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    Legally Speaking: Pre-trial agreements alter monetary awards


    Complications during prolapse repair surgery

    A 67-year-old New Jersey woman suffering from urinary incontinence underwent an operation to address the prolapse and a hysterectomy. She suffered complications due to a tear in the transverse colon, and developed infections that led to further surgeries, a colostomy, malabsorption, and frequent intravenous treatments.

    The woman sued the gynecologist and claimed that he deviated from the standard of care by failing to convert from a laparoscopic procedure to an open one when complications arose. The gynecologist argued that other doctors involved with the woman’s care were at fault for the patient’s complications and injury.

    The verdict

    The parties entered into a settlement in the amount of $6.25 million.

    Failure to recognize postpartum hemorrhage leads to death

    In 2014, a California woman pregnant with her second child went to a hospital with symptoms of labor. She underwent a repeat cesarean performed by her obstetrician. At the conclusion of the operation the anesthesiologist removed the surgical drapes and discovered massive blood loss. The patient became hypotensive and tachycardic and was hypovolemic. He ordered medications and blood products, including 4 units of packed RBCs. The decision was made to transfer the woman to the intensive care unit (ICU) and a critical care specialist was notified of the patient’s condition, including the possibility that she was still actively bleeding. She was taken to the ICU 90 minutes after the conclusion of the cesarean. Seventeen minutes later the obstetrician left the hospital, noting that the patient’s vital signs were normal. Her vital signs actually continued to deteriorate and about 3 hours, later a code blue was called and she was placed on a respirator. She was eventually taken back to the operating room but never recovered and her family ultimately removed her from life support. She died 5 days after the cesarean delivery.

    Recommended: Debriefing after adverse outcomes to improve quality and patient safety

    The patient’s husband and 2 minor sons sued the obstetrician, the anesthesiologist, the critical care specialist, a neurologist, a hematologist, and the hospital. The hospital settled for a confidential amount and the anesthesiologist, neurologist, and hematologist were dismissed from the case. The matter went forward against the obstetrician and critical care specialist. The suit claimed the obstetrician was absent from the operating room immediately post-op and that he did not follow up on the patient’s status after leaving the hospital. The notes made by the ICU nurses after they received the patient indicated she was still actively bleeding, and despite repeated calls to the critical care specialist, the patient was not seen and continued to bleed.

    The obstetrician countered that he remained in the operating room after the surgery and left the hospital only after he placed an intrauterine balloon and administered medications to the patient. He also disputed the accuracy of the nurse’s notes, which alleged that “at all times” the patient’s vital signs indicated active bleeding. The critical care specialist argued that he had recommended to the anesthesiologist that he keep the patient in the operating room instead of transferring her to the ICU and he also denied that he received any contact or calls from the ICU staff after the initial admission to the ICU.

    The verdict

    The jury found the critical care specialist was not negligent but that the obstetrician was and determined the patient’s present value of damages totaled $9.28 million.

    NEXT: Failed tubal ligation results in unintended pregnancy

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    • UBM User
      After years of reading about trial and settlement results, it strikes me that there is no real educational purpose reading about the cases selected. Clearly, as readers not privy to the additional details necessary to render a peer-reviewed opinion, we are left with a recurring theme. What are we supposed to conclude? Let's be frank - it is simply that our current tort system is incapable - by its own design - to render a predictable outcome. Attempts to rationalize this are disingenuous, at best. This is a national disgrace and our respective physician representative organizations have been frustrated for decades at every attempt to reform it by making the system fairer to the alleged injured party and to the providers who render care. OBGs and our specialty have taken many direct hits as a result. So, why do keep reading about these cases? Why are we even considering a strategy where the physician is put in a "catch-22" and loses each time? It may have something to do with the fact that the people in control of the system like it that way because they benefit? If they were actually concerned about the unreliable results of "their system" and if they had a conscious they would be proponents for an alternative system where justice could be reliably metered out.


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