Woman wins $1.53m suit on unwanted Caesarean

The Boston Globe, Wednesday, June 16, 1993, pp. 1, 34.

In a break with the longstanding pattern in cases involving Caesarean deliveries, a Middlesex Superior Court jury has awarded $1.53 million to an Arlington woman who said her fourth child was delivered surgically against her wishes.

The woman, who suffered severe complications, claimed the surgery was unnecessary.

The case, decided June 7, is among the first in the nation in which a patient successfully sued on a malpractice clam that a Caesarean section was unnecessary, said Penny Rutledge, staff attorney for the American College of Obstetricians and Gynecologists. For years, doctors have been sued for the opposite – failing to perform a Caesarean section promptly when it was medically necessary, thus causing damage to the baby.

David M. Gould, a lawyer speaking for the two doctors sued for malpractice, Sidney Stahler and Ruben Gheridian of Cambridge, yesterday contended that the woman, Mary D. Meador, changed her mind after labor began and wanted a Caesarean. He said the surgery was medically warranted because it appeared that Meador's pregnancy might be continuing beyond her due date.

However, Gould, of Ficksman & Conley of Boston, said no decision had been made on whether to appeal.

One obstetrician who researches Caesarean sections said the jury's verdict could be "pivotal" in starting to shift legal pressures that have tended to encourage the surgery. For years, siad Dr. Bruce L. Flamm, research chairman of Kaiser Permanente Medical Center in Riverside, Calif., doctors have though that "the only Caesarean you get sued for is the one you don't do."

Flamm added, however, that the verdict could cause doctors to view themselves as "caught between a rock and a hard place."

Lisa M. Gery, president of International Caesarean Awareness Network of Eastern Massachusetts, said she was thrilled at the verdict and hoped other women who have undergone unnecessary Caesareans would sue, too.

The child delivered in the 1985 Caesarean is now a healthy 7-year-old girl. Her mother did not fare so well. The surgery apparently triggered a rare, dormant intestinal condition called hollow visceral myopathy that had not caused symptoms before. Meador was hospitalized for nearly a year after the Caesarean and was bedridden for much of the second year as well, unable to care for her baby or three older children.

In the year after surgery, Meador, who had weighed 180 pounds, dwindled to 80 pounds and was tube-fed, said her lawyer, Michael S. Appel, of Sugarman, Rogers, Barshak & Cohen of Boston. Meador ultimately required operations to remove part of her intestine and permanently insert a tube to drain wastes.

"For somebody who didn't want one surgery, I ended up with four," says Meador, now 50. She says she still cannot work.

Stahler and Gheridian practice at Mount Auburn Hospital in Cambridge, where the surgery was done. The hospital was not named in the lawsuit. Stahler retired from delivering babies two months after Meador's baby was born.

Lawyers reluctant

For more than a year, Meador said in a telephone interview yesterday, she could not find a lawyer to take her case or a doctor to testify on her behalf. Meador said she felt not only that her rights as a patient had been violated, but her rights as a "citizen of the United States" were infringed by the difficulty she had bringing her case to court.

Advocates of natural childbirth, joined in recent years by the medical establishment itself, have sought to reduce the soaring number of Caesarean births in the United States; after 20 years on the increase, it now has stabilized but still accounts for nearly one of every four births. A major element in that fight has been to overturn the old idea that if a woman had one child by Caesarean section, all subsequent children had to be delivered the same way or risk a rupture of the uterus.

Research has shown, however, that this risk is extremely small, about one-half of 1 percent, said Flamm, and a rupture is rarely fatal to mother or child.

In 1980, a consensus of experts called by the National Institutes of Health said vaginal births after prior Caesareans should be an option for women. In 1988, the American College of Obstetricians and Gynecologists went further, saying that unless there were medical reasons for surgery, pregnant women with previous Caesareans should be encouraged to deliver vaginally.

Meador said that from the start of her fourth pregnancy, she wanted to avoid a second Caesarean and sought an obstetrician willing to help her deliver vaginally. Stahler agreed. Two weeks before the baby was due, Stahler told her he was going on vacation and was going to schedule a Caesarean section, said Appel, her lawyer. When she objected, Stahler told her that labor would be risky to her and the baby and compared her uterus to a "hydrogen bomb," Meador said.

Gould, Stahler's lawyer, said Stahler denies ever mentioning a bomb, but said the doctor was concerned that if Meador didn't go into labor soon, the baby might be endangered by going past the due date.

Labor began before surgery

Meador tried and was unable to find another obstetrician to take her case so late in the pregnancy and reluctantly checked into Mount Auburn Hospital for the Caesarean on Oct. 23, 1985. She went into labor that night, and in the morning, she said, again asked to deliver vaginally. Gheridian, who was on call for Stahler, performed a Caesarean section instead.

Gheridian testified that Meador changed her mind at the last minute and asked for a Caesarean, even though he offered her a vaginal delivery.

Dr. Fredric D. Frigoletto Jr., chief of obstetrics at Brigham and Women's Hospital and chairman of the committee on professional standards of the Obstetricians and Gynecologists organization, said he thought it "sad" that Meador had no alternatives when her agreement with her doctor broke down. In 1985, he said, many obstetricians would have been reluctant to help a woman who had had a previous Caesarean deliver vaginally, especially if asked at the end of the pregnancy.

After a six-day trial, the Middlesex Superior Court deliberated three days before arriving at a verdict on June 7. Meador was awarded $400,000 for pain and suffering and $315,000 for lost earning capacity. Her husband, a college professor, and four children were awarded a total of $275,000 for loss of companionship. Approcximately $544,000 in interest was awarded. The case was heard by Judge Judith Cowin.


Plaintiff introduced testimony from a psychiatrist, Dr. Harold J. Bursztajn, that plaintiff was suffering from a severe Post-Traumatic Stress Disorder as a result of the defendant's conduct in scheduling and performing a Caesarean section against the expressed wishes of the plaintiff. Her suffering, and the suffering of the family, could have been prevented had the defendants engaged in an informed consent process.