Facts

On June 18, 2004, plaintiff Jane Wang, a 53-year-old bank data entry clerk, presented to defendant Dr. Kuan Wang, an OB-GYN, for a complaint of heavy discharge since menopause. His diagnostic work-up including an ultrasound of the uterus and endometrial biopsy revealed an enlarged uterus with well differentiated adenocarcinoma. Given the known diagnosis of endometrial cancer, Dr. Wang consulted with Dr. John Schlaerth, a gynecologic oncologist, regarding plaintiff's pending surgery.

On July 20, 2004, plaintiff was taken to surgery. The first phase of the surgery included a hysterectomy and removal of the fallopian tubes and ovaries. Dr. Wang was the primary surgeon for this portion of the procedure. Surgical specimens were taken during this initial phase, which suggested that the uterine cancer was not invasive. The next phase of the surgery was dedicated to surgical staging. Dr. John Schlaerth was the primary surgery for this portion of the procedure. He removed the pelvic, peri-aortic and renal lymph nodes. There were no apparent complications and plaintiff left the OR in good condition. The frozen section analysis of the surgical specimens including the uterus, tubes, ovaries and three sets of lymph nodes suggested the absence of invasive and metastatic disease. According to defense counsel, the permanent section, available 48 hours after the procedure at issue, revealed Grade 2 or moderately differentiated adenocarcinoma with a tumor mass totaling 2.0 centimeters. (Plaintiff's counsel denied this). There was no evidence of metastatic disease on the permanent sections.

The plaintiff returned to the ER on July 29, 2004, with complaints of abdominal pain at which time she was diagnosed by imaging studies as having an injury to her left ureter. A stent was eventually placed to allow for healing, however, due to a stricture that developed in the area of the opening, the plaintiff required multiple additional procedures, including transplantation of a portion of the gastrointestinal tract for the purpose of forming a bypass around the stricture.

PLAINTIFF'S CONTENTIONS:
The plaintiff contended that the lymph node sampling in general and specifically, the peri-aortic lymph node sampling was unnecessary given the pre-operative evidence of Grade I adenocarcinoma and the frozen section analysis which suggested non-invasive cancer of the uterus. In addition, the results of the peri-aortic lymph node sampling did not alter the treatment plan for plaintiff after the surgery at issue.

DEFENDANT'S CONTENTIONS:
Defendant Dr. Wang contended that he reasonably consulted with Dr. John Schlaerth, an expert in gynecologic oncology. Moreover, that he was entitled to rely on Dr. Schlaerth, because he is a recognized authority in his field, the frozen section results are known to be unreliable and the risk of a ureter injury is extremely low.

Settlement Discussions

At trial, prior to the commencement of closing arguments, the plaintiff made an informal offer to resolve her claim in exchange for payment of $150,000. The only offer by defendant was a waiver of defense costs and rights to a malicious prosecution action.

Result

Defense verdict for Dr. Kuan Wang.

Other Information

At trial, the plaintiff's economist testified that the plaintiff's past and future loss of earnings was $135,000 (present value). In addition, in closing argument, the plaintiff's counsel ask for $918,000 in general damages. Finally, in evidence was a MediCal lien in the amount of approximately $66,600. EXPERT TESTIMONY: Plaintiff's expert, Harvey Kalan, M.D., general and oncologic surgeon, testified that Dr. Wang's failure to terminate the surgery on July 20, 2004, prior to the lymph node sampling was below the standard of care given plaintiff's low grade cancer as demonstrated on the pre-surgery endometrial biopsy and frozen section of the uterus. In addition, the ureter injury at issue was caused by a hemoclip that was placed on the ureter during the peri-aortic lymph dissection. Edwin Jacobs, M.D., oncologist testified that the peri-aortic lymph node sampling was inappropriate and did not add any useful information to the management of the patient post surgery. Defendant's experts James Macer, M.D., OB/GYN, testified that it was reasonable to consult with a gynecologic oncologist regarding the nature and extent of surgical staging indicated. Furthermore, it was well within the standard of care to rely on the recommendations of the sub-specialist for surgical decisions pertinent to cancer. Philip DiSaia, M.D., gynecologic oncology, testified that given the size of the uterus found pre-operatively and the risk of metastatic cancer, the risks of not sampling far outweighed the risk of sampling. The results of the peri-aortic sampling provided definitive information that plaintiff did not need radiation therapy. FILING DATE: July 15, 2005.

Deliberation

70 minutes

Poll

10-2 (in favor of Dr. Wang)

Length

seven days