Ureter transected during TLH
A 38-year-old Washington woman underwent a total laparoscopic hysterectomy (TLH) in 2011. During the procedure the right ureter was transected without the surgeon being aware of that. The patient continued to have pain and eventually collapsed. She was airlifted to another hospital in septic shock where she underwent emergency life-saving surgery. She suffered septic shock, near complete loss of function of the left kidney, bilateral adrenal gland hemorrhages, chronic lower extremity pain, cognitive impairment secondary to shock, situational depression and anxiety.
The verdict: A lawsuit was filed against those involved with the operation. After it was learned that the gynecologist did not have privileges at the hospital to perform a TLH, the patient reached a $3 million settlement with the hospital. Just prior to trial, a settlement with the gynecologist and his practice was reached for $1 million and $150,000 from another defendant for a total recovery of $4.15 million.
Question of bowel perforation during hysterectomy
In 2013, a day after a Missouri woman underwent a hysterectomy, she felt ill and presented to the emergency room. She was diagnosed with a pulmonary embolism and treated with anticoagulants. Her problems persisted and over the next 17 days some computed tomography (CT) scans showed fluid in her abdomen and she developed a vaginal fistula. An exploratory laparotomy eventually was required, which revealed a bowel perforation.
The patient sued the surgeon who had performed the hysterectomy alleging that he had perforated her bowel during the procedure. She also sued the hospital where the procedure had taken place. She contended that CT scans showing fluid buildup and her early symptoms after surgery were consistent with a bowel perforation which ultimately caused leakage into the peritoneal cavity and eventually a fistula in the vagina. Her expert pathologist testified that the findings under the microscope could only exist if a bowel perforation had been there a significant period of time before the fistula developed. While she agreed that continuous leakage from the bowel for 17 days would have likely resulted in her death, she presented experts who argued that her injury was not a “free perforation” but had been contained by her body, preventing the spread of the infection.
The case against the hospital was resolved before trial. The matter proceeded against the surgeon only. He maintained that the perforation didn’t happen during the hysterectomy but developed in the days just before the perforation was discovered. The defense argued that a collection of infected fluid at the vaginal cuff over time eroded into the bowel, creating an entryway for stool to pass into the vagina. The defense experts testified that it would have been impossible for the patient to survive if she had an untreated bowel perforation for 17 days. The jury found in favor of the gynecologist.
The verdict: The jury found in favor of the gynecologist.
Hypoxic brain damage after failure to monitor FHR alleged
A Texas woman delivered a baby in 2012. During the oxytocin-augmented labor, the fetal heart rate (FHR) tracing was not recording well on the monitor strip. At delivery the infant had a tight nuchal cord and at birth there were no signs of life. The child was successfully resuscitated but was found to have sustained severe brain damage as a result of profound fetal hypoxia and will require 24-hour nursing and supportive care for life.
The patient sued those involved with her delivery and alleged that losing the FHR tracing was below the standard of care and resulted in the caregivers being unaware of the increasing condition of fetal intolerance to labor, leading to the brain damage. They claimed the nuchal cord was cutting off the oxygen supply to the fetal brain, which would have been seen on the FHR monitor strip and earlier intervention would have prevented the injury.
The defense argued that the nurses continuously monitored by listening to sounds coming out of the bedside monitor even though no recording of the FHR was occurring on the central monitors or FHR monitor strip. They contended that the nuchal cord was an unforeseeable medical emergency and that nothing different could have been done to change the outcome.
The verdict After a week of trial, the parties reached a settlement for an undisclosed amount.