Did physician's failure to communicate biopsy results lead to patient's death?

August 1, 2011

A Virginia woman went to her gynecologist for an annual physical. The pap smear revealed human papillomavirus and abnormal cells. A cone biopsy was performed and the pathology report from the biopsy revealed adenoid cystic carcinoma. However, the gynecologist did not tell the patient about the cervical cancer; instead she was told to undergo a hysterectomy.

The patient did not have the hysterectomy, and 9 months later she began to have abdominal bloating. She went to her primary care physician, who found a pelvic mass. She was immediately sent for a computed tomography scan, which revealed a mass within the pelvis and masses throughout the liver consistent with metastasis. The woman was referred to a medical center, but it was determined that surgery was not an option because of the metastatic nature of the cancer. Chemotherapy was started, but the woman died within the month.

The lawsuit filed on her behalf alleged that the gynecologist had been negligent in failing to correctly report the results of the biopsy. A settlement for $1.4 million was reached during mediation.

A PREGNANT CALIFORNIA WOMAN who was incarcerated at a state prison for women delivered vaginally at term in 2007. The infant died the next day from a group B streptococcal (GBS) infection. The woman filed a lawsuit against the prison warden and the physicians involved in her care at the prison and in the hospital. She claimed that her GBS status was unknown, that she never was informed that she needed GBS testing, and that she never was tested for GBS.

Several initial defendants were released from the case on motions to dismiss and summary judgment. The matter ultimately went to trial against 2 physicians on claims for malpractice and wrongful death.

During the trial, the woman settled for $150,000 with 1 physician and the case proceeded against the delivering doctor, who argued that she had no duty to administer GBS testing because she was not the primary obstetrician. She also claimed that administering prophylactic antibiotics in the absence of certain risk factors, none of which were present, was inappropriate. A defense verdict was returned for this physician.

Discharge questioned for woman with HELLP syndrome

A 37-YEAR OLD INDIANA WOMAN with a history of chronic high blood pressure became pregnant in 2003. At 32 weeks' gestation she went to her doctor, complaining of a headache and blurred vision. Her blood pressure was 188 mm Hg/100 mm Hg and she was sent to a hospital, where she was kept overnight and given medication to lower her blood pressure. The next day her blood pressure was considerably reduced and she wanted to go home. Her physician examined her, diagnosed mild preeclampsia, and sent her home. Three days later she returned to the hospital with a severe headache, nausea, vomiting, and vision problems. Her blood pressure was 174 mm Hg/90 mm Hg. Fetal demise with placental separation was discovered and the infant was delivered stillborn after labor was induced. The patient developed acute renal failure and was diagnosed with hemolysis, elevated liver enzymes, and low platelet counts (ie, the HELLP syndrome).

The patient sued those involved with her care, asserting that she should not have been discharged from the hospital on her first visit and that a referral for treatment of a high-risk pregnancy should have been made.

The defense claimed that the decision to release the patient was proper and that she had been given appropriate discharge instructions. A defense verdict was returned.

Ms Collins is an attorney specializing in medical malpractice in Long Beach, California. She welcomes feedback on this column via e-mail to dawncfree@gmail.com
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