Episode 110: A Fact of Life

Speaker 1: You are listening to Your Practice Made Perfect; support, protection, and advice for practicing medical professionals. Brought to you by SVMIC.

J. Baugh: Hello, everyone. And welcome to this episode of Your Practice Made Perfect. My name is J. Baugh, and I'll be your host for today's episode. Today, we're going to be covering another closed claim. And joining me in discussing this closed claim is one of our Claims Attorneys, Katy Smith. Katy, welcome.

Katy: Thanks, Jay. I'm glad to be back here to discuss this interesting case.

J. Baugh: Yeah, it's good to have you back. Those of you who have listened to other podcasts know that Katy and I have occasionally covered different closed claims, and we're going to be discussing another one today. I have about 20 years of experience in the claims department, Katy has 15. So in our combined 35 years of claims experience, we've seen a lot of potential claims and a lot of actual claims in the years that we've been in the claims department. And today, we're going to cover another closed claim.

There are no perfect cases for either the defendant or the plaintiff. Today, we're going to discuss a case where the outcome was not certain, as it rarely is. But a doctor fought to defend his care regardless. We will start with some background information. On June 1st, a 24-year-old obese female patient at 11 weeks gestation presented to the OBGYN clinic to see, we'll call him Dr. Smith. She had been treated at the same clinic for her three prior pregnancies. Time passed for the patient and her pregnancy and on a typical prenatal visit on September 3rd, Dr. Smith scheduled the patient for a three-hour glucose tolerance test, or a GTT, which was performed on September 12th. According to those test results, the patient did not meet the criteria for gestational diabetes.

Katy: So Jay, our patient was seen again at the clinic for prenatal visits on October 6th, and again on October 23rd. And at this latter visit, she was found to have lost nine pounds and had 3+ glucosuria. The patient reported that she had been suffering from a stomach bug and had been drinking a high sugar content sports drink while in the waiting room. The weight loss was consistent with her reported illness and glucosuria was attributed to consuming the sports drink. The patient also had a history of late-term weight loss in one of her prior pregnancies.

J. Baugh: Yeah. That's right, Katy. So because the patient had this history of weight loss in a prior pregnancy and had been sick with a stomach bug, plus the sports drink, these stats were not alarming to Dr. Smith. Now, on October 28th, the patient presented to the small local hospital with complaints of nausea, vomiting and shortness of breath. And she was transferred to regional hospital with a diagnosis of severe diabetic ketoacidosis. The patient was induced, resulting in a stillborn male at approximately 33 weeks. The autopsy report stated multiple causes of the stillbirth with the mother's diabetes being the most likely cause.

Katy: The patient filed a lawsuit alleging that Dr. Smith failed to properly diagnose and treat her blood glucose levels, resulting in the death of her child. She sued for medical expenses and also for the wrongful death damages for the death of her child, including loss of earnings and earning capacity, burial expenses and non-economic damages for loss of love and companionship.

J. Baugh: Okay. So, this is obviously a very unfortunate turn of events that happened from a medical perspective, and so we're going to take a closer look at the litigation process that followed. The plaintiff's OBGYN expert opined that the child should have been delivered by caesarian section on October 23rd. His opinion was based on the patient's numerous health issues, including obesity, excessive weight gain, and a family history of diabetes. Yet, he could not cite any medical authority for his opinions. The plaintiff claimed non-economic damages, which were capped by state law, and economic damages of approximately $950,000. The economic damages claims were supported by the testimony of an economist expert for the plaintiff.

Katy: Dr. Smith's defense on the standard of care side, was that he appropriately and timely performed testing for gestational diabetes with negative results. The subsequent weight loss and finding of 3+ glucosuria was not indicative of the development of gestational diabetes. And the evaluation at the October 23rd office visit was reasonable, based on the patient's report of illness and drinking a sugary sports drink in the waiting room. Back to what you said, Jay, at the start of this episode about this not being a perfect case. There was apparently a lack of documentation from the October 23rd visit, as to the patient's report of the recent illness and of drinking a sports drink while waiting for her appointment. And this did complicate Dr. Smith's defense. Dr. Smith recalled the information and he testified to it in his deposition, but better documentation would have strengthened the defense. Probably, this was information that was not very remarkable at the time of the care, but it ended up being crucial to the defense in the lawsuit.

Regardless, the defense theme was supported by multiple standard of care experts. And then on the causation side, a placental pathologist disputed the conclusion in the autopsy report and reported that the autopsy slides indicated that the child did not die as a result of gestational diabetes. There were signs of maternal vascular issues, but the placenta was not typical for a diabetic mother. The expert opined that the most likely cause of field demise was placental abruption. So, this was an alternative cause of death that Dr. Smith's defense presented. A maternal-fetal medicine specialist testified about standard of care and causation. He testified that Dr. Smith complied with the standard of care, that there was no requirement to repeat the GTT. This expert believed that the patient suffered from either a UTI or gastroenteritis, which hearkens back to our presentation on October 23rd, and this condition sent the patient into ketoacidosis. The expert testified that earlier delivery on October 23rd would probably have resulted in a stillborn or severely impaired baby.

J. Baugh: The second specialist to review the case concluded the patient was not a chronic diabetic and did not develop gestational diabetes. Further, Dr. Smith appropriately screened the patient for gestational diabetes. Considering the findings of the placental pathologist, this maternal-fetal medicine reviewer opined that an unrecognizable placental abruption led to death of the unborn child. According to this reviewer, all care by Dr. Smith was appropriate and within the standard of care.

Katy: So after developing all of this expert witness support in preparing the case, defense counsel recommended defending the case through trial. Dr. Smith wanted to defend his care and did not give consent to settle. Trial started nearly five years after Dr. Smith treated the patient and lasted a total of five days. So a little point there, Jay, about how long it took to conclude this case - five years from the care until the trial actually occurred.

J. Baugh: Yeah, that's a good point, Katy. I think some of our listeners may be surprised to hear that sometimes trials take that long, but they can. There can be a lot of delays that happen. There can be cases that are withdrawn and then refiled again. And so unfortunately, sometimes it does take five years after treatment, or sometimes even longer, before a case actually goes to trial.

Katy: That's right, Jay. And Dr. Smith though remained steadfast in his desire to try the case and trial occurred. The plaintiff was a likable person and she made a good and sympathetic witness. Her case was primarily based on sympathy. However, the medical and factual evidence at the trial strongly favored Dr. Smith. Dr. Smith and his three experts were all strong witnesses. They appeared in-person at the trial. They effectively refuted the plaintiff's claims with facts and medical science, explaining the standard of care and how Dr. Smith met that standard. Further, they were able to offer a plausible alternative theory for the cause of the child's death. At the end of the five-day trial, after about two hours of deliberation, the jury returned a verdict in favor of Dr. Smith.

J. Baugh: So as we're beginning to wrap up this podcast, let's go back to the beginning and what we said, and that is, there are no perfect cases. Perfect cases never get to the courtroom. And so, trial is always somewhat risky, and it's unlikely that there are any doctors who enjoy being the defendant in a trial. The outcome of a fight is rarely certain. However, this case is an example of when a good doctor fought to defend his care and prevailed, despite the tragic outcome. So Katy, I want to thank you for joining us today and talking about this closed claim. Hopefully, our listeners learned a point or two through review of this claim that will help them in providing care to their patients in the future. So again, thanks for joining us.

Katy: Thanks, Jay.

Speaker 1: Thank you for listening to this episode of Your Practice Made Perfect. Listen to more episodes, subscribe to the podcast, and find show notes at SVMIC.com/podcast.

The contents of this podcast are intended for informational purposes only and do not constitute legal advice. Policyholders are urged to consult with their personal attorney for legal advice, as specific legal requirements may vary from state to state and change over time. All names in the case have been changed to protect privacy.