Expert Witness Case #9

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A woman in her twenties presented to an OBGYN for her 5th pregnancy. She had one living child from the previous 4 pregnancies, and had pre-eclampsia following the delivery of her child.

The pregnancy in question was initially uncomplicated. She would eventually be seen by 3 obstetricians, Dr. S, Dr. O, and Dr. G. At 28 weeks gestation she was found to be hypertensive with a systolic blood pressure in the 130s. An ultrasound and labs ordered by Dr. S were reassuring. During the following appointments, she repeatedly reported general malaise, headache, and abdominal pain. The office blood pressure readings were all around 130 systolic, but she reported that multiple home blood pressures were much higher.

Her symptoms continued to worsen, and at a re-check, she was noted to have a blood pressure in the 180s. She was sent to the hospital, where she reportedly had severe abdominal pain. She was diagnosed with HELLP, and an ultrasound confirmed fetal demise. She was taken to the OR where a large liver hematoma was found.

After referral to a tertiary hospital and a long inpatient course, she was released.

A lawsuit was filed against the 3 physicians who had seen her during her pregnancy. The expert was critical of the actions of all 3 physicians.

The lawsuit was withdrawn after a confidential settlement was reached.

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MedMalReviewer Opinion:

This is a tragic case of undetected preeclampsia that developed into eclampsia and resulted in the death of the fetus. There are several interesting discussion points from this case.

1) The plaintiff obtained the patient’s call records. The numerous calls to the doctor’s office will be used to help build the narrative that the patient was desperately seeking help for her escalating symptoms. The jury will be told a story of a cold-hearted physician who ignored her pleas and numerous phone calls while she slowly decompensated.

2) Home blood pressure measurements are a frequent topic of disagreement between patients and physicians. In non-pregnant patients, these devices often give inaccurate measurements and can cause more harm by inducing anxiety. Documenting the patient’s self-reported blood pressures and an explanation of how they play into the doctor’s decision-making can help provide some degree of medicolegal protection.

3) The expert witness opinion paints a very clear picture of classic preeclampsia symptoms. Her headache, visual disturbance, and abdominal pain are all red flags. She later developed right shoulder pain, likely radiating from her injured liver. However, all of these symptoms are viewed through a lens of hindsight bias and with the clear goal of making the physicians seem negligent. Take them with a grain of salt.

4) The biggest factor that will play into the physician’s defense is the fact that 3 separate physicians were named as defendants. It is much easier to show that one physician violated the standard of care. The fact that they all provided treatment that was internally consistent indicates that they were doing what any reasonable doctor would have done.

5) [Commentary written prior to settlement] I expect Dr. O and Dr. S to be dismissed from the lawsuit, and Dr. G (who provided most of the care shortly before the bad outcome) will likely settle this case. It is an uncomfortable fact that the settlement for a case in which a child dies is usually smaller than a settlement in which the child lives, as there are not ongoing medical expenses for the child.

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