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Nonstress test misread, call to Ob delayed
Following a nonstress test for fetal well-being, a 20-year-old woman at 37 weeks’ gestation was discharged from a hospital. She called 6 days later, noting decreased fetal movement, and returned to the hospital the following day; fetal monitoring revealed a nonreassuring heart rate tracing.
Rather than contact the physician on duty, a nurse called the defendant attending obstetrician, who arrived approximately 30 minutes later. Three hours passed before a cesarean delivery was ordered, and another 1 hour before the child was delivered. His Apgar scores at birth were 0 and 0; he now suffers developmental delay, as well as inability to walk or feed himself.
It was revealed at trial that the non-stress test at 37 weeks showed a sinusoidal pattern, which the plaintiffs claimed the nurse failed to recognize. The plaintiffs argued that the staff should have called an obstetrician immediately upon inspection of the fetal heart rate tracing.
The hospital claimed nurses acted appropriately, and charged that any negligence was that of the defendant physician.
- The plaintiff was awarded a $16 million default judgment against the obstetrician. The hospital settled for $1.4 million.
Following a nonstress test for fetal well-being, a 20-year-old woman at 37 weeks’ gestation was discharged from a hospital. She called 6 days later, noting decreased fetal movement, and returned to the hospital the following day; fetal monitoring revealed a nonreassuring heart rate tracing.
Rather than contact the physician on duty, a nurse called the defendant attending obstetrician, who arrived approximately 30 minutes later. Three hours passed before a cesarean delivery was ordered, and another 1 hour before the child was delivered. His Apgar scores at birth were 0 and 0; he now suffers developmental delay, as well as inability to walk or feed himself.
It was revealed at trial that the non-stress test at 37 weeks showed a sinusoidal pattern, which the plaintiffs claimed the nurse failed to recognize. The plaintiffs argued that the staff should have called an obstetrician immediately upon inspection of the fetal heart rate tracing.
The hospital claimed nurses acted appropriately, and charged that any negligence was that of the defendant physician.
- The plaintiff was awarded a $16 million default judgment against the obstetrician. The hospital settled for $1.4 million.
Following a nonstress test for fetal well-being, a 20-year-old woman at 37 weeks’ gestation was discharged from a hospital. She called 6 days later, noting decreased fetal movement, and returned to the hospital the following day; fetal monitoring revealed a nonreassuring heart rate tracing.
Rather than contact the physician on duty, a nurse called the defendant attending obstetrician, who arrived approximately 30 minutes later. Three hours passed before a cesarean delivery was ordered, and another 1 hour before the child was delivered. His Apgar scores at birth were 0 and 0; he now suffers developmental delay, as well as inability to walk or feed himself.
It was revealed at trial that the non-stress test at 37 weeks showed a sinusoidal pattern, which the plaintiffs claimed the nurse failed to recognize. The plaintiffs argued that the staff should have called an obstetrician immediately upon inspection of the fetal heart rate tracing.
The hospital claimed nurses acted appropriately, and charged that any negligence was that of the defendant physician.
- The plaintiff was awarded a $16 million default judgment against the obstetrician. The hospital settled for $1.4 million.
No Ob available for shoulder dystocia
By 37 weeks’ gestation, a woman who experienced shoulder dystocia and macrosomia with her first pregnancy had a 56-pound weight gain and an estimated fetal weight of greater than 8 pounds. Despite a request for cesarean delivery, she was scheduled for labor induction at 38 weeks.
Due to the complications with her first child, both a midwife and obstetrician were slated to be present for the delivery. At the time of the scheduled induction, however, the physician was investigating psychiatric care for his wife, and asked another obstetrician to cover. That physician, however, was available only for portions of the day in question. None of these changes were communicated to the mother.
Despite an awareness of the Ob scheduling problems, the midwife proceeded with the induction; delivery was complicated by shoulder dystocia. With no obstetrician available, the midwife performed the McRoberts and Wood’s maneuvers. The infant was born with Erb palsy and loss of function in her left arm.
The plaintiffs sued the scheduled obstetrician, claiming he did not arrange for adequate coverage. They also named the midwife, alleging she failed to ensure an obstetrician was present for delivery and that she used excessive force in attempting to dislodge the child’s shoulder.
- The jury awarded the plaintiffs $3.09 million.
By 37 weeks’ gestation, a woman who experienced shoulder dystocia and macrosomia with her first pregnancy had a 56-pound weight gain and an estimated fetal weight of greater than 8 pounds. Despite a request for cesarean delivery, she was scheduled for labor induction at 38 weeks.
Due to the complications with her first child, both a midwife and obstetrician were slated to be present for the delivery. At the time of the scheduled induction, however, the physician was investigating psychiatric care for his wife, and asked another obstetrician to cover. That physician, however, was available only for portions of the day in question. None of these changes were communicated to the mother.
Despite an awareness of the Ob scheduling problems, the midwife proceeded with the induction; delivery was complicated by shoulder dystocia. With no obstetrician available, the midwife performed the McRoberts and Wood’s maneuvers. The infant was born with Erb palsy and loss of function in her left arm.
The plaintiffs sued the scheduled obstetrician, claiming he did not arrange for adequate coverage. They also named the midwife, alleging she failed to ensure an obstetrician was present for delivery and that she used excessive force in attempting to dislodge the child’s shoulder.
- The jury awarded the plaintiffs $3.09 million.
By 37 weeks’ gestation, a woman who experienced shoulder dystocia and macrosomia with her first pregnancy had a 56-pound weight gain and an estimated fetal weight of greater than 8 pounds. Despite a request for cesarean delivery, she was scheduled for labor induction at 38 weeks.
Due to the complications with her first child, both a midwife and obstetrician were slated to be present for the delivery. At the time of the scheduled induction, however, the physician was investigating psychiatric care for his wife, and asked another obstetrician to cover. That physician, however, was available only for portions of the day in question. None of these changes were communicated to the mother.
Despite an awareness of the Ob scheduling problems, the midwife proceeded with the induction; delivery was complicated by shoulder dystocia. With no obstetrician available, the midwife performed the McRoberts and Wood’s maneuvers. The infant was born with Erb palsy and loss of function in her left arm.
The plaintiffs sued the scheduled obstetrician, claiming he did not arrange for adequate coverage. They also named the midwife, alleging she failed to ensure an obstetrician was present for delivery and that she used excessive force in attempting to dislodge the child’s shoulder.
- The jury awarded the plaintiffs $3.09 million.
Nurses question FHR tracing
<court>Hennepin County (Minn) District Court</court>
A 26-year-old woman at term presented to a hospital with ruptured membranes and clear amniotic fluid. The physician ordered oxytocin, but over the next 5 hours nurses twice halted its administration and contacted the obstetrician due to concerns regarding the fetal heart rate (FHR) tracing. Both times, oxytocin was resumed.
The physician reviewed the fetal monitoring strips after the second cessation, but when nurses called again approximately 1 hour later, opted not to review the strips and instructed the nursing staff to proceed as planned.
A vaginal exam 1 hour later revealed meconium, and fetal monitoring showed a 3-minute deceleration with a fetal heart rate in the 50s. The defendant ordered amnioinfusion and, following evidence of late variables, placed a scalp electrode.
Half an hour later the mother was fully dilated and began pushing, but dystocia was encountered, leading to 3 unsuccessful vacuum extraction attempts. Delivery was switched to cesarean. The child—born with Apgar scores of 1, 4, and 4—was diagnosed with hypoxic ischemic encephalopathy and is now in a vegetative state.
In suing, the plaintiff argued the physician should have halted oxytocin administration and delivered the child sooner.
The defendant claimed the child’s injuries stemmed from a sudden event immediately before delivery that could be neither predicted nor avoided.
- The case settled for $3.2 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>Hennepin County (Minn) District Court</court>
A 26-year-old woman at term presented to a hospital with ruptured membranes and clear amniotic fluid. The physician ordered oxytocin, but over the next 5 hours nurses twice halted its administration and contacted the obstetrician due to concerns regarding the fetal heart rate (FHR) tracing. Both times, oxytocin was resumed.
The physician reviewed the fetal monitoring strips after the second cessation, but when nurses called again approximately 1 hour later, opted not to review the strips and instructed the nursing staff to proceed as planned.
A vaginal exam 1 hour later revealed meconium, and fetal monitoring showed a 3-minute deceleration with a fetal heart rate in the 50s. The defendant ordered amnioinfusion and, following evidence of late variables, placed a scalp electrode.
Half an hour later the mother was fully dilated and began pushing, but dystocia was encountered, leading to 3 unsuccessful vacuum extraction attempts. Delivery was switched to cesarean. The child—born with Apgar scores of 1, 4, and 4—was diagnosed with hypoxic ischemic encephalopathy and is now in a vegetative state.
In suing, the plaintiff argued the physician should have halted oxytocin administration and delivered the child sooner.
The defendant claimed the child’s injuries stemmed from a sudden event immediately before delivery that could be neither predicted nor avoided.
- The case settled for $3.2 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>Hennepin County (Minn) District Court</court>
A 26-year-old woman at term presented to a hospital with ruptured membranes and clear amniotic fluid. The physician ordered oxytocin, but over the next 5 hours nurses twice halted its administration and contacted the obstetrician due to concerns regarding the fetal heart rate (FHR) tracing. Both times, oxytocin was resumed.
The physician reviewed the fetal monitoring strips after the second cessation, but when nurses called again approximately 1 hour later, opted not to review the strips and instructed the nursing staff to proceed as planned.
A vaginal exam 1 hour later revealed meconium, and fetal monitoring showed a 3-minute deceleration with a fetal heart rate in the 50s. The defendant ordered amnioinfusion and, following evidence of late variables, placed a scalp electrode.
Half an hour later the mother was fully dilated and began pushing, but dystocia was encountered, leading to 3 unsuccessful vacuum extraction attempts. Delivery was switched to cesarean. The child—born with Apgar scores of 1, 4, and 4—was diagnosed with hypoxic ischemic encephalopathy and is now in a vegetative state.
In suing, the plaintiff argued the physician should have halted oxytocin administration and delivered the child sooner.
The defendant claimed the child’s injuries stemmed from a sudden event immediately before delivery that could be neither predicted nor avoided.
- The case settled for $3.2 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.
Sponge missed, second surgery needed
Several days after delivering a child by cesarean section, a woman began experiencing severe abdominal pain. Although no abnormality was noted on postoperative x-ray, a surgical sponge was later found in her abdomen, requiring surgical removal.
The woman claimed negligence was committed by the Ob/Gyn for not removing the sponge, the radiologist for not detecting its presence on x-ray, and the hospital team for inaccurately accounting for the sponges prior to surgical closure.
The Ob/Gyn testified that he relied on the surgical team to keep accurate track of the sponges used.
- The radiologist settled for an undisclosed sum. The jury awarded the plaintiff $175,000, with fault assigned at 20% to the Ob/Gyn, 20% to the radiologist, and 60% to the hospital.
Several days after delivering a child by cesarean section, a woman began experiencing severe abdominal pain. Although no abnormality was noted on postoperative x-ray, a surgical sponge was later found in her abdomen, requiring surgical removal.
The woman claimed negligence was committed by the Ob/Gyn for not removing the sponge, the radiologist for not detecting its presence on x-ray, and the hospital team for inaccurately accounting for the sponges prior to surgical closure.
The Ob/Gyn testified that he relied on the surgical team to keep accurate track of the sponges used.
- The radiologist settled for an undisclosed sum. The jury awarded the plaintiff $175,000, with fault assigned at 20% to the Ob/Gyn, 20% to the radiologist, and 60% to the hospital.
Several days after delivering a child by cesarean section, a woman began experiencing severe abdominal pain. Although no abnormality was noted on postoperative x-ray, a surgical sponge was later found in her abdomen, requiring surgical removal.
The woman claimed negligence was committed by the Ob/Gyn for not removing the sponge, the radiologist for not detecting its presence on x-ray, and the hospital team for inaccurately accounting for the sponges prior to surgical closure.
The Ob/Gyn testified that he relied on the surgical team to keep accurate track of the sponges used.
- The radiologist settled for an undisclosed sum. The jury awarded the plaintiff $175,000, with fault assigned at 20% to the Ob/Gyn, 20% to the radiologist, and 60% to the hospital.
Ob opts for monitoring instead of cerclage
A woman at 10 weeks’ gestation presented to an obstetrician in June; her history was significant for diethylstilbestrol exposure, laser conization of the cervix due to noninvasive cervical cancer, a cerclage placed at pregnancy 7 years earlier, and several years of in vitro fertility treatments leading to this conception.
Though her prior obstetrician—now retired—had anticipated a need for cervical cerclage with any future pregnancies, her current doctor opted for frequent monitoring via ultrasound in lieu of cerclage.
Sonograms at 14 and 18 weeks revealed a normal cervix. An ultrasound in late August, however, showed the cervix 1 cm dilated with membranes bulging into the vagina; an emergency cerclage was ordered. The woman was released home and ordered to bed rest.
The woman’s membranes ruptured at 25 weeks’ gestation. At 26 weeks, 3 days, contractions began; the child was delivered via cesarean section. He now suffers from spastic diplegia.
The plaintiff noted that the child’s injuries stemmed from his premature birth.
The Ob/Gyn maintained that the mother’s history did not warrant cerclage placement, and argued that regular monitoring was an appropriate course of action.
- The case settled for $1.4 million.
A woman at 10 weeks’ gestation presented to an obstetrician in June; her history was significant for diethylstilbestrol exposure, laser conization of the cervix due to noninvasive cervical cancer, a cerclage placed at pregnancy 7 years earlier, and several years of in vitro fertility treatments leading to this conception.
Though her prior obstetrician—now retired—had anticipated a need for cervical cerclage with any future pregnancies, her current doctor opted for frequent monitoring via ultrasound in lieu of cerclage.
Sonograms at 14 and 18 weeks revealed a normal cervix. An ultrasound in late August, however, showed the cervix 1 cm dilated with membranes bulging into the vagina; an emergency cerclage was ordered. The woman was released home and ordered to bed rest.
The woman’s membranes ruptured at 25 weeks’ gestation. At 26 weeks, 3 days, contractions began; the child was delivered via cesarean section. He now suffers from spastic diplegia.
The plaintiff noted that the child’s injuries stemmed from his premature birth.
The Ob/Gyn maintained that the mother’s history did not warrant cerclage placement, and argued that regular monitoring was an appropriate course of action.
- The case settled for $1.4 million.
A woman at 10 weeks’ gestation presented to an obstetrician in June; her history was significant for diethylstilbestrol exposure, laser conization of the cervix due to noninvasive cervical cancer, a cerclage placed at pregnancy 7 years earlier, and several years of in vitro fertility treatments leading to this conception.
Though her prior obstetrician—now retired—had anticipated a need for cervical cerclage with any future pregnancies, her current doctor opted for frequent monitoring via ultrasound in lieu of cerclage.
Sonograms at 14 and 18 weeks revealed a normal cervix. An ultrasound in late August, however, showed the cervix 1 cm dilated with membranes bulging into the vagina; an emergency cerclage was ordered. The woman was released home and ordered to bed rest.
The woman’s membranes ruptured at 25 weeks’ gestation. At 26 weeks, 3 days, contractions began; the child was delivered via cesarean section. He now suffers from spastic diplegia.
The plaintiff noted that the child’s injuries stemmed from his premature birth.
The Ob/Gyn maintained that the mother’s history did not warrant cerclage placement, and argued that regular monitoring was an appropriate course of action.
- The case settled for $1.4 million.
Ureter sutured during myomectomy
<court>Kings County (NY) Supreme Court</court>
Pelvic examination and sonogram on a 40-year-old woman revealed a uterus 20 weeks in size due to multiple fibroids. The woman underwent myomectomy with uterine reconstruction, fulguration of endometriosis, and resection of a right ovarian cyst.
While attempting to remove an irregular calcified fibroid 15 cm in diameter, the physician perforated the patient’s uterine artery, which he repaired before completing the myomectomy and peritoneal and abdominal closure.
Following surgery, the patient experienced decreased urine output; it was discovered her right ureter had been sutured during the procedure. Multiple surgeries were needed to repair the obstruction. Recovery took 6 months, during 2 of which the woman was required to wear a nephrostomy bag.
The patient claimed that the physician conducted inadequate pre- and perioperative testing. Proper testing, she argued, could have prevented the suture injury—or at least alerted the physician to its presence prior to closure, allowing for timely repair.
The physician argued that it was during peritoneal closure—not the uterine artery repair—that the ureter was sutured, and that the woman’s injury was a known risk of this closure. He maintained appropriate testing was conducted.
- The parties reached a posttrial settlement of $150,000.
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>Kings County (NY) Supreme Court</court>
Pelvic examination and sonogram on a 40-year-old woman revealed a uterus 20 weeks in size due to multiple fibroids. The woman underwent myomectomy with uterine reconstruction, fulguration of endometriosis, and resection of a right ovarian cyst.
While attempting to remove an irregular calcified fibroid 15 cm in diameter, the physician perforated the patient’s uterine artery, which he repaired before completing the myomectomy and peritoneal and abdominal closure.
Following surgery, the patient experienced decreased urine output; it was discovered her right ureter had been sutured during the procedure. Multiple surgeries were needed to repair the obstruction. Recovery took 6 months, during 2 of which the woman was required to wear a nephrostomy bag.
The patient claimed that the physician conducted inadequate pre- and perioperative testing. Proper testing, she argued, could have prevented the suture injury—or at least alerted the physician to its presence prior to closure, allowing for timely repair.
The physician argued that it was during peritoneal closure—not the uterine artery repair—that the ureter was sutured, and that the woman’s injury was a known risk of this closure. He maintained appropriate testing was conducted.
- The parties reached a posttrial settlement of $150,000.
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>Kings County (NY) Supreme Court</court>
Pelvic examination and sonogram on a 40-year-old woman revealed a uterus 20 weeks in size due to multiple fibroids. The woman underwent myomectomy with uterine reconstruction, fulguration of endometriosis, and resection of a right ovarian cyst.
While attempting to remove an irregular calcified fibroid 15 cm in diameter, the physician perforated the patient’s uterine artery, which he repaired before completing the myomectomy and peritoneal and abdominal closure.
Following surgery, the patient experienced decreased urine output; it was discovered her right ureter had been sutured during the procedure. Multiple surgeries were needed to repair the obstruction. Recovery took 6 months, during 2 of which the woman was required to wear a nephrostomy bag.
The patient claimed that the physician conducted inadequate pre- and perioperative testing. Proper testing, she argued, could have prevented the suture injury—or at least alerted the physician to its presence prior to closure, allowing for timely repair.
The physician argued that it was during peritoneal closure—not the uterine artery repair—that the ureter was sutured, and that the woman’s injury was a known risk of this closure. He maintained appropriate testing was conducted.
- The parties reached a posttrial settlement of $150,000.
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.
Uterine rupture follows failed VBAC
A woman at 41.5 weeks’ gestation was admitted to a hospital for induction of labor after an ultrasound revealed vertex presentation and normal amniotic fluid volume, and a nonstress test was interpreted as nonreactive. The patient had delivered a child by emergency cesarean 4 and a half years earlier; however, she wished to attempt vaginal birth after cesarean (VBAC) for this delivery, and signed a consent form noting the procedure’s risks.
The day following admission, after her membranes spontaneously ruptured and she was fully dilated, the woman began pushing. An hour later, the fetal heart rate dropped suddenly. The doctor began a cesarean delivery approximately 20 minutes later, at which time a uterine rupture was discovered in the lateral fundus. Six minutes after initiation of surgery, the infant was born.
Analysis of cord blood gas revealed severe metabolic acidosis. The newborn was diagnosed with hypoxic-ischemic encephalopathy and required a feeding gastrostomy. He underwent a tracheostomy 6 months later.
In suing, the plaintiffs alleged a negligent delay in both the physician’s recognition of the uterine rupture and the initiation of cesarean delivery.
The defense denied negligence and maintained a timely delivery occurred.
- The case settled for $3.5 million at mediation.
A woman at 41.5 weeks’ gestation was admitted to a hospital for induction of labor after an ultrasound revealed vertex presentation and normal amniotic fluid volume, and a nonstress test was interpreted as nonreactive. The patient had delivered a child by emergency cesarean 4 and a half years earlier; however, she wished to attempt vaginal birth after cesarean (VBAC) for this delivery, and signed a consent form noting the procedure’s risks.
The day following admission, after her membranes spontaneously ruptured and she was fully dilated, the woman began pushing. An hour later, the fetal heart rate dropped suddenly. The doctor began a cesarean delivery approximately 20 minutes later, at which time a uterine rupture was discovered in the lateral fundus. Six minutes after initiation of surgery, the infant was born.
Analysis of cord blood gas revealed severe metabolic acidosis. The newborn was diagnosed with hypoxic-ischemic encephalopathy and required a feeding gastrostomy. He underwent a tracheostomy 6 months later.
In suing, the plaintiffs alleged a negligent delay in both the physician’s recognition of the uterine rupture and the initiation of cesarean delivery.
The defense denied negligence and maintained a timely delivery occurred.
- The case settled for $3.5 million at mediation.
A woman at 41.5 weeks’ gestation was admitted to a hospital for induction of labor after an ultrasound revealed vertex presentation and normal amniotic fluid volume, and a nonstress test was interpreted as nonreactive. The patient had delivered a child by emergency cesarean 4 and a half years earlier; however, she wished to attempt vaginal birth after cesarean (VBAC) for this delivery, and signed a consent form noting the procedure’s risks.
The day following admission, after her membranes spontaneously ruptured and she was fully dilated, the woman began pushing. An hour later, the fetal heart rate dropped suddenly. The doctor began a cesarean delivery approximately 20 minutes later, at which time a uterine rupture was discovered in the lateral fundus. Six minutes after initiation of surgery, the infant was born.
Analysis of cord blood gas revealed severe metabolic acidosis. The newborn was diagnosed with hypoxic-ischemic encephalopathy and required a feeding gastrostomy. He underwent a tracheostomy 6 months later.
In suing, the plaintiffs alleged a negligent delay in both the physician’s recognition of the uterine rupture and the initiation of cesarean delivery.
The defense denied negligence and maintained a timely delivery occurred.
- The case settled for $3.5 million at mediation.
Cerebral palsy due to too many embryos?
<court>Bronx County (NY) Supreme Court</court>
A 29-year-old woman underwent in vitro fertilization and 7 embryos were transferred to her uterus. She became pregnant with triplets and at 5 months developed cervical dilation noted by sonography. She was instructed to cease working. In vitro fertilization. Four days later, the woman presented to the doctor’s office, at which time she was admitted to the hospital.
Four days after admission, the patient went into premature labor. Over the next 6 days she delivered the triplets, all of whom suffered cerebral palsy.
The plaintiffs sued the doctor who performed the implantation, alleging that no more than 2 embryos should have been transferred to the woman’s uterus at 1 time. The transfer of 7 embryos, they argued, was negligent, as this increased the risk of a multigestation pregnancy, which in turn increased the risk of preterm birth. They also sued the physician who reviewed the abnormal ultrasound, arguing that the doctor should have ordered bed rest at that time.
- The 2 defendant physicians and the defendant hospital settled, agreeing to contribute $14 million into a structured settlement expected to pay more than $100 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>Bronx County (NY) Supreme Court</court>
A 29-year-old woman underwent in vitro fertilization and 7 embryos were transferred to her uterus. She became pregnant with triplets and at 5 months developed cervical dilation noted by sonography. She was instructed to cease working. In vitro fertilization. Four days later, the woman presented to the doctor’s office, at which time she was admitted to the hospital.
Four days after admission, the patient went into premature labor. Over the next 6 days she delivered the triplets, all of whom suffered cerebral palsy.
The plaintiffs sued the doctor who performed the implantation, alleging that no more than 2 embryos should have been transferred to the woman’s uterus at 1 time. The transfer of 7 embryos, they argued, was negligent, as this increased the risk of a multigestation pregnancy, which in turn increased the risk of preterm birth. They also sued the physician who reviewed the abnormal ultrasound, arguing that the doctor should have ordered bed rest at that time.
- The 2 defendant physicians and the defendant hospital settled, agreeing to contribute $14 million into a structured settlement expected to pay more than $100 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>Bronx County (NY) Supreme Court</court>
A 29-year-old woman underwent in vitro fertilization and 7 embryos were transferred to her uterus. She became pregnant with triplets and at 5 months developed cervical dilation noted by sonography. She was instructed to cease working. In vitro fertilization. Four days later, the woman presented to the doctor’s office, at which time she was admitted to the hospital.
Four days after admission, the patient went into premature labor. Over the next 6 days she delivered the triplets, all of whom suffered cerebral palsy.
The plaintiffs sued the doctor who performed the implantation, alleging that no more than 2 embryos should have been transferred to the woman’s uterus at 1 time. The transfer of 7 embryos, they argued, was negligent, as this increased the risk of a multigestation pregnancy, which in turn increased the risk of preterm birth. They also sued the physician who reviewed the abnormal ultrasound, arguing that the doctor should have ordered bed rest at that time.
- The 2 defendant physicians and the defendant hospital settled, agreeing to contribute $14 million into a structured settlement expected to pay more than $100 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.
Easier reimbursement: How the new ICD-9 helps
Thanks to the newly revised Pap smear section of the International Classification of Diseases–9th Revision–Clinical Modification (ICD-9-CM), frustrating scenarios like the one above are now a thing of the past.
The updated Pap codes are the most welcome changes to ICD-9 for 2005, but they’re not the only revisions that will ease coding difficulties in the coming year. A clip-and-save chart details the changes most relevant to Ob/Gyn practice.
Reporting Pap smear results
The ambiguous nature of Pap smear coding in recent years stemmed from some unfortunate timing: In October 2001, the codes for abnormal Pap smear (795.0X) were revised to correspond to Bethesda system findings, reported by more than 90% of US laboratories. Just before this revision was implemented, however, the Bethesda Committee revised its terminology, so the new codes no longer matched.
The codes now reflect the hierarchy of conditions as described by Bethesda. Thus, reference to “favor benign” and “favor dysplasia” were removed.
Category 795 was changed to “Other and nonspecific abnormal cytological, histological, immunological and DNA test findings.” Next, the heading for code 795.0 was changed to allow coding for both an abnormal Pap smear and cervical human papillomavirus (HPV).
New codes were added to report findings of a high-grade squamous intraepithelial lesion (HGSIL) and low-grade squamous intraepithelial lesion (LGSIL), and to differentiate between these results from a Pap smear specimen and histologic confirmation of dysplasia from a tissue biopsy.
A few notes:
- Glandular cell changes are now coded to 795.00. This includes a “favor neoplastic” finding, which solves the dilemma posed by the case example.
- Unsatisfactory or inadequate smear, previously coded with 795.09, is now 795.08.
- Code 795.09 is now used when a DNA test indicates a low risk for HPV (HPV types 6 and 11)
- When reporting 795.05 or 795.09, use an additional code for the associated HPV (079.4).
The revision also clarifies that category 795 diagnostic codes are not used for cervical intraepithelial neoplasia (CIN) or dysplasia pathology results.
CIN or dysplasia
For tissue biopsy pathology results indicating CIN 3 or severe dysplasia of the cervix, use code 233.1. For CIN 1 or 2 or mild to moderate dysplasia, use one of the expanded dysplasia codes from the 622.1 series.
Remember: The dysplasia codes are reported as a result of histologic confirmation; codes 795.00 to 795.09 involve a cytologic examination only.
Genital prolapse: more detail on the cause
Previously, code 618.0 covered a range of conditions, from cystocele to vaginal prolapse. However, since CPT is more specific about the various prolapse-repair procedures, ACOG requested an expansion of this code to provide additional detail.
Note, also, that a new code for overflow incontinence, 788.38, was added.
Female genital mutilation
A new subcategory—629.2, female genital mutilation (FGM) status—includes codes representing the range of FGM procedures, from partial clitoris amputation to the procedure known as infibulation.
Use these codes for a primary diagnosis in a nonpregnant patient seeking treatment to correct the mutilation, or as a secondary diagnosis when the patient is currently pregnant, or to medically justify cesarean delivery or a complicated vaginal delivery.
Endometrial hyperplasia
Code 621.3, previously used to report endometrial cystic hyperplasia, has been expanded to 4 new codes.
Peripartum cardiomyopathy
Code 648.6X (other cardiovascular diseases) now specifically excludes peripartum cardiomyopathy, which is coded 674.5X.
Diabetes mellitus
Diabetes is no longer termed insulin-dependent and non–insulin-dependent, but rather type I or type II (differentiated by the functioning of pancreatic beta cells, not by insulin use). Thus, the fifth-digit subclassification used with the diabetes codes in category 250 was revised as follows:
- 0–type II or unspecified type, not stated as uncontrolled
- 1–type I (juvenile type), not stated as uncontrolled
- 2–type II or unspecified type, uncontrolled
- 3–type I (juvenile type), uncontrolled
Report fifth-digits 0 and 2 even if the patient requires insulin—in which case, you may also report the new code V58.67 (long-term current use of insulin). This can be used as a secondary diagnosis, or as a primary diagnosis when the patient is seen for possible long-term effects rather than diabetic control. (Long-term current use of aspirin was also given a code, V58.66.)
V code changes Gynecologic exam
Per ACOG’s request, V72.3 has been expanded into 2 codes:
V72.31 covers routine gynecologic examination—including a Pap smear, if performed. Thus, do not report V76.2 (special screening for malignant neoplasms, cervix) with V72.31 for the exam. Note, however, that if the patient’s cervix is absent and a vaginal Pap smear is collected at the time of the visit, code V76.47 (routine vaginal Pap smear) is also needed.
V72.32 describes a repeat Pap smear in the following scenario: A patient has an abnormal Pap test and is brought back 3 months later for a follow-up Pap. (The diagnosis for that visit is the abnormal result.) The results come back normal and she is asked to return in a few months. You will use V72.32 for this last encounter.
ACOG clarifies V72.32 may be used more than once at the physician’s discretion, since the usual protocol is to perform more frequent Pap smears until obtaining 3 consecutive negative results. Caveat: Check with your Medicare carrier before using this code for the repeat Pap smears.
Pregnancy tests
With the expansion of V72.4, ICD-9 now has an option for a pregnancy test done prior to a procedure that may harm a fetus, or simply because you suspect pregnancy:
Use V72.40 when you perform a pregnancy test, but have not determined whether the patient is pregnant by the end of the visit (ie, a blood rather than urine test). Note that if the pregnancy test is positive, also report code V22.X, per ICD-9 guidelines. This pregnancy diagnosis can be linked to the CPT pregnancy test code.
Use V72.41 if you confirm she is not pregnant during this visit. (Again, if the test is positive, use code V22.X.)
Hormone replacement therapy
The term “postmenopausal” was moved to a parenthetical note for code V07.4, to denote that this code should be reported anytime a woman is placed on estrogen replacement therapy. ICD-9 also has clarified that it is not appropriate to use V58.69 (long-term [current] use of other high-risk medications) for patients on hormone replacement therapy—instead, select code V07.4.
Screening for osteoporosis
ICD-9 has clarified that code V07.4 should be reported with the code for osteoporosis screening (V82.81), if applicable.
Genetic susceptibility to disease
A new category addresses prophylactic organ removal. Until now, ICD-9 had codes to indicate that an encounter was for organ removal, but not to describe the reason for the removal.
Further, these codes were needed because the “carrier status” codes can be used only when the patient is a disease carrier, able to pass it to offspring—not when she herself is at risk.
Note that before you can use these codes, the patient’s record should show an abnormal gene confirmed by genetic test.
Acquired absence of organ
ICD-9 has clarified that code V45.77 (acquired absence of genital organs), excludes the new FGM status codes (629.20 to 629.23).
Exposure to communicable diseases
The American Academy of Pediatrics requested the addition of exposure codes to viral and other communicable diseases. Most important to Ob/Gyns is exposure to chickenpox (varicella), if the mother was not previously exposed. This new code, V01.71, may be enough to support the medical necessity for laboratory work to test for immunity to chickenpox.
Report code V01.79 for exposure to other viral diseases.
Lack of adequate sleep
New code V69.4 is reported for sleep deprivation, but excludes insomnia.
Thanks to the newly revised Pap smear section of the International Classification of Diseases–9th Revision–Clinical Modification (ICD-9-CM), frustrating scenarios like the one above are now a thing of the past.
The updated Pap codes are the most welcome changes to ICD-9 for 2005, but they’re not the only revisions that will ease coding difficulties in the coming year. A clip-and-save chart details the changes most relevant to Ob/Gyn practice.
Reporting Pap smear results
The ambiguous nature of Pap smear coding in recent years stemmed from some unfortunate timing: In October 2001, the codes for abnormal Pap smear (795.0X) were revised to correspond to Bethesda system findings, reported by more than 90% of US laboratories. Just before this revision was implemented, however, the Bethesda Committee revised its terminology, so the new codes no longer matched.
The codes now reflect the hierarchy of conditions as described by Bethesda. Thus, reference to “favor benign” and “favor dysplasia” were removed.
Category 795 was changed to “Other and nonspecific abnormal cytological, histological, immunological and DNA test findings.” Next, the heading for code 795.0 was changed to allow coding for both an abnormal Pap smear and cervical human papillomavirus (HPV).
New codes were added to report findings of a high-grade squamous intraepithelial lesion (HGSIL) and low-grade squamous intraepithelial lesion (LGSIL), and to differentiate between these results from a Pap smear specimen and histologic confirmation of dysplasia from a tissue biopsy.
A few notes:
- Glandular cell changes are now coded to 795.00. This includes a “favor neoplastic” finding, which solves the dilemma posed by the case example.
- Unsatisfactory or inadequate smear, previously coded with 795.09, is now 795.08.
- Code 795.09 is now used when a DNA test indicates a low risk for HPV (HPV types 6 and 11)
- When reporting 795.05 or 795.09, use an additional code for the associated HPV (079.4).
The revision also clarifies that category 795 diagnostic codes are not used for cervical intraepithelial neoplasia (CIN) or dysplasia pathology results.
CIN or dysplasia
For tissue biopsy pathology results indicating CIN 3 or severe dysplasia of the cervix, use code 233.1. For CIN 1 or 2 or mild to moderate dysplasia, use one of the expanded dysplasia codes from the 622.1 series.
Remember: The dysplasia codes are reported as a result of histologic confirmation; codes 795.00 to 795.09 involve a cytologic examination only.
Genital prolapse: more detail on the cause
Previously, code 618.0 covered a range of conditions, from cystocele to vaginal prolapse. However, since CPT is more specific about the various prolapse-repair procedures, ACOG requested an expansion of this code to provide additional detail.
Note, also, that a new code for overflow incontinence, 788.38, was added.
Female genital mutilation
A new subcategory—629.2, female genital mutilation (FGM) status—includes codes representing the range of FGM procedures, from partial clitoris amputation to the procedure known as infibulation.
Use these codes for a primary diagnosis in a nonpregnant patient seeking treatment to correct the mutilation, or as a secondary diagnosis when the patient is currently pregnant, or to medically justify cesarean delivery or a complicated vaginal delivery.
Endometrial hyperplasia
Code 621.3, previously used to report endometrial cystic hyperplasia, has been expanded to 4 new codes.
Peripartum cardiomyopathy
Code 648.6X (other cardiovascular diseases) now specifically excludes peripartum cardiomyopathy, which is coded 674.5X.
Diabetes mellitus
Diabetes is no longer termed insulin-dependent and non–insulin-dependent, but rather type I or type II (differentiated by the functioning of pancreatic beta cells, not by insulin use). Thus, the fifth-digit subclassification used with the diabetes codes in category 250 was revised as follows:
- 0–type II or unspecified type, not stated as uncontrolled
- 1–type I (juvenile type), not stated as uncontrolled
- 2–type II or unspecified type, uncontrolled
- 3–type I (juvenile type), uncontrolled
Report fifth-digits 0 and 2 even if the patient requires insulin—in which case, you may also report the new code V58.67 (long-term current use of insulin). This can be used as a secondary diagnosis, or as a primary diagnosis when the patient is seen for possible long-term effects rather than diabetic control. (Long-term current use of aspirin was also given a code, V58.66.)
V code changes Gynecologic exam
Per ACOG’s request, V72.3 has been expanded into 2 codes:
V72.31 covers routine gynecologic examination—including a Pap smear, if performed. Thus, do not report V76.2 (special screening for malignant neoplasms, cervix) with V72.31 for the exam. Note, however, that if the patient’s cervix is absent and a vaginal Pap smear is collected at the time of the visit, code V76.47 (routine vaginal Pap smear) is also needed.
V72.32 describes a repeat Pap smear in the following scenario: A patient has an abnormal Pap test and is brought back 3 months later for a follow-up Pap. (The diagnosis for that visit is the abnormal result.) The results come back normal and she is asked to return in a few months. You will use V72.32 for this last encounter.
ACOG clarifies V72.32 may be used more than once at the physician’s discretion, since the usual protocol is to perform more frequent Pap smears until obtaining 3 consecutive negative results. Caveat: Check with your Medicare carrier before using this code for the repeat Pap smears.
Pregnancy tests
With the expansion of V72.4, ICD-9 now has an option for a pregnancy test done prior to a procedure that may harm a fetus, or simply because you suspect pregnancy:
Use V72.40 when you perform a pregnancy test, but have not determined whether the patient is pregnant by the end of the visit (ie, a blood rather than urine test). Note that if the pregnancy test is positive, also report code V22.X, per ICD-9 guidelines. This pregnancy diagnosis can be linked to the CPT pregnancy test code.
Use V72.41 if you confirm she is not pregnant during this visit. (Again, if the test is positive, use code V22.X.)
Hormone replacement therapy
The term “postmenopausal” was moved to a parenthetical note for code V07.4, to denote that this code should be reported anytime a woman is placed on estrogen replacement therapy. ICD-9 also has clarified that it is not appropriate to use V58.69 (long-term [current] use of other high-risk medications) for patients on hormone replacement therapy—instead, select code V07.4.
Screening for osteoporosis
ICD-9 has clarified that code V07.4 should be reported with the code for osteoporosis screening (V82.81), if applicable.
Genetic susceptibility to disease
A new category addresses prophylactic organ removal. Until now, ICD-9 had codes to indicate that an encounter was for organ removal, but not to describe the reason for the removal.
Further, these codes were needed because the “carrier status” codes can be used only when the patient is a disease carrier, able to pass it to offspring—not when she herself is at risk.
Note that before you can use these codes, the patient’s record should show an abnormal gene confirmed by genetic test.
Acquired absence of organ
ICD-9 has clarified that code V45.77 (acquired absence of genital organs), excludes the new FGM status codes (629.20 to 629.23).
Exposure to communicable diseases
The American Academy of Pediatrics requested the addition of exposure codes to viral and other communicable diseases. Most important to Ob/Gyns is exposure to chickenpox (varicella), if the mother was not previously exposed. This new code, V01.71, may be enough to support the medical necessity for laboratory work to test for immunity to chickenpox.
Report code V01.79 for exposure to other viral diseases.
Lack of adequate sleep
New code V69.4 is reported for sleep deprivation, but excludes insomnia.
Thanks to the newly revised Pap smear section of the International Classification of Diseases–9th Revision–Clinical Modification (ICD-9-CM), frustrating scenarios like the one above are now a thing of the past.
The updated Pap codes are the most welcome changes to ICD-9 for 2005, but they’re not the only revisions that will ease coding difficulties in the coming year. A clip-and-save chart details the changes most relevant to Ob/Gyn practice.
Reporting Pap smear results
The ambiguous nature of Pap smear coding in recent years stemmed from some unfortunate timing: In October 2001, the codes for abnormal Pap smear (795.0X) were revised to correspond to Bethesda system findings, reported by more than 90% of US laboratories. Just before this revision was implemented, however, the Bethesda Committee revised its terminology, so the new codes no longer matched.
The codes now reflect the hierarchy of conditions as described by Bethesda. Thus, reference to “favor benign” and “favor dysplasia” were removed.
Category 795 was changed to “Other and nonspecific abnormal cytological, histological, immunological and DNA test findings.” Next, the heading for code 795.0 was changed to allow coding for both an abnormal Pap smear and cervical human papillomavirus (HPV).
New codes were added to report findings of a high-grade squamous intraepithelial lesion (HGSIL) and low-grade squamous intraepithelial lesion (LGSIL), and to differentiate between these results from a Pap smear specimen and histologic confirmation of dysplasia from a tissue biopsy.
A few notes:
- Glandular cell changes are now coded to 795.00. This includes a “favor neoplastic” finding, which solves the dilemma posed by the case example.
- Unsatisfactory or inadequate smear, previously coded with 795.09, is now 795.08.
- Code 795.09 is now used when a DNA test indicates a low risk for HPV (HPV types 6 and 11)
- When reporting 795.05 or 795.09, use an additional code for the associated HPV (079.4).
The revision also clarifies that category 795 diagnostic codes are not used for cervical intraepithelial neoplasia (CIN) or dysplasia pathology results.
CIN or dysplasia
For tissue biopsy pathology results indicating CIN 3 or severe dysplasia of the cervix, use code 233.1. For CIN 1 or 2 or mild to moderate dysplasia, use one of the expanded dysplasia codes from the 622.1 series.
Remember: The dysplasia codes are reported as a result of histologic confirmation; codes 795.00 to 795.09 involve a cytologic examination only.
Genital prolapse: more detail on the cause
Previously, code 618.0 covered a range of conditions, from cystocele to vaginal prolapse. However, since CPT is more specific about the various prolapse-repair procedures, ACOG requested an expansion of this code to provide additional detail.
Note, also, that a new code for overflow incontinence, 788.38, was added.
Female genital mutilation
A new subcategory—629.2, female genital mutilation (FGM) status—includes codes representing the range of FGM procedures, from partial clitoris amputation to the procedure known as infibulation.
Use these codes for a primary diagnosis in a nonpregnant patient seeking treatment to correct the mutilation, or as a secondary diagnosis when the patient is currently pregnant, or to medically justify cesarean delivery or a complicated vaginal delivery.
Endometrial hyperplasia
Code 621.3, previously used to report endometrial cystic hyperplasia, has been expanded to 4 new codes.
Peripartum cardiomyopathy
Code 648.6X (other cardiovascular diseases) now specifically excludes peripartum cardiomyopathy, which is coded 674.5X.
Diabetes mellitus
Diabetes is no longer termed insulin-dependent and non–insulin-dependent, but rather type I or type II (differentiated by the functioning of pancreatic beta cells, not by insulin use). Thus, the fifth-digit subclassification used with the diabetes codes in category 250 was revised as follows:
- 0–type II or unspecified type, not stated as uncontrolled
- 1–type I (juvenile type), not stated as uncontrolled
- 2–type II or unspecified type, uncontrolled
- 3–type I (juvenile type), uncontrolled
Report fifth-digits 0 and 2 even if the patient requires insulin—in which case, you may also report the new code V58.67 (long-term current use of insulin). This can be used as a secondary diagnosis, or as a primary diagnosis when the patient is seen for possible long-term effects rather than diabetic control. (Long-term current use of aspirin was also given a code, V58.66.)
V code changes Gynecologic exam
Per ACOG’s request, V72.3 has been expanded into 2 codes:
V72.31 covers routine gynecologic examination—including a Pap smear, if performed. Thus, do not report V76.2 (special screening for malignant neoplasms, cervix) with V72.31 for the exam. Note, however, that if the patient’s cervix is absent and a vaginal Pap smear is collected at the time of the visit, code V76.47 (routine vaginal Pap smear) is also needed.
V72.32 describes a repeat Pap smear in the following scenario: A patient has an abnormal Pap test and is brought back 3 months later for a follow-up Pap. (The diagnosis for that visit is the abnormal result.) The results come back normal and she is asked to return in a few months. You will use V72.32 for this last encounter.
ACOG clarifies V72.32 may be used more than once at the physician’s discretion, since the usual protocol is to perform more frequent Pap smears until obtaining 3 consecutive negative results. Caveat: Check with your Medicare carrier before using this code for the repeat Pap smears.
Pregnancy tests
With the expansion of V72.4, ICD-9 now has an option for a pregnancy test done prior to a procedure that may harm a fetus, or simply because you suspect pregnancy:
Use V72.40 when you perform a pregnancy test, but have not determined whether the patient is pregnant by the end of the visit (ie, a blood rather than urine test). Note that if the pregnancy test is positive, also report code V22.X, per ICD-9 guidelines. This pregnancy diagnosis can be linked to the CPT pregnancy test code.
Use V72.41 if you confirm she is not pregnant during this visit. (Again, if the test is positive, use code V22.X.)
Hormone replacement therapy
The term “postmenopausal” was moved to a parenthetical note for code V07.4, to denote that this code should be reported anytime a woman is placed on estrogen replacement therapy. ICD-9 also has clarified that it is not appropriate to use V58.69 (long-term [current] use of other high-risk medications) for patients on hormone replacement therapy—instead, select code V07.4.
Screening for osteoporosis
ICD-9 has clarified that code V07.4 should be reported with the code for osteoporosis screening (V82.81), if applicable.
Genetic susceptibility to disease
A new category addresses prophylactic organ removal. Until now, ICD-9 had codes to indicate that an encounter was for organ removal, but not to describe the reason for the removal.
Further, these codes were needed because the “carrier status” codes can be used only when the patient is a disease carrier, able to pass it to offspring—not when she herself is at risk.
Note that before you can use these codes, the patient’s record should show an abnormal gene confirmed by genetic test.
Acquired absence of organ
ICD-9 has clarified that code V45.77 (acquired absence of genital organs), excludes the new FGM status codes (629.20 to 629.23).
Exposure to communicable diseases
The American Academy of Pediatrics requested the addition of exposure codes to viral and other communicable diseases. Most important to Ob/Gyns is exposure to chickenpox (varicella), if the mother was not previously exposed. This new code, V01.71, may be enough to support the medical necessity for laboratory work to test for immunity to chickenpox.
Report code V01.79 for exposure to other viral diseases.
Lack of adequate sleep
New code V69.4 is reported for sleep deprivation, but excludes insomnia.
Fistula follows vaginal hysterectomy
<court>Maricopa County (Ariz) Superior Court</court>
After undergoing a vaginal hysterectomy, a 52-year-old woman suffered a rectovaginal fistula. She claimed the physician was negligent for not converting to an abdominal procedure.
The defense argued the fistula stemmed from endometriosis found during surgery, and added that this complication is a known risk of vaginal hysterectomy.
- 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>Maricopa County (Ariz) Superior Court</court>
After undergoing a vaginal hysterectomy, a 52-year-old woman suffered a rectovaginal fistula. She claimed the physician was negligent for not converting to an abdominal procedure.
The defense argued the fistula stemmed from endometriosis found during surgery, and added that this complication is a known risk of vaginal hysterectomy.
- 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>Maricopa County (Ariz) Superior Court</court>
After undergoing a vaginal hysterectomy, a 52-year-old woman suffered a rectovaginal fistula. She claimed the physician was negligent for not converting to an abdominal procedure.
The defense argued the fistula stemmed from endometriosis found during surgery, and added that this complication is a known risk of vaginal hysterectomy.
- 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.