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Failure to Timely Perform Cesarean Section; Obstetrician Liability


A patient presented to the hospital to give birth. The patient’s labor slowed. An obstetrician performed an emergency bedside cesarean section. Subsequently, another obstetrician performed a bedside laparotomy and assisted in an emergency bedside hysterectomy. Twenty-five hours after being admitted to the hospital, the patient died from hemorrhagic shock; disseminated intravascular coagulation, widespread activation of the clotting cascade that results in the formation of small clots in small blood vessels throughout the body; and amniotic fluid embolism, when amniotic fluid or fetal material enters the maternal blood stream.

 

The patient’s estate filed a medical malpractice claim against the obstetricians involved in the patient’s care. The complaint alleged that the obstetricians failed to timely recognize that the patient’s condition required a cesarean section; failed to ensure, after performing an emergency bedside cesarean section, that the patient’s abdomen be left open to monitor for uterine bleeding; failed to place the patient in or near an operating room in case an emergency hysterectomy was also required; failed to sufficiently monitor the patient and recognize that the patient’s condition necessitated a hysterectomy until after the patient coded a second time; waited too long to perform the emergency hysterectomy; performed the emergency hysterectomy in the patient’s bed and without proper medical tools, such as a scalpel, because of the delay in performing the procedure and because of the earlier failure to place the patient in or near an operating room.

 

In support of the complaint, the patient’s estate filed an expert report. The expert opined that the obstetricians’ medical treatment fell below the accepted standard of care and resulted in the patient’s injury, suffering, and premature and preventable death. Regarding the obstetrician who participated in the emergency bedside cesarean section, the expert opined that the obstetrician deviated from the accepted standard of care when the obstetrician failed to leave the patient’s abdomen open for close monitoring and evaluation of uterine bleeding; failed to keep the patient in the operating room or the nearest recovery unit, so that all necessary tools would be readily available in the event an emergency hysterectomy was required; and, upon recognition of uterine atony, failed to perform an emergent hysterectomy. Regarding the obstetrician who participated in the emergency bedside hysterectomy, the expert opined that the obstetrician waited far too long to perform the emergency hysterectomy.

 

The Superior Court Department, Suffolk County, dismissed the patient’s estate’s claim. The trial court held that the patient’s estate failed to raise a legitimate question of liability with respect to the obstetricians.

 

The Appeals Court of Massachusetts, Suffolk County, reversed. The court held that the patient’s estate raised a legitimate question of liability with respect to the obstetricians.

 

The patient’s estate raised a legitimate question of liability with respect to the obstetricians. The court held that the expert’s opinion was sufficient to raise a legitimate question of liability with respect to the first obstetrician. The court held that extrinsic evidence supported the expert’s opinion with regard to the second obstetrician. Specifically, the medical records showed that the emergency hysterectomy was not performed until approximately one hour after the medical records indicated the second obstetrician arrived to the procedure and that the patient’s condition necessitated a hysterectomy by the time the second obstetrician arrived. The court determined that a sufficient question of liability against the second obstetrician was raised by the patient’s estate. The court concluded that the trial court erred in holding that the patient’s estate failed to raise a legitimate question of liability with respect to the obstetricians.

 

The Appeals Court of Massachusetts, Suffolk County, reversed the trial court’s dismissal of the patient’s estate’s claim.

 

See: Feliciano v. Attanucci, 2019 WL 1104747 (Mass.App.Ct., March 11, 2019) (not designated for publication).

 

Medical Risk Law: Mothers, Infants, and Obstetrical Injuries: Labor and Delivery Liability

 

 

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