Is One hour and ten minutes too long to get a hemorrhaging patient with placenta previa into the OR and C-sectioned delivered (Case #282)

• Medical Probability: 8 / 10
• Medical Error Summary: There is no reasonable explanation to obtain a vaginal probe ultrasound and somebody with a hemorrhaging placenta previa. If the intent was to quickly assess the fetus, and abdominal ultrasound would ...
• Causation Probability: 8 / 10
• Causation Summary: In this case, the delay in delivery could have caused hypertension, hypoxemia, or both in the infant.
• Expert Summary: 30 years of providing obstetric care to women of both low and high risk pregnancy.
• Similar Summary: Possibly once or twice a year, placenta previa is not all that common.

Uterine rupture during TOLAC (Case #336)

• Medical Probability: 8 / 10
• Medical Error Summary: This patient already has two known risk factors heading into the procedure, she is obese and has had a prior C-section. We don’t know the estimated fetal weight, or if he has any comorbid medical co...
• Causation Probability: 8 / 10
• Causation Summary: If he just was showing signs of early compromise, secondary to the chorioamnionitis. The mother began expressing pain, despite what seem to be an adequate epidural. This was a clear indication of uter...
• Expert Summary: I’ve been in practice for 34 years up till my retirement date, which was July 2022. During this time I supervised the residence in our residency program, attended morbidity and mortality, meetings, ...
• Similar Summary: Fortunately, where I practice, we were very careful and in tune to risk factors in the individual patient undergoing Trial of labor, after having a cesarean section. We were fortunate to have very few...

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

• Medical Probability: 7 / 10
• Medical Error Summary: The patient has a mother who has a diagnosis of breast cancer, which automatically places this patient in a high-risk category. However, what I do not know from the history is how old the mother was w...
• Causation Probability: 7 / 10
• Causation Summary: Earlier screening should have been performed based on the patient’s family history. Again, however, without the history, as indicated above, I do not know whether or not she would be a candidate for...
• Expert Summary: I’ve been in practice for 34 years and involved with well woman exams, as well as screening, which included routine screening, but also genetic screening. I have taught residence for 34 years along ...
• Similar Summary: Fortunately, these cases are foreign few in between, and usually referred in. Again with my practice we are very proactive with screening and obtaining good histories, as well as encouraging patients ...

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

• Medical Probability: 8 / 10
• Medical Error Summary: One of the primary duties of the operating position, upon getting ready to enter, the lower, uterine segment, is to assess whether or not I love you doing segment is very thin or thick. If the segment...
• Causation Probability: 9 / 10
• Causation Summary: From the pictures, it is very clear that the only thing that could’ve happened was a scalpel, pressing through, not only the lower, uterine segment, but the infants cheek. With respect to the infant...
• Expert Summary: I have practiced Ob/Gyn for 33 years. I have had many cases where the lower uterine segment was very thin. And in all such cases, careful, palpation, and attention to technique allowed me to deliver i...
• Similar Summary: Again, this is not an uncommon situation and happens quite frequently. One may encounter this several times a week, or you may go several weeks without encountering this. However, it again goes back t...

31 y.o. woman with ectopic pregnancy (seeking causation opinion) (Case #353)

• Medical Probability: 7 / 10
• Medical Error Summary: The initial finding of an hCG of 878, is below the threshold, where you would see in intrauterine pregnancy. As such the women’s symptoms did not suggest anything other than what was done properly t...
• Causation Probability: 8 / 10
• Causation Summary: Again, based on my reasoning above, surgery may not have been necessary. If the follow-up hCG was declining, and in hospital observation to make sure she was hemodynamically stable for the next 24–4...
• Expert Summary: I am retired, but I had 34 years of active practice and was in a residency program where I was actively teaching medical students and residents. I have encountered dozens and Dozens of ectopic, pregna...
• Similar Summary: The one above may present anywhere is from two per month, to three per month, especially when you’re involved in a residency program.

46yo F ureter injury/transection during elective TLH/BS. Req additional procedures, follow up and extended recovery. (Case #395)

• Medical Probability: 8 / 10
• Medical Error Summary: The case as described in the operative report, is a laparoscopic robotic technique, utilizing cautery techniques only. The report does outline the steps taken in very good detail also describing the s...
• Causation Probability: 8 / 10
• Causation Summary: Again, because of the nature of the technique used i.e. cauterization, there is only one way the blockage could have been affected. If this were a suture technique, theoretically, a kinking of the ure...
• Expert Summary: I have been in practice for 34 years, at a teaching hospital, whereby all my surgeries were attended by various levels of residents. We utilized various techniques in performing hysterectomies, and la...
• Similar Summary: Fortunately, these are encountered fairly infrequently thanks to the level of skill and postop recognition in our hospital. From time to time they are brought up at morbidity and mortality conferences...

Death of 66 y.o. Woman for Hemorrhagic Shock after TAH-BSO for Stage I Endometrial Ca (Case #407)

• Medical Probability: 10 / 10
• Medical Error Summary: The mere fact that no other lab test were run during this patient’s postoperative phase,,when clearly one of the differential diagnosis had to have been bleeding, This after a complicated Oncology c...
• Causation Probability: 10 / 10
• Causation Summary: Obviously, upon undergoing the second surgery, the fact that there was bleeding within the abdomen, demonstrates that the uterine artery in question was not clearly ligated to the point where this pat...
• Expert Summary: I’ve been in practice as a general gynecologist for 34 years. I worked in the hospital training residence alongside of working with general surgeons and GYN oncologists. Over the years, I have faced...
• Similar Summary: I would say 1-4 per month of varying degrees.. The need to return to the OR occurs about one per month,

Unnecessary Hysterectomy and BSO (Case #411)

• Medical Probability: 8 / 10
• Medical Error Summary: From the above notes, the first physician performed a hysterectomy and BSO in an attempt to discontinue this women’s bleeding. He previously performed a procedure that showed she had an atrophic ute...
• Causation Probability: 8 / 10
• Causation Summary: The patient underwent an unnecessary procedure in attempt to stop bleeding, for which the procedure had a very low likelihood of resolving since a different source i.e. the vaginal lesion had already ...
• Expert Summary: I have had 34 years of general, Ob/Gyn practice and concentrated strictly on Gyn the last several years up until my retirement two years ago. During this time I worked in a academic institution where ...
• Similar Summary: Cases like this while not common, were seeing from time to time. It was always important to perform a full work up to make sure that the bleeding source was not within the uterus and cervix or ovaries...

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

• Medical Probability: 8 / 10
• Medical Error Summary: First off, a hysterectomy performed at the time of cesarean section is much riskier because of the increased blood flow and engorgement of the tissues due to the pregnancy status. While injury to a si...
• Causation Probability: 8 / 10
• Causation Summary: The ureters, according to the information given, had thermal damage. This indicates that cautery was used in the vicinity of this vital structure. Given her pregnancy status, and knowing the anatomy, ...
• Expert Summary: Although retired, I had been an active practice in a teaching hospital with residents for 34 years. I’ve done numerous hysterectomies in addition to several cesarean, planned hysterectomies. The lad...
• Similar Summary: Fortunately placenta accreta is a rare instance, and we may see one or two of these a year. Since we also cover the Resident practice, we see a handful of these a year in addition.

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

• Medical Probability: 8 / 10
• Medical Error Summary: This is a very long and involved case with multiple areas where a more aggressive course would’ve helped. First off, during the course of surgery the patient is noted to have multiple adhesions. Was...
• Causation Probability: 8 / 10
• Causation Summary: While, any surgery can have complications, it is the discovery and handling of these complications that will often lead to a successful outcome, or further injury and problems for the patient. Again, ...
• Expert Summary: I’ve been in practice privately for 34 years. I have performed dozens upon dozens of hysterectomies, both open, vaginal, and laparoscopically. The hospitals where I worked, had residents which I per...
• Similar Summary: In our own practice, these may occur once a year since we use direct view entry upon laparoscopy, which assist greatly in avoiding these, as well as being very judicious as to which patients are good ...