Jury Absolves GYN Surgeon of Malpractice in Surgical Misadventure
The defendant specializes in laparoscopic surgery, in this case to remove a fibroid uterus estimated to be the equivalent of a 28 – 30 week pregnancy. He is board certified in obstetrics and gynecology and female pelvic medicine and reconstructive surgery. Near the end of the procedure, some blood was seen in the Foley. The defendant searched for and found a three millimeter defect in the dome of the bladder, and repaired it with a stitch and lapra-ty. The plaintiff was discharged with a Foley in place.
After allowing a week for the bladder to heal, the Foley was removed. Shortly after the Foley was removed, the repair failed. The plaintiff underwent laparotomy and repair with a different surgeon at a different medical center.
While the second bladder repair was apparently successful, the plaintiff claimed to suffer from overactive bladder, and her expert witness testified it was due to bladder irritation from the second bladder repair. In order to control those symptoms, she eventually had a neurostimulator implant. This relieved her urinary symptoms but left her with complaints of pain at the implant site.
Plaintiff’s expert testified that standard of care called for a cystogram to be done before removal of the Foley, and that based on the near contemporaneous failure of the first repair, the test would have shown a leak. Then, the Foley would have remained in place for a week to ten days. Another cystogram would be performed, and so on, until the bladder was healed.
The defense expert testified that there is no requirement that a cystogram be performed in th case of every inadvertent cystotomy. The decision to order, or not, rested within the discretion of the surgeon. In this case, there was a very small cystotomy. It appeared clean and healthy around the edges, as if it were from sharp dissection. The repair was “well approximated,” meaning that the cystotomy closed nicely. The defendant testified that he was highly confident in the repair, and that under the circumstances, no cystogram was required.
The jury found that the defendant’s failure to order a cystogram was not a departure from accepted medical practice.