Delay in diagnosis of Type 2 endometrial cancer (Case #274)

• Medical Probability: 7 / 10
• Medical Error Summary: If endometrial sampling is inadequate, there should have been follow up with another method of sampling.
• Causation Probability: 5 / 10
• Causation Summary: It is difficult to tell whether a delay from August 2021 to April 2022 led to upstaging of disease from an earlier stage where survival was more likely, to stage IVB - it is possible that in August 20...
• Expert Summary: I am a board-certified gynecologic oncologist
• Similar Summary: Endometrial cancer - 1-4 cases a week

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: 6 / 10
• Medical Error Summary: A couple of points seem unclear or questionable. With a diagnosis of placenta previa, the facts that a “doctor tried to check her” (If this means sterile vaginal exam to assess cervical dilation)...
• Causation Probability: 6 / 10
• Causation Summary: If truly extra, unnecessary steps (attempted exam, vaginal ultrasound) were taken that lengthened the interval between when the decision to deliver should have been made (I.e., on a patient with known...
• Expert Summary: I am a board-certified obstetrician-gynecologist (though have subspecialized in gynecologic oncology and do not practice obstetrics). I also did my residency at New York-Presbyterian Hospital (Cornell...
• Similar Summary: None, I’m a gynecologic oncologist. But this was encountered during training as well as during continuing medical education

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

• Medical Probability: 5 / 10
• Medical Error Summary: The operative report documented having visualized the bilateral ureters. Peristalsis doesn’t guarantee functioning ureters without obstruction, but during a hysterectomy, being able to visualize the...
• Causation Probability: 4 / 10
• Causation Summary: N/A see above - from the operative report it is difficult to ascertain error; if anything, care was taken to ensure ureteral damage was avoided. The only additional thing would have been to do cystosc...
• Expert Summary: I am 13 years out of OBGYN residency and 10 years out of gynecologic oncology fellowship, and have been consulted by my colleagues on cases of injuries similar to this.
• Similar Summary: Once every year or so will get consulted on similar case. A few times a year I will encounter incidental/unavoidable ureteral injury/transection due to cancer involvement

Unnecessary Hysterectomy and BSO (Case #411)

• Medical Probability: 8 / 10
• Medical Error Summary: Based on the description given (missing notes or discussion from the defendant gynecologic oncologist), it seems like inadequate justification/rationale/medical indication was given for the planned/pe...
• Causation Probability: 7 / 10
• Causation Summary: The patient ended up undergoing major surgery - total hysterectomy and bilateral salpingo-oophorectomy, in addition to upper vaginectomy - without adequate rationale and without improvement in symptom...
• Expert Summary: I am a gynecologic oncologist, 10 years in practice, first 9 focused exclusively on surgical management, and evaluated similar cases and have performed numerous surgeries - hysterectomy, vaginal/cervi...
• Similar Summary: Post-menopausal bleeding a couple of times a week. Vulvovaginal lesion/condyloma every other week or so. I perform about an average of 5 hysterectomies a week

Young woman with pelvic mass, rupture during removal, multiple complications. (Case #435)

• Medical Probability: 6 / 10
• Medical Error Summary: Potential error in question is dissemination of malignant immature teratoma (or perhaps the mature components within) at time of laparoscopy on 3/9. Based on the operative report, there was spillage...
• Causation Probability: 4 / 10
• Causation Summary: While the initial surgical management may have resulted in the initial spread of the immature teratoma, the injury in the case is noted to be the pulmonary toxicity of bleomycin, which would have been...
• Expert Summary: I am a gynecologic oncologist in practice for 11 years, with focus on surgical treatment of gynecologic cancers. I have treated both mature and immature teratomas in my practice and am comfortable dis...
• Similar Summary: Mature teratomas once every month or so, immature teratomas every couple of years

34 yo female with significant complications following second trimester D&E (Case #444)

• Medical Probability: 7 / 10
• Medical Error Summary: There was enough concern to have repeated the ultrasound and then denote specifically exam was done to evaluate / rule out a defect, If defect were identified/confirmed before additional instrumentati...
• Causation Probability: 7 / 10
• Causation Summary: If uterine perforation were confirmed earlier, and no additional instrumentation done, likely no significant injury (other than uterine defect) or less significant injury (only localized bleed and no...
• Expert Summary: I am a gynecologic oncologist in practice x 10 years at alarge academic center, routinely on back up call for OBGYNs
• Similar Summary: I encounter variations of this scenario - possible perforation, retroperitoneal bleed, intraoperative hemorrhage - on intraoperative consult about once a month or so

Client believes untreated placenta accreta resulted in her requiring a hysterectomy. (Case #507)

• Medical Probability: 4 / 10
• Medical Error Summary: Pathology reports of either the original placenta or more importantly the hysterectomy would be helpful. Patients with prior uterine manipulation/procedures can be at higher risk of placenta accreta ...
• Causation Probability: 4 / 10
• Causation Summary: See above; pathological examination would tell us if there was accreta in the first place, and management based on intraoperative findings at time of c-section seems justified as there was not increas...
• Expert Summary: Gynecologic oncologist with 11 years of experience, actively involved with accreta team at large academic center
• Similar Summary: As a gynecologic oncologist actively involved with our accreta team, I am involved in placenta accreta spectrum disease cases about once a month or so

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

• Medical Probability: 6 / 10
• Medical Error Summary: The injury itself, without documented distortion of ureters leading to diseased anatomy being the culprit, is likely res ipsa loquitur of medical error. With cesarean hysterectomies, due to distorted...
• Causation Probability: 7 / 10
• Causation Summary: If the ureters were not identified during the hysterectomy and were noted to have been injured after, the injury is likely due to unrecognized injury at time of hysterectomy
• Expert Summary: I am a gynecologic oncologist at a lage academic center and am routinely involved in placenta accreta cases and cesarean hysterectomies, about a case every 1-2 months.
• Similar Summary: I am a gynecologic oncologist at a lage academic center and am routinely involved in placenta accreta cases and cesarean hysterectomies, about a case every 1-2 months.

8-month delay in diagnosing carcinoid tumor of the ovary/fallopian tube (Case #545)

• Medical Probability: 7 / 10
• Medical Error Summary: With weight loss, anorexia and pelvic mass, a pelvic exam and ultrasound is likely inadequate workup to conclude the mass as being benign. A formal ultrasound to evaluate for vascularity of the mass, ...
• Causation Probability: 7 / 10
• Causation Summary: While carcinoid tumors tend to be indolent, serotonin secretion may have led to the cardiac valvular disease. If the diagnosis had been made earlier with more workup when she presented in March 2024, ...
• Expert Summary: I am a gynecologic oncologist in practice (in private practice as well as academic medical center settings) for 12 years and have worked up and managed several patients with carcinoid tumors. I have d...
• Similar Summary: 1-2 cases a year over the past 12 years

Robotic Hysterectomy Injury (Case #548)

• Medical Probability: 6 / 10
• Medical Error Summary: It seems like there was a post-op bleed/hematoma which is a known complication of surgery and evaluation with CT scan and management with IR or reoperation would be correct. The thing that raises a qu...
• Causation Probability: 6 / 10
• Causation Summary: If the ovary were sutured to the vaginal cuff, it is possible to have been the source of the hematoma, though cuff vessel or uterine artery branch bleeding are more likely culprits of post-hysterectom...
• Expert Summary: Have been in practice as a Gynecologic oncologist for 11 years and perform robotic surgeries including hysterectomies (more than 200 hysterectomies over the past year). I have also given depositions i...
• Similar Summary: I usually have 1-4 hysterectomies every week