordered, but 34 minutes passed before an operating room was available. The child was born with an Apgar score of 0, but was resuscitated. He suffers brain damage and cerebral palsy, and is unable to walk or talk.
In suing, the plaintiff argued that nurses were negligent for not notifying the obstetrician of the heart-rate decelerations promptly. Had this information been conveyed, it was argued, cesarean delivery would have occurred sooner. The plaintiff further cited the hospital for negligence for failing to have an operating room available.
The defendants argued the child’s condition stemmed from a ruptured umbilical cord.
- The obstetrician settled for $450,000 during trial. The jury awarded the plaintiff $23.3 million against the hospital.
Approximately 1 half-hour after admission, fetal monitoring of a woman presenting with ruptured membranes revealed 2 periods of brief deceleration. In the half-hour that followed, however, no decelerations were reported.
The obstetrician left to see other patients, and instructed the nurse to continue fetal monitoring and report any changes. Several periods of decelerations followed, but the nurse never informed the physician. Instead, approximately 1 hour after the first of these decelerations, she reported to the doctor that both mother and fetus were fine.
Following this conversation, the child’s heart rate again dropped, at one point reaching 39 beats per minute. A new nurse contacted the doctor, noting the woman was 8 cm dilated but never conveying the extent of the decelerations.
An emergency cesarean was ordered, but 34 minutes passed before an operating room was available. The child was born with an Apgar score of 0, but was resuscitated. He suffers brain damage and cerebral palsy, and is unable to walk or talk.
In suing, the plaintiff argued that nurses were negligent for not notifying the obstetrician of the heart-rate decelerations promptly. Had this information been conveyed, it was argued, cesarean delivery would have occurred sooner. The plaintiff further cited the hospital for negligence for failing to have an operating room available.
The defendants argued the child’s condition stemmed from a ruptured umbilical cord.
- The obstetrician settled for $450,000 during trial. The jury awarded the plaintiff $23.3 million against the hospital.
Approximately 1 half-hour after admission, fetal monitoring of a woman presenting with ruptured membranes revealed 2 periods of brief deceleration. In the half-hour that followed, however, no decelerations were reported.
The obstetrician left to see other patients, and instructed the nurse to continue fetal monitoring and report any changes. Several periods of decelerations followed, but the nurse never informed the physician. Instead, approximately 1 hour after the first of these decelerations, she reported to the doctor that both mother and fetus were fine.
Following this conversation, the child’s heart rate again dropped, at one point reaching 39 beats per minute. A new nurse contacted the doctor, noting the woman was 8 cm dilated but never conveying the extent of the decelerations.
An emergency cesarean was ordered, but 34 minutes passed before an operating room was available. The child was born with an Apgar score of 0, but was resuscitated. He suffers brain damage and cerebral palsy, and is unable to walk or talk.
In suing, the plaintiff argued that nurses were negligent for not notifying the obstetrician of the heart-rate decelerations promptly. Had this information been conveyed, it was argued, cesarean delivery would have occurred sooner. The plaintiff further cited the hospital for negligence for failing to have an operating room available.
The defendants argued the child’s condition stemmed from a ruptured umbilical cord.
- The obstetrician settled for $450,000 during trial. The jury awarded the plaintiff $23.3 million against the hospital.
Did negligence lead to ureter, colon injury?
<court>Lucas County (Ohio) Common Pleas Court</court>
Following a laparoscopic bilateral salpingo-oophorectomy in a 53-year-old woman with chronic pelvic pain, a pyelogram revealed an injured ureter. The injury was repaired and the patient discharged.
The woman returned to the hospital a week and a half later, at which time it was discovered that her sigmoid colon had also been injured in the first surgery, leading to a fistula. She was treated with a colostomy, and 6 months later the bowel was reanastomosed.
In suing, the woman claimed the physician was negligent for injuring her ureter and colon, and failing to detect the damage in a timely fashion. Had the injury been promptly identified, she argued, her complications would have been less severe.
The defendant denied negligence, noting that ureter injury is a known complication of salpingo-oophorectomy. He further claimed that the damage subsequently discovered developed as a complication of the ureter injury, which was detected and repaired promptly after surgery.
- The jury returned a defense verdict.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
<court>Lucas County (Ohio) Common Pleas Court</court>
Following a laparoscopic bilateral salpingo-oophorectomy in a 53-year-old woman with chronic pelvic pain, a pyelogram revealed an injured ureter. The injury was repaired and the patient discharged.
The woman returned to the hospital a week and a half later, at which time it was discovered that her sigmoid colon had also been injured in the first surgery, leading to a fistula. She was treated with a colostomy, and 6 months later the bowel was reanastomosed.
In suing, the woman claimed the physician was negligent for injuring her ureter and colon, and failing to detect the damage in a timely fashion. Had the injury been promptly identified, she argued, her complications would have been less severe.
The defendant denied negligence, noting that ureter injury is a known complication of salpingo-oophorectomy. He further claimed that the damage subsequently discovered developed as a complication of the ureter injury, which was detected and repaired promptly after surgery.
- The jury returned a defense verdict.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
<court>Lucas County (Ohio) Common Pleas Court</court>
Following a laparoscopic bilateral salpingo-oophorectomy in a 53-year-old woman with chronic pelvic pain, a pyelogram revealed an injured ureter. The injury was repaired and the patient discharged.
The woman returned to the hospital a week and a half later, at which time it was discovered that her sigmoid colon had also been injured in the first surgery, leading to a fistula. She was treated with a colostomy, and 6 months later the bowel was reanastomosed.
In suing, the woman claimed the physician was negligent for injuring her ureter and colon, and failing to detect the damage in a timely fashion. Had the injury been promptly identified, she argued, her complications would have been less severe.
The defendant denied negligence, noting that ureter injury is a known complication of salpingo-oophorectomy. He further claimed that the damage subsequently discovered developed as a complication of the ureter injury, which was detected and repaired promptly after surgery.
- The jury returned a defense verdict.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
Did bowel injury lead to finger amputation?
Following a hysterectomy, a 46-year-old woman suffered multiple complications, requiring 112 days of hospitalization and 6 subsequent surgeries—including amputation of her left thumb and index finger.
In suing, the woman claimed the Ob/Gyn injured her bowel during surgery; this injury went undetected, which led to infection and, ultimately, gangrene in her left hand and septic shock. In addition to the amputation, she also required a tracheostomy and a colostomy for almost a full year. Also cited in the suit were the hospital and several surgical consultants.
The defendant maintained that the woman’s complications were due not to bowel injury, but rather to an unavoidable vaginal cuff infection.
- The hospital and consulting surgeons settled for an undisclosed amount. The jury returned a plaintiff verdict, finding the Ob/Gyn 70% at fault. A gross verdict of $6.6 million was reduced to $5.3 million for appointment of fault.
Following a hysterectomy, a 46-year-old woman suffered multiple complications, requiring 112 days of hospitalization and 6 subsequent surgeries—including amputation of her left thumb and index finger.
In suing, the woman claimed the Ob/Gyn injured her bowel during surgery; this injury went undetected, which led to infection and, ultimately, gangrene in her left hand and septic shock. In addition to the amputation, she also required a tracheostomy and a colostomy for almost a full year. Also cited in the suit were the hospital and several surgical consultants.
The defendant maintained that the woman’s complications were due not to bowel injury, but rather to an unavoidable vaginal cuff infection.
- The hospital and consulting surgeons settled for an undisclosed amount. The jury returned a plaintiff verdict, finding the Ob/Gyn 70% at fault. A gross verdict of $6.6 million was reduced to $5.3 million for appointment of fault.
Following a hysterectomy, a 46-year-old woman suffered multiple complications, requiring 112 days of hospitalization and 6 subsequent surgeries—including amputation of her left thumb and index finger.
In suing, the woman claimed the Ob/Gyn injured her bowel during surgery; this injury went undetected, which led to infection and, ultimately, gangrene in her left hand and septic shock. In addition to the amputation, she also required a tracheostomy and a colostomy for almost a full year. Also cited in the suit were the hospital and several surgical consultants.
The defendant maintained that the woman’s complications were due not to bowel injury, but rather to an unavoidable vaginal cuff infection.
- The hospital and consulting surgeons settled for an undisclosed amount. The jury returned a plaintiff verdict, finding the Ob/Gyn 70% at fault. A gross verdict of $6.6 million was reduced to $5.3 million for appointment of fault.
Your Hardest Task
Firing an employee may be the most difficult task most employers face, and it is particularly tough on physicians. We hate doing it so much that many of us prefer to tolerate poor and marginal employees rather than replace them with good ones.
That exacts a heavy toll on the efficiency of many practices. And the longer you procrastinate, the tougher it becomes as the mediocre employee forms relationships with other employees, and with you.
So it is important to recognize poor performance early on, and, if it cannot be improved, to replace that employee with one who can perform up to your expectations.
First, make sure your reasons for termination are legal. Federal law prohibits most employers from firing an employee because of race, gender, national origin, disability, religion, or age (if the person is over age 40). It also prohibits firing someone because that person is pregnant or has recently given birth, or because of any related medical conditions. It is also illegal to fire employees for asserting their rights under state and federal antidiscrimination laws, for refusing to take a lie detector test, or for complaining about possible OSHA violations or other illegal conduct.
And you can't terminate someone for refusing to commit an illegal act (such as falsifying insurance claims), or for exercising a legal right (such as voting, public demonstration, or other political activity).
You cannot fire someone for alcohol abuse unless he or she is caught drinking on the job, but many forms of illegal drug use are legitimate cause for termination.
Other laws may apply, depending on your state. To find out more about your applicable state laws, contact your state labor department or fair employment office.
Next, make sure you have all the documentation you need. When you give verbal warnings, be sure to document them. In today's litigious society, without proper documentation you may very well find yourself in a wrongful termination lawsuit, with the former employee claiming he or she was fired for one of the illegal reasons listed above.
After you have all your legal ducks in a row, don't put it off. Monday morning is better than the traditional Friday end-of-the-day termination. This will spare you from worrying about the dreaded task all week long, and keep the fired employee from stewing about it all weekend.
Explain to the employee the performance you have expected, the steps you have taken to help him or her meet that level of performance, and the fact that it has not been met. I try to limit the conversation to less than 5 minutes, and I make it very clear that the decision has already been made, so begging, pleading, or crying will not change anything. Avoid a shouting match at all costs.
My “speech” goes something like this: “I have called you in to discuss a difficult matter. You know that we have not been happy with your performance. (This is where specific examples are inserted). We are still not happy with it, despite all the discussions we have had, and we feel you can do better elsewhere. So today we will part company, and I wish you the best of luck in your future endeavors. Here is your severance check, along with any other monies owed you. I hope there are no hard feelings.”
Be sure to get all your keys back (or change the locks if you can't), back up any important computer files, and change all of your passwords. (Most employees know more of them than you think.)
Afterward, call the staff together and explain what happened. They should hear it from you, not through the rumor mill. You don't have to give all the specifics, but you should explain how it will affect them, the responsibilities that will be shifted, and when you plan to hire a replacement.
If you are asked in the future to give a phone reference or letter of recommendation, make sure everything you say is truthful and well documented. Anything else could trigger a libel suit.
Firing an employee may be the most difficult task most employers face, and it is particularly tough on physicians. We hate doing it so much that many of us prefer to tolerate poor and marginal employees rather than replace them with good ones.
That exacts a heavy toll on the efficiency of many practices. And the longer you procrastinate, the tougher it becomes as the mediocre employee forms relationships with other employees, and with you.
So it is important to recognize poor performance early on, and, if it cannot be improved, to replace that employee with one who can perform up to your expectations.
First, make sure your reasons for termination are legal. Federal law prohibits most employers from firing an employee because of race, gender, national origin, disability, religion, or age (if the person is over age 40). It also prohibits firing someone because that person is pregnant or has recently given birth, or because of any related medical conditions. It is also illegal to fire employees for asserting their rights under state and federal antidiscrimination laws, for refusing to take a lie detector test, or for complaining about possible OSHA violations or other illegal conduct.
And you can't terminate someone for refusing to commit an illegal act (such as falsifying insurance claims), or for exercising a legal right (such as voting, public demonstration, or other political activity).
You cannot fire someone for alcohol abuse unless he or she is caught drinking on the job, but many forms of illegal drug use are legitimate cause for termination.
Other laws may apply, depending on your state. To find out more about your applicable state laws, contact your state labor department or fair employment office.
Next, make sure you have all the documentation you need. When you give verbal warnings, be sure to document them. In today's litigious society, without proper documentation you may very well find yourself in a wrongful termination lawsuit, with the former employee claiming he or she was fired for one of the illegal reasons listed above.
After you have all your legal ducks in a row, don't put it off. Monday morning is better than the traditional Friday end-of-the-day termination. This will spare you from worrying about the dreaded task all week long, and keep the fired employee from stewing about it all weekend.
Explain to the employee the performance you have expected, the steps you have taken to help him or her meet that level of performance, and the fact that it has not been met. I try to limit the conversation to less than 5 minutes, and I make it very clear that the decision has already been made, so begging, pleading, or crying will not change anything. Avoid a shouting match at all costs.
My “speech” goes something like this: “I have called you in to discuss a difficult matter. You know that we have not been happy with your performance. (This is where specific examples are inserted). We are still not happy with it, despite all the discussions we have had, and we feel you can do better elsewhere. So today we will part company, and I wish you the best of luck in your future endeavors. Here is your severance check, along with any other monies owed you. I hope there are no hard feelings.”
Be sure to get all your keys back (or change the locks if you can't), back up any important computer files, and change all of your passwords. (Most employees know more of them than you think.)
Afterward, call the staff together and explain what happened. They should hear it from you, not through the rumor mill. You don't have to give all the specifics, but you should explain how it will affect them, the responsibilities that will be shifted, and when you plan to hire a replacement.
If you are asked in the future to give a phone reference or letter of recommendation, make sure everything you say is truthful and well documented. Anything else could trigger a libel suit.
Firing an employee may be the most difficult task most employers face, and it is particularly tough on physicians. We hate doing it so much that many of us prefer to tolerate poor and marginal employees rather than replace them with good ones.
That exacts a heavy toll on the efficiency of many practices. And the longer you procrastinate, the tougher it becomes as the mediocre employee forms relationships with other employees, and with you.
So it is important to recognize poor performance early on, and, if it cannot be improved, to replace that employee with one who can perform up to your expectations.
First, make sure your reasons for termination are legal. Federal law prohibits most employers from firing an employee because of race, gender, national origin, disability, religion, or age (if the person is over age 40). It also prohibits firing someone because that person is pregnant or has recently given birth, or because of any related medical conditions. It is also illegal to fire employees for asserting their rights under state and federal antidiscrimination laws, for refusing to take a lie detector test, or for complaining about possible OSHA violations or other illegal conduct.
And you can't terminate someone for refusing to commit an illegal act (such as falsifying insurance claims), or for exercising a legal right (such as voting, public demonstration, or other political activity).
You cannot fire someone for alcohol abuse unless he or she is caught drinking on the job, but many forms of illegal drug use are legitimate cause for termination.
Other laws may apply, depending on your state. To find out more about your applicable state laws, contact your state labor department or fair employment office.
Next, make sure you have all the documentation you need. When you give verbal warnings, be sure to document them. In today's litigious society, without proper documentation you may very well find yourself in a wrongful termination lawsuit, with the former employee claiming he or she was fired for one of the illegal reasons listed above.
After you have all your legal ducks in a row, don't put it off. Monday morning is better than the traditional Friday end-of-the-day termination. This will spare you from worrying about the dreaded task all week long, and keep the fired employee from stewing about it all weekend.
Explain to the employee the performance you have expected, the steps you have taken to help him or her meet that level of performance, and the fact that it has not been met. I try to limit the conversation to less than 5 minutes, and I make it very clear that the decision has already been made, so begging, pleading, or crying will not change anything. Avoid a shouting match at all costs.
My “speech” goes something like this: “I have called you in to discuss a difficult matter. You know that we have not been happy with your performance. (This is where specific examples are inserted). We are still not happy with it, despite all the discussions we have had, and we feel you can do better elsewhere. So today we will part company, and I wish you the best of luck in your future endeavors. Here is your severance check, along with any other monies owed you. I hope there are no hard feelings.”
Be sure to get all your keys back (or change the locks if you can't), back up any important computer files, and change all of your passwords. (Most employees know more of them than you think.)
Afterward, call the staff together and explain what happened. They should hear it from you, not through the rumor mill. You don't have to give all the specifics, but you should explain how it will affect them, the responsibilities that will be shifted, and when you plan to hire a replacement.
If you are asked in the future to give a phone reference or letter of recommendation, make sure everything you say is truthful and well documented. Anything else could trigger a libel suit.