VIOLATED
By Patricia I. Carney, MD
OB/Gyn/Columbia, SC
Six years ago, I met a woman who would change my professional life. When we first met, she was a patient. For the past three years, she has been referred to as "the plaintiff." Somewhere along the way, I transformed from physician to "defendant."
Ms. V (she really did have a name back then) came to see me because of pain in her right lower abdomen. She brought an ultrasound report that showed a 5 cm irregularly shaped mass on her right ovary. Her most likely diagnosis was an endometrioma, but, considering that she was 42, I explained to her that we needed to remove it.
I knew Ms. V was upset, and I asked her to return to the office with her husband so that we could discuss everything. At that visit, we spoke for 30 minutes, and it's documented in the chart that we discussed laparoscopy vs laparotomy, cystectomy vs oophorectomy, risk of infection, bleeding, and injury to GI and GU organs, especially in light of two previous surgeries.
The patient adamantly wanted a laparoscopy over an open procedure because she needed to care for two small children at home. Before the surgery, I met with Ms. V a third time and dictated a lengthy preoperative note, again describing surgical risks as explained to the patient. I also noted that a laparotomy may be needed if the patient suffered any injury to surrounding organs during laparoscopy.
The surgery took place on a Friday morning. The chart proves I met with the patient yet again before the case. During the next two and a half hours, my partner and I dissected a large endometrioma from Ms. V's right ovary, tube, uterus, and rectosigmoid. We were extremely pleased with the way the case went.
I then made the biggest mistake of the entire case. I filled out the face sheet of the chart, but decided it was more important to get to the patients who had been waiting in the office for the past hour than to dictate the operative report.
I'll think twice before going out of town
It was unusual for me to go away for the weekend?I had two young children. But, ironically, the weekend of Ms. V.'s surgery, I did. When I returned on Sunday evening, I found a message on my answering machine telling me Ms. V. had been admitted to the hospital. I went there immediately, and later that night assisted the general surgeon on an exploratory laparotomy. It revealed a bowel perforation, and we did a resection and colostomy.
Before going back to talk with the family, the general surgeon stopped me in the elevator. He told me emphatically that this wasn't my fault, that I'm a good surgeon, and that if I do enough surgery, I will get complications. It took me several months before I truly believed those words.
I visited Ms. V in the hospital every day and did whatever I could to help her and her family deal with the social problems caused by her hospitalization. After much self-flagellation, I dictated the operative report as it should have been dictated on the date of the original surgery. Ms. V had her colostomy reversed a couple of months later.
On a personal level, I decided to leave private practice to return to academia, and I accepted a job 500 miles away. I also separated from my husband of 18 years, negotiated child custody, and became a single mother. Difficult stuff, but I consider myself a pretty tough cookie. I was about to be put to the test.
A lawsuit casts me as sacrificial lamb
Three years ago, on the day before the statute of limitations would have expired, Ms. V filed suit. She alleged that she hadn't received informed consent and that the surgery was performed in a negligent manner.
The attorney I hired is someone who's handled all of my professional legal work. He's one of the best local malpractice defense attorneys, something my insurance company agreed to. He told me not to worry, because they really didn't have a case. Then he told me what every malpractice attorney tells his client: "Don't discuss this case with anyone."
Two years went by. Then, on a Monday morning, the trial date arrived. I got my pre-trial instructions from my lawyer: Be pleasant, professional, don't react to anything that is said, don't nod your head; don't say a word while in the courthouse or in the two block area around the courthouse where jurors might be hanging out.
I thought, "And why don't I just stand on one foot and balance my briefcase on my head while we're at it?" But, of course, I complied.
The first order of business was pre-trial motions. By mid-morning, both my ex-partner and the hospital were dismissed from the suit for lack of evidence. I had to agree that any act of negligence on the part of my partner would be my responsibility. I felt like the sacrificial lamb.
The plaintiff's attorney called me as the second witness. I quickly realized that he had absolutely no interest in the "whole truth." "Doctor, during the deposition, did you say the operative report you dictated was true and accurate?" "Yes." "Knowing the final pathology, is the operative report true and accurate?" "No, but . . ." "Just answer the question. So, Doctor, isn't it correct then that you falsified information in the operative report?"
The plaintiff had one expert witness?a physician I'd worked with during residency. During his testimony, he identified an anatomical structure on my operative photographs as a fallopian tube, while five other physicians identified it as the colon. Under oath, he claimed to have privileges at one of the local hospitals when, in truth, he'd given up his privileges three years before. He stated my conduct fell below the standard of care because I'd lysed adhesions while removing an endometrioma, which was adherent to the uterus and sigmoid. He stated I had "no business" being near the bowel. He insinuated that the hospital pathologist lied on her pathology report simply because she and I worked at the same hospital.
