External sphincter muscle damage undetected during delivery

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District of Columbia (DC) Superior Court

The physician performed an episiotomy on a 24-year-old gravida delivering her first baby. According to the medical record, a fourth-degree laceration occurred, but no damage to the anal sphincter muscle was noted.

At an examination 4 weeks later, the patient indicated that she was experiencing urgency during bowel movements; her doctor detected no anatomical problems.

Dissatisfied with her physicians, the woman went to another doctor, who noted “thinness” in her external anal sphincter. During surgery to repair the injury, it was discovered that scar tissue had grown around one third of the anal sphincter, preventing proper repair. She now suffers chronic bowel urgency and leakage.

In suing, the woman said the doctor was negligent for failing to find and properly repair the external sphincter defect at the time of the tear. The doctor maintained that the patient suffered an occult tear. Hospital staff had no recollection of the incident.

  • The jury awarded the plaintiff $50 million.
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.
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District of Columbia (DC) Superior Court

The physician performed an episiotomy on a 24-year-old gravida delivering her first baby. According to the medical record, a fourth-degree laceration occurred, but no damage to the anal sphincter muscle was noted.

At an examination 4 weeks later, the patient indicated that she was experiencing urgency during bowel movements; her doctor detected no anatomical problems.

Dissatisfied with her physicians, the woman went to another doctor, who noted “thinness” in her external anal sphincter. During surgery to repair the injury, it was discovered that scar tissue had grown around one third of the anal sphincter, preventing proper repair. She now suffers chronic bowel urgency and leakage.

In suing, the woman said the doctor was negligent for failing to find and properly repair the external sphincter defect at the time of the tear. The doctor maintained that the patient suffered an occult tear. Hospital staff had no recollection of the incident.

  • The jury awarded the plaintiff $50 million.
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.

District of Columbia (DC) Superior Court

The physician performed an episiotomy on a 24-year-old gravida delivering her first baby. According to the medical record, a fourth-degree laceration occurred, but no damage to the anal sphincter muscle was noted.

At an examination 4 weeks later, the patient indicated that she was experiencing urgency during bowel movements; her doctor detected no anatomical problems.

Dissatisfied with her physicians, the woman went to another doctor, who noted “thinness” in her external anal sphincter. During surgery to repair the injury, it was discovered that scar tissue had grown around one third of the anal sphincter, preventing proper repair. She now suffers chronic bowel urgency and leakage.

In suing, the woman said the doctor was negligent for failing to find and properly repair the external sphincter defect at the time of the tear. The doctor maintained that the patient suffered an occult tear. Hospital staff had no recollection of the incident.

  • The jury awarded the plaintiff $50 million.
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.
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Labor triage: Not an ER service

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Q Some pregnant patients (trauma cases, etc) go through our hospital emergency room (ER), but most go to our labor and delivery triage center, which is staffed by residents 24 hours a day, with an in-house attending always available. Some universities I know use ER codes for triage-center billing, because they feel it meets the requirements of an ER. Is this acceptable?

A No. Both Medicare and CPT guidelines state that to use the ER services codes, you must provide the service in the hospital’s designated emergency room or department. The emergency department is defined as an organized hospital-based facility for the provision of unscheduled or episodic services to patients who present for immediate medical attention. Within this definition, there is the tacit understanding that such care must be provided to all, without discrimination as to gender or age. You have stated that your hospital has a designated ER; thus, the emergency services codes (99281-99285) are appropriate only when care is provided in that setting.

If physicians in the labor and delivery center are seeing pregnant patients for triage, your coding choices are:

  • observation care admission (99218-99220),
  • observation care discharge (99217),
  • same-day observation admission and discharge (99234-99236),
  • outpatient care (99201-99215), or
  • outpatient consultations (99241-99245).

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.

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Q Some pregnant patients (trauma cases, etc) go through our hospital emergency room (ER), but most go to our labor and delivery triage center, which is staffed by residents 24 hours a day, with an in-house attending always available. Some universities I know use ER codes for triage-center billing, because they feel it meets the requirements of an ER. Is this acceptable?

A No. Both Medicare and CPT guidelines state that to use the ER services codes, you must provide the service in the hospital’s designated emergency room or department. The emergency department is defined as an organized hospital-based facility for the provision of unscheduled or episodic services to patients who present for immediate medical attention. Within this definition, there is the tacit understanding that such care must be provided to all, without discrimination as to gender or age. You have stated that your hospital has a designated ER; thus, the emergency services codes (99281-99285) are appropriate only when care is provided in that setting.

If physicians in the labor and delivery center are seeing pregnant patients for triage, your coding choices are:

  • observation care admission (99218-99220),
  • observation care discharge (99217),
  • same-day observation admission and discharge (99234-99236),
  • outpatient care (99201-99215), or
  • outpatient consultations (99241-99245).

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 Some pregnant patients (trauma cases, etc) go through our hospital emergency room (ER), but most go to our labor and delivery triage center, which is staffed by residents 24 hours a day, with an in-house attending always available. Some universities I know use ER codes for triage-center billing, because they feel it meets the requirements of an ER. Is this acceptable?

A No. Both Medicare and CPT guidelines state that to use the ER services codes, you must provide the service in the hospital’s designated emergency room or department. The emergency department is defined as an organized hospital-based facility for the provision of unscheduled or episodic services to patients who present for immediate medical attention. Within this definition, there is the tacit understanding that such care must be provided to all, without discrimination as to gender or age. You have stated that your hospital has a designated ER; thus, the emergency services codes (99281-99285) are appropriate only when care is provided in that setting.

If physicians in the labor and delivery center are seeing pregnant patients for triage, your coding choices are:

  • observation care admission (99218-99220),
  • observation care discharge (99217),
  • same-day observation admission and discharge (99234-99236),
  • outpatient care (99201-99215), or
  • outpatient consultations (99241-99245).

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.

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Coding the Sims-Huhner postcoital analysis

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Q One of my doctors performed a postcoital analysis of a patient’s mucous due to infertility issues. The physician called it a Sims-Huhner test. How should I code for this service?

A The postcoital test—also known as the Sims-Huhner, or Huhner, test—analyzes the cervical canal after sexual intercourse to determine whether sperm are present and moving. The cervical mucus also may be evaluated to determine its elasticity and drying pattern.

The test is performed 1 to 2 days before ovulation is expected, when the cervical mucus is thin, elastic, and easily penetrable by sperm. Two to 4 hours after the couple has sexual intercourse (without lubricants), a clinician collects the specimen and analyzes it under a microscope.

As it happens, there is a non-CPT code for this procedure: code Q0115, (postcoital direct, qualitative examinations of vaginal or cervical mucous). It is part of the HIPAA-specified code set, and as such may be used to bill for the procedure. Note this is considered a physician-performed microscopy (PPM) procedure, which requires a Clinical Laboratories Improvement Amendments PPM certificate.

A good second choice is the CPT code 89300 (presence and/or motility of sperm including Huhner test [postcoital]), which includes semen analysis. Some infertility physicians I have spoken with recommend using 89300 for the Huhner test even when the semen analysis is not performed. In this scenario, you might consider adding the modifier -52 (reduced services) to be truly “coding accurate.”

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.

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Q One of my doctors performed a postcoital analysis of a patient’s mucous due to infertility issues. The physician called it a Sims-Huhner test. How should I code for this service?

A The postcoital test—also known as the Sims-Huhner, or Huhner, test—analyzes the cervical canal after sexual intercourse to determine whether sperm are present and moving. The cervical mucus also may be evaluated to determine its elasticity and drying pattern.

The test is performed 1 to 2 days before ovulation is expected, when the cervical mucus is thin, elastic, and easily penetrable by sperm. Two to 4 hours after the couple has sexual intercourse (without lubricants), a clinician collects the specimen and analyzes it under a microscope.

As it happens, there is a non-CPT code for this procedure: code Q0115, (postcoital direct, qualitative examinations of vaginal or cervical mucous). It is part of the HIPAA-specified code set, and as such may be used to bill for the procedure. Note this is considered a physician-performed microscopy (PPM) procedure, which requires a Clinical Laboratories Improvement Amendments PPM certificate.

A good second choice is the CPT code 89300 (presence and/or motility of sperm including Huhner test [postcoital]), which includes semen analysis. Some infertility physicians I have spoken with recommend using 89300 for the Huhner test even when the semen analysis is not performed. In this scenario, you might consider adding the modifier -52 (reduced services) to be truly “coding accurate.”

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 One of my doctors performed a postcoital analysis of a patient’s mucous due to infertility issues. The physician called it a Sims-Huhner test. How should I code for this service?

A The postcoital test—also known as the Sims-Huhner, or Huhner, test—analyzes the cervical canal after sexual intercourse to determine whether sperm are present and moving. The cervical mucus also may be evaluated to determine its elasticity and drying pattern.

The test is performed 1 to 2 days before ovulation is expected, when the cervical mucus is thin, elastic, and easily penetrable by sperm. Two to 4 hours after the couple has sexual intercourse (without lubricants), a clinician collects the specimen and analyzes it under a microscope.

As it happens, there is a non-CPT code for this procedure: code Q0115, (postcoital direct, qualitative examinations of vaginal or cervical mucous). It is part of the HIPAA-specified code set, and as such may be used to bill for the procedure. Note this is considered a physician-performed microscopy (PPM) procedure, which requires a Clinical Laboratories Improvement Amendments PPM certificate.

A good second choice is the CPT code 89300 (presence and/or motility of sperm including Huhner test [postcoital]), which includes semen analysis. Some infertility physicians I have spoken with recommend using 89300 for the Huhner test even when the semen analysis is not performed. In this scenario, you might consider adding the modifier -52 (reduced services) to be truly “coding accurate.”

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.

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Was brain damage due to unnoticed cord compression?

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Westchester County (NY) Supreme Court

A woman presented to a hospital for delivery. During labor, hospital staff noted variable decelerations on the fetal heart monitor. The defendant physician administered oxytocin to accelerate labor, but ultimately opted for cesarean.

Following delivery, the infant boy was intermittently hospitalized and intubated. It was later revealed that he suffered brain damage, which led to extensive physical, occupational, and speech therapy. The child, 4 years old at the time of trial, cannot speak at an ageappropriate level; educators anticipate he will require special education classes.

The mother contended that the fetal monitoring decelerations stemmed from umbilical-cord compression, which was aggravated by the oxytocin. She claimed this led to hypoxia during delivery. She added that the doctor should have performed fetal scalp sampling and amnioinfusion, and should have conducted the cesarean earlier.

The physician maintained that it was not hypoxia, but an unexpected placental abruption that caused the infant’s depressed postpartum condition. He noted that the fetal decelerations did not establish a nonreassuring pattern.

  • The jury awarded the plaintiff $14,703,347.
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.
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Westchester County (NY) Supreme Court

A woman presented to a hospital for delivery. During labor, hospital staff noted variable decelerations on the fetal heart monitor. The defendant physician administered oxytocin to accelerate labor, but ultimately opted for cesarean.

Following delivery, the infant boy was intermittently hospitalized and intubated. It was later revealed that he suffered brain damage, which led to extensive physical, occupational, and speech therapy. The child, 4 years old at the time of trial, cannot speak at an ageappropriate level; educators anticipate he will require special education classes.

The mother contended that the fetal monitoring decelerations stemmed from umbilical-cord compression, which was aggravated by the oxytocin. She claimed this led to hypoxia during delivery. She added that the doctor should have performed fetal scalp sampling and amnioinfusion, and should have conducted the cesarean earlier.

The physician maintained that it was not hypoxia, but an unexpected placental abruption that caused the infant’s depressed postpartum condition. He noted that the fetal decelerations did not establish a nonreassuring pattern.

  • The jury awarded the plaintiff $14,703,347.
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.

Westchester County (NY) Supreme Court

A woman presented to a hospital for delivery. During labor, hospital staff noted variable decelerations on the fetal heart monitor. The defendant physician administered oxytocin to accelerate labor, but ultimately opted for cesarean.

Following delivery, the infant boy was intermittently hospitalized and intubated. It was later revealed that he suffered brain damage, which led to extensive physical, occupational, and speech therapy. The child, 4 years old at the time of trial, cannot speak at an ageappropriate level; educators anticipate he will require special education classes.

The mother contended that the fetal monitoring decelerations stemmed from umbilical-cord compression, which was aggravated by the oxytocin. She claimed this led to hypoxia during delivery. She added that the doctor should have performed fetal scalp sampling and amnioinfusion, and should have conducted the cesarean earlier.

The physician maintained that it was not hypoxia, but an unexpected placental abruption that caused the infant’s depressed postpartum condition. He noted that the fetal decelerations did not establish a nonreassuring pattern.

  • The jury awarded the plaintiff $14,703,347.
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.
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Delayed ectopic diagnosis results in tubal rupture

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Ingham County (Mich) Circuit Court

A 31-year-old woman presented to an obstetrician for prenatal care. An ultrasound was reported to demonstrate a gestational sac in the uterus but no fetal pole or yolk sac. The doctor ruled out a nonviable fetus and diagnosed her with early pregnancy.

The following day, the patient called the doctor complaining of sudden pain in her left lower stomach. She was referred to a radiologist for an ultrasound, which revealed a small amount of intrauterine fluid with no visible yolk sac or fetal pole, and no free fluid in the pelvis. Later that evening, the woman presented to a hospital with continued pain and vaginal bleeding. She was diagnosed with a threatened abortion and discharged.

The next morning, the woman returned to the obstetrician for another ultrasound; this revealed free fluid in the pelvic cavity, suggesting a ruptured ectopic pregnancy. The patient was immediately admitted to the hospital. She was diagnosed with a ruptured fallopian tube, which was subsequently removed.

The woman sued, arguing that the ectopic pregnancy would have been discovered prior to the rupture had the doctor performed an examination. She also claimed the fallopian tube could have been repaired before the rupture.

The doctor argued that the standard of care did not necessitate an examination the day before the rupture, and maintained that tube removal would have been necessary even if the patient had been seen.

  • 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.
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Ingham County (Mich) Circuit Court

A 31-year-old woman presented to an obstetrician for prenatal care. An ultrasound was reported to demonstrate a gestational sac in the uterus but no fetal pole or yolk sac. The doctor ruled out a nonviable fetus and diagnosed her with early pregnancy.

The following day, the patient called the doctor complaining of sudden pain in her left lower stomach. She was referred to a radiologist for an ultrasound, which revealed a small amount of intrauterine fluid with no visible yolk sac or fetal pole, and no free fluid in the pelvis. Later that evening, the woman presented to a hospital with continued pain and vaginal bleeding. She was diagnosed with a threatened abortion and discharged.

The next morning, the woman returned to the obstetrician for another ultrasound; this revealed free fluid in the pelvic cavity, suggesting a ruptured ectopic pregnancy. The patient was immediately admitted to the hospital. She was diagnosed with a ruptured fallopian tube, which was subsequently removed.

The woman sued, arguing that the ectopic pregnancy would have been discovered prior to the rupture had the doctor performed an examination. She also claimed the fallopian tube could have been repaired before the rupture.

The doctor argued that the standard of care did not necessitate an examination the day before the rupture, and maintained that tube removal would have been necessary even if the patient had been seen.

  • 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.

Ingham County (Mich) Circuit Court

A 31-year-old woman presented to an obstetrician for prenatal care. An ultrasound was reported to demonstrate a gestational sac in the uterus but no fetal pole or yolk sac. The doctor ruled out a nonviable fetus and diagnosed her with early pregnancy.

The following day, the patient called the doctor complaining of sudden pain in her left lower stomach. She was referred to a radiologist for an ultrasound, which revealed a small amount of intrauterine fluid with no visible yolk sac or fetal pole, and no free fluid in the pelvis. Later that evening, the woman presented to a hospital with continued pain and vaginal bleeding. She was diagnosed with a threatened abortion and discharged.

The next morning, the woman returned to the obstetrician for another ultrasound; this revealed free fluid in the pelvic cavity, suggesting a ruptured ectopic pregnancy. The patient was immediately admitted to the hospital. She was diagnosed with a ruptured fallopian tube, which was subsequently removed.

The woman sued, arguing that the ectopic pregnancy would have been discovered prior to the rupture had the doctor performed an examination. She also claimed the fallopian tube could have been repaired before the rupture.

The doctor argued that the standard of care did not necessitate an examination the day before the rupture, and maintained that tube removal would have been necessary even if the patient had been seen.

  • 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.
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Laparoscopy leads to laceration of aorta, vena cava

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Otsego County (NY) Supreme Court

A 34-year-old woman with a history of chronic pelvic pain underwent a hysteroscopy and diagnostic laparoscopy. During the laparoscopy, she suffered a laceration to her abdominal aorta and vena cava. The surgery was converted to an open procedure so that the lacerations could be repaired.

In suing, the patient claimed that the doctor negligently inserted the trocar and/or Veress needle, since the injury occurred 0.5 cm above the bifurcation of her aorta and vena cava. She also claimed 37 minutes elapsed between the discovery of her injuries and the repair.

The doctor argued that blood vessel injuries are a known risk of laparoscopic procedures. He also denied that a 37-minute lapse in time occurred in repairing her injury.

  • 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.
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Otsego County (NY) Supreme Court

A 34-year-old woman with a history of chronic pelvic pain underwent a hysteroscopy and diagnostic laparoscopy. During the laparoscopy, she suffered a laceration to her abdominal aorta and vena cava. The surgery was converted to an open procedure so that the lacerations could be repaired.

In suing, the patient claimed that the doctor negligently inserted the trocar and/or Veress needle, since the injury occurred 0.5 cm above the bifurcation of her aorta and vena cava. She also claimed 37 minutes elapsed between the discovery of her injuries and the repair.

The doctor argued that blood vessel injuries are a known risk of laparoscopic procedures. He also denied that a 37-minute lapse in time occurred in repairing her injury.

  • 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.

Otsego County (NY) Supreme Court

A 34-year-old woman with a history of chronic pelvic pain underwent a hysteroscopy and diagnostic laparoscopy. During the laparoscopy, she suffered a laceration to her abdominal aorta and vena cava. The surgery was converted to an open procedure so that the lacerations could be repaired.

In suing, the patient claimed that the doctor negligently inserted the trocar and/or Veress needle, since the injury occurred 0.5 cm above the bifurcation of her aorta and vena cava. She also claimed 37 minutes elapsed between the discovery of her injuries and the repair.

The doctor argued that blood vessel injuries are a known risk of laparoscopic procedures. He also denied that a 37-minute lapse in time occurred in repairing her injury.

  • 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.
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Did use of vacuum, forceps lead to brain damage?

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Undisclosed County (Mass) Superior Court

After experiencing ruptured membranes with clear amniotic fluid at 33 weeks’ gestation, a 25-year-old gravida was hospitalized. Two weeks of regular fetal monitoring showed no fetal compromise.

At 34 weeks’ gestation, the woman began to experience contractions. Hospital staff noted her white blood cell count had elevated to 16,700 and her temperature was 99°. Amniotic fluid analysis showed a positive PG, indicating fetal lung maturity.

At 9:15 that evening, the mother was fully dilated. By 11:00 PM, the woman had been pushing for nearly 2 hours but the infant had not moved past the +2 station in occiput anterior position. The Ob/Gyn then made several unsuccessful attempts at vacuum extraction before ultimately using forceps to deliver the baby at 11:09 pm.

Upon delivery, the newborn had Apgar scores of 8/9. A few minutes later, however, he developed breathing problems and within 24 hours experienced seizures. A large bruise was noted on his head. Magnetic resonance imaging (MRI) taken 8 days later revealed he had suffered a subarachnoid hemorrhage. The child has severe permanent brain damage and suffers from extensive handicaps and cerebral palsy.

In suing, the plaintiff alleged that the Ob/Gyn failed to conduct proper examinations and perform a timely cesarean. Further, he claimed the doctor did not properly communicate the risks of vacuum or forceps delivery. The plaintiff charged that the doctor’s misuse of the vacuum and forceps led to his brain damage.

The doctor maintained that he did not deviate from the standard of care and that the child’s injuries were the result of prematurity. Further, the physician argued that the MRI images were inconsistent with the type of trauma that would result from the use of a vacuum or forceps.

  • The case settled for $3.25 million.
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.
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Undisclosed County (Mass) Superior Court

After experiencing ruptured membranes with clear amniotic fluid at 33 weeks’ gestation, a 25-year-old gravida was hospitalized. Two weeks of regular fetal monitoring showed no fetal compromise.

At 34 weeks’ gestation, the woman began to experience contractions. Hospital staff noted her white blood cell count had elevated to 16,700 and her temperature was 99°. Amniotic fluid analysis showed a positive PG, indicating fetal lung maturity.

At 9:15 that evening, the mother was fully dilated. By 11:00 PM, the woman had been pushing for nearly 2 hours but the infant had not moved past the +2 station in occiput anterior position. The Ob/Gyn then made several unsuccessful attempts at vacuum extraction before ultimately using forceps to deliver the baby at 11:09 pm.

Upon delivery, the newborn had Apgar scores of 8/9. A few minutes later, however, he developed breathing problems and within 24 hours experienced seizures. A large bruise was noted on his head. Magnetic resonance imaging (MRI) taken 8 days later revealed he had suffered a subarachnoid hemorrhage. The child has severe permanent brain damage and suffers from extensive handicaps and cerebral palsy.

In suing, the plaintiff alleged that the Ob/Gyn failed to conduct proper examinations and perform a timely cesarean. Further, he claimed the doctor did not properly communicate the risks of vacuum or forceps delivery. The plaintiff charged that the doctor’s misuse of the vacuum and forceps led to his brain damage.

The doctor maintained that he did not deviate from the standard of care and that the child’s injuries were the result of prematurity. Further, the physician argued that the MRI images were inconsistent with the type of trauma that would result from the use of a vacuum or forceps.

  • The case settled for $3.25 million.
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.

Undisclosed County (Mass) Superior Court

After experiencing ruptured membranes with clear amniotic fluid at 33 weeks’ gestation, a 25-year-old gravida was hospitalized. Two weeks of regular fetal monitoring showed no fetal compromise.

At 34 weeks’ gestation, the woman began to experience contractions. Hospital staff noted her white blood cell count had elevated to 16,700 and her temperature was 99°. Amniotic fluid analysis showed a positive PG, indicating fetal lung maturity.

At 9:15 that evening, the mother was fully dilated. By 11:00 PM, the woman had been pushing for nearly 2 hours but the infant had not moved past the +2 station in occiput anterior position. The Ob/Gyn then made several unsuccessful attempts at vacuum extraction before ultimately using forceps to deliver the baby at 11:09 pm.

Upon delivery, the newborn had Apgar scores of 8/9. A few minutes later, however, he developed breathing problems and within 24 hours experienced seizures. A large bruise was noted on his head. Magnetic resonance imaging (MRI) taken 8 days later revealed he had suffered a subarachnoid hemorrhage. The child has severe permanent brain damage and suffers from extensive handicaps and cerebral palsy.

In suing, the plaintiff alleged that the Ob/Gyn failed to conduct proper examinations and perform a timely cesarean. Further, he claimed the doctor did not properly communicate the risks of vacuum or forceps delivery. The plaintiff charged that the doctor’s misuse of the vacuum and forceps led to his brain damage.

The doctor maintained that he did not deviate from the standard of care and that the child’s injuries were the result of prematurity. Further, the physician argued that the MRI images were inconsistent with the type of trauma that would result from the use of a vacuum or forceps.

  • The case settled for $3.25 million.
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.
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Was abscess missed on CT?

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Was abscess missed on CT?

Bowie County (Tex) District Court

Five days after giving birth to a girl via cesarean section, a 24-year-old woman underwent computed tomography (CT) imaging, with normal results. Four days later, another CT scan showed an abscess at the incision. Although the abscess was drained and treated with antibiotics, it did not clear up for 2 weeks. The patient was discharged after 25 days. She reportedly suffers from continued back pain.

In suing, she alleged that the doctor failed to take proper cultures and did not read the first CT scan correctly. The incorrect diagnosis delayed proper management, she argued.

  • 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.
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Bowie County (Tex) District Court

Five days after giving birth to a girl via cesarean section, a 24-year-old woman underwent computed tomography (CT) imaging, with normal results. Four days later, another CT scan showed an abscess at the incision. Although the abscess was drained and treated with antibiotics, it did not clear up for 2 weeks. The patient was discharged after 25 days. She reportedly suffers from continued back pain.

In suing, she alleged that the doctor failed to take proper cultures and did not read the first CT scan correctly. The incorrect diagnosis delayed proper management, she argued.

  • 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.

Bowie County (Tex) District Court

Five days after giving birth to a girl via cesarean section, a 24-year-old woman underwent computed tomography (CT) imaging, with normal results. Four days later, another CT scan showed an abscess at the incision. Although the abscess was drained and treated with antibiotics, it did not clear up for 2 weeks. The patient was discharged after 25 days. She reportedly suffers from continued back pain.

In suing, she alleged that the doctor failed to take proper cultures and did not read the first CT scan correctly. The incorrect diagnosis delayed proper management, she argued.

  • 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.
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Ruptured diverticulum, death follow hysterectomy

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Cook County (Ill) Circuit Court

A 45-year-old woman underwent a hysterectomy. A week after her staples were removed, she experienced vomiting and a fever of 100°. The patient’s husband called the doctor, who made a differential diagnosis of viral gastroenteritis and advised continued monitoring of her temperature.

The following day, the woman called the doctor with a temperature of 101° and continued vomiting. The doctor again advised her to drink plenty of fluids and to call back if symptoms persisted or worsened. Two days later, the woman was brought to the hospital in septic shock with a ruptured diverticulum and spreading peritonitis. She died later that day.

In suing, the woman’s husband contended that the doctor should have examined her in person.

The doctor argued that a diagnosis of viral gastroenteritis was reasonable and said the development of diverticulitis following a hysterectomy was not foreseeable.

  • 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.
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Cook County (Ill) Circuit Court

A 45-year-old woman underwent a hysterectomy. A week after her staples were removed, she experienced vomiting and a fever of 100°. The patient’s husband called the doctor, who made a differential diagnosis of viral gastroenteritis and advised continued monitoring of her temperature.

The following day, the woman called the doctor with a temperature of 101° and continued vomiting. The doctor again advised her to drink plenty of fluids and to call back if symptoms persisted or worsened. Two days later, the woman was brought to the hospital in septic shock with a ruptured diverticulum and spreading peritonitis. She died later that day.

In suing, the woman’s husband contended that the doctor should have examined her in person.

The doctor argued that a diagnosis of viral gastroenteritis was reasonable and said the development of diverticulitis following a hysterectomy was not foreseeable.

  • 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.

Cook County (Ill) Circuit Court

A 45-year-old woman underwent a hysterectomy. A week after her staples were removed, she experienced vomiting and a fever of 100°. The patient’s husband called the doctor, who made a differential diagnosis of viral gastroenteritis and advised continued monitoring of her temperature.

The following day, the woman called the doctor with a temperature of 101° and continued vomiting. The doctor again advised her to drink plenty of fluids and to call back if symptoms persisted or worsened. Two days later, the woman was brought to the hospital in septic shock with a ruptured diverticulum and spreading peritonitis. She died later that day.

In suing, the woman’s husband contended that the doctor should have examined her in person.

The doctor argued that a diagnosis of viral gastroenteritis was reasonable and said the development of diverticulitis following a hysterectomy was not foreseeable.

  • 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.
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Cancerous vulvar lesion misdiagnosed as eczema

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Ocean County (NJ) Superior Court

In February 1997, a 49-year-old woman presented to her gynecologist with a white lesion on her vulva. The doctor diagnosed the lesion as eczema but also recommended a biopsy. However, the biopsy was not performed until January 1999.

The patient was subsequently diagnosed with vulvar cancer and required a radical hemivulvectomy. Another surgeon removed 17 lymph nodes to determine whether the cancer had spread.

The patient sued, claiming that the cancer cells might have been removed if a biopsy had been performed earlier.

  • The case settled for $525,000.
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.
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Ocean County (NJ) Superior Court

In February 1997, a 49-year-old woman presented to her gynecologist with a white lesion on her vulva. The doctor diagnosed the lesion as eczema but also recommended a biopsy. However, the biopsy was not performed until January 1999.

The patient was subsequently diagnosed with vulvar cancer and required a radical hemivulvectomy. Another surgeon removed 17 lymph nodes to determine whether the cancer had spread.

The patient sued, claiming that the cancer cells might have been removed if a biopsy had been performed earlier.

  • The case settled for $525,000.
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.

Ocean County (NJ) Superior Court

In February 1997, a 49-year-old woman presented to her gynecologist with a white lesion on her vulva. The doctor diagnosed the lesion as eczema but also recommended a biopsy. However, the biopsy was not performed until January 1999.

The patient was subsequently diagnosed with vulvar cancer and required a radical hemivulvectomy. Another surgeon removed 17 lymph nodes to determine whether the cancer had spread.

The patient sued, claiming that the cancer cells might have been removed if a biopsy had been performed earlier.

  • The case settled for $525,000.
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.
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