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Adhesions from prior C-sections lead to severe bladder injuries. Dray v. Staten Island Univ. Hosp., 2022 N.Y. Slip Op. 32994 (N.Y. Sup. Ct. 2022)


In a contentious medical malpractice and negligence case involving Rinat Dray against Dr. Leonid Gorelik, Metropolitan Ob-Gyn Associates, Dr. James C. Ducey, and Staten Island University Hospital (SIUH), the court faced motions and a cross-motion addressing the appropriateness of a repeat cesarean section (C-section) performed on Dray.

A woman who has undergone two previous Cesarean sections often develops adhesions where scar tissue forms between the bladder and the uterus. These adhesions can vary in density and extent, posing significant risks in subsequent surgeries, particularly another C-section. In such cases, the adhesions increase the likelihood of bladder injuries because the scarred tissues can complicate the separation of the bladder from the uterus during surgery. This necessitates meticulous surgical techniques and thorough preoperative assessments to identify and manage the adhesions effectively, minimizing the risk of damaging the bladder during the surgical procedure.

Background Facts
On July 26, 2011, Dray, a private patient under the care of Dr. Gorelik and Metropolitan, was subjected to a repeat C-section at SIUH despite her objections. Dray had two previous C-sections which caused adhesions between her bladder and uterus, increasing her risk for bladder injury during another C-section. Despite this, Dr. Gorelik opted for emergency surgery without attempting non-surgical interventions to improve fetal well-being, despite abnormal fetal monitoring strips. Dray resisted the surgery but was overruled after Dr. Gorelik consulted with Dr. Ducey and SIUH’s in-house counsel. During the procedure, the doctors did not properly address the adhesions, leading to bladder lacerations. The baby was delivered through an incision that inadvertently involved the bladder. Dray required significant additional surgery to repair her bladder. Five days later, they were discharged, but Dray had to keep her suprapubic catheter for two more weeks. After its removal, Dray faced various physical and psychological challenges stemming from the C-section and the complications of the bladder repair. Dray filed a lawsuit against the doctors claiming medical malpractice and negligence.

Whether the C-section was medically necessary and conducted with the proper surgical techniques. Dray’s lawsuit claimed negligence in overriding her treatment refusal and alleged medical malpractice for the emergent nature of the surgery and the techniques used, which resulted in severe bladder injuries.

The court denied the summary judgment motions regarding the medical necessity and proper techniques of the C-section, indicating these issues possessed significant factual disputes requiring a trial. However, it granted dismissal of the “failure to consult” claims, which related to the hospital’s handling of Dray’s objections to the surgery.

The court found that expert testimonies presented by both parties raised substantial issues of material fact that could not be resolved without a trial. These included debates over the interpretation of fetal monitoring strips and the decision-making process leading to the surgery. Experts disagreed significantly on whether the surgical approach and the urgency of the procedure were appropriate, suggesting potential deviations from standard medical practices.

The court dismissed the failure to consult claim because the defendants successfully demonstrated that summoning and consulting a patient advocate or bioethics department would not have prevented the performance of the C-section under the circumstances presented. The hospital’s policy at the time allowed for overriding a patient’s refusal of a C-section if certain conditions deemed by the medical staff were met, particularly in emergency situations. This policy, although later rescinded, supported the defendants’ argument that the consultation with a patient advocate or bioethics committee was not feasible or required in the emergency context of this case, leading to the dismissal of the claim.

If you or someone you know has experienced complications or injuries related to childbirth that might involve medical malpractice or negligence, it is important to seek legal counsel. An experienced New York birth injury lawyer can provide guidance and representation, ensuring that your rights are protected and you receive the compensation you deserve. These cases can be highly complex, requiring thorough investigation and expert testimony to establish the facts and advocate effectively on your behalf.

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