Plaintiff loses ability to get pregnant after fibroid removal surgery, sues for med mal. Defense verdict. Los Angeles County.

Facts and Background

• Facts and Background:

  Plaintiff was 38 years old when she suffered a miscarriage in July, 2016. Ultrasound imaging at that time revealed fibroids in the wall of her uterus, including a large fibroid approximating 10-12 cm in size. A pelvic MRI on July 29, 2016 confirmed the presence of 10 fibroids in the uterine wall, with no evidence of any pathology within the uterine cavity itself. Plaintiff was referred to Steve Yu, M.D. for consideration of a myomectomy.

  Plaintiff consulted with Dr. Yu on August 4, 2016, at which time the recommendation was made that she undergo a laparoscopic myomectomy in order to support her efforts to become pregnant. In light of the fact that none of the 10 fibroids were in the uterine cavity, Dr. Yu did not advise the patient of any risk of intrauterine scarring from the procedure. The surgery was scheduled to take place on September 27, 2016 with no efforts to confirm the integrity of the uterine cavity before proceeding to surgery.

  The planned laparoscopic myomectomy was performed as scheduled on September 27, 2016 by Steve Yu, M.D. with assistance from a resident physician, Dr. Sonya Tat. The Operative Report for this procedure described both “anterior and posterior hysterotomies” as well as one inadvertent entry into the uterine cavity during the removal of an anterior wall fibroid. Despite these developments, no preventive measures were taken to avoid scarring within the uterine cavity and the patient was not informed that the uterine cavity had been entered. The Operative Report was prepared by the resident, Dr. Sonya Tat, and then co-signed by Dr. Steve Yu.

  Dr. Yu and Dr. Tat did not order any postoperative imaging or other investigations to determine the status of the uterine cavity.

  On February 27, 2017, plaintiff commenced fertility efforts with Dr. Meredith Brower. That physician ordered a hysterosalpingogram, which was performed on April 28, 2017, revealing a filling defect within the uterine cavity. However, a saline sonogram on May 26, 2017 was interpreted by both Dr. Ingrid Rodi and Dr. Meredith Brower to reveal a normal uterine cavity. Based upon that interpretation, the patient underwent four attempts at intrauterine insemination, all of which failed to produce a pregnancy.

  On November 17, 2017, Dr. Brower performed a diagnostic hysteroscopy, finding fibrous tissue at the utero-cervical junction (later described by pathology as a polyp) and finding an entire half of the cervix fused together by scar tissue and “obliterated.” Dr. Brower informed the patient that she could not have a successful pregnancy under these circumstances, which she indicated was “likely due to the prior myomectomy,” and recommended that plaintiff consider surrogacy. 

  Another option for this patient was to undergo serial hysteroscopies to break up the scar tissue in the uterine cavity and reconstruct the cavity for purposes of future pregnancy. Dr. Brower referred the patient to Dr. Charles March at USC for that purpose, and Dr. March performed four serial hysteroscopies before pronouncing the uterine cavity ready for an attempted pregnancy. Dr. March also informed Ms. Dange that the scarring in her uterine cavity was due to the prior myomectomy, and specifically due to the failure of Dr. Yu and Dr. Tat to place any type of uterine stent or balloon to prevent the sides of the uterine cavity from scarring together.

  Plaintiff proceeded with one unsuccessful attempt at in vitro fertilization before turning her efforts to surrogacy.

• Plaintiff's Contentions:

  Plaintiff contended that Dr. Yu and Dr. Tat should have informed her prior to surgery that a laparoscopic myomectomy posed a risk of intrauterine scarring that would potentially interfere with her hopes of having a baby. Moreover, once the uterine cavity was entered at the time of surgery, the defendant physicians should have placed a uterine stent or balloon to guard against the development of intrauterine scarring, and should have informed her of that intraoperative development. Indeed, plaintiff contended that since the resident, Dr. Tat, prepared the Operative Report, that indicated that she had undertaken an inappropriately large role in a difficult surgery.  Moreover, plaintiff contended that the use of the phrase “anterior and posterior hysterotomies” in the Operative Report reflected multiple entries into the uterine cavity, dramatically increasing the risk of intrauterine scarring.

  Finally, plaintiff argued that the standard of care required postoperative imaging or investigation of the uterine cavity to make sure that she was ready to pursue a pregnancy.

• Defendant's Contentions:

  The two defendant physicians asserted that their care and treatment of this patient complied with the standard of care in all respects. Dr. Yu was the attending surgeon for this patient and made all decisions regarding the care to be rendered. Dr. Yu was not required by the standard of care to warn the patient of any risk of intrauterine scarring, since all fibroids were located entirely in the wall of the uterus. Furthermore, since the issue being presented to Dr. Yu was exclusively the uterine fibroids in the wall of the uterus, he had no preoperative or postoperative obligation to evaluate or investigate the integrity of the uterine cavity.

  The resident physician, Dr. Tat, acted exclusively as Dr. Yu’s assistant surgeon and under his direction and guidance, consistent with her role as a resident learning from Dr. Yu. That training included the preparation of the Operative Report, which did not reflect her taking an inappropriately large role in surgery.

  Dr. Tat and Dr. Yu both testified that they only entered the uterine cavity on one occasion during the myomectomy despite the language in the Operative Report reflecting both “anterior and posterior hysterotomies.” Under the circumstances of only one entry into the uterine cavity, the defense argued that no indications were present for the use of an intrauterine stent or balloon.