A look back at our top cases

Thank you to our Legally Speaking experts, Andrew Kaplan, ESQ, and James Shwayder, MD, JD, for great legal insights in all of our 2020 articles.

Malpractice claims are not a rare occurrence. In fact, 50% of ob/gyns are likely to get sued at least once before they turn 55. An average of 162 claims were filed for every 100 ob/gyns, which may be due to the high-risk nature of the practice.

Being named in a lawsuit, however, does not always mean a medical error was made. Most claims are dropped, dismissed, or withdrawn, and trials are often won by the physician. Take a look back at the year’s top cases and see how each one unfolded.

Major vascular injury incurred at laparoscopy (Vol 65 No 09)

An LVAH case underscores the importance of continuing education.

This case highlights the importance of remaining cognizant of current literature and surgical practices. All too often, physicians fail to remain current in the various areas of their practices.

One would assume that maintenance of certification would allow physicians to stay current in their practice. However, ongoing education in specific practice areas may be required. Ultrasound, a valuable adjunct to our care of patients, is rapidly changing.

Was loss of ovary in this pediatric case avoidable? (Vol 65 No 08)

This case involves an eight-year-old patient who originally presented with a chief complaint of right-sided abdominal pain and one episode of vomiting.

Sometimes medicolegal cases have so many moving parts that until they are all fleshed out, as it were, one cannot be certain as to where the focused allegations and defenses will lie. While this started out as a misdiagnosis and delay case as to all defendants, through the discovery process and expert evaluation, we were able to determine that the pathologic findings rendered any delay argument, at least as to our client, moot.

Was this a failure to diagnose ovarian failure? (Vol 65, No 10)

The outcome in this case underscores the need for solid documentation, especially when one of the defendants has passed.

Putting aside the opportunity to resolve this case for less than the cost of trying it, the matter settled primarily for two reasons.

The first reason was the absence of any documentation by the defendants of awareness or follow-up with the patient for the elevated FSH. Whether or not the die was cast, as it were, documenting acknowledgment of the abnormal results and discussion with the patient still was required.

Cesarean delivery leads to unexpected outcome (Vol 65 No 11)

This case presents a unique dynamic involving certified nurse midwives; following protocols enhanced defensibility.

This case presented a unique dynamic, with CNMs providing the primary management of the patient. In contrast to a separate birthing center, this hospital had established a birthing unit in Labor and Delivery, allowing CNMs to manage patients with immediate physician consultation if needed.

Shoulder dystocia: The unpredictable nightmare (Vol 65 No 07)

This case involves induction of labor for a suspected large for gestational age (LGA) baby in a mother with a normal antepartum course.

This case was defensible, except for two major issues: the lack of a pre-induction estimated fetal weight and the resulting nerve avulsion. The lack of an estimated fetal weight is not uncommon in shoulder dystocia cases resulting in litigation.

Even though inaccurate, a clinical or ultrasound-based estimated fetal weight should be included in the initial assessment of all patients, whether for induction or in labor. Documentation of an estimated fetal weight, even if inaccurate, renders cases more defensible.

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