Episiotomy delivers doctor to court, settlement reached

Before the medical malpractice trial of a Jefferson County doctor began on Monday, April 16, prospective jurors were warned the content of the trial -- complications following an episiotomy -- may turn even the strongest of stomachs.

Apparently, the defense thought the details were too gruesome for jurors to digest. The case was settled the next day.

Sara Wallace regularly complained of pain in her uterus region after she gave birth. Then she awoke one morning to find feces in her vagina. She and her husband David sued the on-call doctor who delivered their baby.

According to the plaintiffs' second amended petition, on Aug. 16, 2003, Sara Wallace was a patient at Mid-Jefferson Hospital in Nederland. She had gone into early labor and her treating physician, Dr. Stephanie Cunningham, was out of town at the time. The on-call doctor, Dr. Donald Long, stepped in and delivered the baby using forceps, a vacuum-assisted device, and a third-degree episiotomy.

An episiotomy is when the physician cuts the tissue between the anus and the vagina, creating a large enough opening to birth the infant.

The plaintiff's lawyer, Mike McGown, said in his opening remarks that after the procedure, Long stitched the wound but neglected to check for a rectovaginal fistula, a hole between the anus and vagina that is often the result of an episiotomy. He also neglected to inform the Wallaces that such a wound could form after procedure.

McGown continued by saying that although Long contends he performed an inspection, there are no medical records to support that he performed a check up after the procedure. "I believe (Long's) defense will be (that he wasn't the Wallaces) regular doctor."

"Although Long indicated he examined the inside of the uterus, the operative report omitted any description of any post-delivery or post-episiotomy-repair," the petition said.

On Nov. 18, 2003, Sara had an appointment with Cunningham and informed her she was passing stool through her vagina. A rectal exam revealed a two centimeter defect into the rectovaginal.

Seven months later, the rectovaginal fistula was surgically repaired at Memorial Methodist Hospital in Houston, the petition stated.

McGown says the surgery cost the Wallaces $14,000 and that Sara is still experiencing pain. "She had to endure painful enemas for four months following the surgery."

McGown went on to say the incident has been a source of embarrassment and mental anguish for the Wallaces and has strained their intimate marital relations.

The plaintiffs are suing Long for negligence and violating the medical standard of care.

"The medical standard of care applicable to Wallace's treatment dictate that an inspection of the rectum and repair of any transrectal defects must be performed at the time of the initial repair of the episiotomy and the traumatic extension of the episiotomy," The petition said.

"Long had a duty to perform a rectal examination after the episiotomy in order for the rectovaginal fistula to be identified. Instead, he breached the standard of by (failing) to perform a rectal examination and discover the rectovaginal fistula."

Judge Gary Sanderson, Jefferson County 60th District Court, presided over the case.

Cause No. B-175585