Retained foreign object after gyn surgery

In 2012, a 73-year-old Pennsylvania woman underwent vaginal prolapse surgery, which was performed in a hospital by her gynecologist. During the operation, a surgical needle was mistakenly left inside the patient’s body. Over the next 3 years the she claimed she suffered generalized bowel complaints-pain and gas-which progressed by 2014 to diarrhea, severe abdominal pain, nausea, difficult eating, and weight loss. In early 2015, an imaging study identified the needle from the original surgery, and the woman was diagnosed with a bowel perforation and diverticulitis, which she had also been diagnosed with in 2000 and 2012. The needle was removed, the patient was treated with antibiotics, and her bowel perforation was repaired.

The patient sued the gynecologist, his practice, and the hospital alleging they were negligent in leaving the needle in her after surgery. She claimed to have weight loss, abdominal pain, and diarrhea leading up to the discovery of the surgical needle, and in addition she had a continued need for medication to alleviate her bowel cramping issues. She sought damages for past and future pain and suffering as well as the recovery of $3,292.30 in medical costs.

The patient’s expert witness faulted the gynecologist for leaving the surgical needle inside the patient; he also faulted the surgical nurses for failing to provide a proper count of the needles to the surgeon. The expert determined that the needle was free-floating and could have caused the bowel perforation at any time.

The gynecologist’s expert in colorectal surgery maintained that surgical metallic objects are left frequently in the body without causing problems to patients. In this instance, the needle was nestled in the cul-de-sac in her lower pelvis, below a considerable amount of tissue, and did not cause the patient’s bowel perforation. The expert concluded that he was not negligent in leaving the needle inside the patient, and instead faulted the nurses for their improper needle count. The gynecologist’s radiology expert confirmed that the needle inside the patient had not moved more than 1 mm during the various studies.

The jury found in favor of the patient, after deliberating for 6 hours at the conclusion of a 5-day trial. The jury found the hospital but not the gynecologist negligent and awarded $13,292.30.

ANALYSIS

In medical malpractice cases involving retained foreign objects, it is common for the hospital to settle with the patient because it is negligent to leave a sponge or needle inside a patient when a correct count has been reported to the surgeon. The issue then becomes the amount of compensation for damages to the patient. Occasionally a trial goes forward to assess a surgeon’s part in leaving a foreign object. In this case, the patient and the hospital entered a confidential settlement prior to trial, but due to the gynecologist’s claims against the hospital, the hospital remained on the verdict slip and was present at trial, and so, the jury assessed the hospital with responsibility.

Complications following urinary sling procedure

A 63-year-old Pennsylvania woman went to her gynecologist for treatment of urinary incontinence and subsequently underwent surgery to implant a transobturator urethral sling. After that, the patient claimed she experienced chronic pelvic pain and urinary urgency, intermittent incontinence, and dyspareunia. She returned to the gynecologist twice and he examined her with a scope on the second visit. She then sought a second opinion and that physician found a large mass in the patient’s bladder consisting of a crystalline piece of tape used to secure the sling. The mass was removed and alleviated many of the woman’s symptoms, but she sued the first gynecologist and claimed she was still not pain-free.  

The patient alleged that the gynecologist failed to do a repeat cystoscopy when she had onset of new symptoms; failed to diagnose and treat bladder stones resulting from the transobturator midurethral sling; negligently inserted the sling through one wall of her bladder and failed to detect the malpositioned urethral sling.

The gynecologist contended that the patient did not complain of ongoing symptoms until 1 year after insertion of the sling. The jury awarded the patient $2 million.

Colon perforated during hysterectomy

A 59-year-old Virginia woman with a previous history of umbilical hernia repair underwent laparoscopic total hysterectomy and salpingectomy. During the procedure, the gynecologist inserted a Veress needle and trocar through her umbilicus, causing an approximately 3 cm anterior and 1 cm posterior perforation to the transverse colon. The injury went undiagnosed during the procedure. During the 2 days following the operation, the patient experienced abdominal pain, chills, distention, and foul-smelling discharge from her umbilical suture site. She presented to the emergency room, where a computed tomography scan revealed a bowel perforation. The woman was taken to surgery for exploratory laparotomy with transverse colon resection and right colon colostomy with Hartmann’s pouch and subsequently wore an ostomy bag for approximately 8 months. She developed an infection because of the colostomy and required an additional surgery to resolve a small bowel obstruction and incisional hernias.

The parties reached a $1 million settlement.

Bowel injured during laparoscopic tubal ligation

A 40-year-old Louisiana woman underwent an outpatient laparoscopic tubal cauterization. Two hours after the procedure, her blood pressure began to drop. She was promptly transferred to a hospital and underwent emergency surgery, which revealed an injury to her bowel. Apparently, a trocar had perforated the bowel. The woman lost part of her small intestine and endured other complications.

She sued the surgeon and alleged she had committed medical error.

The surgeon contended the bowel injury was a known complication of the procedure. The jury returned a defense verdict.

Vesicovaginal fistula following hysterectomy

A 40-year-old Michigan woman underwent a hysterectomy due to painful and prolonged periods. During the procedure, the gynecologist inadvertently placed a stitch in the bladder. Despite the presence of blood in the catheter bag after the procedure, the gynecologist did not consult a urologist. Later, when the patient suffered from urinary retention, a urologist was called, performed a cystoscopy and discovered the stitch in the bladder.

The patient sued the gynecologist and contended that the presence of blood in the catheter bag required a urology consult and cystoscopy immediately, which would have revealed the stitch and prevented all the subsequent injuries.

The gynecologist argued that she used reasonable judgment as there were explanations for the blood due to a difficult catheter placement and the lysis of bladder adhesions. She further argued that a urologist would not have performed a cystoscopy or removed the stitch even if called at that point. The jury found in favor of the defense.

Failure to timely treat preeclampsia

A Florida woman presented to her obstetrician at 24 weeks’ gestation for a routine appointment. Testing showed that she had proteinuria and high blood pressure. The following day she underwent a 24-hour urine test and a blood pressure evaluation at the hospital. The results came back suspicious for preeclampsia. Over the next several days, the patient continued to experience high blood pressure and increased proteinuria, and restricted fetal growth was seen on ultrasound. She returned to the hospital, where she underwent an emergency cesarean section. Her child was born with periventricular leukomalacia.

The patient sued the hospital and obstetrician both individually and on behalf of her daughter, and alleged the hospital and obstetrician failed to diagnose and treat her preeclampsia in a timely fashion to prevent the very premature delivery. The jury awarded $23.1 million, apportioning liability at 70% to the obstetrician and 30% to the hospital.

Shoulder dystocia

A California woman delivered her child in the hospital at term. During delivery a shoulder dystocia was encountered and the obstetrician released the impacted shoulder to accomplish the delivery. Unfortunately, the infant suffered a brachial plexus injury.  Despite nerve graft surgery, the infant was left with permanent paralysis of the right arm, shoulder, and hand.

The parents sued the obstetrician and alleged a failure to properly manage the delivery. They claimed that a shoulder dystocia had been encountered in a previous delivery, and that the obstetrician failed to realize the need for cesarean delivery in future pregnancies.

The obstetrician denied all liability, but the case settled for $950,000. 

Perineal burns during hydrothermal ablation surgery

A Texas woman in her 40s underwent a myomectomy followed by a hydrothermal ablation of the endometrium for treatment of heavy menstrual flow. During the hydrothermal ablation, the equipment was shut down immediately after an alarm sounded to indicate that it was leaking hot water. Unknown to gynecologist the patient sustained perineal burns from the leak. A week later, she returned to the clinic with perineal irritation and was seen by another gynecologist who diagnosed the burns.

The patient sued the gynecologist and her practice and claimed that she sustained burns to both her external and internal genitalia. She alleged that the internal band of scar tissue makes sexual intercourse painful. The patient’s expert urogynecologist examined the patient at her attorneys' request and he opined that hydrothermal ablation was not indicated. The expert opined that the gynecologist failed to exercise reasonable care during the procedure.

The gynecologist contended that the ablation procedure was indicated, that her decision to perform it was supported by the medical literature, and that perineum burns are a known risk of the procedure, and questioned whether the patient sustained any injury to her internal genitalia. She also noted that the procedure was otherwise successful. The defense noted that the plaintiff's expert did not perform hydrothermal ablation procedures. It was also argued that 2 days before her expert examined her, the patient had undergone an annual exam by her regular ob/gyn, who found nothing out of the ordinary. The gynecologist also noted that, based on the external burn pattern, the external injury was from just a few droplets and was therefore relatively minor. The jury returned a defense verdict, after deliberating for 4 hours at the conclusion of a 4-day trial.