Before being treated by Defendant ob/gyn A, the plaintiff had seen Co-defendant ob/gyn B in January 2013 for worsening symptoms of prolapse. Her complaints included incomplete voiding, urinary frequency, nocturia, urgency two to four times per day, and some rare episodes of stress urinary incontinence (SUI).
Dr. B found that the plaintiff had evidence of Stage II uterovaginal prolapse 1 cm past the hymen. His impression was uterine prolapse, cystocele, rectocele, and urinary incontinence, and a need to rule out voiding dysfunction. The plaintiff’s treatment by Dr. B continued through the winter of 2013, during which various surgical interventions were explained to her. She ultimately gave him consent for a laparotomy, supracervical hysterectomy, bilateral salpingo-oophorectomy (BSO), sacrocolpopexy with permanent mesh, possible cystocele and rectocele repair, and cystoscopy.
The plaintiff underwent surgery with Dr. B at Codefendant Hospital on May 7, 2013. Dr. B discussed the risks of surgery with the plaintiff including possible bowel injury. He encountered significant scarring, which he stated might be secondary to previous obstetrical injury. He did not perform the sacrocolpopexy because of his intraoperative findings of a deep pelvis, pelvic adhesions, redundant bowel, and diverticular disease. In the setting of an obese woman with diabetes, risk of infection and mesh erosion was greater, therefore, he elected to perform a modified colpopexy.
The plaintiff was on disability from May through July 2013 and Dr. B continued to treat her during that period. However, by the August 19, 2013 visit with Dr. B, it appeared that the plaintiff was having recurrence of prolapse. He had a long conversation with her but did not recommend any surgical intervention. The plaintiff’s last visit with Dr. B was on November 18, 2013. He noted she was having chronic constipation, and was not only bothered by vaginal protrusion, but there were days when she felt some discomfort. On exam, Dr. B noted excellent healing of the abdominal incision and no apical approach or cystocele. During maximal straining, a small Stage I rectocele and distal component 2 cm above the hymen was noted. There were no foreign bodies in the vagina and no antrocele. Dr. B instructed the plaintiff to do pelvic floor exercises and to lose weight. He noted that at that time he was very pleased with the results.
On February 24, 2014, the plaintiff presented to Nonparty ob/gyn C and his facility for an assessment of her recurring vaginal prolapse. Dr. C noted that she was a 62-year-old G4P3 who presented with a chief complaint of occasional urgency with leakage. She also admitted to frequency and nocturia but denied urinary leakage with cough, laugh or sneeze (SUI). She reported feeling a bulge and was status post-supracervical abdominal hysterectomy, uterosacral ligament suspension, and posterior repair done in May 2013 at Co-defendant Hospital (by Dr. B). Dr. C indicated that he reviewed those records and that Dr. B had originally consented the plaintiff for a mesh sacral colpopexy, but that intraoperatively, Dr. B decided against the use of mesh.
A review of systems and physical exam were generally within normal limits except that the exterior vaginal wall demonstrated a large cystocele to 1 cm past the introitus, cervix at the level of the introitus, and there was a large rectocele. Bedside cystometrics was also performed and demonstrated a fair sensation at 100; fullness 270, max capacity at 300 with a negative cough stress test, pretest postvoid residual (PVR) of 180, and post-test residue of less than 10. Dr. C’s overall impression was that the plaintiff had a large recurrent prolapse, status post-uterosacral ligament suspension.
Dr. C indicated he had a “long discussion” with the plaintiff. He noted that uterosacral ligament suspensions have a success rate at best in the range of 60% to 80%. Sacral colpopexy would give her a success rate of close to 99%. His note also indicated that the plaintiff would consider having a sacral colpopexy as well as anterior and posterior repair. Dr. C also indicated that he took time to discuss the pros, cons, risks, benefits, success and failure rates of the proposed procedure as well as complications including but not limited to injury to bowel, urinary tract infection (UTI), blood loss, mesh erosion, new onset of incontinence, urinary retention, and need for additional surgery.