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    Maternal death from intracranial hemorrhage

    A  34-year-old woman was under the care of her long-time 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 came for a regular prenatal visit, but she also complained of a headache and a cough. Her blood pressure (B/P) was 130/90. Two days later, she reported acute vaginal bleeding and a headache. The physician admitted her to the hospital with a diagnosis of potential placental abruption. An ultrasound revealed oligohydramnios, intrauterine growth restriction, and grade II placenta. She had repeated high blood pressure readings, headaches, and decreasing platelets. The fetal heart rate (FHR) showed variable and late decelerations. She was subsequently discharged to another hospital to undergo another ultrasound evaluation. Five days after her original admission, the patient’s husband informed the physician that the patient was vomiting, with abdominal pain, and headaches. He brought her to the hospital, where her B/P was 155/100 and she complained of severe headache from front to back, constant throbbing, facial edema, and vomiting. She was admitted and at 3:15 a.m. the following day the nurse found the patient with her head hanging over the bed, having vomited, and unresponsive. The on-call obstetrician diagnosed her with eclampsia and ordered magnesium sulfate, hydralazine, and an immediate cesarean. The infant was delivered, but the patient remained unresponsive and a computed tomography scan revealed a massive intracranial hemorrhage. She was pronounced dead at 5:10 p.m. that same day.

    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 the family physician did not 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 her condition or refer her to an obstetrician and, as a result, the patient suffered severe injury which caused her death. Another claim was that the physician materially misrepresented to the patient that she was experienced and trained in the treatment of all her obstetric needs.

    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 B/P elevations were never sustained or reached a level that would require a consult with an obstetrician prior to the event at 3:15 a.m.  The physician maintained that she had consulted with a maternal-fetal medicine specialist at an earlier time who recommended antepartum testing and induction at 39 weeks’ gestation. She argued that the patient never met all the criteria for pre-eclampsia.

    The verdict: The jury awarded the patient’s estate $6,067,830 in compensatory damages. The award was reduced to $900,000 pursuant to a high/low agreement

    Analysis

    While the family practice 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, was inadequately trained and inexperienced to treat the patient’s complications and actually 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 as to all issues.

    NEXT: Unrecognized postpartum cardiomyopathy

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