By Damian D. Capozzola, Esq.
The Law Offices of Damian D. Capozzola
Los Angeles
Jamie Terrence, RN
President and Founder, Healthcare Risk Services
Former Director of Risk Management Services
(2004-2013)
California Hospital Medical Center
Los Angeles
News: A Pennsylvania jury awarded $8 million to a patient and her husband for a physician’s failure to perform a proper post-cesarean section inspection, resulting in the patient twice experiencing a cardiac arrest and requiring an emergency hysterectomy.
Initially, the physician attempted a vacuum extraction when the baby’s heart rate began to drop, but eventually resorted to an emergency cesarean section. The surgery was successful, but the patient’s vital signs soon deteriorated sharply. A different physician found significant blood accumulation in the patient’s abdomen, requiring an emergency hysterectomy.
After a trial, the jury found the physician who performed the cesarean section negligent for failing to perform proper postoperative procedures. The jury awarded the patient and her husband $8 million for pain and suffering and the loss of society, comfort, and companionship. The outcome of this case serves as a stark reminder of the critical importance of postoperative care and the potential risks and complications associated with emergency procedures.
Background: The patient was 39 weeks pregnant with her second child when she went into labor on Dec. 10, 2013. The baby’s heart rate began to slow, so the physician attempted delivery using a vacuum extractor. When the vacuum did not work, the physician performed an emergency cesarean section, and successfully delivered the child.
Following the surgery, the mother’s vital signs deteriorated. She went into cardiac arrest, requiring a round of chest compressions and resuscitation measures. Another physician opened the patient’s incision and found nearly three liters of blood had collected in her abdomen. After a “massive hemorrhage protocol” was ordered, the second physician began an emergency hysterectomy, joined by an OB/GYN and gynecologic oncologist during the surgery. Although the patient survived, she suffered another cardiac arrest.
The patient and her husband sued all four physicians and the hospital, alleging although the delivering physician performed a bilateral extension of the uterine incision during the cesarean section, she failed to recognize the left uterine artery was bleeding profusely because it was “completely transected” following the delivery. The plaintiffs further argued although the surgical team noted and repaired the damage to the right uterine cavity, there was no indication the physician or her team inspected the left uterine artery despite the bilateral incision. The plaintiffs also alleged the three other physicians who provided post-cesarean care failed to recognize warning signs, such as the patient’s abnormally low blood pressure, elevated pulse, and other indications of intra-abdominal hemorrhage.
The jury found the delivering physician failed to properly diagnose and treat the uterine rupture, failed to provide the patient with adequate pain medication, and failed to properly monitor the patient’s postoperative condition. The jury awarded the plaintiffs $8 million in noneconomic damages: $5.5 million for pain and suffering and $2.5 million for loss of society, comfort, and companionship. The delivering physician was liable for 100% of the damages. The court ordered the damages to be paid by the physician’s employer under vicarious liability.
What This Means for You: This case serves as a stark reminder to medical professionals about the critical importance of closely monitoring patients after surgery and preparing to intervene promptly if complications arise. The incident underscores the significance of knowing the risks and potential complications associated with emergency cesarean sections.
In this case, the physician attempted vacuum-assisted delivery before the emergent cesarean section. This also is a high-risk procedure that is discouraged unless most other options for a successful vaginal delivery have been attempted. It also indicates the infant’s head probably was wedged within the pelvic arch with possible cord compression causing the deceleration of the infant’s heart rate. With these complications occurring simultaneously, it can be safely assumed the delivering physician was under a great deal of stress. The delivering physician could have called on other team members for immediate assistance before the injuries occurred. Physicians often are reluctant to ask for assistance until after the most critical and high-risk tasks have been attempted. This heroism or martyrdom behavior is dangerous to the patient, the physician, and the healthcare facility. It is fortunate other physicians stepped in once the injuries were taking their toll and they saved the patient’s life. But physicians need to recognize their own limitations, especially during stressful and unexpected circumstances. They, like their patients, should reach out for help.
One of the key takeaways from this case is the need for medical professionals to be vigilant in postoperative care. The jury found the physician liable for negligence due to her failure to properly diagnose and treat the patient’s rupture of her left uterine artery. This demonstrated a lapse in the physician’s attention to detail and thoroughness. This oversight led to the accumulation of a significant amount of blood in the patient, cardiac arrest, and need for an emergency hysterectomy.
The verdict also sheds light on the willingness of juries to impose significant awards for noneconomic damages. Despite the absence of any economic damages, the jury awarded $8 million solely for pain and suffering and the loss of society, comfort, and companionship experienced by the patient and her husband. This serves as a reminder that juries are willing to assign significant noneconomic damages when medical professionals fail in their duty of care.
However, the case also shows juries may likewise carefully consider who should not be held liable for medical negligence. The plaintiffs sued not just the delivering physician — they also sued three other physicians who were involved in the postoperative care or the emergency hysterectomy. The plaintiffs alleged the three other physicians also failed to recognize the patient’s condition had deteriorated significantly, including hemorrhaging. The jury found the other three physicians were not liable for any medical negligence. Although the verdict form does not list the jury’s reasons for their decision, the verdict does suggest they weighed the evidence, assigned liability, and assessed significant damages against only whom they believed truly at fault. It supports the notion that juries recognize the individual roles and responsibilities of each physician and evaluate their actions independently.
Finally, this case emphasizes the importance of meticulous documentation. A surgeon’s postoperative note is one of the most critical documents in the medical record when a case is litigated. Yet it is often the most hastily written, leaving holes where crucial information is omitted or inaccuracies where misinformation is added. Accuracy takes patience, and patience takes time. It is time well spent for both physician and patient. Here, the plaintiffs took advantage of the lack of notes or records indicating the delivering physician ordered or conducted a postoperative inspection of the left uterine artery. Although contemporaneous notes may not have given the defendant a strong argument considering the accumulation of three liters of blood in the patient’s abdomen, the lack of notes may have emboldened a jury that was determined to award damages to the plaintiffs. Accurate medical records and clear, concise notes — particularly in emergency situations — play a crucial role in establishing a comprehensive record of patient care and can serve as vital evidence in case of any subsequent disputes or legal proceedings.
By maintaining a high standard of care, diligence in postoperative monitoring, documenting actions thoroughly, and staying informed about the risks associated with emergency procedures, medical professionals can strive to prevent similar incidents, ensure the well-being of their patients, and avoid costly lawsuits and blemishes on their records.
REFERENCE
- Decided June 2023 in the Montgomery County Court of Common Pleas, Pennsylvania, Case No. 2014-27658.
This case serves as a stark reminder to medical professionals about the critical importance of closely monitoring patients after surgery and preparing to intervene promptly if complications arise. The incident underscores the significance of knowing the risks and potential complications associated with emergency cesarean sections.
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