Managing Your Practice

Los Angeles County (Calif) Superior Court

A woman presenting to a hospital at 36 4/7 weeks’ gestation successfully delivered an infant son. The next day, however, the child developed respiratory distress. He was transferred to another hospital where he was diagnosed with group B streptococcus (GBS) meningitis. He was treated with intravenous antibiotics for 3 weeks and then discharged.

Nine days later, he was readmitted to the hospital with coarse breathing sounds, congestion, and fever. Magnetic resonance imaging results were read as normal; the attending doctor believed the symptoms were related to the resolving GBS infection.

Approximately 7 weeks later, during a routine examination, the child was noted as macrocephalic. Computed tomography confirmed a diagnosis of hydrocephalus.

In suing, the infant patient claimed his meningitis and hydrocephalus stemmed from improper treatment of the GBS. He argued that since his mother presented for delivery at less than 37 weeks’ gestation, she should have received prophylactic intravenous antibiotics—as recommended by the American College of Obstetricians and Gynecologists (ACOG) in a protocol announced 3 months prior to his birth. The child, now 6 years old, has been assessed as borderline mentally retarded, which he claims is due to the events following his birth.

The doctor and staff maintained that the standard of care did not require intravenous antibiotics, as the ACOG recommendations were too recently announced to have become routine practice. They further argued that the hydrocephalus was congenital and not related to GBS, and thus antibiotics would not have altered the outcome.

• The case settled for $3 million.
  

Los Angeles County (Calif) Superior Court

A woman presenting to a hospital at 36 4/7 weeks’ gestation successfully delivered an infant son. The next day, however, the child developed respiratory distress. He was transferred to another hospital where he was diagnosed with group B streptococcus (GBS) meningitis. He was treated with intravenous antibiotics for 3 weeks and then discharged.

Nine days later, he was readmitted to the hospital with coarse breathing sounds, congestion, and fever. Magnetic resonance imaging results were read as normal; the attending doctor believed the symptoms were related to the resolving GBS infection.

Approximately 7 weeks later, during a routine examination, the child was noted as macrocephalic. Computed tomography confirmed a diagnosis of hydrocephalus.

In suing, the infant patient claimed his meningitis and hydrocephalus stemmed from improper treatment of the GBS. He argued that since his mother presented for delivery at less than 37 weeks’ gestation, she should have received prophylactic intravenous antibiotics—as recommended by the American College of Obstetricians and Gynecologists (ACOG) in a protocol announced 3 months prior to his birth. The child, now 6 years old, has been assessed as borderline mentally retarded, which he claims is due to the events following his birth.

The doctor and staff maintained that the standard of care did not require intravenous antibiotics, as the ACOG recommendations were too recently announced to have become routine practice. They further argued that the hydrocephalus was congenital and not related to GBS, and thus antibiotics would not have altered the outcome.

• The case settled for $3 million.
  

Los Angeles County (Calif) Superior Court

A woman presenting to a hospital at 36 4/7 weeks’ gestation successfully delivered an infant son. The next day, however, the child developed respiratory distress. He was transferred to another hospital where he was diagnosed with group B streptococcus (GBS) meningitis. He was treated with intravenous antibiotics for 3 weeks and then discharged.

Nine days later, he was readmitted to the hospital with coarse breathing sounds, congestion, and fever. Magnetic resonance imaging results were read as normal; the attending doctor believed the symptoms were related to the resolving GBS infection.

Approximately 7 weeks later, during a routine examination, the child was noted as macrocephalic. Computed tomography confirmed a diagnosis of hydrocephalus.

In suing, the infant patient claimed his meningitis and hydrocephalus stemmed from improper treatment of the GBS. He argued that since his mother presented for delivery at less than 37 weeks’ gestation, she should have received prophylactic intravenous antibiotics—as recommended by the American College of Obstetricians and Gynecologists (ACOG) in a protocol announced 3 months prior to his birth. The child, now 6 years old, has been assessed as borderline mentally retarded, which he claims is due to the events following his birth.

The doctor and staff maintained that the standard of care did not require intravenous antibiotics, as the ACOG recommendations were too recently announced to have become routine practice. They further argued that the hydrocephalus was congenital and not related to GBS, and thus antibiotics would not have altered the outcome.

• The case settled for $3 million.
  

Los Angeles County (Calif) Superior Court

A mentally retarded woman was transferred to a 50-bed residential care facility where her boyfriend, also mentally retarded, lived.

Her mother was assured that her daughter would receive a contraceptive, starting on the day she was transferred to the facility. However, 6 months passed before she received her first contraceptive injection. It was later discovered that the woman became pregnant before the birth control was administered. The woman’s child now suffers from severe neurologic disorders.

In suing, the woman claimed that the facility and its owner were not only negligent, but that these actions constituted dependent adult abuse.

The defendants maintained that they were not required to provide the woman with birth control, and that, due to her right to privacy, they had no right to intervene. They filed a cross-suit against the woman’s physician.

• The case settled for $2 million. The cross-complaint was dismissed for a waiver of costs.
  

Los Angeles County (Calif) Superior Court

A mentally retarded woman was transferred to a 50-bed residential care facility where her boyfriend, also mentally retarded, lived.

Her mother was assured that her daughter would receive a contraceptive, starting on the day she was transferred to the facility. However, 6 months passed before she received her first contraceptive injection. It was later discovered that the woman became pregnant before the birth control was administered. The woman’s child now suffers from severe neurologic disorders.

In suing, the woman claimed that the facility and its owner were not only negligent, but that these actions constituted dependent adult abuse.

The defendants maintained that they were not required to provide the woman with birth control, and that, due to her right to privacy, they had no right to intervene. They filed a cross-suit against the woman’s physician.

• The case settled for $2 million. The cross-complaint was dismissed for a waiver of costs.
  

Los Angeles County (Calif) Superior Court

A mentally retarded woman was transferred to a 50-bed residential care facility where her boyfriend, also mentally retarded, lived.

Her mother was assured that her daughter would receive a contraceptive, starting on the day she was transferred to the facility. However, 6 months passed before she received her first contraceptive injection. It was later discovered that the woman became pregnant before the birth control was administered. The woman’s child now suffers from severe neurologic disorders.

In suing, the woman claimed that the facility and its owner were not only negligent, but that these actions constituted dependent adult abuse.

The defendants maintained that they were not required to provide the woman with birth control, and that, due to her right to privacy, they had no right to intervene. They filed a cross-suit against the woman’s physician.

• The case settled for $2 million. The cross-complaint was dismissed for a waiver of costs.
  

Q Genetic testing for a patient with a personal history of breast cancer revealed a high risk for ovarian cancer. She is scheduled to have a total vaginal hysterectomy and bilateral oophorectomy as a precautionary measure. Which diagnosis do I use? She has no signs or symptoms.

A Use V50.49 (other prophylactic organ removal), V50.42 (prophylactic organ removal of ovary), and V10.3 (personal history of breast cancer). If you are obtaining prior authorization, submit a letter with the request in which you list these codes as the reason for the surgery and explain the circumstances.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Genetic testing for a patient with a personal history of breast cancer revealed a high risk for ovarian cancer. She is scheduled to have a total vaginal hysterectomy and bilateral oophorectomy as a precautionary measure. Which diagnosis do I use? She has no signs or symptoms.

A Use V50.49 (other prophylactic organ removal), V50.42 (prophylactic organ removal of ovary), and V10.3 (personal history of breast cancer). If you are obtaining prior authorization, submit a letter with the request in which you list these codes as the reason for the surgery and explain the circumstances.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Genetic testing for a patient with a personal history of breast cancer revealed a high risk for ovarian cancer. She is scheduled to have a total vaginal hysterectomy and bilateral oophorectomy as a precautionary measure. Which diagnosis do I use? She has no signs or symptoms.

A Use V50.49 (other prophylactic organ removal), V50.42 (prophylactic organ removal of ovary), and V10.3 (personal history of breast cancer). If you are obtaining prior authorization, submit a letter with the request in which you list these codes as the reason for the surgery and explain the circumstances.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Which CPT code would I use for vaginal cuff repair?

A This is one of the most frequently asked coding questions—and one of the toughest to answer.

Most coders suggest using either an unlisted code or the repair codes from CPT’s integumentary section. The circumstance of the repair will determine which course of action is best:

• You cannot use the codes for a simple (12001-12007) or intermediate repair (12041-12047), because they specify external genitalia.
  
• If the repair is due to the original sutures coming loose, you can try 12020 (treatment of superficial wound dehiscence; simple closure).
  
• Codes 13131–13133 (repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet;…) specify only “genitalia,” which includes internal structures of the vaginal canal. However, you may use these codes only if the patient’s record lists the size of the repair and the repair meets the definition of “complex” as outlined in the CPT guideline.
  
• If the repair is necessary because of an injury, use 57200 (colporrhaphy, suture of injury of vagina [nonobstetrical]).
  
• If none of these fit, you will be stuck with 58999 (unlisted procedure, female genital system [nonobstetrical]).
  
• Remember to add modifier -78 (return to the operating room for a related procedure during the postoperative period) if the repair is related to previous surgery and you are in the global period.
  

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Which CPT code would I use for vaginal cuff repair?

A This is one of the most frequently asked coding questions—and one of the toughest to answer.

Most coders suggest using either an unlisted code or the repair codes from CPT’s integumentary section. The circumstance of the repair will determine which course of action is best:

• You cannot use the codes for a simple (12001-12007) or intermediate repair (12041-12047), because they specify external genitalia.
  
• If the repair is due to the original sutures coming loose, you can try 12020 (treatment of superficial wound dehiscence; simple closure).
  
• Codes 13131–13133 (repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet;…) specify only “genitalia,” which includes internal structures of the vaginal canal. However, you may use these codes only if the patient’s record lists the size of the repair and the repair meets the definition of “complex” as outlined in the CPT guideline.
  
• If the repair is necessary because of an injury, use 57200 (colporrhaphy, suture of injury of vagina [nonobstetrical]).
  
• If none of these fit, you will be stuck with 58999 (unlisted procedure, female genital system [nonobstetrical]).
  
• Remember to add modifier -78 (return to the operating room for a related procedure during the postoperative period) if the repair is related to previous surgery and you are in the global period.
  

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Which CPT code would I use for vaginal cuff repair?

A This is one of the most frequently asked coding questions—and one of the toughest to answer.

Most coders suggest using either an unlisted code or the repair codes from CPT’s integumentary section. The circumstance of the repair will determine which course of action is best:

• You cannot use the codes for a simple (12001-12007) or intermediate repair (12041-12047), because they specify external genitalia.
  
• If the repair is due to the original sutures coming loose, you can try 12020 (treatment of superficial wound dehiscence; simple closure).
  
• Codes 13131–13133 (repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet;…) specify only “genitalia,” which includes internal structures of the vaginal canal. However, you may use these codes only if the patient’s record lists the size of the repair and the repair meets the definition of “complex” as outlined in the CPT guideline.
  
• If the repair is necessary because of an injury, use 57200 (colporrhaphy, suture of injury of vagina [nonobstetrical]).
  
• If none of these fit, you will be stuck with 58999 (unlisted procedure, female genital system [nonobstetrical]).
  
• Remember to add modifier -78 (return to the operating room for a related procedure during the postoperative period) if the repair is related to previous surgery and you are in the global period.
  

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q I have searched, but cannot find a code for what the physician is calling a “friable cervix.” Can you help?

A The friable cervix is one that is prone to bleeding. The underlying cause is usually chlamydia infection, cervical erosion, or, sometimes, cervical cancer.

If the physician is trying to rule out infection or if all tests are negative, use the code for the patient’s symptom. Possible choices include cervical inflammation (616.0), cervical erosion (622.0), pain with intercourse (625.0), and other abnormal bleeding from the female genital tract (626.8). Once the reason for the friable cervix is determined, that becomes the diagnosis.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q I have searched, but cannot find a code for what the physician is calling a “friable cervix.” Can you help?

A The friable cervix is one that is prone to bleeding. The underlying cause is usually chlamydia infection, cervical erosion, or, sometimes, cervical cancer.

If the physician is trying to rule out infection or if all tests are negative, use the code for the patient’s symptom. Possible choices include cervical inflammation (616.0), cervical erosion (622.0), pain with intercourse (625.0), and other abnormal bleeding from the female genital tract (626.8). Once the reason for the friable cervix is determined, that becomes the diagnosis.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q I have searched, but cannot find a code for what the physician is calling a “friable cervix.” Can you help?

A The friable cervix is one that is prone to bleeding. The underlying cause is usually chlamydia infection, cervical erosion, or, sometimes, cervical cancer.

If the physician is trying to rule out infection or if all tests are negative, use the code for the patient’s symptom. Possible choices include cervical inflammation (616.0), cervical erosion (622.0), pain with intercourse (625.0), and other abnormal bleeding from the female genital tract (626.8). Once the reason for the friable cervix is determined, that becomes the diagnosis.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Cook County (Ill) Circuit Court

On 4 visits between August 1996 and February 1997, a woman complained to her gynecologist of vaginal bleeding. The woman’s condition was diagnosed as cervicitis.

Despite a January 1997 Pap smear that was read as normal, the patient was diagnosed with cervical cancer in February 1997. In November 1999 she died as a result of her condition.

In suing, the patient’s family claimed the woman’s abnormal vaginal bleeding should have prompted a biopsy to rule out cervical cancer. The family also claimed the cytology lab and 2 cytotechnologists were negligent for allegedly misreading Pap smears conducted 1 and 3 years before the diagnosis.

The doctors argued that they were within the standard of care in relying on the patient’s history of negative Pap smears, considering that she was at low risk for cervical cancer and that, given her history, cervicitis was more likely than cancer to cause her bleeding.

• The jury awarded the plaintiff $5.25 million against the physicians, but the doctors settled for $3 million while the jury was deliberating. In addition, the cytology lab settled for $1.1 million.
  

Cook County (Ill) Circuit Court

On 4 visits between August 1996 and February 1997, a woman complained to her gynecologist of vaginal bleeding. The woman’s condition was diagnosed as cervicitis.

Despite a January 1997 Pap smear that was read as normal, the patient was diagnosed with cervical cancer in February 1997. In November 1999 she died as a result of her condition.

In suing, the patient’s family claimed the woman’s abnormal vaginal bleeding should have prompted a biopsy to rule out cervical cancer. The family also claimed the cytology lab and 2 cytotechnologists were negligent for allegedly misreading Pap smears conducted 1 and 3 years before the diagnosis.

The doctors argued that they were within the standard of care in relying on the patient’s history of negative Pap smears, considering that she was at low risk for cervical cancer and that, given her history, cervicitis was more likely than cancer to cause her bleeding.

• The jury awarded the plaintiff $5.25 million against the physicians, but the doctors settled for $3 million while the jury was deliberating. In addition, the cytology lab settled for $1.1 million.
  

Cook County (Ill) Circuit Court

On 4 visits between August 1996 and February 1997, a woman complained to her gynecologist of vaginal bleeding. The woman’s condition was diagnosed as cervicitis.

Despite a January 1997 Pap smear that was read as normal, the patient was diagnosed with cervical cancer in February 1997. In November 1999 she died as a result of her condition.

In suing, the patient’s family claimed the woman’s abnormal vaginal bleeding should have prompted a biopsy to rule out cervical cancer. The family also claimed the cytology lab and 2 cytotechnologists were negligent for allegedly misreading Pap smears conducted 1 and 3 years before the diagnosis.

The doctors argued that they were within the standard of care in relying on the patient’s history of negative Pap smears, considering that she was at low risk for cervical cancer and that, given her history, cervicitis was more likely than cancer to cause her bleeding.

• The jury awarded the plaintiff $5.25 million against the physicians, but the doctors settled for $3 million while the jury was deliberating. In addition, the cytology lab settled for $1.1 million.
  

Orange County (Calif) Superior Court

A 47-year-old woman presented to an Ob/Gyn with a Pap smear indicating cervical intraepithelial neoplasia (CIN) 2. The doctor performed a colposcopy of the cervix and an endocervical curettage, but did not find any abnormalities. The physician then performed a loop electrosurgical excision procedure (LEEP), which was also normal.

He later performed liquid-based cytology (Thin-Prep; Cytyc Corp; Boxborough, Mass), which showed the abnormality from the prior Pap had worsened to CIN 3. Another LEEP was performed, but neither abnormal cells nor dysplasia were revealed.

Believing the abnormalities must be higher in the endocervical canal, the doctor recommended a hysterectomy and oophorectomy. Postoperatively, it was determined that there was no evidence of cancer. Six months later, however, the woman was diagnosed with vaginal cancer.

In suing, the patient contended that the Ob/Gyn was negligent for focusing his cancer search only on her cervix, and not performing a colposcopy of her vagina. She argued that had he checked the vagina for abnormalities, the cancer would have been found and treated in its infancy and her life expectancy extended. She further maintained that the hysterectomy was unnecessary.

The doctor argued that the abnormal Pap offered no indication that colposcopic examination of the vagina was needed. He maintained that the hysterectomy and oophorectomy were reasonable under the circumstances. He added that even if the vaginal cancer had been diagnosed earlier, the treatment required and the patient’s life expectancy would have been the same.

• The jury returned a defense verdict.
  

Orange County (Calif) Superior Court

A 47-year-old woman presented to an Ob/Gyn with a Pap smear indicating cervical intraepithelial neoplasia (CIN) 2. The doctor performed a colposcopy of the cervix and an endocervical curettage, but did not find any abnormalities. The physician then performed a loop electrosurgical excision procedure (LEEP), which was also normal.

He later performed liquid-based cytology (Thin-Prep; Cytyc Corp; Boxborough, Mass), which showed the abnormality from the prior Pap had worsened to CIN 3. Another LEEP was performed, but neither abnormal cells nor dysplasia were revealed.

Believing the abnormalities must be higher in the endocervical canal, the doctor recommended a hysterectomy and oophorectomy. Postoperatively, it was determined that there was no evidence of cancer. Six months later, however, the woman was diagnosed with vaginal cancer.

In suing, the patient contended that the Ob/Gyn was negligent for focusing his cancer search only on her cervix, and not performing a colposcopy of her vagina. She argued that had he checked the vagina for abnormalities, the cancer would have been found and treated in its infancy and her life expectancy extended. She further maintained that the hysterectomy was unnecessary.

The doctor argued that the abnormal Pap offered no indication that colposcopic examination of the vagina was needed. He maintained that the hysterectomy and oophorectomy were reasonable under the circumstances. He added that even if the vaginal cancer had been diagnosed earlier, the treatment required and the patient’s life expectancy would have been the same.

• The jury returned a defense verdict.
  

Orange County (Calif) Superior Court

A 47-year-old woman presented to an Ob/Gyn with a Pap smear indicating cervical intraepithelial neoplasia (CIN) 2. The doctor performed a colposcopy of the cervix and an endocervical curettage, but did not find any abnormalities. The physician then performed a loop electrosurgical excision procedure (LEEP), which was also normal.

He later performed liquid-based cytology (Thin-Prep; Cytyc Corp; Boxborough, Mass), which showed the abnormality from the prior Pap had worsened to CIN 3. Another LEEP was performed, but neither abnormal cells nor dysplasia were revealed.

Believing the abnormalities must be higher in the endocervical canal, the doctor recommended a hysterectomy and oophorectomy. Postoperatively, it was determined that there was no evidence of cancer. Six months later, however, the woman was diagnosed with vaginal cancer.

In suing, the patient contended that the Ob/Gyn was negligent for focusing his cancer search only on her cervix, and not performing a colposcopy of her vagina. She argued that had he checked the vagina for abnormalities, the cancer would have been found and treated in its infancy and her life expectancy extended. She further maintained that the hysterectomy was unnecessary.

The doctor argued that the abnormal Pap offered no indication that colposcopic examination of the vagina was needed. He maintained that the hysterectomy and oophorectomy were reasonable under the circumstances. He added that even if the vaginal cancer had been diagnosed earlier, the treatment required and the patient’s life expectancy would have been the same.

• The jury returned a defense verdict.
  

Du Page County (Ill) Circuit Court

Results from a June 1998 ultrasound indicated that the fetus of a 20-year-old gravida had gastroschisis—a congenital condition in which a defect of the abdominal wall causes the intestines and certain organs to extrude outside the body while remaining connected internally.

From July to September, the woman’s physicians did not order any additional ultrasounds. In late September, a follow-up ultrasound performed by another obstetrician revealed a low amniotic fluid index and a fetal birth weight in the 3-percentile range. This physician sent the woman’s primary obstetricians a typed report, which arrived 2 days later.

After consulting with a perinatologist, the woman’s doctors advised her to have an induction of labor. On arrival at the hospital, an ultrasound showed no heartbeat. After labor induction, the stillborn infant was delivered.

In suing, the mother alleged her 2 primary obstetricians failed to communicate properly regarding what tests should monitor fetal growth. Further, they failed to advise her on how much fetal activity to expect and how to respond to decreased movement. In addition, she argued that the doctors failed to order a stat ultrasound and did not appropriately follow up with the physician who performed the late-September ultrasound. She also maintained that the third obstetrician was obligated to telephone her primary Ob/Gyns with the portentous findings. She contended that the fetus died as a result of cord compression and that delivery a few days prior would have saved the baby’s life.

The lead obstetricians claimed the pregnancy appeared normal and the patient was advised of how to determine proper fetal activity. The third physician argued that ultrasound findings prior to fetal demise were within the normal range for a fetus with gastroschisis.

• The jury returned a defense verdict.
  

Du Page County (Ill) Circuit Court

Results from a June 1998 ultrasound indicated that the fetus of a 20-year-old gravida had gastroschisis—a congenital condition in which a defect of the abdominal wall causes the intestines and certain organs to extrude outside the body while remaining connected internally.

From July to September, the woman’s physicians did not order any additional ultrasounds. In late September, a follow-up ultrasound performed by another obstetrician revealed a low amniotic fluid index and a fetal birth weight in the 3-percentile range. This physician sent the woman’s primary obstetricians a typed report, which arrived 2 days later.

After consulting with a perinatologist, the woman’s doctors advised her to have an induction of labor. On arrival at the hospital, an ultrasound showed no heartbeat. After labor induction, the stillborn infant was delivered.

In suing, the mother alleged her 2 primary obstetricians failed to communicate properly regarding what tests should monitor fetal growth. Further, they failed to advise her on how much fetal activity to expect and how to respond to decreased movement. In addition, she argued that the doctors failed to order a stat ultrasound and did not appropriately follow up with the physician who performed the late-September ultrasound. She also maintained that the third obstetrician was obligated to telephone her primary Ob/Gyns with the portentous findings. She contended that the fetus died as a result of cord compression and that delivery a few days prior would have saved the baby’s life.

The lead obstetricians claimed the pregnancy appeared normal and the patient was advised of how to determine proper fetal activity. The third physician argued that ultrasound findings prior to fetal demise were within the normal range for a fetus with gastroschisis.

• The jury returned a defense verdict.
  

Du Page County (Ill) Circuit Court

Results from a June 1998 ultrasound indicated that the fetus of a 20-year-old gravida had gastroschisis—a congenital condition in which a defect of the abdominal wall causes the intestines and certain organs to extrude outside the body while remaining connected internally.

From July to September, the woman’s physicians did not order any additional ultrasounds. In late September, a follow-up ultrasound performed by another obstetrician revealed a low amniotic fluid index and a fetal birth weight in the 3-percentile range. This physician sent the woman’s primary obstetricians a typed report, which arrived 2 days later.

After consulting with a perinatologist, the woman’s doctors advised her to have an induction of labor. On arrival at the hospital, an ultrasound showed no heartbeat. After labor induction, the stillborn infant was delivered.

In suing, the mother alleged her 2 primary obstetricians failed to communicate properly regarding what tests should monitor fetal growth. Further, they failed to advise her on how much fetal activity to expect and how to respond to decreased movement. In addition, she argued that the doctors failed to order a stat ultrasound and did not appropriately follow up with the physician who performed the late-September ultrasound. She also maintained that the third obstetrician was obligated to telephone her primary Ob/Gyns with the portentous findings. She contended that the fetus died as a result of cord compression and that delivery a few days prior would have saved the baby’s life.

The lead obstetricians claimed the pregnancy appeared normal and the patient was advised of how to determine proper fetal activity. The third physician argued that ultrasound findings prior to fetal demise were within the normal range for a fetus with gastroschisis.

• The jury returned a defense verdict.
  

Jefferson Parish (La) District Court

One week prior to delivery, a gravida underwent an ultrasound, which placed her infant’s estimated fetal weight at 8 lb, 4 oz. During her pregnancy, the patient had gained over 50 lb.

In the second stage of labor, the patient pushed for more than 2 hours. The doctor used forceps from a +2 station to deliver the fetal head. Shoulder dystocia was encountered and a variety of maneuvers were used, including fundal pressure, thus delaying delivery. The baby ultimately died of asphyxia. The infant’s birth weight was 11 lb, 5 oz.

In suing, the mother alleged that the doctor underestimated the baby’s weight and panicked when she encountered the shoulder dystocia. Further, the physician allegedly asked 2 nurses untrained in dystocia delivery to pull on the baby’s head with the forceps.

Expert defense witnesses contended that the baby died in utero before the head was delivered due to a short umbilical cord. The defendant maintained that when forceps were applied, the fetal monitor did not show the baby in distress.

• The jury awarded the plaintiffs $900,000. Due to Louisiana’s Medical Malpractice Cap provisions, damages were reduced to $500,000.
  

Jefferson Parish (La) District Court

One week prior to delivery, a gravida underwent an ultrasound, which placed her infant’s estimated fetal weight at 8 lb, 4 oz. During her pregnancy, the patient had gained over 50 lb.

In the second stage of labor, the patient pushed for more than 2 hours. The doctor used forceps from a +2 station to deliver the fetal head. Shoulder dystocia was encountered and a variety of maneuvers were used, including fundal pressure, thus delaying delivery. The baby ultimately died of asphyxia. The infant’s birth weight was 11 lb, 5 oz.

In suing, the mother alleged that the doctor underestimated the baby’s weight and panicked when she encountered the shoulder dystocia. Further, the physician allegedly asked 2 nurses untrained in dystocia delivery to pull on the baby’s head with the forceps.

Expert defense witnesses contended that the baby died in utero before the head was delivered due to a short umbilical cord. The defendant maintained that when forceps were applied, the fetal monitor did not show the baby in distress.

• The jury awarded the plaintiffs $900,000. Due to Louisiana’s Medical Malpractice Cap provisions, damages were reduced to $500,000.
  

Jefferson Parish (La) District Court

One week prior to delivery, a gravida underwent an ultrasound, which placed her infant’s estimated fetal weight at 8 lb, 4 oz. During her pregnancy, the patient had gained over 50 lb.

In the second stage of labor, the patient pushed for more than 2 hours. The doctor used forceps from a +2 station to deliver the fetal head. Shoulder dystocia was encountered and a variety of maneuvers were used, including fundal pressure, thus delaying delivery. The baby ultimately died of asphyxia. The infant’s birth weight was 11 lb, 5 oz.

In suing, the mother alleged that the doctor underestimated the baby’s weight and panicked when she encountered the shoulder dystocia. Further, the physician allegedly asked 2 nurses untrained in dystocia delivery to pull on the baby’s head with the forceps.

Expert defense witnesses contended that the baby died in utero before the head was delivered due to a short umbilical cord. The defendant maintained that when forceps were applied, the fetal monitor did not show the baby in distress.

• The jury awarded the plaintiffs $900,000. Due to Louisiana’s Medical Malpractice Cap provisions, damages were reduced to $500,000.
  

<court>Bronx Jefferson County (Ala) Circuit Court</court>

When a pregnant woman presented to her obstetrician for prenatal care, a 1- to 2-cm mass in her breast was detected. She was referred to a surgeon for further evaluation. The doctor diagnosed the mass as a cyst by observation only; he did not perform a fineneedle aspiration or other tests.

Two years later, a mammogram revealed a 3-cm lump, which was excised and found to be cancerous. The woman underwent a radical mastectomy, chemotherapy, and breast reconstruction.

In suing, the woman claimed that earlier diagnosis or monitoring of the mass could have prevented her subsequent treatment.

The doctor denied any negligence and argued the malignant mass was not the same as the one previously detected.

• The jury returned a defense verdict.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (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 Jefferson County (Ala) Circuit Court</court>

When a pregnant woman presented to her obstetrician for prenatal care, a 1- to 2-cm mass in her breast was detected. She was referred to a surgeon for further evaluation. The doctor diagnosed the mass as a cyst by observation only; he did not perform a fineneedle aspiration or other tests.

Two years later, a mammogram revealed a 3-cm lump, which was excised and found to be cancerous. The woman underwent a radical mastectomy, chemotherapy, and breast reconstruction.

In suing, the woman claimed that earlier diagnosis or monitoring of the mass could have prevented her subsequent treatment.

The doctor denied any negligence and argued the malignant mass was not the same as the one previously detected.

• The jury returned a defense verdict.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (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 Jefferson County (Ala) Circuit Court</court>

When a pregnant woman presented to her obstetrician for prenatal care, a 1- to 2-cm mass in her breast was detected. She was referred to a surgeon for further evaluation. The doctor diagnosed the mass as a cyst by observation only; he did not perform a fineneedle aspiration or other tests.

Two years later, a mammogram revealed a 3-cm lump, which was excised and found to be cancerous. The woman underwent a radical mastectomy, chemotherapy, and breast reconstruction.

In suing, the woman claimed that earlier diagnosis or monitoring of the mass could have prevented her subsequent treatment.

The doctor denied any negligence and argued the malignant mass was not the same as the one previously detected.

• The jury returned a defense verdict.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (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.