In the Wayne County action the Plaintiffs were alleging that the defendant obstetrician/gynecologist failed to properly repair a fourth degree laceration/tear (a tear from the vagina to the rectum).   The Plaintiff was a 34 year old woman who vaginally delivered a 10 pound baby with the assistance of a nurse midwife.

Following the delivery, the nurse midwife noted that the Plaintiff had sustained a fourth degree laceration and she called the defendant OB/GYN. He promptly came to the labor and delivery room and repaired the laceration. Within a week of the Plaintiff’s discharge from the hospital, she began to experience a brown discharge. At that point in time she did not know from where the discharge was coming.

When she returned to the nurse midwife for her six week post-partum check up the nurse midwife noted that the Plaintiff had a rectal vaginal fistula. Arrangements were made for the Plaintiff to see an OB/GYN in order that the fistula could be repaired. However, shortly thereafter the Plaintiff suffered a gallbladder attack and she was referred to a colorectal surgeon.

When the surgeon examined the Plaintiff he learned that in addition to a diseased gallbladder she had rectal vaginal fistula (a communication between the rectum and vagina). He recommended that she have her gallbladder removed and that she subsequently have the rectal vaginal fistula repaired.  He removed the gallbladder successfully.

According to his testimony, he also repaired the rectal vaginal fistula successfully but, the failure of the defendant’s repair of the fourth degree laceration, left the Plaintiff with an incompetent sphincter muscle which caused her to be incontinent.  Over the next three years the Plaintiff underwent three procedures to repair the sphincter muscle. The last required her to have a colostomy for one year after which she underwent a fourth procedure to reverse the colostomy.

By the time of trial it had been determined that the third attempted repair had been successful and the colostomy had been reversed.

The breakdown of a repair of a fourth degree laceration is a known complication of the procedure. However, Plaintiffs were contending that because the breakdown occurred within a week following the Plaintiff’s discharge from the hospital and because there was no other explanation for the breakdown, e.g. infection, the repair failed because it had not been performed properly.  In addition, the Plaintiff was contending that she was given inadequate discharge instructions, e.g. dietary instructions, which increased the risk that the repair would fail.

Simply put, the defendant was contending that he did repair the laceration properly and that the breakdown of the repair was a recognized complication of the procedure. He further contended that the discharge instructions given to the patient were appropriate and, in fact, were consistent with the discharge instructions that had been suggested by, the Plaintiff’s expert.