40 year old female had her left ovary and fallopian tube removed. She then had a tubal ligation to her right fallopian tube as she did not want to get pregnant. She then got pregnant. There are some serious health problems with the child unrelated to any malpractice. The child was delivered C-section and at that surgery the doctor noted evidence of the patient’s previous right tubal ligation.

Issue:

1. Do women still get pregnant even after their tubes have been tied?

2. Is there necessarily malpractice if this happens?

MEDQUEST EXPERT RESPONSES

There is no procedure that is 100% effective for sterilization. However, having stated that, I need to know what kind of tubal sterilization procedure was done to her right fallopian tube and whether there was a specimen sent to the pathology department to ensure the tube was cut. During a laparotomy there should be a portion of the tube sent to Path to verify the fallopian tube was ligated. If Path report indicated portion of fallopian tube present then there was absolutely no malpractice. Dr VB- OBGYN

Tubal ligation as a failure rate of approx 1%. A failure reflects malpractice only if the ligation procedure is done improperly. DrDP – OBGYN

Women do pregnant after tubal ligation, which is called a failure. The stated failure rate is 5 per 1000 cases (every year). It is not malpractice if it happens. Dr JH – OBGYN

Indeed, this can happen 1/500 times. This is a known risk and not in and of itself, malpractice. Dr FB – OBGYN

DVT FOLLOWING ANKLE SURGERY

49 yo male suffered bilateral heel injuries in a work-related accident on 1/20. Patient is a 3 ppd smoker. Ht. 6′ Wt. 230lbs. Heel injuries were more specifically diagnosed as on the left, a fracture at the posterior facet involving the lateral one-third, some impaction in that area. “There is lateral wall blowout, the fracture line extends into the anterior calcaneal cuboid joint that is “minimally displaced.” On the right, posterior facet “more or less” intact, some fracture lines involving the tuberosity. The middle facet was a little bit impacted as well. Impression was bilateral calcaneal fractures.

Patient was completely non-weight bearing. No surgery required on the right, but surgery recommended and performed on the left on January 29. Post operatively, he was required to remain non-weight bearing. On January 27th, the patient died after suffering bilateral pulmonary emboli secondary to post traumatic blood clots.

Should patient have been prescribed prophylactic anticoagulation therapy to prevent clots, DVT and resultant PE?

MEDQUEST EXPERT RESPONSES

This is tricky. We have no guidelines to suggest DVT prophylaxis in this population, what to use, how to administer, and for how long. This is a judgment call by the physician. Given that he is a large person and in a prolonged non-weight bearing status might consider at risk for DVT. Dr RS – Orthopedist

This case will end up in a gray zone, will be hard to support one way or another. Dr JG – Orthopedist

There is no set standard for dvt prevention in surgery of the foot and ankle. Dr JH – Orthopedist