By Damian D. Capozzola, Esq., and Jamie Terrence, RN
News
On Dec. 6, 2024, the Pennsylvania Superior Court upheld an $8 million jury verdict against a hospital in a medical malpractice case stemming from a cesarean delivery procedure. The appellate court found sufficient evidence to hold the hospital vicariously liable for its employees’ conduct, affirming claims that failures during surgery and post-operative care led to permanent harm to the plaintiff.
The case centered on the plaintiff’s allegations that the hospital and its medical team failed to identify and repair a bleeding uterine artery during childbirth, which she claimed resulted in significant internal hemorrhage, cardiac arrest, and an emergency hysterectomy. She alleged that the hospital’s surgical staff breached the standard of care by overlooking the injury during the initial cesarean delivery and delaying a return to the operating room despite clear signs of her internal bleeding.
At trial, the jury awarded $5.5 million for the plaintiff’s pain and suffering and an additional $2.5 million for her husband’s loss of consortium. The hospital appealed, arguing errors in evidence admission, jury instructions, and causation findings. The Superior Court rejected the hospital’s claims on appeal and affirmed the trial court’s rulings and the jury’s verdict.
Background
The case arose from the plaintiff’s experience delivering her second child at a Pennsylvania hospital. She was admitted for labor, and doctors determined an emergency cesarean delivery was necessary because of concerns about the baby’s heart rate and stalled labor progression. During the procedure, tears to the plaintiff’s uterus occurred, which required surgical repair. The plaintiff alleged that while the doctors addressed bleeding from the right uterine artery, they failed to identify and repair an injury to the left uterine artery. The plaintiff claimed that the surgical team neglected to conduct a thorough inspection of the site, leaving the artery to bleed undetected.
Post-surgery, the plaintiff experienced low blood pressure, rapid heart rate, and other signs of internal hemorrhage. Despite these clear indicators, the medical team did not act immediately. About three hours later, her condition deteriorated into cardiac arrest. Emergency resuscitation efforts were initiated, and she was returned to surgery, where doctors discovered three liters of blood in her abdomen caused by the actively bleeding left uterine artery. To stop the hemorrhage and stabilize her, the doctors performed an emergency hysterectomy, resulting in the permanent loss of her ability to have children.
The plaintiff and her husband sued the hospital, alleging that the surgical team’s failure to repair the artery during the initial procedure and the delayed response to post-operative hemorrhage constituted a breach of the standard of care. At trial, the plaintiffs’ experts testified that prompt identification and intervention could have prevented the severe blood loss, cardiac arrest, and hysterectomy.
The hospital defended its care, arguing that the artery could have ruptured spontaneously after surgery, supported by their expert. The hospital also suggested the plaintiff’s refusal to push during labor contributed to the need for the cesarean delivery. The jury rejected these arguments and awarded the plaintiff $5.5 million for pain and suffering and $2.5 million to her husband for loss of consortium.
On appeal, the hospital challenged the verdict on several grounds. It argued that there was insufficient evidence of negligence for the verdict, errors in expert testimony, and improper jury instructions. The Pennsylvania Superior Court upheld the trial court’s rulings and the jury’s decision. The appellate court rejected the hospital’s arguments challenging the jury’s findings and trial rulings. It upheld the sufficiency of the evidence, noting that the plaintiffs’ experts provided compelling testimony showing the failure to identify and repair the left uterine artery during surgery was a clear breach of the standard of care. The experts also testified that warning signs of hemorrhage — low blood pressure, rapid heart rate, and physical distress — required immediate intervention, and the jury was entitled to credit this testimony.
The court further held that the trial court properly admitted expert opinions on causation, as they were based on medical records, professional experience, and established standards of care. The court clarified that disputes over the credibility or weight of such testimony are for the jury to resolve. Lastly, the appellate court found no error in the jury instructions regarding causation and comparative negligence, emphasizing that the hospital failed to present sufficient evidence to link the plaintiff’s alleged refusal to push during labor to the complications she experienced.
What This Means for You
A key principle reinforced by the appellate court’s analysis in this case is the significant deference given to juries in evaluating evidence and resolving conflicting testimony. In medical malpractice trials, juries are tasked with weighing complex facts, expert opinions, and witness credibility to determine whether the standard of care was breached and if that breach caused harm. Because trials often span days, weeks, or even months, juries are uniquely positioned to assess live testimony, evidence, and the demeanor of witnesses — factors that appellate courts cannot replicate through the trial record alone. The Pennsylvania Superior Court emphasized the standard of review on appeal: Appellate courts must view the evidence in the light most favorable to the prevailing party (here, the plaintiffs) and determine only whether sufficient evidence exists to support the jury’s verdict. Appellate courts are not permitted to reweigh evidence, resolve conflicts in testimony, or substitute their judgment for that of the jury when there is adequate evidence to sustain the verdict. As the court noted, the jury’s role in resolving factual disputes is paramount, and its findings will stand unless no reasonable juror could have reached the same conclusion based on the evidence presented.
In this case, the jury found the plaintiffs’ expert testimony and factual evidence more credible and compelling than the defense’s arguments. The Superior Court deferred to the jury’s assessment, noting that it is not the appellate court’s role to second-guess a jury’s factual findings when the record provides ample support. Appellate review is primarily limited to identifying legal errors rather than revisiting the weight or credibility of evidence, which the jury has the exclusive authority to decide. This principle reflects the judiciary’s trust in the jury system as a cornerstone of the trial process and underscores the finality of a jury’s determination on factual issues.
In some negligence cases, a defendant argues that even if it was responsible for some of the harm that the plaintiff experienced, the plaintiff also should be held to account for contributing to their harm. This is a doctrine called comparative or contributory negligence. Here, the defense argued to the trial court that the plaintiff’s actions during labor — such as her reluctance to push — contributed to the need for an emergency cesarean delivery, and, accordingly, the jury should take that into account if they found the doctors and hospitals liable for medical negligence. The defense asked the trial court to give the jury instructions on comparative negligence, but the trial court declined. But the trial court rejected this request because the medical expert who testified about the plaintiff’s refusal to push failed to do so with the required level of certainty for expert testimony, and the appellate court agreed. Comparative negligence defenses must be supported by clear and specific evidence. In practice, this means that, if providers seek to argue that a patient’s choices contributed to a poor outcome, they must document those concerns contemporaneously and ensure there is a strong clinical basis for any such assertions.
As is typical in medical malpractice cases, expert testimony was critical to the plaintiff’s claims. Expert testimony is required in nearly all medical malpractice cases because the issues involved — such as the appropriate standard of care and causation — often are complex and beyond the commonsense understanding of lay jurors. Courts require expert testimony to establish what a competent medical professional would have done under similar circumstances and whether the defendant’s actions fell below that standard. To be admissible, expert testimony must meet certain standards, such as demonstrating that it is based on reliable principles, sufficient facts, and the expert’s specialized knowledge, skill, or training. Documentation, adherence to protocols, and defensible clinical reasoning are important not only to provide quality care but also to equip expert witnesses with the foundation needed to support or refute claims of negligence.
The verdict also highlights that juries are unafraid to award significant damages when they believe it is warranted, especially in cases involving severe, preventable harm with sympathetic plaintiffs. Here, the plaintiff’s emergency hysterectomy — caused by delayed recognition of internal bleeding — resulted in permanent loss of fertility, a life-altering outcome that deeply affected her and her family. The $8 million judgment, including $2.5 million for her husband’s emotional distress and loss of companionship, reflects the jury’s recognition of both the personal and familial consequences of the hospital’s and doctors’ errors. For hospitals and healthcare providers, these large awards are a reminder of the financial pressures that can arise from preventable mistakes. Beyond the immediate monetary effect, large damages awards can strain hospitals through reputational harm, reduced patient trust, and rising liability insurance premiums. Healthcare professionals should mitigate these risks whenever possible.
Finally, in this case, surgical and post-operative standards of care were not met. Following a scheduled or emergent cesarean delivery, the surgeon is compelled to inspect the surgical site for signs of unusual bleeding from unintended sources. Within the uterus is an extremely vascular placenta fed by large vessels to supply blood to the fetus. Sharp instruments can and do occasionally nick or cut into uterine vessels, and a thorough check to assure their integrity must take place before closure. Post-operative bleeding after delivery is not a rare occurrence, and nurses who work in labor and delivery units are trained to identify signs of internal blood loss. Hospitals are mandated by regulations to have emergency procedures in place to manage maternal hemorrhaging quickly and safely.
Reference
- Decided on Dec. 6, 2024, in the Superior Court of Pennsylvania, Case No. J-A24043-24.
Damian D. Capozzola, Esq., The Law Offices of Damian D. Capozzola, Los Angeles
Jamie Terrence, RN, President and Founder, Healthcare Risk Services, Former Director of Risk Management Services (2004-2013), California Hospital Medical Center, Los Angeles
On Dec. 6, 2024, the Pennsylvania Superior Court upheld an $8 million jury verdict against a hospital in a medical malpractice case stemming from a cesarean delivery procedure. The appellate court found sufficient evidence to hold the hospital vicariously liable for its employees’ conduct, affirming claims that failures during surgery and post-operative care led to permanent harm to the plaintiff.
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