Doctors Must Pay $8M for Failing to Diagnose Pregnant Woman's Cancer

The Georgia Court of Appeals recently upheld a $8.5 million verdict in favor of the estate of Debbie Sain, a pregnant woman whose rare and fatal cancer was not diagnosed during her pregnancy. Sain subsequently passed away about a year after giving birth. Her husband, Jason Sain, filed a lawsuit against his wife’s healthcare providers for medical malpractice and wrongful death. The jury found in favor of the estate and awarded $8.5 million in economic and non-economic damages, but did not award an amount for wrongful death. On appeal, the appellate court rejected the defendants’ argument that the verdict was inconsistent.

What Happened?

Debbie Sain (at the time, age 36) became pregnant in early 2012 and had ultrasounds performed at Preferred Women’s Healthcare LLC on three separate occasions in April. Each ultrasound revealed a mass in Debbie’s right adnexa (the space inside her abdomen and pelvis, between her abdominal wall and uterus, which includes all structures that attach to the uterus). The sonographers documented their findings in Debbie’s medical records.

The mass, which measured between 5.7 and 6.27 centimeters, was consistent with a dermoid (a benign tumor of the ovary that does not go away on its own), as per the sonographer and the two expert witnesses presented at trial. However, PWH’s obstetrician-gynecologist, Audrey Arona, M.D., did not indicate any concern. Debbie was not advised about the mass during any of her visits, nor did her medical records indicate that her doctors at PWH took any action to remove or treat the mass. Byron Dickerson, one of Debbie’s PWH physicians and a named defendant, also failed to inform her maternal-fetal medicine specialist, Charles Read, of the mass during the referral in April or May 2012. The May 2012 ultrasound performed in Read’s office also indicated the presence of the right adnexal mass, but medical records did not show that Debbie or Jason were informed of the mass before she gave birth in November 2012 via cesarean section by Mary Long, MD. Likewise, Long did not identify the mass during the delivery.

On January 3, 2013, Debbie underwent emergency surgery performed by Dickerson after visiting the emergency room with complaints of abdominal pain and fever. The mass, which had ruptured, was 11 centimeters when removed, suggesting that prior to rupture, the mass measured between 12 and 15 centimeters. The mass contained squamous cell carcinoma, an epithelial ovarian cancer that forms within a benign dermoid or teratoma. Debbie underwent several additional surgeries, chemotherapy, and radiation in order to treat the cancer. She passed away in December 2013 after the treatments proved unsuccessful in staving off the cancer.

The Trial and Verdict

In 2014, Jason filed a medical malpractice and wrongful death lawsuit against PWH and its physicians. Initially, during the pre-trial stage, the trial court granted the defendants’ motion to exclude the testimony of plaintiff expert, Christopher DeSimone, M.D., but that ruling was subsequently changed on Jason’s motion for reconsideration. DeSimone and another medical expert, James Quirk, M.D., testified at trial that the defendants’ failure to diagnose and treat Debbie’s mass likely caused or substantially hastened her death and but for these failures, her survival rate could have been five years (though DeSimone conceded there is only limited data available as to this particular form of rare cancer). Another expert, John McBroom, M.D., testified that at the time of Debbie’s delivery, her cancer was likely classified as stage 1A and that had the mass been removed then, she would have likely survived. Debbie’s gynecological oncologist, Rachel Grisham, M.D., also testified that the rupture worsened her prognosis.

The defense expert argued that Debbie’s cancer had an extraordinarily high fatality rate, so her rate of survival likely would not have changed if the mass was removed when she gave birth.

The jury found in favor of the estate and awarded a total of $8,520,182.60 in damages -- approximately $7 million for pain and suffering, $1 million for past medical expenses, $500,000 for loss of consortium, and $7,000 for funeral expenses. No award was given for wrongful death.

The Appellate Court’s Decision

In part on the basis of the wrongful death award, the defendants appealed the verdict, arguing that a verdict that awards damages for funeral expenses but not for wrongful death is impermissibly inconsistent. The appellate court held that “the jury reasonably could have found that, while the defendants’ negligence was the immediate cause of Debbie’s death (thus justifying the award of funeral expenses…), Jason did not meet his burden as the plaintiff of establishing by a preponderance of the evidence a meaningful, reasonable monetary value for the jury to award as damages on his wrongful death claim, given the sharply conflicting evidence that was presented as to Debbie’s life expectancy.” The appellate court also noted that the verdict form clearly indicated that the jury found in favor of the plaintiffs and attributed fault proportionately to all defendants, and not the plaintiff.

Overall, this case (Preferred Women’s Healthcare LLC, et al. v. Sain et al., A23A0413) is a perfect example of fact-specific circumstances that can lead to zero damages being awarded for wrongful death, yet defendants still being held liable for the claims.