Lack of informed consent for laparotomy

July 31, 2015

Following a successful delivery, a woman seeks a tubal ligation and ventral hernia repair, to be performed laparoscopically. The procedure was performed as a laparotomy, which led to a lack of informed consent suit.

A Louisiana woman delivered a child in 2009 and then sought a tubal ligation and a ventral hernia repair from her obstetrician. The patient was an LPN, and was concerned about the risk of infection and scarring and consented to a laparoscopic procedure. The physician did not perform a laparoscopy but began the procedure as a laparotomy. The patient has a 6-in scar on her abdomen.

More: Morcellation risk outweight by risks of lapartomy

The women sued those involved with the operation and alleged lack of informed consent for the laparotomy.

The hospital argued that the consent procedure was to make sure the consent form that was signed by the patient in the doctor’s office was present in the medical record. The physician claimed that the patient had signed a general consent form that permitted him to do what was reasonable in his judgment, and that he had determined that a laparoscopic procedure presented more risk to the patient.

The verdict: A jury found in favor of the patient against the gynecologist, and awarded $150,000.

NEXT: Did doctors fail to treat a patient's postpartum preeclampsia?

 

Alleged failure to treat postpartum preeclampsia

A 24-year-old North Carolina woman was pregnant in early 2011. She received prenatal care through a Naval hospital obstetric clinic. She developed preeclampsia and at 36 weeks’ gestation she presented at the clinic with complaints of a headache, “seeing spots,” and not feeling well. Her blood pressure was 169/89. It was decided to deliver her and she was admitted to the hospital with severe preeclampsia and started on magnesium sulfate. A healthy baby was delivered 2 days later.

Recommended: USPSTF preeclampsia prophylaxis guidelines

The patient continued to have high blood pressures and was prescribed nifedipine. At discharge her pressure was 148/88, and she was not continued on any antihypertensive medication. She was given the standard postpartum instructions and was told to schedule a follow-up appointment in 6 weeks. None of the instructions addressed preeclampsia.

Five days after discharge the woman began having shortness of breath and swelling in her extremities. The next day she had a very difficult time breathing and emergency medical services were called and the patient arrested when they arrived. The arrest continued during transport and a prolonged resuscitation was required at the hospital. She was stabilized, but remained intubated on a respirator. A head computed tomography scan revealed cerebral edema from prolonged hypoxia and she was transferred to another hospital, where she again arrested on arrival. A neurologist determined that she had profound anoxic brain injury. Three days later the patient suffered a cardiac arrest and died.

In the lawsuit filed by her estate, negligence was alleged in the failure to inform the patient of the signs and symptoms of continuing preeclampsia following delivery so she would have sought medical care sooner. The claim also included a failure to continue antihypertensive medication at discharge, and failure to schedule a follow-up appointment 1 week postpartum.

The defense maintained that the patient had been given verbal instructions regarding precautions for postpartum preeclampsia.

The verdict: A $50,000 settlement was reached.

NEXT: Did improper placement cause a sling to erode? 

 

Patient charges improper placement of sling caused erosion

In 2004, a 50-year-old Connecticut woman sought treatment for stress urinary incontinence from a gynecologist. A pubovaginal sling procedure was performed with anterior colporrhaphy, using an IVS tunneler device. The sling eroded and the patient required multiple surgeries to remove the material and place a new sling.

Next: Is the verdict in on mid-urethral slings?

The woman sued the original surgeon and his assistant, claiming that the sling material was improperly placed into the bladder during the first operation and that this was not recognized at the time. The woman died of unrelated causes during the lawsuit and her executor was substituted as plaintiff.

The physicians maintained that the sling was properly placed and that it eroded into the bladder in the years after the procedure. They also argued that studies performed after this surgery showed that the specific sling material used demonstrated a higher-than-expected rate of erosion into surrounding structures.

The verdict: A defense verdict was returned.