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Peter I. Bergé, PA, JD Bendit Weinstock, PA West Orange, NJ.

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Presentation on theme: "Peter I. Bergé, PA, JD Bendit Weinstock, PA West Orange, NJ."— Presentation transcript:

1 Peter I. Bergé, PA, JD Bendit Weinstock, PA West Orange, NJ

2  Tort Reform  Case studies  Take-home lessons

3  Not a content expert  Not an OBG practitioner  Intent of the program

4  Healthy 6 y/o girl, abrupt onset of abdominal pain; vomits x 1  To local community hospital ED  Hypotensive, tachycardic, tachypneic  Peripheral and circumoral cyanosis  Decreased level of consciousness

5  IV, two saline boluses 20 ml/kg  NG tube  Chest/abdominal films  CBCD, chem  Blood cx.

6  Abdominal films: large, dilated loops of bowel with air-fluid levels

7  ED doctor: boarded in EM/Peds  Arranges transport to tertiary care center for pediatric surgical consultation  Peds intensive care team/transport at ED within 1 hour of arrival  PICU resident on transport team:  Third saline bolus  Calls ahead to order abdominal CT

8  Child admitted to PICU; notations by nurses/resident of cyanosis and decreased LOC  Pediatric surgeon arrives (~10 PM Sunday) and assesses child  After fluid resuscitation, BP low normal, tachycardic, LOC WNL  Diagnosis: urosepsis vs. gastroenteritis  No further evaluation

9  Mother: why no CT?  Surgeon goes home  6 hours later: PICU calls surgeon to inform that they are doing CPR  Child dies in front of parents  Autopsy: necrotic bowel; malrotation  Parents under psychiatric care years later  Mother medicated and under intensive treatment

10  Economic value of case?  Should he be sued?  Do the parents deserve redress?  You are the jury...

11  Shoulder dystocia/brachial plexus injury  Ultrasound issues  Prenatal testing  Perinatal Group B strep  Preterm labor  Improper fetal monitoring  Pregnancy-induced hypertension/preeclampsia

12  Vaginal birth after cesarean section (VBAC)  Negligent neonatal resuscitation  Postdatism and prematurity  Genetic counseling and testing  Potentially: ectopic pregnancy

13  Delayed diagnosis of cancer  Cervical  Uterine  Breast  Ovarian  Failure to diagnose PID  Injuries during fertility procedures  Prescription of OCPs  Prescription of HRT

14  59-year-old woman with hx. of triple vessel coronary disease in 2003, hysterectomy in Had been on hRT.  Despite recent developments, GYN continued hRT due to cardiac risk  Stopped for about a year, then re-started. Wanted to stop: cysts on every mammogram  Radiologist referred to “estrogen cysts”

15  Believed that cysts “went away” during hiatus in therapy  In 2004 required excisional biopsy of lesion because radiography was equivocal  Benign cyst

16  Claimed negligence:  Improper prescription of HRT  Product liability  Claimed injury  Surgery (excisional biopsy)  Increased medical monitoring

17  Deviation from SOC (breach)?  Injury?  Causation?  Damages?  Outcome:

18  December 2001: 24 –year-old gravida 5, para 3, TAB 1 presented to family practice for prenatal care  weeks gestation by dates  Hx. of minor congenital defects in previous children  Presented relatively late because was not sure before that she wished to continue the pregnancy

19  The baby was born with no arms.  Not discovered because no U/S was done.

20  Deviation from SOC (breach)?

21  Breach?  Injury?

22  Causation?  Damages?  Decision:

23

24

25  Stick to the schedule  Immediately, clearly document reasons for any variations from schedule  When something is missed, mitigate where possible

26  January 2003: 27-year-old female with h/o incompetent cervix and two prior C-sections  On bed rest with cerclage  Taken to surgery for C-section  Develops heavy bleeding during surgery  Told afterward that a hysterectomy was done  Infant is fine

27  Deviation from SOC (breach)?  Injury?  Causation?  Damages?  Outcome:

28  Deviation from SOC (breach)?  Patient communication?

29  Injury?  Causation?  Damages  Outcome

30  Talk to your patients!  Tell them, tell them again  Write down what you told them and give it to them  Write in the chart that you wrote what you told them and gave it to them

31  year-old female comes under care of OBG (Dr. O).  While performing obstetric U/S Dr. O notes apparent cleft palate and cannot visualize eye sockets well  Dr. O. refers patient to MFM, Dr. U, for level II U/S  Writes on Rx. to look for cleft palate and eyes  Dr. U performs multiple views of cleft palate

32  Dr. U does not examine or report on eyes  Infant is born with anophthalmia

33  Deviation from SOC (breach)?  Injury?  Causation?  Damages?  Outcome:

34  Deviation?  Dr. O.:  Dr. U.:

35  Injury?  Wrongful birth case  Child born without eyes  Trauma to parents  Expenses and special needs

36  Causation? “But for...”  Dr. O?  Dr. U?

37  Damages?

38

39  Have concrete, consistent, reproducible system for  Tracking tests ordered  Following up on results  Contacting patients with results  Documenting all of the above  Attempts to reach patients should be proportionate to the potential harm to the patient  Documentation should be extensive

40 OTHER COMMUNICATION POINTS  Tell patient what your concern is  Cancer, losing pregnancy, bleeding, etc.  Use the words and document that you did (do not leave room for patient to say that you didn’t tell her how serious it was)  Follow-up instructions need to be clear, detailed and individualized

41 OTHER COMMUNICATION POINTS  Cover contingencies: Call if... Come back if... To ED if... Call 911 if...  Call if problems with medication; unexpected spotting or cramping...  Come back if unexpected bleeding or moderate pain  To ED if severe pain, heavy bleeding, shoulder pain  911 if lightheadedness or passing out

42 OTHER COMMUNICATION POINTS  Document all of the above  If possible, keep a copy of what you gave the patient

43  Abbott Brown, Esq.  You  For completing evals  For your attention Peter I. Bergé, Esq. Bendit Weinstock 80 Main St. Ste. 260 West Orange, NJ


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