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    Maternal death from intracranial hemorrhage

    Case hinges on family physician’s knowledge of obstetric conditions

    A 34-year-old Ohio woman was under the care of her longtime family physician for her pregnancy in 2009. The physician had minor privileges to deliver uncomplicated pregnancies at a specific hospital. The patient was in her third trimester when she presented for a prenatal visit complaining of a headache and a cough. Her blood pressure (BP) was 130/90. Two days later, she reported she had acute vaginal bleeding and a headache. The physician admitted her to the hospital with a diagnosis of potential placental abruption. An ultrasound (U/S) revealed oligohydramnios, intrauterine growth restriction (IUGR), and grade II placenta. She had repeated high BP readings, headaches, and decreasing platelets. The fetal heart rate (FHR) monitor showed variable and late decelerations. She was discharged to another hospital to undergo another U/S evaluation.

    Five days after her original admission to the hospital, the patient’s husband informed the physician that the woman was vomiting and had abdominal pain and headaches. He brought her to the hospital, where her BP was found to be 155/100. She complained of severe headache from front to back, constant throbbing, facial edema, and vomiting. She was admitted and at 3:15 AM the following day the nurse found her unresponsive. The on-call obstetrician diagnosed her with eclampsia. He ordered magnesium sulfate, hydralazine, and an immediate cesarean. The infant was delivered, but the patient remained unresponsive and a CT scan revealed a massive intracranial hemorrhage. The patient was pronounced dead at 5:10 PM.

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    A lawsuit was filed against the family physician, her group, the hospital, and the nurse involved in the patient’s care. The claims included the fact that the family physician never called for an obstetrician to treat the patient, nor did the physician come to the hospital to evaluate her patient. It was alleged that she deviated from the accepted standard of medical care by failing to adequately diagnose and treat the patient’s condition or refer her to an obstetrician and, as a result, the patient suffered severe injury causing her death. Another claim was that the physician materially misrepresented to the patient that she was experienced and trained in the treatment of obstetric conditions.

    The defense contended that the physician met the standard of care and that she was credentialed to practice obstetrics at the specified hospital. They also claimed the patient’s BP elevations were never sustained or reached a level that would require a consult with an obstetrician prior to the event at 3:15 AM. The physician maintained that earlier in the patient’s pregnancy she had consulted with a maternal-fetal medicine specialist who recommended antepartum testing and induction at 39 weeks’ gestation. She argued that the patient never met all the criteria for preeclampsia.

    The verdict: The jury awarded the patient’s estate $6.1 million in compensatory damages. The award was reduced to $900,000 pursuant to a high/low agreement.

    Analysis: While the family physician in this case did have privileges at the hospital to deliver uncomplicated pregnancies, she was accused of fraudulently concealing from the patient that her abilities in caring for obstetric patients were limited. The plaintiff’s counsel alleged that the physician was guilty of constructive fraud and that she was inadequately trained and inexperienced to treat the patient’s complications and had abandoned the patient. The physician developed breast cancer prior to the initial trial date, which was postponed, and she eventually died from her disease. The trial proceeded against the physician’s estate and medical practice.

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