Medicolegal Issues

Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.

Perforation During “Unnecessary” Procedure
A Wyoming man in his mid-30s began to experience back and abdominal pain, apparently related to a previous surgery. The patient was seen by defendant Dr. A., who performed an upper endoscopy that revealed no abnormalities. Three days later, Dr. A. performed an endoscopic retrograde cholangiopancreatography and biliary sphincterotomy.

Apparently, a perforation of the duodenum occurred during the latter procedure, resulting in a leakage of fluids into the abdominal cavity and causing the patient to become critically ill. He returned to the hospital the next day and was seen again by Dr. A., who failed to diagnose or treat the perforation. Once a diagnosis was made, the plaintiff gave consent for defendant Dr. B. to perform a duodenal diverticulization, but instead, she performed a duodenotomy, pyloric exclusion, and gastrojejunostomy.

The plaintiff claimed that both the follow-up procedures performed by Dr. A. and the pyloric exclusion and the gastrojejunostomy performed by Dr. B. were unnecessary. The plaintiff claimed that Dr. A. was responsible for perforation of the duodenum, and that during the procedures performed by Dr. B., the duodenum reopened, again leaking fluids into his abdominal cavity.

Dr. C. took over for Dr. B. and performed five additional surgeries, all of which the plaintiff alleged were unnecessary and further complicated his recovery. The plaintiff was finally transferred to another facility—but not soon enough, he claimed. The plaintiff’s stomach has now been substantially reconstructed with a special mesh that restricts him in movement, lifting, and prospects for employment.

The defendants each denied any negligence.

According to a published account, a $1.87 million verdict was returned, with Dr. A. found 60% at fault and Dr. B. found 40% at fault. Dr. C. was found not liable. The verdict included an award of $380,000 to the federal government for past medical expenses as the patient was serving in the armed forces at the time of his initial surgery.

Inconsistent Reading of Chest X-Rays
An Ohio woman, age 67, was diagnosed with non–small cell lung cancer. Her cancer progressed over a 20-month period from curable to incurable. At the time of settlement, she had stage IV lung cancer with only a 10% to 20% chance of surviving five years.

Defendant Dr. L., the woman’s primary care physician, had ordered chest x-rays on two occasions. Each revealed findings suggestive of a pulmonary mass in the left lower lobe of her lung. The first chest x-ray was properly read by a radiologist, who recommended follow-up in six to eight weeks. Dr. L. did nothing, disregarding this recommendation.

When the second chest x-ray was performed 11 months later, a different radiologist failed to detect an increase in the mass in the left lower lobe of the lung and incorrectly interpreted this chest x-ray. A third chest x-ray performed during an emergency department (ED) evaluation for the complaint of chest pain revealed a 3.0-cm mass in the patient’s left lung. The mass was appropriately investigated and treated, but the cancer had metastasized and was eventually confirmed to involve the peribronchial lymph nodes, the pleura, and the right femur. The woman was confirmed to have moderately differentiated adenocarcinoma.

She underwent surgical resection of the lung cancer with five cycles of chemotherapy. This was followed by salvage chemotherapy, which placed her in remission. A $700,000 settlement was reached.

Investigation Inadequate for Blackouts
At age 37, an obese woman in Illinois had a complicated medical history, including a tonsillectomy and adenoidectomy, bleeding ulcers, hypertension, and a left-lobe thyroidectomy. In March, she began to experience blackouts, during which she often collapsed.

Her primary care physician hospitalized her for diagnostic testing, but all results were normal. When the patient’s blackouts continued, she was referred to the defendant neurologist, Dr. F., for evaluation. She was in Dr. F.’s care from May to June, when she was also being seen by the defendant Dr. G. for treatment of chronic back pain. This involved multiple medications, including rofecoxib (a COX-2 inhibitor that was voluntarily withdrawn from the market in 2005).

Dr. F. ordered an echocardiogram, an electroencephalogram, and Holter monitoring to rule out cardiac and neurologic causes. She also prescribed the anticonvulsant divalproex sodium. At the patient’s last visit with Dr. F., the neurologist ordered a gradual increase of divalproex from 500 mg/d to 1500 mg/d.

Three days later, the patient died in her sleep. She was found with blood coming from her nose and on the bedding. At the time of death, blood was also found in her stomach. The coroner listed the cause of death as cardiac arrhythmia secondary to atherosclerotic heart disease; this was thought to have been precipitated by an acute hemorrhagic gastritis attributed to rofecoxib therapy. There was no evidence of a blood clot or heart attack.

The plaintiff claimed that the decedent had experienced more than two dozen blackouts before she died and that she should have been hospitalized by Dr. F. until their cause was determined. The plaintiff also claimed that the decedent should have been evaluated for obstructive sleep apnea, claiming that the patient’s death was caused by sleep apnea coupled with the effects of prescribed central nervous system depressants. These, the plaintiff claimed, prevented the decedent from clearing her airway of the blood attributed to her rofecoxib use.

The defendants claimed that a work-up for sleep apnea was not indicated. The defendants claimed that the woman died as a result of a primary cardiac arrhythmia.

According to a published account, a defense verdict was returned.

Failure to Remove Pacemaker for Heart Infection
In August 2003, a 58-year-old woman underwent implantation of a pacemaker by the defendant cardiologist at a Michigan hospital. The patient was discharged under the care of a visiting nurse service.

A week after her surgery, the woman presented to the hospital’s ED with bloody drainage from the surgical wound. Her cardiologist ruled out bacteremia, sepsis, an abscess, and a pacemaker pocket infection. Consultation with an internist and infectious disease specialist led to a recommendation that cultures be taken of the pacemaker site and the pocket drainage to rule out a deep pocket infection or infected hematoma. No cultures were taken, however, and the patient was discharged after four days with a 12-day prescription for vancomycin; but the infectious disease specialist discontinued the order for antibiotics after seven days, and the patient’s condition began to decline.

In late August, she was evaluated by the cardiologist, who performed a second surgery in late September. Upon finding a large hematoma in the pacemaker pocket, he revised the pocket, removed the hematoma, rinsed the pocket with an antibiotic solution, and closed the surgical wound without removing the pacemaker.

The woman was discharged the following day with orders for cephalexin, doxycycline, and clonidine, but she was given no prescriptions. Although a visiting nurse reportedly contacted the cardiologist for prescriptions, he provided them for doxycycline and clonidine only.

The patient returned to the ED in early November with complaints of neck pain and vomiting. She was given a diagnosis of pyelonephritis and dehydration. Three days later, she experienced a neurologic collapse, after which it was determined that she had a heart infection with vegetation on the heart valves. She died nine days later. An autopsy confirmed her death as resulting from septic embolic infarct and bacterial endocarditis.

The plaintiff claimed that the decedent’s pacemaker should have been removed during the second surgery, that proper antibiotic therapy should have been prescribed, and that the decedent should have been hospitalized in late August for diagnostic testing. The defendant denied any negligence.

According to a published report, a $145,000 settlement was reached.

Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.

Perforation During “Unnecessary” Procedure
A Wyoming man in his mid-30s began to experience back and abdominal pain, apparently related to a previous surgery. The patient was seen by defendant Dr. A., who performed an upper endoscopy that revealed no abnormalities. Three days later, Dr. A. performed an endoscopic retrograde cholangiopancreatography and biliary sphincterotomy.

Apparently, a perforation of the duodenum occurred during the latter procedure, resulting in a leakage of fluids into the abdominal cavity and causing the patient to become critically ill. He returned to the hospital the next day and was seen again by Dr. A., who failed to diagnose or treat the perforation. Once a diagnosis was made, the plaintiff gave consent for defendant Dr. B. to perform a duodenal diverticulization, but instead, she performed a duodenotomy, pyloric exclusion, and gastrojejunostomy.

The plaintiff claimed that both the follow-up procedures performed by Dr. A. and the pyloric exclusion and the gastrojejunostomy performed by Dr. B. were unnecessary. The plaintiff claimed that Dr. A. was responsible for perforation of the duodenum, and that during the procedures performed by Dr. B., the duodenum reopened, again leaking fluids into his abdominal cavity.

Dr. C. took over for Dr. B. and performed five additional surgeries, all of which the plaintiff alleged were unnecessary and further complicated his recovery. The plaintiff was finally transferred to another facility—but not soon enough, he claimed. The plaintiff’s stomach has now been substantially reconstructed with a special mesh that restricts him in movement, lifting, and prospects for employment.

The defendants each denied any negligence.

According to a published account, a $1.87 million verdict was returned, with Dr. A. found 60% at fault and Dr. B. found 40% at fault. Dr. C. was found not liable. The verdict included an award of $380,000 to the federal government for past medical expenses as the patient was serving in the armed forces at the time of his initial surgery.

Inconsistent Reading of Chest X-Rays
An Ohio woman, age 67, was diagnosed with non–small cell lung cancer. Her cancer progressed over a 20-month period from curable to incurable. At the time of settlement, she had stage IV lung cancer with only a 10% to 20% chance of surviving five years.

Defendant Dr. L., the woman’s primary care physician, had ordered chest x-rays on two occasions. Each revealed findings suggestive of a pulmonary mass in the left lower lobe of her lung. The first chest x-ray was properly read by a radiologist, who recommended follow-up in six to eight weeks. Dr. L. did nothing, disregarding this recommendation.

When the second chest x-ray was performed 11 months later, a different radiologist failed to detect an increase in the mass in the left lower lobe of the lung and incorrectly interpreted this chest x-ray. A third chest x-ray performed during an emergency department (ED) evaluation for the complaint of chest pain revealed a 3.0-cm mass in the patient’s left lung. The mass was appropriately investigated and treated, but the cancer had metastasized and was eventually confirmed to involve the peribronchial lymph nodes, the pleura, and the right femur. The woman was confirmed to have moderately differentiated adenocarcinoma.

She underwent surgical resection of the lung cancer with five cycles of chemotherapy. This was followed by salvage chemotherapy, which placed her in remission. A $700,000 settlement was reached.

Investigation Inadequate for Blackouts
At age 37, an obese woman in Illinois had a complicated medical history, including a tonsillectomy and adenoidectomy, bleeding ulcers, hypertension, and a left-lobe thyroidectomy. In March, she began to experience blackouts, during which she often collapsed.

Her primary care physician hospitalized her for diagnostic testing, but all results were normal. When the patient’s blackouts continued, she was referred to the defendant neurologist, Dr. F., for evaluation. She was in Dr. F.’s care from May to June, when she was also being seen by the defendant Dr. G. for treatment of chronic back pain. This involved multiple medications, including rofecoxib (a COX-2 inhibitor that was voluntarily withdrawn from the market in 2005).

Dr. F. ordered an echocardiogram, an electroencephalogram, and Holter monitoring to rule out cardiac and neurologic causes. She also prescribed the anticonvulsant divalproex sodium. At the patient’s last visit with Dr. F., the neurologist ordered a gradual increase of divalproex from 500 mg/d to 1500 mg/d.

Three days later, the patient died in her sleep. She was found with blood coming from her nose and on the bedding. At the time of death, blood was also found in her stomach. The coroner listed the cause of death as cardiac arrhythmia secondary to atherosclerotic heart disease; this was thought to have been precipitated by an acute hemorrhagic gastritis attributed to rofecoxib therapy. There was no evidence of a blood clot or heart attack.

The plaintiff claimed that the decedent had experienced more than two dozen blackouts before she died and that she should have been hospitalized by Dr. F. until their cause was determined. The plaintiff also claimed that the decedent should have been evaluated for obstructive sleep apnea, claiming that the patient’s death was caused by sleep apnea coupled with the effects of prescribed central nervous system depressants. These, the plaintiff claimed, prevented the decedent from clearing her airway of the blood attributed to her rofecoxib use.

The defendants claimed that a work-up for sleep apnea was not indicated. The defendants claimed that the woman died as a result of a primary cardiac arrhythmia.

According to a published account, a defense verdict was returned.

Failure to Remove Pacemaker for Heart Infection
In August 2003, a 58-year-old woman underwent implantation of a pacemaker by the defendant cardiologist at a Michigan hospital. The patient was discharged under the care of a visiting nurse service.

A week after her surgery, the woman presented to the hospital’s ED with bloody drainage from the surgical wound. Her cardiologist ruled out bacteremia, sepsis, an abscess, and a pacemaker pocket infection. Consultation with an internist and infectious disease specialist led to a recommendation that cultures be taken of the pacemaker site and the pocket drainage to rule out a deep pocket infection or infected hematoma. No cultures were taken, however, and the patient was discharged after four days with a 12-day prescription for vancomycin; but the infectious disease specialist discontinued the order for antibiotics after seven days, and the patient’s condition began to decline.

In late August, she was evaluated by the cardiologist, who performed a second surgery in late September. Upon finding a large hematoma in the pacemaker pocket, he revised the pocket, removed the hematoma, rinsed the pocket with an antibiotic solution, and closed the surgical wound without removing the pacemaker.

The woman was discharged the following day with orders for cephalexin, doxycycline, and clonidine, but she was given no prescriptions. Although a visiting nurse reportedly contacted the cardiologist for prescriptions, he provided them for doxycycline and clonidine only.

The patient returned to the ED in early November with complaints of neck pain and vomiting. She was given a diagnosis of pyelonephritis and dehydration. Three days later, she experienced a neurologic collapse, after which it was determined that she had a heart infection with vegetation on the heart valves. She died nine days later. An autopsy confirmed her death as resulting from septic embolic infarct and bacterial endocarditis.

The plaintiff claimed that the decedent’s pacemaker should have been removed during the second surgery, that proper antibiotic therapy should have been prescribed, and that the decedent should have been hospitalized in late August for diagnostic testing. The defendant denied any negligence.

According to a published report, a $145,000 settlement was reached.

Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.

Perforation During “Unnecessary” Procedure
A Wyoming man in his mid-30s began to experience back and abdominal pain, apparently related to a previous surgery. The patient was seen by defendant Dr. A., who performed an upper endoscopy that revealed no abnormalities. Three days later, Dr. A. performed an endoscopic retrograde cholangiopancreatography and biliary sphincterotomy.

Apparently, a perforation of the duodenum occurred during the latter procedure, resulting in a leakage of fluids into the abdominal cavity and causing the patient to become critically ill. He returned to the hospital the next day and was seen again by Dr. A., who failed to diagnose or treat the perforation. Once a diagnosis was made, the plaintiff gave consent for defendant Dr. B. to perform a duodenal diverticulization, but instead, she performed a duodenotomy, pyloric exclusion, and gastrojejunostomy.

The plaintiff claimed that both the follow-up procedures performed by Dr. A. and the pyloric exclusion and the gastrojejunostomy performed by Dr. B. were unnecessary. The plaintiff claimed that Dr. A. was responsible for perforation of the duodenum, and that during the procedures performed by Dr. B., the duodenum reopened, again leaking fluids into his abdominal cavity.

Dr. C. took over for Dr. B. and performed five additional surgeries, all of which the plaintiff alleged were unnecessary and further complicated his recovery. The plaintiff was finally transferred to another facility—but not soon enough, he claimed. The plaintiff’s stomach has now been substantially reconstructed with a special mesh that restricts him in movement, lifting, and prospects for employment.

The defendants each denied any negligence.

According to a published account, a $1.87 million verdict was returned, with Dr. A. found 60% at fault and Dr. B. found 40% at fault. Dr. C. was found not liable. The verdict included an award of $380,000 to the federal government for past medical expenses as the patient was serving in the armed forces at the time of his initial surgery.

Inconsistent Reading of Chest X-Rays
An Ohio woman, age 67, was diagnosed with non–small cell lung cancer. Her cancer progressed over a 20-month period from curable to incurable. At the time of settlement, she had stage IV lung cancer with only a 10% to 20% chance of surviving five years.

Defendant Dr. L., the woman’s primary care physician, had ordered chest x-rays on two occasions. Each revealed findings suggestive of a pulmonary mass in the left lower lobe of her lung. The first chest x-ray was properly read by a radiologist, who recommended follow-up in six to eight weeks. Dr. L. did nothing, disregarding this recommendation.

When the second chest x-ray was performed 11 months later, a different radiologist failed to detect an increase in the mass in the left lower lobe of the lung and incorrectly interpreted this chest x-ray. A third chest x-ray performed during an emergency department (ED) evaluation for the complaint of chest pain revealed a 3.0-cm mass in the patient’s left lung. The mass was appropriately investigated and treated, but the cancer had metastasized and was eventually confirmed to involve the peribronchial lymph nodes, the pleura, and the right femur. The woman was confirmed to have moderately differentiated adenocarcinoma.

She underwent surgical resection of the lung cancer with five cycles of chemotherapy. This was followed by salvage chemotherapy, which placed her in remission. A $700,000 settlement was reached.

Investigation Inadequate for Blackouts
At age 37, an obese woman in Illinois had a complicated medical history, including a tonsillectomy and adenoidectomy, bleeding ulcers, hypertension, and a left-lobe thyroidectomy. In March, she began to experience blackouts, during which she often collapsed.

Her primary care physician hospitalized her for diagnostic testing, but all results were normal. When the patient’s blackouts continued, she was referred to the defendant neurologist, Dr. F., for evaluation. She was in Dr. F.’s care from May to June, when she was also being seen by the defendant Dr. G. for treatment of chronic back pain. This involved multiple medications, including rofecoxib (a COX-2 inhibitor that was voluntarily withdrawn from the market in 2005).

Dr. F. ordered an echocardiogram, an electroencephalogram, and Holter monitoring to rule out cardiac and neurologic causes. She also prescribed the anticonvulsant divalproex sodium. At the patient’s last visit with Dr. F., the neurologist ordered a gradual increase of divalproex from 500 mg/d to 1500 mg/d.

Three days later, the patient died in her sleep. She was found with blood coming from her nose and on the bedding. At the time of death, blood was also found in her stomach. The coroner listed the cause of death as cardiac arrhythmia secondary to atherosclerotic heart disease; this was thought to have been precipitated by an acute hemorrhagic gastritis attributed to rofecoxib therapy. There was no evidence of a blood clot or heart attack.

The plaintiff claimed that the decedent had experienced more than two dozen blackouts before she died and that she should have been hospitalized by Dr. F. until their cause was determined. The plaintiff also claimed that the decedent should have been evaluated for obstructive sleep apnea, claiming that the patient’s death was caused by sleep apnea coupled with the effects of prescribed central nervous system depressants. These, the plaintiff claimed, prevented the decedent from clearing her airway of the blood attributed to her rofecoxib use.

The defendants claimed that a work-up for sleep apnea was not indicated. The defendants claimed that the woman died as a result of a primary cardiac arrhythmia.

According to a published account, a defense verdict was returned.

Failure to Remove Pacemaker for Heart Infection
In August 2003, a 58-year-old woman underwent implantation of a pacemaker by the defendant cardiologist at a Michigan hospital. The patient was discharged under the care of a visiting nurse service.

A week after her surgery, the woman presented to the hospital’s ED with bloody drainage from the surgical wound. Her cardiologist ruled out bacteremia, sepsis, an abscess, and a pacemaker pocket infection. Consultation with an internist and infectious disease specialist led to a recommendation that cultures be taken of the pacemaker site and the pocket drainage to rule out a deep pocket infection or infected hematoma. No cultures were taken, however, and the patient was discharged after four days with a 12-day prescription for vancomycin; but the infectious disease specialist discontinued the order for antibiotics after seven days, and the patient’s condition began to decline.

In late August, she was evaluated by the cardiologist, who performed a second surgery in late September. Upon finding a large hematoma in the pacemaker pocket, he revised the pocket, removed the hematoma, rinsed the pocket with an antibiotic solution, and closed the surgical wound without removing the pacemaker.

The woman was discharged the following day with orders for cephalexin, doxycycline, and clonidine, but she was given no prescriptions. Although a visiting nurse reportedly contacted the cardiologist for prescriptions, he provided them for doxycycline and clonidine only.

The patient returned to the ED in early November with complaints of neck pain and vomiting. She was given a diagnosis of pyelonephritis and dehydration. Three days later, she experienced a neurologic collapse, after which it was determined that she had a heart infection with vegetation on the heart valves. She died nine days later. An autopsy confirmed her death as resulting from septic embolic infarct and bacterial endocarditis.

The plaintiff claimed that the decedent’s pacemaker should have been removed during the second surgery, that proper antibiotic therapy should have been prescribed, and that the decedent should have been hospitalized in late August for diagnostic testing. The defendant denied any negligence.

According to a published report, a $145,000 settlement was reached.

Why wasn’t bloody nipple discharge taken more seriously?

DUE TO BLOODY DISCHARGE from her left nipple, a woman in her thirties had a mammogram; results were suspicious for malignancy. Her surgeon’s examination and biopsy were negative.

Two years later she found a lump in her left breast. Ultrasonography suggested a benign mass at 9 o’clock. Her surgeon could not find a mass at 9 o’clock, but detected a mass at 7 o’clock. He ordered US-guided core biopsy of the 9 o’clock area, but not the 7 o’clock mass—she was instructed to return for removal of the 7 o’clock mass regardless of the biopsy’s outcome. She was impatient for the biopsy, and went to another surgeon. Biopsy results were negative for malignancy.

Months later, during right breast implant replacement, she had the left-sided mass excised. Pathology reported moderate to poorly differentiated infiltrating carcinoma. She underwent a left mastectomy, prophylactic right mastectomy, and chemotherapy.

PATIENT’S CLAIM Further evaluation of her original complaint of bloody nipple discharge by her surgeon would have led to earlier diagnosis.

PHYSICIAN’S DEFENSE The left breast mass was never biopsied because the patient didn’t return as instructed.

VERDICT A Pennsylvania defense verdict was returned.

Uterine artery severed, new mother dies; court mandates changes

THE UTERINE ARTERY WAS SEVERED during cesarean delivery in a 32-year-old woman, causing severe hemorrhage. The ObGyn repaired the uterine vessels in the OR. The patient was sent to the recovery room and then to the surgical ICU, where she was in severe hemorrhagic shock, hypotensive, tachycardic, and had minimal urine output with metabolic acidosis. Exploratory surgery revealed massive blood clots. A trauma surgeon, called in by the ObGyn, found an extensive hematoma and 2 to 3 L of blood in the retroperitoneum. The woman died within 24 hours of delivery.

PLAINTIFF’S CLAIM When repairing injuries that occurred during the cesarean, the ObGyn damaged retroperitoneal uterine arteries. Physicians in the recovery room and surgical ICU informed the ObGyn that the patient appeared to have internal bleeding, but he did not return her to the OR for over 6 hours. After consent for exploratory surgery was signed, the ObGyn left to deliver another baby. The recovery room’s OBIX Perinatal Data System monitors failed to accurately record the patient’s vital signs. Understaffing in the surgical ICU impaired treatment.

DEFENSE CLAIM The ObGyn’s responsibility for the patient was transferred to the recovery room’s attending doctor, who claimed he had discharged his responsibility when he recommended exploratory surgery. After viewing the patient’s chart in the surgical ICU, a surgeon told the ObGyn that immediate treatment was needed for internal bleeding. The hospital claimed staffing issues did not cause the patient’s death.

VERDICT The burden of a $5.2 million settlement was shared by the physicians and hospital. The hospital was mandated to 1) establish an annual lecture on patient safety; 2) purchase a maternal/neonatal simulator to train staff; and 3) change the default settings on all OBIX Perinatal Data System machines to prevent them from defaulting to record normal values for vital signs when the “add” button is pushed.

Severe pain and burns during biopsy and genital wart removal

BIOPSY AND GENITAL WART REMOVAL were performed on a 34-year-old woman without anesthesia. She screamed in pain when the ObGyn biopsied her labia. Pain increased when he removed warts using a trichloroacetic acid mixture. Acid ran into the patient’s vagina and onto her buttocks, causing second-degree burns.

PATIENT’S CLAIM The physician never offered anesthesia, nor did she refuse it. The acid should have been applied more discretely. The paper toweling used to clean up the acid was just moist and could not have caused the acid to spread.

PHYSICIAN’S DEFENSE The ObGyn stated he preferred not to use anesthesia because it might affect the pathology slide quality, but that he offered it to the patient, and she refused. He also claimed that he applied the acid carefully, and attributed the spread and burn to a nurse who brought wet paper towels to dry the patient.

VERDICT A Tennessee defense verdict was returned.

Why wasn’t bloody nipple discharge taken more seriously?

DUE TO BLOODY DISCHARGE from her left nipple, a woman in her thirties had a mammogram; results were suspicious for malignancy. Her surgeon’s examination and biopsy were negative.

Two years later she found a lump in her left breast. Ultrasonography suggested a benign mass at 9 o’clock. Her surgeon could not find a mass at 9 o’clock, but detected a mass at 7 o’clock. He ordered US-guided core biopsy of the 9 o’clock area, but not the 7 o’clock mass—she was instructed to return for removal of the 7 o’clock mass regardless of the biopsy’s outcome. She was impatient for the biopsy, and went to another surgeon. Biopsy results were negative for malignancy.

Months later, during right breast implant replacement, she had the left-sided mass excised. Pathology reported moderate to poorly differentiated infiltrating carcinoma. She underwent a left mastectomy, prophylactic right mastectomy, and chemotherapy.

PATIENT’S CLAIM Further evaluation of her original complaint of bloody nipple discharge by her surgeon would have led to earlier diagnosis.

PHYSICIAN’S DEFENSE The left breast mass was never biopsied because the patient didn’t return as instructed.

VERDICT A Pennsylvania defense verdict was returned.

Uterine artery severed, new mother dies; court mandates changes

THE UTERINE ARTERY WAS SEVERED during cesarean delivery in a 32-year-old woman, causing severe hemorrhage. The ObGyn repaired the uterine vessels in the OR. The patient was sent to the recovery room and then to the surgical ICU, where she was in severe hemorrhagic shock, hypotensive, tachycardic, and had minimal urine output with metabolic acidosis. Exploratory surgery revealed massive blood clots. A trauma surgeon, called in by the ObGyn, found an extensive hematoma and 2 to 3 L of blood in the retroperitoneum. The woman died within 24 hours of delivery.

PLAINTIFF’S CLAIM When repairing injuries that occurred during the cesarean, the ObGyn damaged retroperitoneal uterine arteries. Physicians in the recovery room and surgical ICU informed the ObGyn that the patient appeared to have internal bleeding, but he did not return her to the OR for over 6 hours. After consent for exploratory surgery was signed, the ObGyn left to deliver another baby. The recovery room’s OBIX Perinatal Data System monitors failed to accurately record the patient’s vital signs. Understaffing in the surgical ICU impaired treatment.

DEFENSE CLAIM The ObGyn’s responsibility for the patient was transferred to the recovery room’s attending doctor, who claimed he had discharged his responsibility when he recommended exploratory surgery. After viewing the patient’s chart in the surgical ICU, a surgeon told the ObGyn that immediate treatment was needed for internal bleeding. The hospital claimed staffing issues did not cause the patient’s death.

VERDICT The burden of a $5.2 million settlement was shared by the physicians and hospital. The hospital was mandated to 1) establish an annual lecture on patient safety; 2) purchase a maternal/neonatal simulator to train staff; and 3) change the default settings on all OBIX Perinatal Data System machines to prevent them from defaulting to record normal values for vital signs when the “add” button is pushed.

Severe pain and burns during biopsy and genital wart removal

BIOPSY AND GENITAL WART REMOVAL were performed on a 34-year-old woman without anesthesia. She screamed in pain when the ObGyn biopsied her labia. Pain increased when he removed warts using a trichloroacetic acid mixture. Acid ran into the patient’s vagina and onto her buttocks, causing second-degree burns.

PATIENT’S CLAIM The physician never offered anesthesia, nor did she refuse it. The acid should have been applied more discretely. The paper toweling used to clean up the acid was just moist and could not have caused the acid to spread.

PHYSICIAN’S DEFENSE The ObGyn stated he preferred not to use anesthesia because it might affect the pathology slide quality, but that he offered it to the patient, and she refused. He also claimed that he applied the acid carefully, and attributed the spread and burn to a nurse who brought wet paper towels to dry the patient.

VERDICT A Tennessee defense verdict was returned.

Why wasn’t bloody nipple discharge taken more seriously?

DUE TO BLOODY DISCHARGE from her left nipple, a woman in her thirties had a mammogram; results were suspicious for malignancy. Her surgeon’s examination and biopsy were negative.

Two years later she found a lump in her left breast. Ultrasonography suggested a benign mass at 9 o’clock. Her surgeon could not find a mass at 9 o’clock, but detected a mass at 7 o’clock. He ordered US-guided core biopsy of the 9 o’clock area, but not the 7 o’clock mass—she was instructed to return for removal of the 7 o’clock mass regardless of the biopsy’s outcome. She was impatient for the biopsy, and went to another surgeon. Biopsy results were negative for malignancy.

Months later, during right breast implant replacement, she had the left-sided mass excised. Pathology reported moderate to poorly differentiated infiltrating carcinoma. She underwent a left mastectomy, prophylactic right mastectomy, and chemotherapy.

PATIENT’S CLAIM Further evaluation of her original complaint of bloody nipple discharge by her surgeon would have led to earlier diagnosis.

PHYSICIAN’S DEFENSE The left breast mass was never biopsied because the patient didn’t return as instructed.

VERDICT A Pennsylvania defense verdict was returned.

Uterine artery severed, new mother dies; court mandates changes

THE UTERINE ARTERY WAS SEVERED during cesarean delivery in a 32-year-old woman, causing severe hemorrhage. The ObGyn repaired the uterine vessels in the OR. The patient was sent to the recovery room and then to the surgical ICU, where she was in severe hemorrhagic shock, hypotensive, tachycardic, and had minimal urine output with metabolic acidosis. Exploratory surgery revealed massive blood clots. A trauma surgeon, called in by the ObGyn, found an extensive hematoma and 2 to 3 L of blood in the retroperitoneum. The woman died within 24 hours of delivery.

PLAINTIFF’S CLAIM When repairing injuries that occurred during the cesarean, the ObGyn damaged retroperitoneal uterine arteries. Physicians in the recovery room and surgical ICU informed the ObGyn that the patient appeared to have internal bleeding, but he did not return her to the OR for over 6 hours. After consent for exploratory surgery was signed, the ObGyn left to deliver another baby. The recovery room’s OBIX Perinatal Data System monitors failed to accurately record the patient’s vital signs. Understaffing in the surgical ICU impaired treatment.

DEFENSE CLAIM The ObGyn’s responsibility for the patient was transferred to the recovery room’s attending doctor, who claimed he had discharged his responsibility when he recommended exploratory surgery. After viewing the patient’s chart in the surgical ICU, a surgeon told the ObGyn that immediate treatment was needed for internal bleeding. The hospital claimed staffing issues did not cause the patient’s death.

VERDICT The burden of a $5.2 million settlement was shared by the physicians and hospital. The hospital was mandated to 1) establish an annual lecture on patient safety; 2) purchase a maternal/neonatal simulator to train staff; and 3) change the default settings on all OBIX Perinatal Data System machines to prevent them from defaulting to record normal values for vital signs when the “add” button is pushed.

Severe pain and burns during biopsy and genital wart removal

BIOPSY AND GENITAL WART REMOVAL were performed on a 34-year-old woman without anesthesia. She screamed in pain when the ObGyn biopsied her labia. Pain increased when he removed warts using a trichloroacetic acid mixture. Acid ran into the patient’s vagina and onto her buttocks, causing second-degree burns.

PATIENT’S CLAIM The physician never offered anesthesia, nor did she refuse it. The acid should have been applied more discretely. The paper toweling used to clean up the acid was just moist and could not have caused the acid to spread.

PHYSICIAN’S DEFENSE The ObGyn stated he preferred not to use anesthesia because it might affect the pathology slide quality, but that he offered it to the patient, and she refused. He also claimed that he applied the acid carefully, and attributed the spread and burn to a nurse who brought wet paper towels to dry the patient.

VERDICT A Tennessee defense verdict was returned.

Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.

Empiric Dilation Leads to Esophageal Perforation
A 61-year-old man presented to the defendant gastroenterologist, Dr. B., complaining of intermittent difficulty swallowing liquids. Dr. B. made a diagnosis of liquid dysphagia and performed an upper endoscopy that day. About 10 minutes into the procedure, observing no stricture in the esophagus, Dr. B. decided to perform an empiric dilation.

Immediately after the procedure during the patient’s recuperation in the postanesthesia care unit, he began to complain of pain whenever he inhaled deeply. A chest x-ray showed nothing, and the patient was given an analgesic for pain relief. An hour later, when the man continued to complain of pain, he was given more pain medication but experienced no improvement.

After four hours, a Gastrografin^® scan was performed. It revealed leakage into the mediastinum, confirming a perforated esophagus. A surgical consult was then ordered, and about seven hours after the initial procedure, a vascular surgeon performed surgery to repair the perforation. The man died of complications of acute respiratory distress syndrome, sepsis, and pneumonia about one month later.

The plaintiff alleged negligence in Dr. B.’s failure to obtain the decedent’s medical history before performing the upper endoscopy, in failing to inform the decedent of the dilation, and in failing to obtain informed consent for the dilation. The plaintiff contended that an empiric dilation would have been appropriate only if a stricture had been seen in the esophagus.

The defendant argued that an empiric dilation is proper whenever a patient has symptoms of dysphagia and that perforation is a known risk of the procedure—information that he claimed was communicated to the decedent.

The plaintiff argued that the consent form the decedent signed did not include any reference to a dilation procedure, nor did it detail the risks of the empiric dilation.

According to a published account, a defense verdict was returned.

No Testing for Infant With Large Head Circumference
The plaintiffs’ child was born in February 2005 at the Air Force base where his father was stationed. From the time of the child’s birth until his father’s honorable discharge in May 2005, the infant received clinical care from the medical staff at the base.

Shortly after the father’s discharge, the infant was seen by a pediatrician, who immediately referred him for head CT. He was diagnosed with hydrocephalus and underwent immediate neurosurgery for shunt placement. Since then, the child has undergone shunt revisions, eye surgery, speech therapy, occupational therapy, and physical therapy.

The plaintiffs charged the medical staff at the Air Force base with failure to diagnose the child’s hydrocephalus. The plaintiffs claimed that the child’s head circumference was near the top of the growth chart, that the infant had strabismus (crossed eyes), and that he had failed to reach developmental milestones. The plaintiffs argued that together these factors should have prompted the medical staff at the Air Force base to order diagnostic testing.

The defendants claimed there was no negligence in the failure to diagnose hydrocephalus because the child’s head circumference was not “off the chart.” They also claimed that the family did not complain of strabismus and failed to obtain timely care for the infant after the military discharge. The defendants maintained that the child would have had his current cognitive deficits even if a diagnosis had been made earlier. This claim was based on the defendants’ contention that the child had the congenital condition known as Dandy-Walker syndrome.

According to a published account, a $1.5 million settlement was reached. This included $1 million to be placed in trust for the child’s future care and treatment.

Was Hyponatremia Corrected Too Rapidly?
A 60-year-old woman went to a community hospital emergency department (ED) with a two-week history of cough, diminished appetite, decreased oral intake, and generalized body aches. She had been advised to go to the ED by staff at an urgent care center, where laboratory studies revealed critically low sodium and potassium levels. In the ED, she described herself as very weak and tired with body aches and pain.

According to lab tests performed at the ED, the woman’s sodium and potassium levels had fallen further. She was admitted to the ICU, where she was seen by the defendant physician. He ordered IV fluids with normal saline and potassium supplements, then ordered that the patient be transferred to the ICU at the defendant teaching hospital. There, the patient continued to be administered IV sodium and potassium until she was discharged home. Her final diagnoses included hyponatremia and hypokalemia.

The woman returned to the ED 10 days later with a two-day history of slurred speech. Findings on head CT suggested a basilar tip aneurysm. Subsequent MRI with and without contrast as well as intracranial MR angiography confirmed the presence of a basilar tip aneurysm but also revealed findings consistent with osmotic demyelination syndrome (formerly known as central pontine myelinolysis).

The woman’s initial neurologic examination revealed dysarthria, right upper-extremity weakness without spasticity, and confusion interspersed with lucid intervals. Her presentation and diagnostic imaging findings were felt to be consistent with osmotic demyelination syndrome. This diagnosis was later confirmed in a neurologic consultation.

The patient’s neurologic examination revealed continued mild dysarthria, difficulty standing, and the need for support when she attempted to walk. She also had mild oral and pharyngeal dysphagia and deficits in language and writing.

The plaintiff charged that the defendant raised the plaintiff’s sodium level more rapidly than was appropriate, resulting in neurologically devastating osmotic demyelination. The plaintiff claimed that normal saline should have been administered and that the serum sodium should have been checked every four hours during the first 24 hours of treatment. The plaintiff also alleged negligence in the continuation of normal saline after a serum sodium level of 112 mEq/L was achieved. The defendants, however, maintained that the treatment provided was appropriate.

A $550,000 settlement was reached.      

Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.

Empiric Dilation Leads to Esophageal Perforation
A 61-year-old man presented to the defendant gastroenterologist, Dr. B., complaining of intermittent difficulty swallowing liquids. Dr. B. made a diagnosis of liquid dysphagia and performed an upper endoscopy that day. About 10 minutes into the procedure, observing no stricture in the esophagus, Dr. B. decided to perform an empiric dilation.

Immediately after the procedure during the patient’s recuperation in the postanesthesia care unit, he began to complain of pain whenever he inhaled deeply. A chest x-ray showed nothing, and the patient was given an analgesic for pain relief. An hour later, when the man continued to complain of pain, he was given more pain medication but experienced no improvement.

After four hours, a Gastrografin^® scan was performed. It revealed leakage into the mediastinum, confirming a perforated esophagus. A surgical consult was then ordered, and about seven hours after the initial procedure, a vascular surgeon performed surgery to repair the perforation. The man died of complications of acute respiratory distress syndrome, sepsis, and pneumonia about one month later.

The plaintiff alleged negligence in Dr. B.’s failure to obtain the decedent’s medical history before performing the upper endoscopy, in failing to inform the decedent of the dilation, and in failing to obtain informed consent for the dilation. The plaintiff contended that an empiric dilation would have been appropriate only if a stricture had been seen in the esophagus.

The defendant argued that an empiric dilation is proper whenever a patient has symptoms of dysphagia and that perforation is a known risk of the procedure—information that he claimed was communicated to the decedent.

The plaintiff argued that the consent form the decedent signed did not include any reference to a dilation procedure, nor did it detail the risks of the empiric dilation.

According to a published account, a defense verdict was returned.

No Testing for Infant With Large Head Circumference
The plaintiffs’ child was born in February 2005 at the Air Force base where his father was stationed. From the time of the child’s birth until his father’s honorable discharge in May 2005, the infant received clinical care from the medical staff at the base.

Shortly after the father’s discharge, the infant was seen by a pediatrician, who immediately referred him for head CT. He was diagnosed with hydrocephalus and underwent immediate neurosurgery for shunt placement. Since then, the child has undergone shunt revisions, eye surgery, speech therapy, occupational therapy, and physical therapy.

The plaintiffs charged the medical staff at the Air Force base with failure to diagnose the child’s hydrocephalus. The plaintiffs claimed that the child’s head circumference was near the top of the growth chart, that the infant had strabismus (crossed eyes), and that he had failed to reach developmental milestones. The plaintiffs argued that together these factors should have prompted the medical staff at the Air Force base to order diagnostic testing.

The defendants claimed there was no negligence in the failure to diagnose hydrocephalus because the child’s head circumference was not “off the chart.” They also claimed that the family did not complain of strabismus and failed to obtain timely care for the infant after the military discharge. The defendants maintained that the child would have had his current cognitive deficits even if a diagnosis had been made earlier. This claim was based on the defendants’ contention that the child had the congenital condition known as Dandy-Walker syndrome.

According to a published account, a $1.5 million settlement was reached. This included $1 million to be placed in trust for the child’s future care and treatment.

Was Hyponatremia Corrected Too Rapidly?
A 60-year-old woman went to a community hospital emergency department (ED) with a two-week history of cough, diminished appetite, decreased oral intake, and generalized body aches. She had been advised to go to the ED by staff at an urgent care center, where laboratory studies revealed critically low sodium and potassium levels. In the ED, she described herself as very weak and tired with body aches and pain.

According to lab tests performed at the ED, the woman’s sodium and potassium levels had fallen further. She was admitted to the ICU, where she was seen by the defendant physician. He ordered IV fluids with normal saline and potassium supplements, then ordered that the patient be transferred to the ICU at the defendant teaching hospital. There, the patient continued to be administered IV sodium and potassium until she was discharged home. Her final diagnoses included hyponatremia and hypokalemia.

The woman returned to the ED 10 days later with a two-day history of slurred speech. Findings on head CT suggested a basilar tip aneurysm. Subsequent MRI with and without contrast as well as intracranial MR angiography confirmed the presence of a basilar tip aneurysm but also revealed findings consistent with osmotic demyelination syndrome (formerly known as central pontine myelinolysis).

The woman’s initial neurologic examination revealed dysarthria, right upper-extremity weakness without spasticity, and confusion interspersed with lucid intervals. Her presentation and diagnostic imaging findings were felt to be consistent with osmotic demyelination syndrome. This diagnosis was later confirmed in a neurologic consultation.

The patient’s neurologic examination revealed continued mild dysarthria, difficulty standing, and the need for support when she attempted to walk. She also had mild oral and pharyngeal dysphagia and deficits in language and writing.

The plaintiff charged that the defendant raised the plaintiff’s sodium level more rapidly than was appropriate, resulting in neurologically devastating osmotic demyelination. The plaintiff claimed that normal saline should have been administered and that the serum sodium should have been checked every four hours during the first 24 hours of treatment. The plaintiff also alleged negligence in the continuation of normal saline after a serum sodium level of 112 mEq/L was achieved. The defendants, however, maintained that the treatment provided was appropriate.

A $550,000 settlement was reached.      

Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.

Empiric Dilation Leads to Esophageal Perforation
A 61-year-old man presented to the defendant gastroenterologist, Dr. B., complaining of intermittent difficulty swallowing liquids. Dr. B. made a diagnosis of liquid dysphagia and performed an upper endoscopy that day. About 10 minutes into the procedure, observing no stricture in the esophagus, Dr. B. decided to perform an empiric dilation.

Immediately after the procedure during the patient’s recuperation in the postanesthesia care unit, he began to complain of pain whenever he inhaled deeply. A chest x-ray showed nothing, and the patient was given an analgesic for pain relief. An hour later, when the man continued to complain of pain, he was given more pain medication but experienced no improvement.

After four hours, a Gastrografin^® scan was performed. It revealed leakage into the mediastinum, confirming a perforated esophagus. A surgical consult was then ordered, and about seven hours after the initial procedure, a vascular surgeon performed surgery to repair the perforation. The man died of complications of acute respiratory distress syndrome, sepsis, and pneumonia about one month later.

The plaintiff alleged negligence in Dr. B.’s failure to obtain the decedent’s medical history before performing the upper endoscopy, in failing to inform the decedent of the dilation, and in failing to obtain informed consent for the dilation. The plaintiff contended that an empiric dilation would have been appropriate only if a stricture had been seen in the esophagus.

The defendant argued that an empiric dilation is proper whenever a patient has symptoms of dysphagia and that perforation is a known risk of the procedure—information that he claimed was communicated to the decedent.

The plaintiff argued that the consent form the decedent signed did not include any reference to a dilation procedure, nor did it detail the risks of the empiric dilation.

According to a published account, a defense verdict was returned.

No Testing for Infant With Large Head Circumference
The plaintiffs’ child was born in February 2005 at the Air Force base where his father was stationed. From the time of the child’s birth until his father’s honorable discharge in May 2005, the infant received clinical care from the medical staff at the base.

Shortly after the father’s discharge, the infant was seen by a pediatrician, who immediately referred him for head CT. He was diagnosed with hydrocephalus and underwent immediate neurosurgery for shunt placement. Since then, the child has undergone shunt revisions, eye surgery, speech therapy, occupational therapy, and physical therapy.

The plaintiffs charged the medical staff at the Air Force base with failure to diagnose the child’s hydrocephalus. The plaintiffs claimed that the child’s head circumference was near the top of the growth chart, that the infant had strabismus (crossed eyes), and that he had failed to reach developmental milestones. The plaintiffs argued that together these factors should have prompted the medical staff at the Air Force base to order diagnostic testing.

The defendants claimed there was no negligence in the failure to diagnose hydrocephalus because the child’s head circumference was not “off the chart.” They also claimed that the family did not complain of strabismus and failed to obtain timely care for the infant after the military discharge. The defendants maintained that the child would have had his current cognitive deficits even if a diagnosis had been made earlier. This claim was based on the defendants’ contention that the child had the congenital condition known as Dandy-Walker syndrome.

According to a published account, a $1.5 million settlement was reached. This included $1 million to be placed in trust for the child’s future care and treatment.

Was Hyponatremia Corrected Too Rapidly?
A 60-year-old woman went to a community hospital emergency department (ED) with a two-week history of cough, diminished appetite, decreased oral intake, and generalized body aches. She had been advised to go to the ED by staff at an urgent care center, where laboratory studies revealed critically low sodium and potassium levels. In the ED, she described herself as very weak and tired with body aches and pain.

According to lab tests performed at the ED, the woman’s sodium and potassium levels had fallen further. She was admitted to the ICU, where she was seen by the defendant physician. He ordered IV fluids with normal saline and potassium supplements, then ordered that the patient be transferred to the ICU at the defendant teaching hospital. There, the patient continued to be administered IV sodium and potassium until she was discharged home. Her final diagnoses included hyponatremia and hypokalemia.

The woman returned to the ED 10 days later with a two-day history of slurred speech. Findings on head CT suggested a basilar tip aneurysm. Subsequent MRI with and without contrast as well as intracranial MR angiography confirmed the presence of a basilar tip aneurysm but also revealed findings consistent with osmotic demyelination syndrome (formerly known as central pontine myelinolysis).

The woman’s initial neurologic examination revealed dysarthria, right upper-extremity weakness without spasticity, and confusion interspersed with lucid intervals. Her presentation and diagnostic imaging findings were felt to be consistent with osmotic demyelination syndrome. This diagnosis was later confirmed in a neurologic consultation.

The patient’s neurologic examination revealed continued mild dysarthria, difficulty standing, and the need for support when she attempted to walk. She also had mild oral and pharyngeal dysphagia and deficits in language and writing.

The plaintiff charged that the defendant raised the plaintiff’s sodium level more rapidly than was appropriate, resulting in neurologically devastating osmotic demyelination. The plaintiff claimed that normal saline should have been administered and that the serum sodium should have been checked every four hours during the first 24 hours of treatment. The plaintiff also alleged negligence in the continuation of normal saline after a serum sodium level of 112 mEq/L was achieved. The defendants, however, maintained that the treatment provided was appropriate.

A $550,000 settlement was reached.      

Patient sues drug companies: “HT caused my breast cancer”

A WOMAN IN HER LATE 50S took a combination of Premarin and Provera for 6 years to treat menopausal symptoms. She was then switched to Prempro for 4 years until she detected a lump in her breast. Her physician diagnosed invasive ductal breast cancer and the patient underwent a left mastectomy. Cancer spread to her lymph nodes; she underwent chemotherapy and radiation treatments. She sued the drug manufacturers.

PATIENT’S CLAIM Years of combination hormone therapy (HT) caused her breast cancer. The pharmaceutical companies failed to adequately test the drugs despite knowledge of their cancer-causing potential. If the defendants had begun cancer studies in the early 1980s when they first learned about the cancer risk, the risk would have been discovered before she began taking HT in 1991. She provided letters dated as early as 1976 from the FDA, independent researchers, and internal drug company scientists urging that cancer risk research be conducted. She claimed the defendants intentionally restricted the publication of medical data outlining the cancerous effects of combination HT to physicians and patients.

DEFENDANTS’ DEFENSE The FDA has reviewed the benefits and risks of HT for decades, always finding that the benefits outweighed the risks. Defendants cited 19 studies examining HT and breast cancer risk, the first published in 1959. The Women’s Health Initiative reaffirmed the increased risk of breast cancer, available in the labeling for Prempro in 1995. Labeling for Premarin and Provera included FDA-approved warnings of the breast cancer risk. The physician and patient were adequately warned of risks before use.

VERDICT $34.3 million verdict was returned, including $28 million in total punitive damages against the drug companies.

Was hypertension properly treated in this stroke victim?

AFTER HEAVY VAGINAL BLEEDING was diagnosed in a 49-year-old woman, her gynecologist prescribed medroxyprogesterone acetate. Several months later, she underwent a dilation and curettage for continued bleeding. A year later, her blood pressure (BP) was 140/94 mm Hg, which the physician believed was “white coat” hypertension. The woman returned 10 months later, still complaining of abnormal uterine bleeding, but she refused surgical options; the physician prescribed birth control pills. She returned for a routine exam a year later, when her BP was again elevated. The physician continued the patient’s oral contraceptive prescription and initiated treatment for high BP with triamterene. When the patient called to complain of excessive bleeding the next month, a nurse told her to take ibuprofen and call back if symptoms persisted. Shortly thereafter, the patient suffered a stroke. After rehabilitation, she regained use of her arms and legs, but suffered from foot drop and decreased fine motor skills.

PATIENT’S CLAIM The stroke was caused by uncontrolled hypertension and/or birth control pills. The physician should have initiated treatment the first time her BP was elevated, and it should have been checked more frequently. Birth control pills should have been discontinued when high BP was diagnosed because they are contraindicated in women older than 35 years whose BP is elevated.

PHYSICIAN’S DEFENSE The use of birth control pills was proper; the physician prescribed a low-dose combination medication commonly given to perimenopausal women to control abnormal bleeding. When high BP was first suspected, the physician commenced treatment.

VERDICT A defense verdict was returned.

Painful intercourse reported following incontinence surgery

EIGHT SURGERIES WERE PERFORMED to correct a 54-year-old woman’s cystocele, enterocele, and retrocele. The patient’s bladder, colon, and intestines had been pressing on her vaginal canal causing abdominal pain, painful intercourse, and urinary and fecal incontinence.

PATIENT’S CLAIM The procedures reduced the size of her vaginal opening and the length of her vaginal canal, causing constant pain as well as severe pain with intercourse. She was not informed that this was a risk of surgery.

PHYSICIAN’S DEFENSE The patient’s vaginal opening did shrink due to the release of pressure placed on the vaginal canal by the other organs, but it is still within normal range of vaginal size. The procedures resolved the patient’s incontinence issues.

VERDICT A defense verdict was returned.

Radiotherapy wrong for sarcoma; caused short bowel syndrome

FIBROIDS WERE MORCELLATED during a vaginal hysterectomy in a 56-year-old woman. The patient’s pathology report indicated endometrial stromal sarcoma (ESS). She underwent open surgery for staging and to remove any residual cancer cells that could be identified. The gynecologist referred her to a radiation oncologist. After receiving radiotherapy for 4 months, the patient complained of bowel-related symptoms. Three months later, she sought treatment closer to home for diarrhea and gastrointestinal problems. A surgeon diagnosed radiation-induced short bowel syndrome causing inadequate nutritional absorption. The patient underwent two operations, during which large sections of her bowel were removed, a permanent colostomy was placed. She then required total parenteral nutrition tube feedings.

PLAINTIFF’S CLAIM The radiation oncologist was negligent for recommending and administering radiotherapy because of its limited value in ESS. Hormonal therapy should have been used instead.

PHYSICIAN’S DEFENSE Radiotherapy was necessary because of the patient’s history and disease type. Morcellation during vaginal hysterectomy increased the risk of microscopic cancer cells remaining in the pelvis, supported by the finding of residual cancer cells during the second procedure. Radiotherapy was necessary to treat the residual cancer cells.

VERDICT A defense verdict was returned.

No response to alarm when fetal heart tones are lost

A WOMAN ATTEMPTED VAGINAL BIRTH after having one vaginal birth and one cesarean delivery in the past. Labor progressed slowly with inadequate contractions and lack of descent. After the mother pushed five or six times without progress, the OB left to deliver another baby. Because of lack of progression, the mother requested cesarean delivery, and the husband conveyed their concerns to the nursing staff. The nurses assured them that all was well but did not discuss the parents’ concerns with the OB or other hospital personnel. One hour later, the mother’s uterus ruptured, fetal heart tones were lost from the external fetal monitor, and an alarm sounded.

PLAINTIFF’S CLAIM The nursing staff failed to respond to the alarm immediately; when a response did come, a nurse allegedly stated with excitement that she was amazed that no one had responded. This statement was confirmed by the OB. After 9 minutes of signal loss, a fetal heartbeat of 60 was found, but it was severely bradycardic. The mother was rushed to the OR and the baby was delivered expeditiously. The child was born limp and without respiratory effort, and sustained hypoxic ischemic encephalopathy. At age 5, he had no purposeful movement of his extremities, could not communicate, and was wheelchair-bound, although he was not cognitively impaired.

DEFENDANTS’ DEFENSE The OB offered full policy limits before trial. The hospital claimed that the 9-minute delay in detecting the loss of fetal heart tone and seeking the OB’s intervention was not the proximate cause of the child’s handicaps.

VERDICT A $4.9 million Michigan verdict was reached.

Untreated postpartum infection necessitated hysterectomy

AN 18-YEAR-OLD WOMAN was discharged from the hospital two days after the vaginal birth of her healthy child, although she claimed to not feel well. When a hospital-employed nurse visited her the next day, the patient reported abdominal pain and cramping. Five days later, she returned to the hospital in extreme pain. She was diagnosed with severe Streptococcus A infection, air-lifted to another hospital, and treated with antibiotics for 5 days. A hysterectomy was later performed.

PLAINTIFF’S CLAIM The physician, visiting nurse, and hospital failed to diagnose and treat the infection in a timely manner, resulting in a hysterectomy. Laboratory tests taken before the patient’s hospital discharge showed an elevated white blood cell (WBC) count; the patient should have been prescribed antibiotics before leaving the hospital. The visiting nurse did not react appropriately when the patient reported pain. The hospital was responsible because the results of the WBC test were not entered into the patient’s chart.

DEFENDANTS’ DEFENSE The physician claimed that the elevated WBC count was not recorded in the patient’s medical chart with other lab values. The hospital claimed that a high WBC count is common after childbirth; the test is rarely performed at that time. The only reason it was performed was that the technology automatically recorded WBC when it evaluated hemoglobin and hemocrit. Abdominal cramping reported to the visiting nurse is normal 3 days after childbirth. The patient did not have an infection at discharge or at the time of the nurse’s visit.

VERDICT Suit against the physician was dismissed prior to jury deliberations. A $2.3 million verdict was returned against the hospital.

Did retained sponges lead to PID and gallbladder disease?

A 6-INCH VAGINAL LACERATION was discovered after a woman delivered a healthy baby. The ObGyn, who was covering for the patient’s regular ObGyn because of a snowstorm, could not repair the laceration in the delivery room. He packed the patient’s vagina with gauze sponges, and took her to the OR where he repaired the laceration. The next day, he removed sponges placed after surgery. The patient was discharged with instructions to follow-up with her regular ObGyn. Eight days after delivery, the patient complained to her ObGyn of severe abdominal pain and a foul odor. Antibiotics were prescribed, but she refused a vaginal examination because of the pain. Six weeks after delivery, four gauze sponges were removed from the patient’s vagina.

PLAINTIFF’S CLAIM The physician was negligent in leaving the sponges in her vagina. He should have conducted the follow-up himself because he delivered her child. The infection caused chronic pain from pelvic inflammatory disease (PID), and necessitated the removal of her gallbladder.

PHYSICIAN’S DEFENSE Retained sponges can occur in the absence of negligence. It was proper for the patient to return to her own physician for postoperative follow-up treatment. The patient’s PID and gallbladder problems were unrelated to the retained sponges.

VERDICT A defense verdict was returned. The defendant was granted costs and attorney fees exceeding $27,000.

Patient sues drug companies: “HT caused my breast cancer”

A WOMAN IN HER LATE 50S took a combination of Premarin and Provera for 6 years to treat menopausal symptoms. She was then switched to Prempro for 4 years until she detected a lump in her breast. Her physician diagnosed invasive ductal breast cancer and the patient underwent a left mastectomy. Cancer spread to her lymph nodes; she underwent chemotherapy and radiation treatments. She sued the drug manufacturers.

PATIENT’S CLAIM Years of combination hormone therapy (HT) caused her breast cancer. The pharmaceutical companies failed to adequately test the drugs despite knowledge of their cancer-causing potential. If the defendants had begun cancer studies in the early 1980s when they first learned about the cancer risk, the risk would have been discovered before she began taking HT in 1991. She provided letters dated as early as 1976 from the FDA, independent researchers, and internal drug company scientists urging that cancer risk research be conducted. She claimed the defendants intentionally restricted the publication of medical data outlining the cancerous effects of combination HT to physicians and patients.

DEFENDANTS’ DEFENSE The FDA has reviewed the benefits and risks of HT for decades, always finding that the benefits outweighed the risks. Defendants cited 19 studies examining HT and breast cancer risk, the first published in 1959. The Women’s Health Initiative reaffirmed the increased risk of breast cancer, available in the labeling for Prempro in 1995. Labeling for Premarin and Provera included FDA-approved warnings of the breast cancer risk. The physician and patient were adequately warned of risks before use.

VERDICT $34.3 million verdict was returned, including $28 million in total punitive damages against the drug companies.

Was hypertension properly treated in this stroke victim?

AFTER HEAVY VAGINAL BLEEDING was diagnosed in a 49-year-old woman, her gynecologist prescribed medroxyprogesterone acetate. Several months later, she underwent a dilation and curettage for continued bleeding. A year later, her blood pressure (BP) was 140/94 mm Hg, which the physician believed was “white coat” hypertension. The woman returned 10 months later, still complaining of abnormal uterine bleeding, but she refused surgical options; the physician prescribed birth control pills. She returned for a routine exam a year later, when her BP was again elevated. The physician continued the patient’s oral contraceptive prescription and initiated treatment for high BP with triamterene. When the patient called to complain of excessive bleeding the next month, a nurse told her to take ibuprofen and call back if symptoms persisted. Shortly thereafter, the patient suffered a stroke. After rehabilitation, she regained use of her arms and legs, but suffered from foot drop and decreased fine motor skills.

PATIENT’S CLAIM The stroke was caused by uncontrolled hypertension and/or birth control pills. The physician should have initiated treatment the first time her BP was elevated, and it should have been checked more frequently. Birth control pills should have been discontinued when high BP was diagnosed because they are contraindicated in women older than 35 years whose BP is elevated.

PHYSICIAN’S DEFENSE The use of birth control pills was proper; the physician prescribed a low-dose combination medication commonly given to perimenopausal women to control abnormal bleeding. When high BP was first suspected, the physician commenced treatment.

VERDICT A defense verdict was returned.

Painful intercourse reported following incontinence surgery

EIGHT SURGERIES WERE PERFORMED to correct a 54-year-old woman’s cystocele, enterocele, and retrocele. The patient’s bladder, colon, and intestines had been pressing on her vaginal canal causing abdominal pain, painful intercourse, and urinary and fecal incontinence.

PATIENT’S CLAIM The procedures reduced the size of her vaginal opening and the length of her vaginal canal, causing constant pain as well as severe pain with intercourse. She was not informed that this was a risk of surgery.

PHYSICIAN’S DEFENSE The patient’s vaginal opening did shrink due to the release of pressure placed on the vaginal canal by the other organs, but it is still within normal range of vaginal size. The procedures resolved the patient’s incontinence issues.

VERDICT A defense verdict was returned.

Radiotherapy wrong for sarcoma; caused short bowel syndrome

FIBROIDS WERE MORCELLATED during a vaginal hysterectomy in a 56-year-old woman. The patient’s pathology report indicated endometrial stromal sarcoma (ESS). She underwent open surgery for staging and to remove any residual cancer cells that could be identified. The gynecologist referred her to a radiation oncologist. After receiving radiotherapy for 4 months, the patient complained of bowel-related symptoms. Three months later, she sought treatment closer to home for diarrhea and gastrointestinal problems. A surgeon diagnosed radiation-induced short bowel syndrome causing inadequate nutritional absorption. The patient underwent two operations, during which large sections of her bowel were removed, a permanent colostomy was placed. She then required total parenteral nutrition tube feedings.

PLAINTIFF’S CLAIM The radiation oncologist was negligent for recommending and administering radiotherapy because of its limited value in ESS. Hormonal therapy should have been used instead.

PHYSICIAN’S DEFENSE Radiotherapy was necessary because of the patient’s history and disease type. Morcellation during vaginal hysterectomy increased the risk of microscopic cancer cells remaining in the pelvis, supported by the finding of residual cancer cells during the second procedure. Radiotherapy was necessary to treat the residual cancer cells.

VERDICT A defense verdict was returned.

No response to alarm when fetal heart tones are lost

A WOMAN ATTEMPTED VAGINAL BIRTH after having one vaginal birth and one cesarean delivery in the past. Labor progressed slowly with inadequate contractions and lack of descent. After the mother pushed five or six times without progress, the OB left to deliver another baby. Because of lack of progression, the mother requested cesarean delivery, and the husband conveyed their concerns to the nursing staff. The nurses assured them that all was well but did not discuss the parents’ concerns with the OB or other hospital personnel. One hour later, the mother’s uterus ruptured, fetal heart tones were lost from the external fetal monitor, and an alarm sounded.

PLAINTIFF’S CLAIM The nursing staff failed to respond to the alarm immediately; when a response did come, a nurse allegedly stated with excitement that she was amazed that no one had responded. This statement was confirmed by the OB. After 9 minutes of signal loss, a fetal heartbeat of 60 was found, but it was severely bradycardic. The mother was rushed to the OR and the baby was delivered expeditiously. The child was born limp and without respiratory effort, and sustained hypoxic ischemic encephalopathy. At age 5, he had no purposeful movement of his extremities, could not communicate, and was wheelchair-bound, although he was not cognitively impaired.

DEFENDANTS’ DEFENSE The OB offered full policy limits before trial. The hospital claimed that the 9-minute delay in detecting the loss of fetal heart tone and seeking the OB’s intervention was not the proximate cause of the child’s handicaps.

VERDICT A $4.9 million Michigan verdict was reached.

Untreated postpartum infection necessitated hysterectomy

AN 18-YEAR-OLD WOMAN was discharged from the hospital two days after the vaginal birth of her healthy child, although she claimed to not feel well. When a hospital-employed nurse visited her the next day, the patient reported abdominal pain and cramping. Five days later, she returned to the hospital in extreme pain. She was diagnosed with severe Streptococcus A infection, air-lifted to another hospital, and treated with antibiotics for 5 days. A hysterectomy was later performed.

PLAINTIFF’S CLAIM The physician, visiting nurse, and hospital failed to diagnose and treat the infection in a timely manner, resulting in a hysterectomy. Laboratory tests taken before the patient’s hospital discharge showed an elevated white blood cell (WBC) count; the patient should have been prescribed antibiotics before leaving the hospital. The visiting nurse did not react appropriately when the patient reported pain. The hospital was responsible because the results of the WBC test were not entered into the patient’s chart.

DEFENDANTS’ DEFENSE The physician claimed that the elevated WBC count was not recorded in the patient’s medical chart with other lab values. The hospital claimed that a high WBC count is common after childbirth; the test is rarely performed at that time. The only reason it was performed was that the technology automatically recorded WBC when it evaluated hemoglobin and hemocrit. Abdominal cramping reported to the visiting nurse is normal 3 days after childbirth. The patient did not have an infection at discharge or at the time of the nurse’s visit.

VERDICT Suit against the physician was dismissed prior to jury deliberations. A $2.3 million verdict was returned against the hospital.

Did retained sponges lead to PID and gallbladder disease?

A 6-INCH VAGINAL LACERATION was discovered after a woman delivered a healthy baby. The ObGyn, who was covering for the patient’s regular ObGyn because of a snowstorm, could not repair the laceration in the delivery room. He packed the patient’s vagina with gauze sponges, and took her to the OR where he repaired the laceration. The next day, he removed sponges placed after surgery. The patient was discharged with instructions to follow-up with her regular ObGyn. Eight days after delivery, the patient complained to her ObGyn of severe abdominal pain and a foul odor. Antibiotics were prescribed, but she refused a vaginal examination because of the pain. Six weeks after delivery, four gauze sponges were removed from the patient’s vagina.

PLAINTIFF’S CLAIM The physician was negligent in leaving the sponges in her vagina. He should have conducted the follow-up himself because he delivered her child. The infection caused chronic pain from pelvic inflammatory disease (PID), and necessitated the removal of her gallbladder.

PHYSICIAN’S DEFENSE Retained sponges can occur in the absence of negligence. It was proper for the patient to return to her own physician for postoperative follow-up treatment. The patient’s PID and gallbladder problems were unrelated to the retained sponges.

VERDICT A defense verdict was returned. The defendant was granted costs and attorney fees exceeding $27,000.

Patient sues drug companies: “HT caused my breast cancer”

A WOMAN IN HER LATE 50S took a combination of Premarin and Provera for 6 years to treat menopausal symptoms. She was then switched to Prempro for 4 years until she detected a lump in her breast. Her physician diagnosed invasive ductal breast cancer and the patient underwent a left mastectomy. Cancer spread to her lymph nodes; she underwent chemotherapy and radiation treatments. She sued the drug manufacturers.

PATIENT’S CLAIM Years of combination hormone therapy (HT) caused her breast cancer. The pharmaceutical companies failed to adequately test the drugs despite knowledge of their cancer-causing potential. If the defendants had begun cancer studies in the early 1980s when they first learned about the cancer risk, the risk would have been discovered before she began taking HT in 1991. She provided letters dated as early as 1976 from the FDA, independent researchers, and internal drug company scientists urging that cancer risk research be conducted. She claimed the defendants intentionally restricted the publication of medical data outlining the cancerous effects of combination HT to physicians and patients.

DEFENDANTS’ DEFENSE The FDA has reviewed the benefits and risks of HT for decades, always finding that the benefits outweighed the risks. Defendants cited 19 studies examining HT and breast cancer risk, the first published in 1959. The Women’s Health Initiative reaffirmed the increased risk of breast cancer, available in the labeling for Prempro in 1995. Labeling for Premarin and Provera included FDA-approved warnings of the breast cancer risk. The physician and patient were adequately warned of risks before use.

VERDICT $34.3 million verdict was returned, including $28 million in total punitive damages against the drug companies.

Was hypertension properly treated in this stroke victim?

AFTER HEAVY VAGINAL BLEEDING was diagnosed in a 49-year-old woman, her gynecologist prescribed medroxyprogesterone acetate. Several months later, she underwent a dilation and curettage for continued bleeding. A year later, her blood pressure (BP) was 140/94 mm Hg, which the physician believed was “white coat” hypertension. The woman returned 10 months later, still complaining of abnormal uterine bleeding, but she refused surgical options; the physician prescribed birth control pills. She returned for a routine exam a year later, when her BP was again elevated. The physician continued the patient’s oral contraceptive prescription and initiated treatment for high BP with triamterene. When the patient called to complain of excessive bleeding the next month, a nurse told her to take ibuprofen and call back if symptoms persisted. Shortly thereafter, the patient suffered a stroke. After rehabilitation, she regained use of her arms and legs, but suffered from foot drop and decreased fine motor skills.

PATIENT’S CLAIM The stroke was caused by uncontrolled hypertension and/or birth control pills. The physician should have initiated treatment the first time her BP was elevated, and it should have been checked more frequently. Birth control pills should have been discontinued when high BP was diagnosed because they are contraindicated in women older than 35 years whose BP is elevated.

PHYSICIAN’S DEFENSE The use of birth control pills was proper; the physician prescribed a low-dose combination medication commonly given to perimenopausal women to control abnormal bleeding. When high BP was first suspected, the physician commenced treatment.

VERDICT A defense verdict was returned.

Painful intercourse reported following incontinence surgery

EIGHT SURGERIES WERE PERFORMED to correct a 54-year-old woman’s cystocele, enterocele, and retrocele. The patient’s bladder, colon, and intestines had been pressing on her vaginal canal causing abdominal pain, painful intercourse, and urinary and fecal incontinence.

PATIENT’S CLAIM The procedures reduced the size of her vaginal opening and the length of her vaginal canal, causing constant pain as well as severe pain with intercourse. She was not informed that this was a risk of surgery.

PHYSICIAN’S DEFENSE The patient’s vaginal opening did shrink due to the release of pressure placed on the vaginal canal by the other organs, but it is still within normal range of vaginal size. The procedures resolved the patient’s incontinence issues.

VERDICT A defense verdict was returned.

Radiotherapy wrong for sarcoma; caused short bowel syndrome

FIBROIDS WERE MORCELLATED during a vaginal hysterectomy in a 56-year-old woman. The patient’s pathology report indicated endometrial stromal sarcoma (ESS). She underwent open surgery for staging and to remove any residual cancer cells that could be identified. The gynecologist referred her to a radiation oncologist. After receiving radiotherapy for 4 months, the patient complained of bowel-related symptoms. Three months later, she sought treatment closer to home for diarrhea and gastrointestinal problems. A surgeon diagnosed radiation-induced short bowel syndrome causing inadequate nutritional absorption. The patient underwent two operations, during which large sections of her bowel were removed, a permanent colostomy was placed. She then required total parenteral nutrition tube feedings.

PLAINTIFF’S CLAIM The radiation oncologist was negligent for recommending and administering radiotherapy because of its limited value in ESS. Hormonal therapy should have been used instead.

PHYSICIAN’S DEFENSE Radiotherapy was necessary because of the patient’s history and disease type. Morcellation during vaginal hysterectomy increased the risk of microscopic cancer cells remaining in the pelvis, supported by the finding of residual cancer cells during the second procedure. Radiotherapy was necessary to treat the residual cancer cells.

VERDICT A defense verdict was returned.

No response to alarm when fetal heart tones are lost

A WOMAN ATTEMPTED VAGINAL BIRTH after having one vaginal birth and one cesarean delivery in the past. Labor progressed slowly with inadequate contractions and lack of descent. After the mother pushed five or six times without progress, the OB left to deliver another baby. Because of lack of progression, the mother requested cesarean delivery, and the husband conveyed their concerns to the nursing staff. The nurses assured them that all was well but did not discuss the parents’ concerns with the OB or other hospital personnel. One hour later, the mother’s uterus ruptured, fetal heart tones were lost from the external fetal monitor, and an alarm sounded.

PLAINTIFF’S CLAIM The nursing staff failed to respond to the alarm immediately; when a response did come, a nurse allegedly stated with excitement that she was amazed that no one had responded. This statement was confirmed by the OB. After 9 minutes of signal loss, a fetal heartbeat of 60 was found, but it was severely bradycardic. The mother was rushed to the OR and the baby was delivered expeditiously. The child was born limp and without respiratory effort, and sustained hypoxic ischemic encephalopathy. At age 5, he had no purposeful movement of his extremities, could not communicate, and was wheelchair-bound, although he was not cognitively impaired.

DEFENDANTS’ DEFENSE The OB offered full policy limits before trial. The hospital claimed that the 9-minute delay in detecting the loss of fetal heart tone and seeking the OB’s intervention was not the proximate cause of the child’s handicaps.

VERDICT A $4.9 million Michigan verdict was reached.

Untreated postpartum infection necessitated hysterectomy

AN 18-YEAR-OLD WOMAN was discharged from the hospital two days after the vaginal birth of her healthy child, although she claimed to not feel well. When a hospital-employed nurse visited her the next day, the patient reported abdominal pain and cramping. Five days later, she returned to the hospital in extreme pain. She was diagnosed with severe Streptococcus A infection, air-lifted to another hospital, and treated with antibiotics for 5 days. A hysterectomy was later performed.

PLAINTIFF’S CLAIM The physician, visiting nurse, and hospital failed to diagnose and treat the infection in a timely manner, resulting in a hysterectomy. Laboratory tests taken before the patient’s hospital discharge showed an elevated white blood cell (WBC) count; the patient should have been prescribed antibiotics before leaving the hospital. The visiting nurse did not react appropriately when the patient reported pain. The hospital was responsible because the results of the WBC test were not entered into the patient’s chart.

DEFENDANTS’ DEFENSE The physician claimed that the elevated WBC count was not recorded in the patient’s medical chart with other lab values. The hospital claimed that a high WBC count is common after childbirth; the test is rarely performed at that time. The only reason it was performed was that the technology automatically recorded WBC when it evaluated hemoglobin and hemocrit. Abdominal cramping reported to the visiting nurse is normal 3 days after childbirth. The patient did not have an infection at discharge or at the time of the nurse’s visit.

VERDICT Suit against the physician was dismissed prior to jury deliberations. A $2.3 million verdict was returned against the hospital.

Did retained sponges lead to PID and gallbladder disease?

A 6-INCH VAGINAL LACERATION was discovered after a woman delivered a healthy baby. The ObGyn, who was covering for the patient’s regular ObGyn because of a snowstorm, could not repair the laceration in the delivery room. He packed the patient’s vagina with gauze sponges, and took her to the OR where he repaired the laceration. The next day, he removed sponges placed after surgery. The patient was discharged with instructions to follow-up with her regular ObGyn. Eight days after delivery, the patient complained to her ObGyn of severe abdominal pain and a foul odor. Antibiotics were prescribed, but she refused a vaginal examination because of the pain. Six weeks after delivery, four gauze sponges were removed from the patient’s vagina.

PLAINTIFF’S CLAIM The physician was negligent in leaving the sponges in her vagina. He should have conducted the follow-up himself because he delivered her child. The infection caused chronic pain from pelvic inflammatory disease (PID), and necessitated the removal of her gallbladder.

PHYSICIAN’S DEFENSE Retained sponges can occur in the absence of negligence. It was proper for the patient to return to her own physician for postoperative follow-up treatment. The patient’s PID and gallbladder problems were unrelated to the retained sponges.

VERDICT A defense verdict was returned. The defendant was granted costs and attorney fees exceeding $27,000.

Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.

Kidney Damage After Surgical Clip Left on Ureter
A woman underwent surgical removal of her left Fallopian tube and ovary for treatment of an ovarian tumor. Adhesions noted around the right Fallopian tube were lysed. The surgery was performed by the defendant.

Almost two years later, the patient underwent a second surgery which included a laparoscopy, lysis of adhesions, and biopsy of the right ovary. No mention was made at that time of a clip on the left ureter, but the area may not have been visible. This surgery was performed by a different physician.

The patient underwent a third surgery three months later, an exploratory laparotomy with lysis of adhesions and right ovarian cystectomy and partial omentectomy. During this procedure, performed by a third surgeon, visual inspection of the left kidney revealed that it appeared a bit enlarged, compared with the right. The right ureter was identified and noted to be separate from the surgical area during the operation on the right ovary.

Ten years later, the patient underwent CT urography to evaluate complaints of left-sided abdominal pain. She was diagnosed with hydronephrosis of the left kidney. CT revealed a chronically obstructed left kidney, likely attributable to a surgical clip that was obstructing the distal third of the left ureter. Her left kidney was essentially nonfunctioning. The urologist noted that the surgical clip was likely placed at the time of the patient’s ovarian surgery “10 years ago” (although the surgery in question had actually been performed 12 years earlier).

The plaintiff alleged negligence by the defendant in placing the clip on the left ureter, resulting in kidney damage.

The defendant moved for dismissal and summary judgment based on the statute of limitations and the statute of repose. Both motions were denied. The defendant also argued that it would have been impossible to clip the ureter at the time of the original surgery without the plaintiff experiencing immediate excruciating pain. He admitted, however, that one could have a partial obstruction without pain. The defendant also acknowledged that a partial obstruction could lead to total obstruction and death of the kidney years later.

An arbitration award of $450,000 was made.

Conservative Advice for Postprandial Symptoms
Four years after undergoing gastric bypass surgery, a 48-year-old woman experienced nausea, dry heaves, and a sensation of fullness about 20 minutes after eating. She called her surgeon’s office and reported her symptoms to a representative of his answering service. Dr. M., an internist who was covering for the surgeon that night, called the patient back to discuss her symptoms. She instructed the patient to drink some hot tea, lie down, and call back in an hour or two.

When the patient did not call as requested, Dr. M. phoned her. Her husband, who took the call, reported that the woman was feeling better and had gone to sleep. Dr. M. instructed him to call her if there were further symptoms or problems. She received no additional calls.

The patient awoke in the very early morning hours with shortness of breath, and her husband drove her immediately to the hospital. She had a strangulated bowel and lactic acidosis, which led to full cardiac arrest. The necrotic bowel was surgically removed, but the woman was brain-dead as a result of her arrest. She was taken off life support three days later.

The plaintiff claimed that Dr. M. should have directed the decedent to go to the emergency department. Dr. M. claimed she was never told that the decedent had previously had a small bowel obstruction that was not surgically repaired. The defendant also claimed that the decedent probably experienced an acute bowel obstruction in the early morning hours, which could not have been foreseen.

According to a published account, a defense verdict was returned. A posttrial motion was pending.

Failure to Diagnose Testicular Torsion
A 12-year-old boy presented to his pediatrician with complaints of left groin pain. He reported that the pain had begun when he slid into third base during a baseball game six days earlier.

The pediatrician found trauma to the groin with questionable blood in the sac versus torsion of the testes. He sent the boy to a local hospital for an ultrasound to rule out testicular torsion. A physical examination by the nursing staff at the defendant hospital revealed that the boy’s left testicle was three times larger than the right testicle; the emergency physician noted the left testicle to be markedly enlarged, spongy, and tender. There was no evidence of scrotal swelling or ecchymosis. The physician also noted that the testes were mobile in the scrotal sac with no evidence of a hernia.

Ultrasonography showed testicular contusion with interstitial edema, a left epididymal head cyst, and a left hydrocele. The left testis showed vascularity, which was slightly decreased in the upper pole. The findings were discussed with urology and a follow-up ultrasound was recommended.

The plaintiff was discharged home with instructions to follow up in two weeks for a repeat ultrasound. Four days later, he returned to his pediatrician, who noted that the scrotum was hard to the touch with pain on palpation. On the pediatrician’s recommendation, the plaintiff was returned to the defendant hospital’s emergency department. At admission, it was noted that the testicle had enlarged and was more painful than during the previous visit.

Ultrasonography revealed left testicular ischemia without any left-sided vascular flow signal demonstrated. The plaintiff was then diagnosed with testicular torsion and taken to surgery for a left orchiectomy with contralateral septopexy. The plaintiff was discharged home later that day.

The plaintiff alleged negligence in the failure to diagnose testicular torsion at the time of his first presentation, which he claimed led to ischemia, necrosis, and loss of his left testicle. The defendants all denied negligence, as well as causation and harm. A $662,500 settlement was reached.

Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.

Kidney Damage After Surgical Clip Left on Ureter
A woman underwent surgical removal of her left Fallopian tube and ovary for treatment of an ovarian tumor. Adhesions noted around the right Fallopian tube were lysed. The surgery was performed by the defendant.

Almost two years later, the patient underwent a second surgery which included a laparoscopy, lysis of adhesions, and biopsy of the right ovary. No mention was made at that time of a clip on the left ureter, but the area may not have been visible. This surgery was performed by a different physician.

The patient underwent a third surgery three months later, an exploratory laparotomy with lysis of adhesions and right ovarian cystectomy and partial omentectomy. During this procedure, performed by a third surgeon, visual inspection of the left kidney revealed that it appeared a bit enlarged, compared with the right. The right ureter was identified and noted to be separate from the surgical area during the operation on the right ovary.

Ten years later, the patient underwent CT urography to evaluate complaints of left-sided abdominal pain. She was diagnosed with hydronephrosis of the left kidney. CT revealed a chronically obstructed left kidney, likely attributable to a surgical clip that was obstructing the distal third of the left ureter. Her left kidney was essentially nonfunctioning. The urologist noted that the surgical clip was likely placed at the time of the patient’s ovarian surgery “10 years ago” (although the surgery in question had actually been performed 12 years earlier).

The plaintiff alleged negligence by the defendant in placing the clip on the left ureter, resulting in kidney damage.

The defendant moved for dismissal and summary judgment based on the statute of limitations and the statute of repose. Both motions were denied. The defendant also argued that it would have been impossible to clip the ureter at the time of the original surgery without the plaintiff experiencing immediate excruciating pain. He admitted, however, that one could have a partial obstruction without pain. The defendant also acknowledged that a partial obstruction could lead to total obstruction and death of the kidney years later.

An arbitration award of $450,000 was made.

Conservative Advice for Postprandial Symptoms
Four years after undergoing gastric bypass surgery, a 48-year-old woman experienced nausea, dry heaves, and a sensation of fullness about 20 minutes after eating. She called her surgeon’s office and reported her symptoms to a representative of his answering service. Dr. M., an internist who was covering for the surgeon that night, called the patient back to discuss her symptoms. She instructed the patient to drink some hot tea, lie down, and call back in an hour or two.

When the patient did not call as requested, Dr. M. phoned her. Her husband, who took the call, reported that the woman was feeling better and had gone to sleep. Dr. M. instructed him to call her if there were further symptoms or problems. She received no additional calls.

The patient awoke in the very early morning hours with shortness of breath, and her husband drove her immediately to the hospital. She had a strangulated bowel and lactic acidosis, which led to full cardiac arrest. The necrotic bowel was surgically removed, but the woman was brain-dead as a result of her arrest. She was taken off life support three days later.

The plaintiff claimed that Dr. M. should have directed the decedent to go to the emergency department. Dr. M. claimed she was never told that the decedent had previously had a small bowel obstruction that was not surgically repaired. The defendant also claimed that the decedent probably experienced an acute bowel obstruction in the early morning hours, which could not have been foreseen.

According to a published account, a defense verdict was returned. A posttrial motion was pending.

Failure to Diagnose Testicular Torsion
A 12-year-old boy presented to his pediatrician with complaints of left groin pain. He reported that the pain had begun when he slid into third base during a baseball game six days earlier.

The pediatrician found trauma to the groin with questionable blood in the sac versus torsion of the testes. He sent the boy to a local hospital for an ultrasound to rule out testicular torsion. A physical examination by the nursing staff at the defendant hospital revealed that the boy’s left testicle was three times larger than the right testicle; the emergency physician noted the left testicle to be markedly enlarged, spongy, and tender. There was no evidence of scrotal swelling or ecchymosis. The physician also noted that the testes were mobile in the scrotal sac with no evidence of a hernia.

Ultrasonography showed testicular contusion with interstitial edema, a left epididymal head cyst, and a left hydrocele. The left testis showed vascularity, which was slightly decreased in the upper pole. The findings were discussed with urology and a follow-up ultrasound was recommended.

The plaintiff was discharged home with instructions to follow up in two weeks for a repeat ultrasound. Four days later, he returned to his pediatrician, who noted that the scrotum was hard to the touch with pain on palpation. On the pediatrician’s recommendation, the plaintiff was returned to the defendant hospital’s emergency department. At admission, it was noted that the testicle had enlarged and was more painful than during the previous visit.

Ultrasonography revealed left testicular ischemia without any left-sided vascular flow signal demonstrated. The plaintiff was then diagnosed with testicular torsion and taken to surgery for a left orchiectomy with contralateral septopexy. The plaintiff was discharged home later that day.

The plaintiff alleged negligence in the failure to diagnose testicular torsion at the time of his first presentation, which he claimed led to ischemia, necrosis, and loss of his left testicle. The defendants all denied negligence, as well as causation and harm. A $662,500 settlement was reached.

Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.

Kidney Damage After Surgical Clip Left on Ureter
A woman underwent surgical removal of her left Fallopian tube and ovary for treatment of an ovarian tumor. Adhesions noted around the right Fallopian tube were lysed. The surgery was performed by the defendant.

Almost two years later, the patient underwent a second surgery which included a laparoscopy, lysis of adhesions, and biopsy of the right ovary. No mention was made at that time of a clip on the left ureter, but the area may not have been visible. This surgery was performed by a different physician.

The patient underwent a third surgery three months later, an exploratory laparotomy with lysis of adhesions and right ovarian cystectomy and partial omentectomy. During this procedure, performed by a third surgeon, visual inspection of the left kidney revealed that it appeared a bit enlarged, compared with the right. The right ureter was identified and noted to be separate from the surgical area during the operation on the right ovary.

Ten years later, the patient underwent CT urography to evaluate complaints of left-sided abdominal pain. She was diagnosed with hydronephrosis of the left kidney. CT revealed a chronically obstructed left kidney, likely attributable to a surgical clip that was obstructing the distal third of the left ureter. Her left kidney was essentially nonfunctioning. The urologist noted that the surgical clip was likely placed at the time of the patient’s ovarian surgery “10 years ago” (although the surgery in question had actually been performed 12 years earlier).

The plaintiff alleged negligence by the defendant in placing the clip on the left ureter, resulting in kidney damage.

The defendant moved for dismissal and summary judgment based on the statute of limitations and the statute of repose. Both motions were denied. The defendant also argued that it would have been impossible to clip the ureter at the time of the original surgery without the plaintiff experiencing immediate excruciating pain. He admitted, however, that one could have a partial obstruction without pain. The defendant also acknowledged that a partial obstruction could lead to total obstruction and death of the kidney years later.

An arbitration award of $450,000 was made.

Conservative Advice for Postprandial Symptoms
Four years after undergoing gastric bypass surgery, a 48-year-old woman experienced nausea, dry heaves, and a sensation of fullness about 20 minutes after eating. She called her surgeon’s office and reported her symptoms to a representative of his answering service. Dr. M., an internist who was covering for the surgeon that night, called the patient back to discuss her symptoms. She instructed the patient to drink some hot tea, lie down, and call back in an hour or two.

When the patient did not call as requested, Dr. M. phoned her. Her husband, who took the call, reported that the woman was feeling better and had gone to sleep. Dr. M. instructed him to call her if there were further symptoms or problems. She received no additional calls.

The patient awoke in the very early morning hours with shortness of breath, and her husband drove her immediately to the hospital. She had a strangulated bowel and lactic acidosis, which led to full cardiac arrest. The necrotic bowel was surgically removed, but the woman was brain-dead as a result of her arrest. She was taken off life support three days later.

The plaintiff claimed that Dr. M. should have directed the decedent to go to the emergency department. Dr. M. claimed she was never told that the decedent had previously had a small bowel obstruction that was not surgically repaired. The defendant also claimed that the decedent probably experienced an acute bowel obstruction in the early morning hours, which could not have been foreseen.

According to a published account, a defense verdict was returned. A posttrial motion was pending.

Failure to Diagnose Testicular Torsion
A 12-year-old boy presented to his pediatrician with complaints of left groin pain. He reported that the pain had begun when he slid into third base during a baseball game six days earlier.

The pediatrician found trauma to the groin with questionable blood in the sac versus torsion of the testes. He sent the boy to a local hospital for an ultrasound to rule out testicular torsion. A physical examination by the nursing staff at the defendant hospital revealed that the boy’s left testicle was three times larger than the right testicle; the emergency physician noted the left testicle to be markedly enlarged, spongy, and tender. There was no evidence of scrotal swelling or ecchymosis. The physician also noted that the testes were mobile in the scrotal sac with no evidence of a hernia.

Ultrasonography showed testicular contusion with interstitial edema, a left epididymal head cyst, and a left hydrocele. The left testis showed vascularity, which was slightly decreased in the upper pole. The findings were discussed with urology and a follow-up ultrasound was recommended.

The plaintiff was discharged home with instructions to follow up in two weeks for a repeat ultrasound. Four days later, he returned to his pediatrician, who noted that the scrotum was hard to the touch with pain on palpation. On the pediatrician’s recommendation, the plaintiff was returned to the defendant hospital’s emergency department. At admission, it was noted that the testicle had enlarged and was more painful than during the previous visit.

Ultrasonography revealed left testicular ischemia without any left-sided vascular flow signal demonstrated. The plaintiff was then diagnosed with testicular torsion and taken to surgery for a left orchiectomy with contralateral septopexy. The plaintiff was discharged home later that day.

The plaintiff alleged negligence in the failure to diagnose testicular torsion at the time of his first presentation, which he claimed led to ischemia, necrosis, and loss of his left testicle. The defendants all denied negligence, as well as causation and harm. A $662,500 settlement was reached.

Ureter was severed, reattached, obstructed

A WOMAN IN HER 60S underwent surgery to remove a large abdominal mass. The ObGyn resected a 7-cm portion of her ureter thinking it was a blood vessel. Realizing his mistake during the surgery, he contacted a urologist, who reattached the ureter. Later the patient was rehospitalized when she suffered a ureteral obstruction.

PATIENT’S CLAIM The ObGyn was negligent for failing to identify and protect the ureter, and to properly assess the area before resecting the mass. Also, ureteral obstructions were likely to reoccur.

PHYSICIAN’S DEFENSE The abdominal mass grossly distorted the patient’s anatomy so that the ureter was in front of the mass, which was an unusual presentation. Also, the injury is a known risk of this procedure.

VERDICT Michigan defense verdict.

Did retained cervical cup cause all her pain?

A 40-YEAR-OLD WOMAN was discharged the day after her ObGyn performed laparoscopic supracervical hysterectomy. Two months later, a KOH cervical cup was found in her vagina when she presented at the emergency room for hip pain. It was removed the next day.

PATIENT’S CLAIM The ObGyn failed to remove the cervical cup before her discharge after the original procedure. It compressed her S1 and S2 nerves as well as the pudendal nerve, causing constant pelvic pain. Its presence also changed her gait, resulting in pain and sciatica. Her primary care physician examined her six times following the surgery, but never performed a pelvic exam. It was negligent to leave the device inside her and to fail to find it in the weeks before it was removed.

PHYSICIAN’S DEFENSE The ObGyn admitted negligence for not removing the device at the end of the original procedure. He denied negligence in her follow-up care. Also, her pain was unrelated to the device.

VERDICT $63,500 California verdict against the ObGyn was reduced to no recovery due to a set-off by a confidential settlement with the hospital. The patient had sued the ObGyn, the hospital and its parent company, the device manufacturer, the primary care physician, and the assisting surgeon. The hospital settled before trial, and except for the ObGyn, cases against the other defendants were dismissed.

Sickle-cell mother ends up paralyzed

AFTER DELIVERY OF HER CHILD, a 22-year-old woman with sickle cell trait suffered a precipitous drop in blood pressure. When she was given phenylephrine, her blood pressure rose, and then dropped quickly to as low as 94/17. For nearly half an hour, nothing was done. When she was discharged from recovery, she was unable to move her legs. She remains paraplegic.

PATIENT’S CLAIM The paralysis was most likely caused by a drop in blood flow and proper perfusion in the area of the artery of Adam-kiewicz, resulting in a sludging and subsequent paralysis.

PHYSICIAN’S DEFENSE Not reported.

VERDICT Confidential District of Columbia settlement. During discovery, it was learned that a nurse, A, added a note at a later time saying that she had received approval to transfer the patient from another nurse, B, who had received approval from the anesthesiologist. Both nurse B and the anesthesiologist denied this claim, and the hospital filed a third-party claim against nurse A and her employer.

Fetal remains not kept for Muslim burial

A WOMAN EXPERIENCED PROBLEMS with her pregnancy at 17 to 18 weeks and went to the hospital. She was treated by a midwife, but suffered a miscarriage. The father viewed the remains and requested that they be returned to him so he and his wife could bury their child according to their Muslim beliefs. He returned to pick up the fetus, but the hospital no longer had the remains. The parents were unable to have a funeral.

PLAINTIFF’S CLAIM The hospital was negligent for failing to retain the remains as requested. As a result, the father suffered major depressive disorder and posttraumatic stress disorder.

HOSPITAL’S DEFENSE The plaintiff suffered no damage.

VERDICT $110,000 North Carolina verdict against the hospital.

Ureter was severed, reattached, obstructed

A WOMAN IN HER 60S underwent surgery to remove a large abdominal mass. The ObGyn resected a 7-cm portion of her ureter thinking it was a blood vessel. Realizing his mistake during the surgery, he contacted a urologist, who reattached the ureter. Later the patient was rehospitalized when she suffered a ureteral obstruction.

PATIENT’S CLAIM The ObGyn was negligent for failing to identify and protect the ureter, and to properly assess the area before resecting the mass. Also, ureteral obstructions were likely to reoccur.

PHYSICIAN’S DEFENSE The abdominal mass grossly distorted the patient’s anatomy so that the ureter was in front of the mass, which was an unusual presentation. Also, the injury is a known risk of this procedure.

VERDICT Michigan defense verdict.

Did retained cervical cup cause all her pain?

A 40-YEAR-OLD WOMAN was discharged the day after her ObGyn performed laparoscopic supracervical hysterectomy. Two months later, a KOH cervical cup was found in her vagina when she presented at the emergency room for hip pain. It was removed the next day.

PATIENT’S CLAIM The ObGyn failed to remove the cervical cup before her discharge after the original procedure. It compressed her S1 and S2 nerves as well as the pudendal nerve, causing constant pelvic pain. Its presence also changed her gait, resulting in pain and sciatica. Her primary care physician examined her six times following the surgery, but never performed a pelvic exam. It was negligent to leave the device inside her and to fail to find it in the weeks before it was removed.

PHYSICIAN’S DEFENSE The ObGyn admitted negligence for not removing the device at the end of the original procedure. He denied negligence in her follow-up care. Also, her pain was unrelated to the device.

VERDICT $63,500 California verdict against the ObGyn was reduced to no recovery due to a set-off by a confidential settlement with the hospital. The patient had sued the ObGyn, the hospital and its parent company, the device manufacturer, the primary care physician, and the assisting surgeon. The hospital settled before trial, and except for the ObGyn, cases against the other defendants were dismissed.

Sickle-cell mother ends up paralyzed

AFTER DELIVERY OF HER CHILD, a 22-year-old woman with sickle cell trait suffered a precipitous drop in blood pressure. When she was given phenylephrine, her blood pressure rose, and then dropped quickly to as low as 94/17. For nearly half an hour, nothing was done. When she was discharged from recovery, she was unable to move her legs. She remains paraplegic.

PATIENT’S CLAIM The paralysis was most likely caused by a drop in blood flow and proper perfusion in the area of the artery of Adam-kiewicz, resulting in a sludging and subsequent paralysis.

PHYSICIAN’S DEFENSE Not reported.

VERDICT Confidential District of Columbia settlement. During discovery, it was learned that a nurse, A, added a note at a later time saying that she had received approval to transfer the patient from another nurse, B, who had received approval from the anesthesiologist. Both nurse B and the anesthesiologist denied this claim, and the hospital filed a third-party claim against nurse A and her employer.

Fetal remains not kept for Muslim burial

A WOMAN EXPERIENCED PROBLEMS with her pregnancy at 17 to 18 weeks and went to the hospital. She was treated by a midwife, but suffered a miscarriage. The father viewed the remains and requested that they be returned to him so he and his wife could bury their child according to their Muslim beliefs. He returned to pick up the fetus, but the hospital no longer had the remains. The parents were unable to have a funeral.

PLAINTIFF’S CLAIM The hospital was negligent for failing to retain the remains as requested. As a result, the father suffered major depressive disorder and posttraumatic stress disorder.

HOSPITAL’S DEFENSE The plaintiff suffered no damage.

VERDICT $110,000 North Carolina verdict against the hospital.

Ureter was severed, reattached, obstructed

A WOMAN IN HER 60S underwent surgery to remove a large abdominal mass. The ObGyn resected a 7-cm portion of her ureter thinking it was a blood vessel. Realizing his mistake during the surgery, he contacted a urologist, who reattached the ureter. Later the patient was rehospitalized when she suffered a ureteral obstruction.

PATIENT’S CLAIM The ObGyn was negligent for failing to identify and protect the ureter, and to properly assess the area before resecting the mass. Also, ureteral obstructions were likely to reoccur.

PHYSICIAN’S DEFENSE The abdominal mass grossly distorted the patient’s anatomy so that the ureter was in front of the mass, which was an unusual presentation. Also, the injury is a known risk of this procedure.

VERDICT Michigan defense verdict.

Did retained cervical cup cause all her pain?

A 40-YEAR-OLD WOMAN was discharged the day after her ObGyn performed laparoscopic supracervical hysterectomy. Two months later, a KOH cervical cup was found in her vagina when she presented at the emergency room for hip pain. It was removed the next day.

PATIENT’S CLAIM The ObGyn failed to remove the cervical cup before her discharge after the original procedure. It compressed her S1 and S2 nerves as well as the pudendal nerve, causing constant pelvic pain. Its presence also changed her gait, resulting in pain and sciatica. Her primary care physician examined her six times following the surgery, but never performed a pelvic exam. It was negligent to leave the device inside her and to fail to find it in the weeks before it was removed.

PHYSICIAN’S DEFENSE The ObGyn admitted negligence for not removing the device at the end of the original procedure. He denied negligence in her follow-up care. Also, her pain was unrelated to the device.

VERDICT $63,500 California verdict against the ObGyn was reduced to no recovery due to a set-off by a confidential settlement with the hospital. The patient had sued the ObGyn, the hospital and its parent company, the device manufacturer, the primary care physician, and the assisting surgeon. The hospital settled before trial, and except for the ObGyn, cases against the other defendants were dismissed.

Sickle-cell mother ends up paralyzed

AFTER DELIVERY OF HER CHILD, a 22-year-old woman with sickle cell trait suffered a precipitous drop in blood pressure. When she was given phenylephrine, her blood pressure rose, and then dropped quickly to as low as 94/17. For nearly half an hour, nothing was done. When she was discharged from recovery, she was unable to move her legs. She remains paraplegic.

PATIENT’S CLAIM The paralysis was most likely caused by a drop in blood flow and proper perfusion in the area of the artery of Adam-kiewicz, resulting in a sludging and subsequent paralysis.

PHYSICIAN’S DEFENSE Not reported.

VERDICT Confidential District of Columbia settlement. During discovery, it was learned that a nurse, A, added a note at a later time saying that she had received approval to transfer the patient from another nurse, B, who had received approval from the anesthesiologist. Both nurse B and the anesthesiologist denied this claim, and the hospital filed a third-party claim against nurse A and her employer.

Fetal remains not kept for Muslim burial

A WOMAN EXPERIENCED PROBLEMS with her pregnancy at 17 to 18 weeks and went to the hospital. She was treated by a midwife, but suffered a miscarriage. The father viewed the remains and requested that they be returned to him so he and his wife could bury their child according to their Muslim beliefs. He returned to pick up the fetus, but the hospital no longer had the remains. The parents were unable to have a funeral.

PLAINTIFF’S CLAIM The hospital was negligent for failing to retain the remains as requested. As a result, the father suffered major depressive disorder and posttraumatic stress disorder.

HOSPITAL’S DEFENSE The plaintiff suffered no damage.

VERDICT $110,000 North Carolina verdict against the hospital.