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    Did negligence or nature cause this miscarriage?

     

     

    Andrew I. Kaplan, Esq, is a partner at Aaronson, Rappaport, Feinstein & Deutsch, LLP, New York, New York, specializing in medical malpractice defense and health care litigation. This case was successfully tried by his partner Robert Cecala, Esq.

     

    A 20-year-old woman presented to a hospital on July 20, 2009, at 2:55 am complaining of abdominal pain. She was triaged immediately and noted to be 18 ½ weeks pregnant and receiving prenatal care at an ob/gyn clinic. Her medical history was significant for ovarian cancer (Stage 1C), with surgical treatment consisting of a right oophorectomy in August 2008, followed by chemotherapy, which ended in November 2008.

    Based upon an ob consult sheet by a third-year resident (PGY-3), it appeared that the first treatment the patient received for this pregnancy was during an emergency department (ED) visit on April 27, 2009. During that presentation, the patient claimed that the date of her last menstrual period (LMP) was March 20 to March 25, 2009 and she complained of pelvic pressure and vomiting for 2 days. She denied any vaginal bleeding. The PGY-3 believed she had a likely intrauterine pregnancy (IUP) and instructed her to follow up the next day at the high-risk ob/gyn clinic and undergo an ultrasound (U/S). There was no evidence that consult took place. The plaintiff did not present to the clinic until May 20, when everything was noted to be normal. At her next clinic visit on June 12, her estimated date of delivery (EDD) was December 25, 2009. At another clinic visit on June 24, everything was again noted to be normal. A fetal anatomy scan was to be performed in July.

    During the July 20 ED presentation at issue, the patient denied vaginal bleeding or discharge, back pain, fever, or chills, but she claimed she felt as if she were “having a miscarriage.” The patient was seen by an emergency medicine (EM) PGY-2 resident and an EM attending physician at 5:11 am. A bedside U/S was done by both doctors, which showed an IUP and fetal heart rate (FHR) in the 150s. No pelvic examination was performed. The discharge plan was to have the patient follow up with the ob/gyn clinic the next day.

     

    Andrew I. Kaplan, Esq
    Mr. Kaplan is a partner at Aaronson, Rappaport, Feinstein & Deutsch, LLP, specializing in medical malpractice defense and healthcare ...

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    • Dr. G.L.
      Though the correct verdict was reached here, it still concerns me that in our current system, OB patients receive much of their OB care via emergency departments. How much of this could have been avoided if the patient's OB doctor had simply gone in and done the evaluation him/herself?

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