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Cesarean Lawsuit Won by Patient

Woman wins $1.53m suit on unwanted Caesarean

The Boston Globe, Wednesday, June 16, 1993, pp. 1, 34.

In a break with the longstanding pattern in cases involving Caesarean deliveries, a Middlesex Superior Court jury has awarded $1.53 million to an Arlington woman who said her fourth child was delivered surgically against her wishes.

The woman, who suffered severe complications, claimed the surgery was unnecessary.

The case, decided June 7, is among the first in the nation in which a patient successfully sued on a malpractice clam that a Caesarean section was unnecessary, said Penny Rutledge, staff attorney for the American College of Obstetricians and Gynecologists. For years, doctors have been sued for the opposite – failing to perform a Caesarean section promptly when it was medically necessary, thus causing damage to the baby. David M. Gould, a lawyer speaking for the two doctors sued for malpractice, Sidney Stahler and Ruben Gheridian of Cambridge, yesterday contended that the woman, Mary D. Meador, changed her mind after labor began and wanted a Caesarean. He said the surgery was medically warranted because it appeared that Meador's pregnancy might be continuing beyond her due date.

However, Gould, of Ficksman & Conley of Boston, said no decision had been made on whether to appeal.

One obstetrician who researches Caesarean sections said the jury's verdict could be "pivotal" in starting to shift legal pressures that have tended to encourage the surgery. For years, siad Dr. Bruce L. Flamm, research chairman of Kaiser Permanente Medical Center in Riverside, Calif., doctors have though that "the only Caesarean you get sued for is the one you don't do."

Flamm added, however, that the verdict could cause doctors to view themselves as "caught between a rock and a hard place." Lisa M. Gery, president of International Caesarean Awareness Network of Eastern Massachusetts, said she was thrilled at the verdict and hoped other women who have undergone unnecessary Caesareans would sue, too.

The child delivered in the 1985 Caesarean is now a healthy 7-year-old girl. Her mother did not fare so well. The surgery apparently triggered a rare, dormant intestinal condition called hollow visceral myopathy that had not caused symptoms before. Meador was hospitalized for nearly a year after the Caesarean and was bedridden for much of the second year as well, unable to care for her baby or three older children.

In the year after surgery, Meador, who had weighed 180 pounds, dwindled to 80 pounds and was tube-fed, said her lawyer, Michael S. Appel, of Sugarman, Rogers, Barshak & Cohen of Boston. Meador ultimately required operations to remove part of her intestine and permanently insert a tube to drain wastes.

"For somebody who didn't want one surgery, I ended up with four," says Meador, now 50. She says she still cannot work. Stahler and Gheridian practice at Mount Auburn Hospital in Cambridge, where the surgery was done. The hospital was not named in the lawsuit. Stahler retired from delivering babies two months after Meador's baby was born.

Lawyers reluctant For more than a year, Meador said in a telephone interview yesterday, she could not find a lawyer to take her case or a doctor to testify on her behalf. Meador said she felt not only that her rights as a patient had been violated, but her rights as a "citizen of the United States" were infringed by the difficulty she had bringing her case to court.

Advocates of natural childbirth, joined in recent years by the medical establishment itself, have sought to reduce the soaring number of Caesarean births in the United States; after 20 years on the increase, it now has stabilized but still accounts for nearly one of every four births. A major element in that fight has been to overturn the old idea that if a woman had one child by Caesarean section, all subsequent children had to be delivered the same way or risk a rupture of the uterus.

Research has shown, however, that this risk is extremely small, about one-half of 1 percent, said Flamm, and a rupture is rarely fatal to mother or child.

In 1980, a consensus of experts called by the National Institutes of Health said vaginal births after prior Caesareans should be an option for women. In 1988, the American College of Obstetricians and Gynecologists went further, saying that unless there were medical reasons for surgery, pregnant women with previous Caesareans should be encouraged to deliver vaginally.

Meador said that from the start of her fourth pregnancy, she wanted to avoid a second Caesarean and sought an obstetrician willing to help her deliver vaginally. Stahler agreed. Two weeks before the baby was due, Stahler told her he was going on vacation and was going to schedule a Caesarean section, said Appel, her lawyer. When she objected, Stahler told her that labor would be risky to her and the baby and compared her uterus to a "hydrogen bomb," Meador said. Gould, Stahler's lawyer, said Stahler denies ever mentioning a bomb, but said the doctor was concerned that if Meador didn't go into labor soon, the baby might be endangered by going past the due date.

Labor began before surgery. Meador tried and was unable to find another obstetrician to take her case so late in the pregnancy and reluctantly checked into Mount Auburn Hospital for the Caesarean on Oct. 23, 1985. She went into labor that night, and in the morning, she said, again asked to deliver vaginally. Gheridian, who was on call for Stahler, performed a Caesarean section instead. Gheridian testified that Meador changed her mind at the last minute and asked for a Caesarean, even though he offered her a vaginal delivery. Dr. Fredric D. Frigoletto Jr., chief of obstetrics at Brigham and Women's Hospital and chairman of the committee on professional standards of the Obstetricians and Gynecologists organization, said he thought it "sad" that Meador had no alternatives when her agreement with her doctor broke down.

In 1985, he said, many obstetricians would have been reluctant to help a woman who had had a previous Caesarean deliver vaginally, especially if asked at the end of the pregnancy.

After a six-day trial, the Middlesex Superior Court deliberated three days before arriving at a verdict on June 7. Meador was awarded $400,000 for pain and suffering and $315,000 for lost earning capacity. Her husband, a college professor, and four children were awarded a total of $275,000 for loss of companionship. Approcximately $544,000 in interest was awarded. The case was heard by Judge Judith Cowin.

Comment: Plaintiff introduced testimony from a psychiatrist, Dr. Harold J. Bursztajn, that plaintiff was suffering from a severe Post-Traumatic Stress Disorder as a result of the defendant's conduct in scheduling and performing a Caesarean section against the expressed wishes of the plaintiff. Her suffering, and the suffering of the family, could have been prevented had the defendants engaged in an informed consent process.

June 17, 1993 Wall Street Journal

Caesarean Birth Verdict

A jury has awarded more than $1.5 million to a woman who sued her doctors, claiming that the unnecessarily delivered her child by caesarean section.

The verdict is unusual, lawyers say, because while malpractice cases are often filed in cases in which a mother or child is injured because doctors failed to do caesarean surgery, patients rarely sue on the grounds that a caesarean wasn't necessary.

In the case, which was filed in Cambridge, Mass., the woman, Mary Measdor, developed an intestinal illness which she said was triggered by the caesarean delivery. Her doctors, Stanley Stahler and Ruben Gheridian, said that she had consented to the procedure.

Some more about this case from http:

A Plaintiff's Verdict: Meador v. Stahler and Gheridian -

The $1.5 million award to a Massachusetts woman and her family in Meador v. Stahler and Gheridian3 made news as a rare instance of a malpractice judgment based on an allegedly unwanted and unnecessary cesarean section rather than a failure to perform such an operation. The plaintiff, Mary Meador, did not claim that the procedure was negligently performed or that the rare and disabling physical complications that resulted from it (which left her largely bedridden and unable to work or meet her family responsibilities for several years) were foreseeable. Instead, she claimed that the defendant obstetricians had misrepresented the risks of the alternative procedure (vaginal birth after prior cesarean) and ignored her persistent pleas for this alternative. Moreover, she alleged, they compelled her passive assent to the surgery in an emotionally coercive manner while she was progressing normally in labor, despite their having previously agreed to such a trial of labor. -

Because the consequences of the cesarean were unforeseeable, and because Meador had signed a consent form for the surgery (to be used in case of emergency), this case did not meet the technical requirements specified under Massachusetts law4 for an action based on informed consent. Instead, the case was brought on the theory that the physicians' failure to obtain the patient's informed consent constituted substandard, negligent medical care. The forensic psychiatrist's expert testimony emphasized that the pro forma signing of a consent form did not constitute true informed consent, especially in light of the physicians' alleged disregard of the patient's expressed wishes and their inaccurate representation of the risks and benefits of the approach she preferred.

- The psychiatrist also explained to the jury how Meador's life history left her vulnerable to experiencing the denial of informed consent as a highly traumatic event. Having coped since childhood with serious illnesses in her family, Meador had viewed doctors and nurses as nurturing figures who helped her gain control of potentially tragic situations. She had learned that choice was still possible even amidst illness and death. She had even been inspired to become a nurse herself and to teach this discipline to others. Thus, when she experienced a sudden loss of choice and control during childbirth, she reacted with intense fear and horror and felt she had been betrayed by health professionals, whom she now feared and mistrusted. In this way she lost her accustomed strategy for coping with life. Moreover, having helped hold her original family together in the face of tragic illness, Meador saw the family she had created torn apart by her sudden and devastating loss of control in a medical situation. The jury's recognition of the importance of the emotional facts of the case was highlighted by its awarding almost one-third of the total damages for loss of consortium. -
Thus, it was not simply the physically disabling consequences of the surgery, but the loss of personal decision-making power concerning her body, her health, and the birth of her child, that caused Meador to suffer from Post-Traumatic Stress Disorder. Similarly, her husband's experience of loss of consortium was exacerbated by the physicians' failure to consult him to interpret his wife's wishes during labor. Instead of having participated in a true informed-consent process, he was left to feel powerless and helpless. In this way, forensic psychiatric testimony established a persuasive causal link between the lack of informed consent and the physical and emotional damages suffered by the patient and her family.