Anniversary: Near-fatal third-trimester abortion in New York

A 20-year-old patient, identified in New York medical board documents as "Patient A," was treated by Steven Chase Brigham (pictured) at his American Medical Pavilion and AB Services of New York November 10 and 11 of 1993. To avoid depersonalizing her, I'll call her "Millie".

Millie called Brigham's office at American Medical Services in Spring Valley, NY, on November 7 or 8, 1993. She made an appointment for an abortion beginning on November 10. Brigham performed an ultrasound on Millie at about 5 PM on November 10, and told her that she was 26 weeks pregnant. Although Millie was in the very late second or early 3rd trimester, Brigham and his staff provided her with a "fact sheet" for first trimester abortions.

During the examination on November 10, Brigham "should have been able to observe that Patient A was 26 weeks pregnant, obese, smoked cigaretts and had unspecified allergies. A practitioner would also have been able to observe that this patient had a very long vagina, a very long cervical canal, and a very small external cervix." These were all risk factors for abortion and anesthesia or sedation.

He inserted 12 laminaria to dilate her cervix. He also injected digoxin into the fetal heart to start the abortion. Brigham told her to come back the next day to finish the abortion.

Millie returned at about 9 AM. Brigham performed an evacuation procedure to remove the fetus. Millie was under twilight anesthesia for the abortion. She was transferred to the recovery room at about 11 AM.

"While in the recovery room, Patient A bled profusely, vomited and lost consciousness." Prior to her loss of consciousness, Millie was noted to have been confused and disoriented, with a pulse of 100 at 12:20 PM. By 12:30 PM, Millie's blood pressure was 90/50 and her pulse was 90. By 12:40, her blood pressure had fallen to 85/50. These are signs that the patient's body is trying to compensate for serious blood loss.

During this period, Brigham administered a fast infusion of IV fluids. By 12:50, this brought Millie's blood pressure up to 110/65, and her pulse down to 85. But at 1:00, Millie's blood pressure was 100/50 and her pulse was back up to 93. Brigham resuctioned Millie's uterus and failed to notice any injury. By 1:30, Millie's blood pressure had fallen to 70/50, with a pulse of 90. By 2:05, her blood pressure was 90/50, her pulse was 95, and her oxygen saturation was 92%. Her hematocrit had fallen to 29% from a preoperative level of 35%. Brigham administered oxygen via face mask.

Brigham continued to try to figure out what was wrong with Millie. By 2:30, she was "cool, pale, tired and dry... talking and laughing and had urinated on him." These are signs that a patient is in serious trouble, likely going into shock, and in need of immediate care.

Millie's blood pressure remained low, and her pulse began to climb to 104, 112, 115, and finally 120 at 2:50.

At 2:55, Millie tried to sit up. She experienced dizziness and a guss of blood.

Brigham continued to try to treat Millie in his office until around 3 PM. Her hematocrit was 18%. Brigham finally transferred her to the hospital by ambulance.

Millie was in hypovolemic shock on arrival. Her hematocrit was 9%. She had a cervical laceration extending up into her lower uterus, and her uterine artery had been lacerated. Millie was given 4 units of packed cells, two units of fresh frozen plasma, and 10 units of platelets. She required an emergency hysterectomy.

The medical board specifically faulted Brigham in that he:

"failed to counsel Patient A appropriately prior to the D&E procedure, or to note such counseling.

"failed to have appropriate transfer arrangements in place..."

"failed to recognize the gravity of the laceration in a timely manner."

"continued to attempt to repair the laceration in the office after Patient A's condition required her transfer to a hospital."

"failed to recognize that Patient A was in shock."

The board also noted that Brigham didn't keep records on Millie during the procedure or immediately thereafter. They were written the day after the abortion, when Millie was hospitalized.