Presentation on theme: "Peter I. Bergé, PA, JD Bendit Weinstock, PA West Orange, NJ."— Presentation transcript:
Peter I. Bergé, PA, JD Bendit Weinstock, PA West Orange, NJ
Tort Reform Case studies Take-home lessons
Not a content expert Not an OBG practitioner Intent of the program
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
IV, two saline boluses 20 ml/kg NG tube Chest/abdominal films CBCD, chem Blood cx.
Abdominal films: large, dilated loops of bowel with air-fluid levels
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
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
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
Economic value of case? Should he be sued? Do the parents deserve redress? You are the jury...
Vaginal birth after cesarean section (VBAC) Negligent neonatal resuscitation Postdatism and prematurity Genetic counseling and testing Potentially: ectopic pregnancy
Delayed diagnosis of cancer Cervical Uterine Breast Ovarian Failure to diagnose PID Injuries during fertility procedures Prescription of OCPs Prescription of HRT
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”
Believed that cysts “went away” during hiatus in therapy In 2004 required excisional biopsy of lesion because radiography was equivocal Benign cyst
Claimed negligence: Improper prescription of HRT Product liability Claimed injury Surgery (excisional biopsy) Increased medical monitoring
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
The baby was born with no arms. Not discovered because no U/S was done.
Deviation from SOC (breach)?
Causation? Damages? Decision:
Stick to the schedule Immediately, clearly document reasons for any variations from schedule When something is missed, mitigate where possible
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
Deviation from SOC (breach)? Patient communication?
Injury? Causation? Damages Outcome
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
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
Dr. U does not examine or report on eyes Infant is born with anophthalmia
Injury? Wrongful birth case Child born without eyes Trauma to parents Expenses and special needs
Causation? “But for...” Dr. O? Dr. U?
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
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
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
OTHER COMMUNICATION POINTS Document all of the above If possible, keep a copy of what you gave the patient
Abbott Brown, Esq. You For completing evals For your attention Peter I. Bergé, Esq. Bendit Weinstock 80 Main St. Ste. 260 West Orange, NJ