Virginia Lawyers Weekly//February 20, 2022
Virginia Lawyers Weekly//February 20, 2022//
Type of action: Medical malpractice
Injuries alleged: Alleged rectum injury causing temporary colostomy, two hernias, rectovaginal fistula, three surgeries and physical and mental pain
Name of case: Goldstein v. Heritage
Court: Prince William County Circuit Court
Case no.: CL 19-2503
Tried before: Jury
Name of judge or mediator: Judge James A. Willett
Date resolved: 11/16/2021
Verdict or settlement: Verdict
Amount: $0 (defense)
Attorneys for defendant (and city): Coreen Silverman and Dustin Plumadore, Richmond
Description of case: The plaintiff was diagnosed with multiple fibroids following ultrasound to evaluate the cause of excessive vaginal bleeding and anemia. The defendant attempted to perform myomectomy but aborted the procedure due to excessive bleeding. The defendant counseled the plaintiff and recommended vaginal hysterectomy to remove her uterus and repair cystocele and rectocele. Several months later, the plaintiff returned and agreed to proceed with the vaginal hysterectomy.
During the procedure, the defendant could not access the posterior culdesac, so he proceeded to open the anterior culdesac to access the peritoneum. The defendant found it difficult to obtain descent of the uterus and proceeded to morcellate it. During the morcellation, a piece of stool fell in the operative field. The defendant immediately consulted with a general surgeon and converted to abdominal approach to complete the hysterectomy and repair the bowel injury.
The defendant removed the uterus following conversion and found the vagina densely adherent to the anterior rectum. The general surgeon performed a temporary colostomy, which was successfully reversed. The plaintiff subsequently developed rectovaginal fistula and two hernias, requiring two additional surgeries to repair the hernias. The rectovaginal fistula was repaired but was not successful. The plaintiff alleges she continues to have stool from her vagina, abdominal pain, embarrassment and humiliation. The plaintiff alleges the plaintiff’s uterus was too large to be removed safely via vaginal hysterectomy. The plaintiff’s standard of care expert testified that Dr. Heritage violated the standard of care by not performing an ultrasound, CT scan and rectovaginal examination to determine the presence of adhesions before performing the vaginal hysterectomy and failing to convert to abdominal approach when he could not access the posterior culdesac. The plaintiff’s expert testified that Dr. Heritage perforated plaintiff’s rectum during the morcellation.
The defendant’s expert testified that Dr. Heritage complied with the standard of care at all times and the rectal injury was unavoidable due to the dense adhesions that were unexpected, as the plaintiff had no surgical or medical history that should have caused a reasonable surgeon to suspect the adhesions that fused the posterior wall of the vagina to the anterior wall of the rectum. The defendant colorectal surgeons testified that the rectal injury occurred during the first cut as Dr. Heritage was attempting to access the posterior culdesac and the plaintiff’s complications resulted from her diabetes, hypertension and obesity.
The matter was tried to jury, and after two hours of deliberation, the jury returned a verdict in favor of the defendants.