Botched infant circumcision? (Case #179)

• Medical Probability: 9 / 10
• Medical Error Summary: Denuding the ventral skin excessively leads to scar tissue formation which was the proximal cause to the complications suffered by this child. When there is excessive skin removed and there is also ex...
• Causation Probability: 9 / 10
• Causation Summary: 1. The bleeding was likely due to the fact that excessive skin was removed. 2. The surgeon failed to recognize the cause of the excessive bleeding. 3. The treatment with silver nitrate did not remed...
• Expert Summary: I've performed circumcisions on newborn babies for over 22 years. I've supervised medical residents performing circumcisions. I've seen and health with circumcision complications.
• Similar Summary: This is an extremely rare and unfortunate complication. In supervising residents, I know that this complication results from over aggressive denouement of the ventral skin on the penile shaft.

Uterine rupture during TOLAC (Case #336)

• Medical Probability: 10 / 10
• Medical Error Summary: 1. Patient was afforded a walking epidural. There is no evidence of benefit of walking in high risk delivery. (Bloom SL, McIntire DD, Kelly MA, Beimer HL, Burpo RH, Garcia MA, Leveno KJ. Lack of effec...
• Causation Probability: 9 / 10
• Causation Summary: This patient had a prior c-section, putting her at risk for uterine dehiscence. She was started on pitocin which was continued through tachysystole. The IUPC was failed to register contractions, due t...
• Expert Summary: I’ve been on multiple peer review committees in the past and have reviewed hundreds of tracings over my 23+ years as an OB GYN.
• Similar Summary: We see patients desiring TOLAC maybe about a dozen times per year. We screen patients very closely. About half decide to have a repeat c section, but some go through with it. The patient must have a c...

33-year-old diagnosed with Stage IV breast cancer (Case #342)

• Medical Probability: 9 / 10
• Medical Error Summary: Yes, given the patient's family history of breast cancer, vulvar cancer, heart disease in her father, and the subsequent development of breast cancer in her mother, it would have been appropriate for ...
• Causation Probability: 9 / 10
• Causation Summary: If the patient's breast cancer had been identified earlier through appropriate risk assessment and screening, there might have been more treatment options available, and the prognosis could have been ...
• Expert Summary: I've had 23 years of experience in the field of OB GYN. I'm familiar with the ACOG guidelines for breast cancer screening. I've served as an expert in medical malpractice cases previously.
• Similar Summary: We see a handful of patients annually that are offered BRCA screening and test positive. This results in additional consultations, patient counseling, and better screening for cancer.

Newborn facial laceration from c-section (Case #352)

• Medical Probability: 9 / 10
• Medical Error Summary: In evaluating the case of the 32-year-old G2P1001 patient who underwent a repeat c-section at 39 weeks and 2 days, it is my professional opinion that the unfortunate outcome—a 2.5 cm facial lacerati...
• Causation Probability: 8 / 10
• Causation Summary: The operative report identified a "thinned out lower uterine segment," which should have triggered an elevated level of surgical caution, given that the patient was already at increased risk for compl...
• Expert Summary: I’ve had 25 years OB GYN experience and have served on the peer review committees of many institutions. The physician here had a duty to both mother and baby. As such, informed consent should have b...
• Similar Summary: I’ve had a facial laceration during a stay c section but it didn’t require this type of extensive treatment.

bilateral ureter injury following C-Section hysterectomy in case involving placental accreta (Case #533)

• Medical Probability: 8 / 10
• Medical Error Summary: Based on the limited information provided, I believe there was a significant possibility of medical error. While ureteral injury is a known risk during cesarean hysterectomy for placenta accreta, but ...
• Causation Probability: 9 / 10
• Causation Summary: The reported bilateral ureteral injuries are directly linked to the surgical procedure (cesarean hysterectomy) and are the proximate cause of the patient’s subsequent complications, including the ne...
• Expert Summary: Board-certified OB/GYN with extensive experience in high-risk obstetrics and complex pelvic surgery, including cesarean deliveries and hysterectomy. My clinical practice routinely involves management ...
• Similar Summary: In my practice, I routinely manage high-risk obstetric patients and perform cesarean deliveries, including cases with complex surgical anatomy. In my career spanning 28 years, I've seen, reviewed and ...

Complications Following Laparoscopic Hysterectomy: Enterotomy, Surgical Site Infection (Case #543)

• Medical Probability: 8 / 10
• Medical Error Summary: Based on the information provided, there appears to have been a potential medical error, primarily in the postoperative management rather than necessarily in the occurrence of the bowel injury itself....
• Causation Probability: 7 / 10
• Causation Summary: Based on the information provided, it is likely that the suspected medical error contributed to the patient’s injury. The most plausible causation issue is not the initial bowel injury alone, which ...
• Expert Summary: I am a board-certified OB/GYN with 28 years of clinical experience, including the performance and management of gynecologic surgery and postoperative complications. In addition to my direct clinical w...
• Similar Summary: In a 28-year OB/GYN practice, I have encountered similar cases on multiple occasions, including patients undergoing hysterectomy and other pelvic surgery with extensive adhesive disease, bowel injury ...