Cut Ureter During Hysterectomy Malpractice Lawsuit
This is an OB/GYN malpractice case filed on behalf of a woman in Montgomery County. This case was filed in Health Claims Arbitration on July 1, 2016, and is the 327th medical malpractice case filed in 2016 in Maryland. The case number for this malpractice lawsuit is 424231V.
- Another hysterectomy malpractice lawsuit filed against an OB/GYN in Olney in 2018
- Da Vinci hysterectomy malpractice lawsuits
Plaintiff is a 35-year-old woman who goes to Shady Grove Adventist Hospital in Rockville for a total laparoscopic hysterectomy with bilateral salpingectomy after childbirth. It is called a cesarean hysterectomy but it is really two separate procedures: a C-section and a hysterectomy. The latter procedure involves removal of the cervix, both ovaries, and fallopian tubes. It makes sense to do them both at the same time because the patient has just one procedure instead of two.
During the procedure, a crush injury occurs to the right ureter, allegedly because the OB/GYN did not know the where the uterus was. Once her doctors realize this, she correctly orders a urology consult during the procedure. The urologist finds injuries consistent with a significant ureteral injury and places a stent. Once the stent is in place, defendant doctor re-assumes care of the plaintiff in order to complete the hysterectomy.
The failure to safeguard the ureter during a hysterectomy can result in a ureter being mistakenly ligated or cut. Inadvertent tying off, clipping or cutting of the ureter may cause obstruction of urine or leakage of urine into the abdominal and pelvic cavities. This can also cause kidney damage or infection.
Regrettably, this patient has post-operative complications requiring more urologic procedures and extensive treaters for her injury. She files a claim, due to the severe and permanent injuries she sustained during the procedure. Plaintiff alleges she has had to go multiple corrective surgeries, has a loss of kidney function, has both past and future rehabilitative expenses, suffers a loss of consortium, and will continue to lose wages.Additional Comments
- The essence of this case is that you cannot cut or clip what you cannot see. In other words, she failed to properly identify the path of the ureter in the operative field. A cousin of this type of malpractice is gallbladder removal cases. In these cases, it is not the ureter that gets cut but the common bile duct.
- Usually, when a ureteral injury is discovered at the same time as the hysterectomy a primary repair can be performed. Often, the doctor's negligence in these cases is not just the cut but the failure to see the damage that has been done so it may be repaired immediately. So the injury to the ureter during a hysterectomy can be negligence but usually, the best malpractice cases are the failure to recognize and fix those injuries before the patient was closed.
- This case is about the injury to the ureter during the hysterectomy procedure itself. Again, usually in these cases the OB/GYN will transect the ureter during her hysterectomy procedure but fail to recognize there was a transaction. In this case, the doctor did the right thing after the alleged breach by identifying the injury and getting a urology consult. All things being equal, this is a tough case.
- So the question is can the ureter be transected during a laparoscopic hysterectomy absent any negligence on the part of the operating surgeon? The answer is yes. There are cases where the ureter is in a difficult position. There may be bleeding that needs to be controlled requiring quick clamps and sutures. This urgency gives doctor more of a pass from a medical malpractice perspective to cut the ureter.
- So the path to winning a cut ureteral case as the primary negligence is for the jury to find that the surgeon should have done more. There are standard surgical techniques that are used in order to minimize the risk of ureteral damage. Maybe the doctor used clamps that are placed close to the cervix. Or the doctor did not avoid areas that the doctor should have known the ureter is likely to be located. There is a path to victory in a case like this. But it really depends on the very specific facts of the case.
- The defense in these cases is often that the patient was a "one in a million" with significant adhesions or an abnormal anatomy. But that does not change the core of the case: don't cut unless you know where you are. As plaintiff's expert points out, ureteral catheters would have helped the doctor see the ureter during the procedure. Another on-the-fly option available to the surgeon is to convert the procedure to an open procedure (more traditional surgery) which would give a better visual field.
- Montgomery County
- Simmonds, Martin,&Helmbrecht, a large OB/GYN practice with offices in Damascus, Frederick, and Gaithersburg
- An OB/GYN
- Shady Grove Adventist Hospital (who is not a defendant)
- Causing a preventable iatrogenic injury to plaintiff's ureter during surgery
- Failing to properly locate and visualize plaintiff's ureters prior to placing clamps
- Failing to dissect the ureters and failing to consult with a urologist if visualization was not possible
- Failing to appropriately monitor and treat the ureter injury to the plaintiff post-operatively
- Medical Malpractice
- Jeffrey L. Soffer, M.D. - physician, board certified in obstetrics & gynecology;
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