Alleged failure to disclose salpingo-oophorectomy

Presentation and physician action

In August 2015, a 35-year-old woman came to her obstetrician-gynecologist (Ob-gyn A) reporting abdominal pain after a recent miscarriage. The patient smoked cigarettes daily and had a family history of ovarian and breast cancer.

Ob-gyn A recommended laparoscopic surgery to remove a benign cyst measuring 5 x 4.3 x 5.1 cm on the patient’s right ovary.

Ob-gyn A took the patient to surgery on November 17. The procedure was described in the operative report as a laparoscopic right salpingo-oophorectomy. Ob-gyn A documented that she found a large right ovarian cyst; that she obtained excellent hemostasis; and that preliminary pathology was benign. Ob-gyn A also documented that the right ovary and fallopian tube were removed.

During a post-op visit on November 19, the patient asked for pain medications and a refill on her oral contraceptives. The patient’s subsequent postoperative visits were unremarkable. There was no documentation of any discussion about the removal of the ovary or fallopian tube.

The patient returned to Ob-gyn A in July 2019 reporting that she had missed her periods for three or more months and was not using birth control. Documentation from the physical exam indicated the patient had a normal size right ovary and normal size left ovary. Ob-gyn A later explained that this was an oversight associated with the electronic health record (EHR), specifically a careless click with respect to a normal right ovary.

Fifteen months passed and the patient returned to Ob-gyn A. Documentation from this visit indicated the patient was going through perimenopause. The patient expressed concern about her family history of ovarian and breast cancer. Ob-gyn A diagnosed premature ovarian failure and follow-up visits continued to note normal size right ovary.

In 2021, the patient sought treatment from Ob-gyn B. Ob-gyn B documented the patient’s hereditary breast and ovarian cancer syndrome history. Sonograms of the breast showed scarring and an increased risk of cancer. To reduce this risk, the patient was considering bilateral oophorectomy and mastectomy once she reached menopause.

In February 2023, Ob-gyn B performed a full hysterectomy. During this surgery it was discovered that the patient’s right fallopian tube and ovary had already been removed. In her postoperative note, Ob-gyn B documented absent right fallopian tube and ovary; normal-appearing left fallopian tube and uterus. Ob-gyn B expressed surprise at this finding.

 Allegations

A lawsuit was filed against Ob-gyn A, alleging failure to disclose to the patient that her right ovary and fallopian tube had been removed. The patient claimed that following surgery she experienced unexpected symptoms of loss of libido, mood swings, and hot flashes. The patient further claimed that this emotional distress and mental anguish harmed her marriage.

Legal implications

The plaintiff’s ob-gyn expert consultant alleged that the patient had a “simple cyst that did not justify removal of the ovary and fallopian tube.” This consultant also stated that Ob-gyn A had a duty to disclose to the patient that she removed her right ovary and fallopian tube.

Ob-gyns who evaluated this case for the defense stated that the procedure was indicated and those reviewing the case “would have done the exact same thing for the patient.” Further, documentation before the surgery indicated a review of the plan for ovarian cystectomy versus removal of ovary and that the “patient stated she was not concerned about removal of the ovary.” This language was also on Ob-gyn A’s office visit note before the surgery.

Postoperative documentation was a significant weakness in this case. Ob-gyn A did not document the procedure in the office record and did not document that a copy of the pathology report was shared with the patient. At the patient’s subsequent office visits, the records indicated she had a normal size right ovary. Ob-gyn A advised that this was the result of a careless click in the record system. However, the plaintiffs used these records to assert that Ob-gyn A was concealing the ovary removal from the patient.

 Disposition

This case was settled on behalf of Ob-gyn A.

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