Senior Trial Partner Daniel L. Freidlin, Partner Elizabeth J. Sandonato and Associate Keleisha A. Milton, successfully secured a defense verdict in a case involving a then 41-year-old woman with two children who alleged that our clients, an OB/GYN and Family Nurse Practitioner, failed to timely diagnose and treat pelvic inflammatory disease/ tubo-ovarian abscess (PID/TOA). Plaintiff alleged a two month delay in diagnoses led to the need for a hysterectomy and bilateral salpingo-oophorectomy.
On January 22,2019, plaintiff presented to codefendant Hospital with complaints of left lower quadrant pain. The radiologist reported a 2.2 cm. cystic lesion in the left adnexa with severe inflammation on CT scan of the abdomen/pelvis (without oral contrast). The radiologist reported an impression that favored PID/TOA over colitis. A transvaginal ultrasound reported no specific pathology and a 1.7 cm. follicular cyst. Consults in gynecology and gastroenterology then evaluated the patient. On examination by the gynecologist, there was no cervical motion tenderness (a clinical sign of PID)or mucopurulent vaginal discharge. The gynecologist concluded a low likelihood of PID. The gastroenterologist examined the plaintiff, reviewed the CT scan, and diagnosed mild colitis. Plaintiff was discharged with a diagnosis of colitis.
On January 25,2019, our client Family Nurse Practitioner (hereinafter “FNP”) saw plaintiff in the office for a hospital follow-up visit. The patient was doing well and an abdominal examination was benign. Our client instructed the plaintiff to continue taking her antibiotics, follow with her gastroenterologist for evaluation of colitis and to return to the office if she developed worsening gynecological symptoms or fever. Plaintiff alleged the FNP failed to perform a pelvic exam, order a repeat white count, order repeat imaging, and failed to rule out PID/TOA.
After being seen by several healthcare providers, including her gastroenterologist who discontinued antibiotics and a repeat emergency department presentation for urinary tract infection, plaintiff returned to our client OB/GYN one month later on February 25, 2019 after repeat CT scan showed a 4.6 cm. cystic lesion in the left adnexa. Plaintiff claimed this was the same lesion from one month earlier and that it had grown. Our OB/GYN client examined the plaintiff, at which time there was tenderness at the cervix, uterus and left adnexa. Our OB/GYN client prescribed oral antibiotics and referred the patient to a gynecological surgeon. Plaintiff alleged the standard of care required admission to the hospital for intravenous antibiotics and possible drainage of the abscess.
Plaintiff presented to the gynecological surgeon 17 days later and had a benign examination. Ultrasound showed a 4.1 cm. dermoid cyst. The gynecological surgeon ordered an outpatient MRI and instructed the plaintiff to return for follow-up evaluation of the cyst. Eight days later, plaintiff returned to the surgeons office with an acute onset of pain. The patient was referred to the hospital where an MRI found the TOA to be partially ruptured. Plaintiff underwent hysterectomy and bilateral salpingo-oophorectomy.
At trial, we argued that the 2.2 cm. cystic lesion was a follicular cyst and the cyst later seen on ultrasound was a dermoid cyst. We argued that the standard of care for a hospital follow-up visit was for our FNP to review the Care Plan with the patient and make sure she was improving. We demonstrated that the plaintiff was correctly diagnosed with colitis in January 2019 and that the disease later spread to the left fallopian tube and ovary after the patient's gastroenterologist discontinued her antibiotics. When the plaintiff returned to our client OB/GYN one month later, he appropriately referred her to a gynecological surgeon for definitive diagnosis and treatment. The gynecological surgeon did not manage the situation as an emergency at the time and did not prescribe IV antibiotics. We argued the plaintiff similarly did not require emergent care 17 days earlier.
The jury found in favor of our clients and returned a defense verdict.