Retained sponge following hysterectomy: Who was negligent?

July 1, 2011

A Florida woman underwent a hysterectomy performed by her gynecologist in 2007. Three months later the patient returned with abdominal pain and was diagnosed with appendicitis.

A FLORIDA WOMAN underwent a hysterectomy performed by her gynecologist in 2007. Three months later the patient returned with abdominal pain and was diagnosed with appendicitis. She underwent emergency surgery, during which a surgical sponge was discovered in the abdominal cavity. The patient had developed an interabdominal infection that required a bowel resection.

The woman sued her gynecologist and the hospital, alleging that they were negligent in leaving the sponge behind during her hysterectomy. The hospital settled prior to trial, but the physician maintained that the negligence was on the part of the surgical nurses in their sponge count. A defense verdict was returned for the physician.

LEGAL PERSPECTIVE

In malpractice cases involving an RFO, the negligence usually is assumed by the fact that an instrument or sponge was left in the patient's body. Damages and their monetary value then become the issue. These can include any operation or procedure required to remove the RFO, an assessment of pain and suffering directly related to the RFO that have been experienced by the patient, and any long-term sequelae resulting from the alleged negligence. In this case, the physician maintained that the patient would have required surgery for the appendicitis anyway, and so she did not have an extra operation to support her claim for damages.

Pulmonary embolism after cesarean delivery results in death

IN 2005, A 29-YEAR-OLD ILLINOIS WOMAN, pregnant with twins, had a history of 2 prior cesarean deliveries. She was hospitalized for 6 days on bed rest because of preterm contractions. The patient was discharged home and subsequently was seen several times at the hospital as an outpatient.

Three weeks later she was admitted to the hospital in labor. A cesarean delivery was performed later that day. As the delivery was completed, the patient suddenly became unresponsive and resuscitation attempts were unsuccessful. An autopsy revealed a massive saddle pulmonary embolus, which likely had come from a deep vein thrombus in the legs or pelvis.

A lawsuit was filed and her family testified that the woman had been told to remain on bed rest whenever possible at home and that she had done so. They alleged that when bed rest was recommended, the patient should have been started on deep vein thrombosis prophylaxis such as thromboembolic deterrent hosiery, sequential compression devices, and/or heparin.

The defense maintained that no restrictions had been placed on the patient's activity at home, that she had not been placed on strict bed rest, and that the standard of care required deep vein thrombosis prophylaxis only for patients with a prior history of clots or thrombophilia. They argued that the patient had neither medical condition. They also argued that heparin would have increased the risk of bleeding and that mechanical prophylaxes such as thromboembolic deterrent hosiery and sequential compression devices were not effective in preventing pulmonary embolism or death. A defense verdict was returned.