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You are here: Experts > Health/Fitness > Health Care: UK > Medical Malpractice > Ectopic Pregnancy Misdiagnoses
Expert: Glenn A. Dorfman - 10/25/2009
Question
QUESTION: I got pregnant late August of this year. From the first week I thought I was pregnant, I was bleeding, and the bleeding continued for 3 weeks. It went from spotting to heavy period blood. Well, early on, I called the clinic and told them I was pregnant. They scheduled an ultrasound for Oct. 15. They wanted me to get a blood test sometime before then to confirm being pregnant. Well, in the meantime, my bleeding really concerned me, so I called often with concern, & the nurses weren't all that worried. They said not to worry unless I bleed through a pad an hour, which luckily I never did. They got a little worried finally and ordered lab blood tests to watch hcg levels, and after the 2nd test, my #s went down, so over the phone they said they thought I was miscarrying and did not need me to see them for an ultrasound b/c they'd watch the hcg levels and once they got to 0, I could wait for a period and try again. So, I was diagnosed with a miscarriage over the phone by I think only a nurse (maybe they at least consulated a doctor there, I don't know). I know at that point, based on my LMP, I was at least 5 weeks, enough for them to check with ultrasound.
So a week later I have the worst shooting pain in my rectum that goes straight to my belly and hurts the most on my right side. It's night time, so I call and on call doctor who says if it continues to the a.m. to go to the doctor, because she thinks since the doctor's office said I am miscarrying, I am only passing tissue. Keep in mind, that I give her all the symptoms, and she doesn't tell me to go to the ER. That same day I have hcg levels drawn and got the results the next day and am told to go straight to the ultrasound department b/c my levels skyrocketed b/c it's either ectopic or the pregnancy decided to stick. Long story short, I am diagnosed with an ectopic pregnancy and told the pain the night before was when my right tube ruptured and had it not been for my uterus holding the blood there and not letting me bleed to death, I would not have woken up that morning. So an inch from my right tube was taken out. Because the on call doctor ignored the classic symtoms of an ectopic (pain in rectum and belly) and the nurses blaming the bleeding on implantation bleeding and irritation from having sex or some other theory and me losing a tube, I wondered if I have a case. I feel like, now I lost a tube, which lessens my chance to concieve, & if they had gotten me in a week earlier, and seen where the embryo was, I could have had my tube saved, I mean I WAS bleeding! I not only have only one tube, I have $7500 in medical bills, which I feel should have been prevented. Please let me know:)
ANSWER: I am not a gynecologist but I do have some background in the subject and especially ectopic pregnancies, having handled hundreds of Dalkon Shield IUD cases back in the 80s when women would get pelvic infections that scarred the tubes, resulting in ectopics. So, I will be frank in answering. If you had actually bled to death, it might be a big case. But because you have made a full recovery other than loss of part of the tube, and still have one functional tube presumably, there is no case. Yes, you were the victim of negligence and probably medical malpractice but it would be a long, difficult and expensive undertaking by the attorney with a good chance of a 0 result and tops, what, maybe $100,000 on a good day? That's not good enough odds for the attorney to make the investment. Here is the lay medical opinion I have on your damages, which is the problem here. Even if they diagnosed the ectopic immediately, you would have still needed surgery and the surgery still would have irreparably damaged that tube. There is no way to remove it but to open up the tube. If even a little scar tissue from a minor infection can damage the function of the tube, imagine what cutting into it would do. The tubes are lined with scillia, tiny little hair like things that wave like wheat in a field. They transport the egg to the uterus. If just a few of the scillia (and there are thousands or millions) are damaged, the egg can get stuck. So again, cutting into the tube even in the most delicate fashion, would make the tube useless. Ask your doctor if I am not right. So in summary, yes, you got very bad advice in the beginning and suffered longer than necessary, but in the end, the damage was the same. Hope this makes sense to you.
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QUESTION: I think even a week before the rupture they could have seen by ultrasound where the embryo was and injected me with methotrexate. It's an anti-cancer drug that has a good chance of killing the tissue and saving the tube. Does knowing that have any impact on your answer?
Answer
Presuming what you say about methotrexate is correct (and I have no idea if it is), my view is the same as previously stated in regards to what the potential value of the case would be and what it would take to prosecute the claim. Something I didn't discuss before: if you have any history of and STD such as chlamydia or other bacteria pelvic infections, that you might not have even been aware of (silent infection), the case would have no value at all unless you had a test of viability (hysterosalpingiogram) of the other tube. An STD would have probably caused the same damage to that tube as well. And harking back to those Dalkon Shield days, if you filed a lawsuit you would be questioned in deposition about you sex history and even the type of sex because multiple sex partners and certain sex methods can cause infections and damage tubes. But presuming again that there is no such history, then you still should have one good tube which you could get pregnant with anytime. Therefore, arguing for damages due to infertility would not work, would it? The big picture is, modern medicine is far from perfect, patients do not have the legal right to expect perfect diagnosis and treatment everytime, medical people do not have a legal duty to always provide perfect diagnosis and treatment......they only have to meet the "standard of care". They may have not done so in your case but damages are the problem. As I said before, God forbid, you bled to death, it might have been a workable case but I am sure you would prefer what did happen, painful as it may have been.
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