IUD blamed for multiple miscarriages

An ob/gyn implanted an intrauterine device (IUD) in a Missouri woman in 2005. A month later, the device could not be located on ultrasound and the ob/gyn believed it had been expelled from the patient’s body. The woman suffered 3 miscarriages between 2009 and 2011 and asked her gynecologist if the missing IUD, which she never observed exiting her body, could be contributing to the miscarriages. She was reportedly told that the device was not present. The IUD was eventually seen on an abdominal x-ray in 2013 after the patient switched doctors. After the IUD was removed the patient had a successful pregnancy.

The woman sued the original ob/gyn and the clinic for personal injury and wrongful death of the unborn fetuses. Her experts testified that the time line of the miscarriages was consistent with their causation theory and it was below the standard of care to not perform an abdominal x-ray when the IUD position could not be found.

Related: Using ultrasound to zero in on IUD issues

The gynecologist argued that the American College of Obstetricians and Gynecologists guidelines at the time did not specify that an x-ray was required, although such a guideline was added later. They claimed that the IUD did not cause the miscarriages and instead that the fetal tissue showed abnormalities not attributable to the IUD.

Analysis

In general, for successful prosecution of a wrongful death case, the caregiver’s negligence must be shown to be the proximate cause of the death. In this case, the defense introduced evidence showing that the pathology report on the remains of 2 of the 3 miscarriages showed trisomic abnormalities. The patient’s attorney objected to presentation of the test results, contending that the tissues were sent for testing without the patient’s consent and that the test requisition forms conveyed misinformation. The defense countered that the testing forms had the patient’s signed consent and nothing was misrepresented on the forms. The jurors found for the defense on the wrongful death claims.

NEXT: Failure to diagnose breast cancer

Failure to diagnose breast cancer

A 62-year-old Kentucky woman had been having routine mammograms since 2003. Between 2006 and 2010, her annual mammograms were read as normal by the same radiologist. In 2011 her mammogram was read by another radiologist as normal. A year later the woman’s mammogram showed several cancerous breast masses and the disease was found to have metastasized. She underwent a radical mastectomy and aggressive radiation, but her cancer was deemed incurable.

The woman sued the first radiologist, alleging that he misread her mammograms from 2006 to 2010. Her expert witness testified that in 2006, there was evidence of asymmetric density suggestive of cancer.

The radiologist denied any negligence in reading the mammograms and contended that his interpretation was reasonable.

THE VERDICT: The jury returned a defense verdict.

Blood vessels, bowel damaged in hysterectomy

A 46-year-old woman underwent a laparoscopic hysterectomy performed by an Illinois gynecologist. During the operation, the iliac artery, iliac vein, and small bowel were lacerated during trocar placement. The patient suffered severe bleeding and had a cardiac arrest. She was given large amounts of blood and a surgeon repaired the blood vessels and bowel. The patient was subsequently discharged from the hospital but returned after 1 day with a complaint of thrombosis, which resulted in a requirement for blood thinners for 1 year. During the year after the original surgery, the patient was informed that she received blood that was HIV-positive. Her initial HIV test came back negative.

More: Is there a place for robotic and laparoscopic hysterectomy?

The woman sued the gynecologist and alleged he deviated from the standard of care by performing a “blind trocar insertion,” which caused major vessels to be more susceptible to injury. The gynecologist denied that any care was below the standard.

THE VERDICT: A $383,000 verdict was returned for the woman, including $200,000 for past and future pain and suffering, $5000 for past and future loss of normal life, $5000 for disfigurement, $168,000 for past and future medical expenses, and $5000 for past and future loss of consortium.

NEXT: Delay in ovarian cancer diagnosis

Delay in ovarian cancer diagnosis

A 64-year-old Illinois woman presented to her primary care physician with complaints of worsening abdominal pain, fatigue, and unexplained weight loss. The physician diagnosed gastritis and the patient was treated for that. She then went to another physician, who did imaging studies that resulted in a diagnosis of Stage IV ovarian clear cell carcinoma.

Recommended: Patient sues after wrong ovary removed

The woman sued the primary care physician and alleged that the standard of care required him to order tests to assess her original complaints. She alleged that timely imaging would have diagnosed her ovarian cancer at Stage I or II, which has a 90% survival rate at 10 years, instead of at Stage IV, which has a survival rate of less than 10% at 10 years.

THE VERDICT: The case settled for $1.9 million before a complaint was filed.

Rectovaginal fistula after delivery

A 27-year-old Arizona woman suffered a perineal laceration during vaginal delivery of her first child. She subsequently developed a rectovaginal fistula which persisted for 6 months until it was surgically repaired and closed. As a result of developing a divot in the rectum, she suffers from fecal seepage, which she alleged is a permanent condition.

The woman sued the obstetrician and alleged that her care was below the standard and that she failed to perform a rectal examination after the laceration, which caused the fistula.

The obstetrician argued that she correctly diagnosed and repaired the patient’s third-degree laceration, and claimed the wound later broke down for unknown reasons.

THE VERDICT: The jury returned a defense verdict.

NEXT: Failure to promptly deliver large infant

Failure to promptly deliver large infant

A Washington woman was admitted to the hospital in labor in 2013. Her labor was complicated by very slow progress, fever, and several fetal heart rate abnormalities. Twenty-six hours later, she delivered by emergency cesarean an infant that weighed almost 11 lb. He was resuscitated and admitted to the neonatal intensive care unit with an arterial cord pH of 7.01 and a base excess of -14.4. He started to have seizures 9 days after birth. Placental pathology revealed infection of the placenta with Group B streptococcus. Magnetic resonance imaging showed brain damage and the infant was diagnosed with hypoxic-ischemic encephalopathy.

More: What to say and do right when things go terribly wrong in obstetrics

The woman sued those involved with the delivery and claimed they were negligent in failing to recognize that the fetus was excessively large and failed to deliver more quickly.

THE VERDICT: The parties reached a $5.5 million settlement.

Infection following accidental needle stick

A Kansas woman underwent a forceps-assisted delivery, during which a third-degree laceration was noted and repaired. The woman complained of severe pain and the obstetrician performed a revision of the repair, after which the patient had immediate relief and was discharged.

During the revision operation the obstetrician accidentally stuck himself with a clean needle. He replaced the needle and changed his glove. Following the needle stick the physician’s thumb became red and swollen and he started antibiotics, but did not feel the need to inform the patient of the infection. Two days later the patient reported to her own doctor’s office with fever, pain, and foul order from the surgery site. She was diagnosed with pelvic incisional cellulitus and taken to the operating room for exploration and debridement. She was subsequently transferred to another hospital for episiotomy wound and abscess debridement. She then developed septic shock and necrotizing fasciitis and was placed on a ventilator. She eventually recovered but underwent 13 operations.

The woman sued the physician alleging that he should have informed her of the infection in his hand after the needle stick.

The obstetrician denied that he had any duty to inform her, and had not caused her infection complications.

THE VERDICT: A defense verdict was returned.

NEXT: Hypovolemic shock after cone biopsy

Hypovolemic shock after cone biopsy

A 46-year-old Illinois woman suffered significant bleeding after undergoing a cervical cone biopsy. The gynecologist attempted to control the bleeding by injecting Monsel’s solution. The bleeding slowed but the patient went into hypovolemic shock, which necessitated an emergency laparotomy that revealed a perforated uterine wall and damage to both uterine arteries. A hysterectomy was performed to control the bleeding. The patient improved, but subsequently developed sepsis, small bowel necrosis, and other complications, resulting in her death.

A lawsuit was filed on behalf of the patient’s estate, alleging that the gynecologist was negligent in that an excessive amount of cervical tissue was removed during the cone biopsy and that Monsel’s solution was used inappropriately, which led to hypovolemic shock and ultimately the woman’s death.

THE VERDICT: The jury awarded $4.25 million in damages.

Failure to recognize, treat preeclampsia

A 34-year-old Pennsylvania woman received prenatal care from a general practitioner. During the pregnancy, she developed gestational diabetes. She was admitted in the early third trimester with some bleeding, increased blood pressure, and headache, but was discharged home. At 34 weeks she was readmitted to the hospital with continuing headaches and spiking blood pressures. She lost consciousness and an obstetrician in the hospital delivered the baby. The woman suffered brain damage and subsequently died.

Next: Preeclampsia as a harbinger of longer-term cerebral damage

A lawsuit was filed by the woman’s estate and faulted the general practitioner and her group for failing to diagnose and treat preeclampsia and failing to refer her to an obstetrician. The physician also was alleged to be negligent in failing to come to the hospital after nurses advised her of the patient’s symptoms.

THE VERDICT: The jury found in favor of the patient and awarded $6.07 million to her estate.