Plaintiff claims ovarian cancer spread due to surgical procedure – Defense Verdict

Plaintiff was a 44-year-old postmenopausal woman who was referred to the defendant OB/GYN on Dec. 15, 2009, for complaints of right-sided pelvic pain. A pelvic ultrasound revealed a nearly 12 cm complex solid mass in the area of her right ovary with mild free fluid suggestive of bleeding. The differential diagnosis included benign hemorrhagic cyst vs. malignancy. The defendant ordered a CA-125 test to search for markers of ovarian cancer, referral to a gynecologic oncologist, and a CT scan. The CA-125 was reported as normal. Three days after her first appointment, and before she saw the oncologist, the plaintiff suffered an acute change with increased pain. The defendant instructed her to go to the hospital where labs revealed low hemoglobin and hematocrit suggesting internal bleeding from a ruptured cyst. The defendant performed laparoscopic surgery that evening, finding blood in the pelvis and numerous adhesions, but no evidence of malignancy. The defendant then punctured the cyst to drain it and removed the cyst laparoscopically. Defendant also performed a hysterectomy and removed the contralateral ovary as well. Pathology revealed the right ovarian mass to be cancerous and also revealed a 2 cm cancerous lesion in the left ovary. The cancer was of a non-aggressive type and grade. Seventeen days later, follow-up surgery by a gynecologic oncologist revealed pathologic evidence of cancer in four other locations.

The plaintiff alleged the defendant was negligent in failing to ensure she saw a gynecologic oncologist in the two days between her initial appointment and her change in condition. She further alleged the defendant should not have operated without involving a gynecologic oncologist, should have used an open (rather than laparoscopic) technique, and should not have punctured the mass in order to drain it and remove it laparoscopically. The plaintiff alleged these actions resulted in her cancer spreading over the next 17 days, changing her cancer from Stage I to an incurable Stage IV. The defendant’s experts testified the defendant acted prudently to proceed immediately to surgery in the face of potentially life-threatening internal bleeding and that the laparoscopic technique was appropriate. They further testified the ovarian mass had already ruptured and spilled its contents as evidenced by the patient’s pre-operative pain, pre-operative fluid seen on ultrasound, dropping hemoglobin and hematocrit, and blood in the pelvis found at surgery. There was no evidence to suggest malignancy preoperatively, particularly in light of the normal CA-125, nor was there any visible evidence of cancer at the time the mass was removed nor during subsequent surgery 17 days later. Cancer was only diagnosed pathologically. Accordingly, the surgical technique was appropriate and the defendant did not need to delay surgery to involve a gynecologic oncologist who may not have been available urgently. The experts further testified the plaintiff’s low grade, non-aggressive cancer could not have metastasized in just 17 days and pointed to the fact she not only had a 12 cm mass on her right ovary, but also a 2 cm cancerous mass on her left ovary as well. Accordingly, nothing about the defendant’s care or surgical technique affected the plaintiff’s cancer or its stage. The case was tried over five days, with a gap of four days between the conclusion of the evidence and closing argument due to court holidays. The jury returned a verdict for the defendant in less than 30 minutes.

[13-T-158]

Type of action: Medical malpractice
Injuries alleged: Surgical spread of ovarian cancer resulting in Stage IV disease
Court: Chesapeake Circuit Court
Tried before: Jury
Judge: John W. Brown
Date: Jan. 22, 2013
Special damages: Roughly $188,000
Demand: $2,000,000
Offer: None
Verdict or Settlement: Defense verdict
Attorneys for defendant: Kimberly A. Satterwhite and Todd D. Anderson, Richmond
Plaintiff’s experts: William P. Irvin, M.D., gynecologic oncology, Newport News; Cecilia Boardman, M.D., gynecologic oncology, Richmond; John D. Doppelheuer, M.D., OB/GYN, Reston
Insurance carrier: MAG Mutual Insurance Co.