The Issue – Malpractice Case Examples

Obstetricians probably look at malpractice cases more than any other specialty. Virtually all of our journals have sections summarizing cases pertaining to our profession. One notable fact that stands out when researching these cases is simply that much litigation is a result of “omission” – that is tests not being completed or results not being relayed – resulting in patient harm and subsequent litigation rather than “commission” – when litigation arises from faulty treatment or surgical misadventures. This is true of all specialties – not just Ob-Gyn. The following cases are summaries of various cases that I have read. I have only named the state where the litigation occurred – on purpose. I want to show a trend and not embarrass the involved physicians. Prevention of the patient injury and subsequent litigation of physicians remains the raison d’etre of SecuReach Systems.

Florida

A woman underwent a routine mammogram in October 1999. The report indicated possible nodular density in the upper outer quadrant of the right breast. In August 2000, the woman discovered a mass in this same location during self-examination. She was later diagnosed with breast cancer that had metastasized. She underwent chemo-therapy, a right modified radical mastectomy, and radiation therapy.

In suing, the patient claimed she was never contacted with the results of her 1999 mammogram or about the need for further testing. The physician argued that he tried to contact the patient several times.

The jury awarded the plaintiff $6.8 million.

New Hampshire

A patient had a mole removed in a physician’s office. Two weeks later the patient returned for suture removal. When this was done she was told by the staff member that she was “all set.”

Four years later the mole began to bleed and the resulting biopsy showed malignant melanoma. The patient sued. A review of the chart showed that the pathology lab sent the report to the physician’s office the same day that the sutures were removed. The report showed “atypical cells” in the original tissue sample. These results were never communicated to the patient.

The physician settled for an undisclosed amount prior to the start of the trial.

Ohio

A patient chose a family doctor as her primary care physician from a list of approved physicians from her new insurance company. This insurance company required the physician to be the “gatekeeper” and approve any tests which the patient required. The patient then called the office and said that she required an HCG level for the follow up of a hydatidiform mole. The office gave the requisition and when the test returned (slightly elevated), forwarded the results to gyn-oncologist that the patient had indicated as the treating physician.

Eight months later the patient became pregnant and was referred to an ob-gyn for prenatal care and delivery. After delivery, the patient developed a fatal choriocarcinoma and died. The family sued the gyn-oncologist, the delivering ob-gyn, and the family doctor for wrongful death due to improper follow-up of the hydatidiform mole.

At the time of the jury trial, the gyn-oncologist settled for his policy limits. The trial continued. Under the advice of their defense attorneys, the family doctor and the delivering obstetrician both settled for $375,000 prior to the completion of the trial.

Washington

A 56 year old woman developed deep venous thrombophlebitis and was hospitalized for anticoagulation. She was discharged home on Coumadin. Clotting studies were set up for “Tuesday” but the order was misinterpreted and set up a week later. When the patient was seen in the office, she was immediately sent back to the hospital for blood work. The results were abnormally high, but were never communicated to the patient. Five days later the patient had a cerebral hemorrhage resulting in permanent organic brain damage.

The patient and her family sued saying the brain damage was caused by over-coagulation from Coumadin. The hospital said they called the results to the doctor. The doctor said he received no call and if they called his nurse, she did not tell him the results. The nurse said if she got results like that she would have told the doctor immediately. Nothing was documented.

The jury awarded the plaintiffs:

• $2,220,412 from the doctor and his clinic
• $750,000 from the hospital.

New York

A 41-year-old woman underwent a mammogram and sonogram. The mammogram was normal while the sonogram revealed 3 small cysts. One year later she went to an Ob/Gyn for a breast exam and no abnormalities were discovered. Two years after that, the patient felt a mass in her left breast tissue. A biopsy revealed stage IV breast cancer that had spread to her lymph nodes, sternum, and sacrum bone structures…

In suing, the patient claimed the physician told her the cysts revealed by the sonogram were benign and that a follow-up mammogram and sonogram were not recommended. The physician contended that he did indeed recommend that the patient get a follow-up mammogram and sonogram, and continue to perform monthly self-exams… In addition, the doctor claimed that had the patient not missed a yearly follow-up visit and mammogram, the breast cancer would have been diagnosed earlier.

The jury found that while the physician did indeed order a follow-up mammogram and sonogram, it was his responsibility to ensure the patient completed the tests as ordered. The jury awarded the plaintiff $15 million, which was subsequently settled for a confidential amount.

Note – this case was then appealed and tied up in courts for a long time. I do not know the ultimate outcome.

Montana

A 38-year-old woman underwent a routine Pap on November 5, 1997. The nurse assured her that she would be contacted if the results were abnormal. On November 10, the pathology report indicated “atypical squamous cells of undetermined significance” (ASCUS). However the staff never notified the patient of her results and her chart was returned to central filing.

In February 2000, the woman returned for a routine gynecological exam where she learned of her 1997 results. She underwent colposcopy and biopsy that showed Stage IIA squamous cell carcinoma of the cervix and vagina.

She was successfully treated with radiation therapy and chemotherapy. The case settled for $750,000.

New Hampshire

Routine blood work at the beginning of a pregnancy showed the presence of anti-Kell antibodies. The lab failed to report the results of the antibody screen to the physician. The physician did not see that the test had not been completed and no follow up was done.

The baby developed hydrops and died in utero at 37 weeks. The case settled after suit but before trial for an undisclosed amount.

The SecuReach Solution – Avoiding Communication Errors

It is obvious from reviewing these cases that the physician “error” which led to the patient injury or death and subsequent malpractice award was a failure to communicate. Anyone who works in a physician’s office knows how hard it is to try to keep track of every test or referral. Although we can understand how this happens, we still cannot excuse it. In today’s litigious environment, these cases often result in the nonrenewal of the physician’s malpractice insurance or placement into a “high risk” pool which includes skyrocketing premiums as well deductibles for any subsequent cases.

Even worse than the implications of a malpractice suit, is the injury to the patient. All physicians prescribe to the dictum “First, do no harm.” When a patient is injured due to faulty communication, we all bear responsibility. For the first time, you have a cost effective system to follow all your ordered tests and referrals to be sure that these communication errors do not occur!