Excessive bleeding after childbirth leads to mother's death, over $15 million in damages
By Damian D. Capozzola, Esq.
Law Offices of Damian D. Capozzola
Jamie Terrence, RN
President and Founder, Healthcare Risk Services
Former Director of Risk Management Services (2004-2013)
California Hospital Medical Center
Angelina Gratiano, Esq.
Law Office of Steven Carvel, Manhattan Beach, CA
News: A 33-year-old woman died due to excessive bleeding shortly after childbirth when the two physicians overseeing her care failed to follow established protocol for the woman's high-risk pregnancy. The woman's treating obstetrician failed to note the unique location of the woman's placenta, as the woman suffered from a condition known as placenta accreta. This condition left the woman abnormally vulnerable to a high risk of hemorrhaging during childbirth because her placenta was not as easily removable as in other more common pregnancies. While this condition can be readily diagnosed with well-established imaging techniques and protocols, the physicians overseeing the woman's care failed to request imaging to ensure her placenta had developed properly. Tragically, when the physicians realized the abnormal location of the woman's placenta, it was too late. One of the obstetricians made the decision to separate the woman's placenta from the uterus during the cesarean section, but the physician did not request that additional emergency care, such as extra blood and platelets for blood transfusion and additional nursing and surgical staff, be made immediately available. Without additional blood and staff on hand, the woman's condition rapidly deteriorated, and the woman eventually bled to death. After a two-week trial, the jury deliberated less than six hours before finding both doctors in charge of the woman's care, along with the hospital where the woman was treated, jointly and severally liable for medical malpractice, and imposed $15. 55 million in damages.
Background: A 33-year-old woman received prenatal care during her pregnancy by her treating obstetrician. During a woman's pregnancy, regular visits with her obstetrician are critical to ensure that the pregnancy is progressing normally. At this point, between 15-20 weeks of gestation, the woman's obstetrician requested an obstetrical ultrasound. A separate obstetrician, a specialist in prenatal imaging, failed to properly interpret the woman's ultrasound and failed to diagnose the condition placenta accreta.
While not a concern for most women, placenta accreta is a condition in which the woman's placenta develops with an abnormal attachment to the myometrium. Essentially, the placenta develops through the endometrium, rendering the removal of the placenta during childbirth particularly dangerous. Because the placenta for a woman suffering from placenta accreta has developed with abnormal depth, its removal from the uterine wall causes severe hemorrhaging.
In this case, the woman's condition was not diagnosed before childbirth, which is not entirely uncommon. Placenta accreta can be difficult to diagnose before birth. However, established imaging techniques and protocols can aid obstetricians in establishing a diagnosis. If this condition is suspected, the treating obstetrician might be able to take proactive steps to ensure the safety of the mother and the baby during childbirth.
Three major medical organizations have established physician guidelines for placenta imaging, including the American College of Radiology, the American Congress of Obstetricians and Gynecologists, and the American Institute of Ultrasound in Medicine. All three organizations emphasize the need for physicians to obtain images that show the relationship between the woman's cervix and the placenta during pregnancy. To ensure the physician understands the relationship between the structures, both structures should be included in the same image. In this mother's case, the obstetricians failed to ensure that these images were done in accordance with the established guidelines, such that the physicians did not determine the relationship between her cervix and her placenta. This mistake was a critical one, as the failure to do their due diligence in understanding the relationship between these structures ultimately led to incorrect interpretations of subsequent imaging done on the woman.
Additionally, the obstetrician overseeing the woman at the hospital during her delivery failed to request an ultrasound prior to conducting the woman's cesarean section. An ultrasound image should be done prior to a cesarean section to ensure the placenta is not abnormally attached to the woman's cervix. In this case, by failing to conduct an ultrasound of the woman prior to her surgery, physicians were not aware how deeply attached the woman's placenta was to her cervix. By the time the physicians began the cesarean section and removal of her placenta, they realized that the placenta was so deeply embedded in the cervix that they could not prevent the excessive bleeding.
Lastly, the physicians treating the woman failed to request additional resources prior to the woman's cesarean section. In this case, the doctors failed to request additional blood for a transfusion as well as additional nursing and medical staff to handle any complications. The failure to have additional blood on hand led to the woman bleeding extremely quickly without sufficient blood on hand with which to transfuse her. Unfortunately, the woman died due to excessive bleeding. However, her child was born and survived the cesarean section.
The woman's husband filed a wrongful death suit against the two treating obstetricians and the hospital overseeing her cesarean section, and he asserted joint and several liability. After a two-week trial, the jury found both doctors and the hospital guilty of medical malpractice based on joint and several liability. The jury gave the verdict and awarded the husband $15.55 million in damages after deliberating less than six hours.
What this means to you: When there are established guidelines from professional medical organizations, physicians should heed these guidelines because these guidelines create the professional standard of care expected by reasonable professionals in the doctor's field. Most importantly, it is best not to take shortcuts on these guidelines to ensure proper due diligence has been performed. In this case, had the obstetricians followed the guidelines set out by medical organizations regarding ultrasounds during pregnancies, the doctors would have understood how deeply embedded the woman's placenta was and that removal of her placenta would result in serious medical complications. Instead, the physicians relied on the interpretation of a single ultrasound read by an individual radiologist. They did not view that ultrasound or order additional ultrasounds toward the end of the pregnancy or at the time of the c-section. Relying on one individuals' interpretation of critical information can be problematic. Had they considered the risk factors of a previous c-section and advanced maternal age, they might have made a more thorough assessment of the placental relationship with the uterus.
Another consideration for physicians is the assurance that the hospitals they practice in are prepared for emergencies in the different high-risk specialty areas such as the emergency department, surgery, and labor and delivery. There should be emergency codes that can be called by staff when things go awry, such as a "Code OB Hemorrhage" or a "Code OB. " These rapid response codes ensure needed emergency equipment, blood, drugs, and staff members are given to the patient in minutes. Admitting patients to and practicing in hospitals without these life-saving processes in place can lead to very unfavorable outcomes for both parties.
Additionally, it is important for physicians to actively participate in the current and developing medical knowledge in their respective fields. Keeping up to date with emerging medical knowledge helps ensure that doctors and hospitals are well aware of important issues in the medical field. This step can be accomplished by proactively engaging in attending conferences, seminars, subscribing to medical journals, and even by attending networking dinners or events. Research yields new developments and viewpoints concerning even well-known complications and diseases. Medical professionals who presume that they are above carving out time for continuing professional education run a significant risk of steering themselves and their patients into an adverse outcome that could have been avoided by keeping up with the cutting edge of the profession.
Ultimately, doctors and hospitals want to ensure that they provide the best medical care possible. To do so, due diligence must be done to ensure that the doctors and the hospital are prepared to handle patient needs.
- Case No. 09-L-012356 (Cook County Circuit Court, Cook County, IL). Nov. 22, 2013.