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LEGALLY SPEAKING BY DAWN COLLINS, JD RISK MANAGEMENT IN OBSTETRICS AND GYNECOLOGY Patient alleges she was not advised of likelihood of Down Syndrome A MARYLAND WOMAN was seen by her obstetrician during her pregnancy in 2006. She underwent a blood test that indicated that the fetus had an increased risk of Down Syndrome. The infant was born with Down Syndrome and the woman sued the obstetrician, claiming she was not informed of the risk during her pregnancy. She claimed that if she had been tol
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  LEGALLY SPEAKING BY DAWN COLLINS, JD RISK MANAGEMENT IN OBSTETRICS AND GYNECOLOGY Patient alleges she was not advisedof likelihood of Down Syndrome   M RYL ND WOM N  was seen by her obstetricianduring her pregnancy in 2006. She underwent a bloodtest that indicated that the fetus had an increased riskof Down Syndrome. The infant was born with DownSyndrome and the woman sued the obstetrician claimingshe was not informed of the risk during her pregnancy.She claimed that if  sh had been told of the test resultsand the increased risk she would have terminated thepregnancy. A defense verdict was returned. LEG L  PERSPECTIVE  In  malpractice cases brought on behalf of the  child,  where  he  or she is  born  with anabnormality that  could have been detected  in utero, theparent most  often claims  and must  show  that had  she known of the  abnormality,  she would  have  terminated the pregnancy.  The  usual  damages  are  then the  cost of the child living  with the abnormality  calculated over  the  course of his  or  her  lifetime.  This  lawsuit  was  filed and went  all the way  through  the  litigation process  to  trial,  although the  patient's chart  contained  documentation that  she  hadbeen informed multiple times of the  increased  risk of DownSyndrome.  The  chart  also reflected  that an  amniocentesis had  been  recommended to  her but  she  did not obtain one. The  obstetrician relied  on the  patient s prenatal  records, and  the  suit  was  successfully  defended.   II  III  Mill  j Failure to timely deliver infantresults in neonatal death   ILLINOIS WOM N  was admitted to a hospital fordelivery of her fourth child in 2002. Labor progressednormally until the fetal heart rate showed signs of distresslate that night. The obstetrician performed an emergencycesarean delivery. The infant was born severelycompromised and died about an hour later. In the lawsuitthat followed the patient claimed that the doctor had MS COLLINS  is an attorney speciaiizing in medicai malpractice in Long Beach Caiifornia. She welcomes feedback on this column via  e mail  todawncfree@gmail.com. failed to properly assess fetal distress and failed toperform the cesarean delivery in a timely manner.The physician argued that the timing of the cesareandelivery was appropriate and within the standard of care.He maintained that the fetal heart monitor strips did notindicate fetal distress for more than 5 minutes before theprocedure was ordered. LEG L  PERSPECTIVE  This  suit  was  brought  on behalf of the  deceased child s  estate.  It  alleged negligence  by boththe  obstetrician  and the  hospital.  The  case  eventually proceeded  to trial  against  the  physician only  and was successfully  defended:  The jury returned  a  verdict  in favorof the  doctor. However,  the  hospital  had  settled before  trialwith the  representative  of  the  child s  estate for  1,625,000. Colon perforation duringhysteroscopic surgery A 44-YEAR-OLD NEW YORK WOMAN underwent hysteroscopic surgery in 2006. The procedure involvingremoval of  polyps  and a fibroid tumor was performedby her gynecologist.During the procedure aloop ligature device wasinserted into the uterus.Two days later it wasdetermined that her colonhad been perforated andshe developed peritonitis.She required a resection ofa portion of the colon anda temporary colostomyThe woman sued hergynecologist claiming that the injury was due to thephysician pushing the loop ligature device through theuterus burning a hole in the uterus and the colon. Sheclaimed that the doctor should have performed a moreextensive check to ensure that no perforations had beencreated. Modern Medicine ËI NEWS UPDATES Compareyourmalpracticepremiumswith those of others: www contemporat7Dbgyn net/managerisk 2Q 20 WWW.CONTEMPORARYOBGYN.NET  JANUARY 2011  LEGALLY SPEAKING The physician claimed that the perforation was adelayed thermal effect that did not occur until  2  days afterthe procedure and denied any negligence. A $1.55 millionverdict was returned.   I I I I I I I Alleged misdiagnosisof missed abortion A  GEORGIA WOMAN  was seen by a physician in 2006 aftera positive home pregnancy test.  A  blood test confirmedher pregnancy, but an ultrasound found no intrauterinegestational sac, although a small amount of fluid was seenin the uterus and was deemed to be an early intrauterinepregnancy. Eleven days later she went to the emergencydepartment with painless vaginal bleeding and atransvaginal ultrasound was performed. A gestationalsac and yolk sac were found in the uterus. The womanreported no further bleeding or pain, but 3 days laterher obstetrician noted falling quantitative beta humanchorionic gonadotrophin levels and made a diagnosis ofmissed abortion. The gynecologist prescribed misoprostoland the patient was instructed to return in 2 weeks for aD&C; however, she moved to Washington state and didnot return to her srcinal obstetrician.A few months later, she was seen by a Washingtonobstetrician and was found to be  9  weeks pregnant andleaking amniotic fluid. She was placed on bed rest foralmost  3  months and then delivered an infant by cesareansection. The fetus had continued oligohydramnios, whichresulted in limb injuries and underdeveloped lungs. Sherequired intubation shortly after delivery, was diagnosedwith pulmonary hypoplasia, and required extensivetreatment in the neonatal intensive care unit. She also wasdiagnosed with deficits in cognitive ability, fine motorskills, and speech. The child had 2 hip surgeries as aninfant and was expected to require hip replacements overher lifetime.  A  lawsuit was filed alleging negligence by thesrcinal physician in the failure to perform further testingand examination and confirm a viable pregnancy. Thedefense maintained that the diagnosis of missed abortionwas not negligence; however, a$4.5 million settlement was reached.   M t Was hysterectomy necessary? A  44-YEAR-OLD INDIANA WOMAN  sought a second opinion regarding her Pap smear results in early 1997.She consulted with a gynecologist and underwent acolposcopy on her first visit, with normal results. About6 months later she returned for a follow-up examination.This time her Pap smear was abnormal and suggested alow-grade lesion, which was confirmed by further tests.She then underwent cryocautery and loop electrosurgicalexcision procedures, but she continued to have abnormalPap smears. Ten months later the gynecologist offered thepatient the option of continuing conservative treatmentor undergoing a total hysterectomy and removal of herovaries. She chose surgery, which was performed, butfollow-upPap smears were abnormal over the next several months.The patient then went to another healthcare provider andwas eventually diagnosed with human papillomavirus.The woman sued the gynecologist and claimed that hehad never considered human papillomavirus as a possiblediagnosis and that if he had, the hysterectomy would nothave been needed.The physician claimed that the actions taken wereproper based on the results of the Pap smear and that thepatient had chosen to undergo surgery. A defense verdictwas returned. Neonatal liver laceration blamedon difficult cesarean delivery A MARYLAND WOMAN  was under the care of herobstetrician when she presented in premature labor. Acesarean delivery was performed. During the operationthe obstetrician had difficulty extracting the fetus; whenshe reached in to deliver the fetus, it floated away. Asecond physician then attempted to deliver the fetus whilefundal pressure was applied. Multiple sonograms shortlyafter birth discovered a liver laceration. Surgery to repairthe liver was unsuccessful and the infant subsequentlydied. A photograph taken by the father2 minutes after birth showed large bruises over the liverarea. The patient sued, alleging that a vertical rather thana transverse incision should have been performed initiallybecause of the small size of the fetus and the uterus. Inaddition, the suit claimed that when the fetus could notbe extracted, a T incision should have been made sothe fetus could have been extracted without trauma. Thepatient alleged that the infant's liver ruptured from thepressure used to effect delivery.The defense claimed that the mother had a preexistingdisorder that caused her to bleed before delivery and thatthe infant's liver laceration occurred hours after delivery.A $1,461,507 verdict was returned, which included$461,507 for the infant's estate and $500,000 each for theparents. JANUARY 2 11  CONTEMPORARY OB GYN 23  Copyright of Contemporary OB/GYN is the property of Advanstar Communications Inc. and its content maynot be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express writtenpermission. However, users may print, download, or email articles for individual use.

histerctomi.pdf

Jul 23, 2017
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