Army doctors at the Madigan Army Medical Center in Washington state performed the unsound surgery. The botched surgery resulted in Kasey Woodman suffering multiple surgeries, procedures, and years of pain and incontinence. The defendant, the United States of America, is reviewing the decision and considering its next steps.
Botched Surgery Case Verdict
On May 6, 2022, Judge Landya McCafferty, United States District Judge in the District of New Hampshire, ruled that Woodman was entitled to $5 million “for physical pain, mental suffering and anguish, disability, and disfigurement.”
Physician’s Breached the Medical Standard in the Fistula Repair
McCafferty based the $5 million award on the finding that the U.S. Army physicians breached the standard of care. The physicians breached the applicable standard of care when they attempted to repair Woodman’s rectovaginal fistula too early. This was before her tissue was sufficiently healed to handle such a surgery. The judge also faulted the two army surgeons for suturing only two layers of tissue in their surgical repair of Woodman’s rectovaginal injuries when medical standards called for four layers of suturing.
The judge wrote that this first, unsuccessful fistula repair surgery changed what should have been a very favorable outlook for Woodman into years of complicated, ongoing medical problems and surgeries. In the verdict order, the court explained that the plaintiff endured significant pain, suffering, and anguish for several years. The court found that Woodman’s multiple surgeries burdened her with scarring and deformities. During her medical tribulations, Woodman’s marriage fell apart. Despite the eventual fistula repair, Woodman will likely have to undergo corrective urinary and fecal surgeries in the future.
$5 Million Award Not Disproportionate
Judge McCafferty also ruled that the $5 million verdict was not disproportionate. She described the comparative verdict precedents she used in her evaluation. Furthermore, Judge McCafferty commented that both parties had provided unhelpful, off-point comparative verdict information.
Loss of Consortium $150,000 Award to Former Husband
The court awarded Woodman’s ex-husband Mark Foley $150,000 for loss of consortium. Foley’s award aims to compensate him for the loss of activities that he enjoyed with his wife before the debilitating, post-birth medical problems changed everything.
Attorneys’ Fees Limited to 25% of Judgement
Failures in Preventing the Laceration
Judge McCafferty ruled that the plaintiffs did not prove that a failure to live up to medical standards caused the army doctors to not prevent her fourth-degree laceration suffered during childbirth.
Physicians Not Qualified to Perform Fistula Repair
The court held that Woodman didn’t prove that the army physicians that performed the rectovaginal fistula repair were not qualified.
Botched Surgery Case Background
Woodman gave birth at the Madigan Army Medical Center at Joint Base Lewis-McChord, Washington. She then suffered a severe laceration of the vagina, perineum, and anus. The birth and laceration occurred on January 14, 2015. Army physicians repaired the laceration shortly after the childbirth. However, Woodman developed a “rare but fixable” complication called rectovaginal fistula as she healed from the laceration repair procedure. On or around March 24, 2015, after experiencing extreme pelvic and vaginal pain, army physicians performed surgery to attempt to repair a fistula discovered in between Woodman’s rectum and vagina. A doctor determined the tissues were “sufficiently operable.” The doctor did not consult available urogynecologists on staff at the army medical center.
The young mother needed seven surgeries after the failed laceration surgery. Tragically, Woodman endured an invasive procedure to divert her fecal matter before physicians properly repaired the fistula three years later.
Woodman and her former husband, Mark Foley, residents of New Hampshire, filed a Federal Tort Claims Action lawsuit in the federal New Hampshire District Court. The lawsuit sought a $9 million judgment. Woodman alleged that the army doctors failed to prevent the significant laceration that took place during childbirth. The complaint also claimed that the military physicians did not properly repair the perineal laceration. Furthermore, the complaint alleged that the physicians failed to repair the subsequent fistula. Lastly, Woodman alleged that the doctors who first attempted to repair the fistula were unqualified for that surgery.
How the Trial Went
A bench trial was held via video conference during October 21–28, 2021. The court applied Washington State law because the events occurred in that state.
Kasey Woodman Testimony
The judge’s ruling cites unsettling facts from Woodman’s testimony such as “fecal matter constantly seeped through the fistula and out of her vagina, which caused severe irritation and pain,” including while walking. The young woman testified about the embarrassment of incontinence and having to wear a diaper. Taking care of herself and her new baby was a great difficulty. These facts undoubtedly played a role in the large damages award for pain and suffering.
The District Court judge heard testimony from experts and treating medical providers about how and why fourth-degree lacerations during childbirth and rectovaginal fistulas happen. Experts also spoke on what surgeries correct the conditions and the prognosis in varying patient circumstances.
The defendant’s urogynecology expert and the plaintiff’s expert, also a urogynecologist, agreed that rectovaginal fistula repair is generally best performed 6-12 weeks after childbirth. Both experts also stated that a longer period may be required when the mother is breastfeeding. The waiting period is necessary because the tissue must be sufficiently healed to allow the surgeon to bring the edges of the tissue together in layers to close the fistula hole and the interior of the hole.
The plaintiff’s expert, however, added that when a mother presents with pain or inflammation, a surgeon should wait an additional six weeks to six months. He said pain indicates that the tissue is not of the quality required for a successful surgery. The army doctors performed the fistula repair surgery on March 19, 2015. This was after Woodman returned to the Madigan Post-partum Triage Center with extreme pelvic pain and stool seepage into her vaginal area.
The Court’s Decision on Expert Testimonies in Botched Surgery Case
The judge in a bench trial makes findings on witness credibility. Here, the judge stated that she found the plaintiff’s expert’s testimony “most credible and therefore g[i]ves it the most weight.” Likewise, the judge found the defendant’s expert’s testimony credible “but not as comprehensive and persuasive as [the plaintiff’s expert’s] testimony.” The judge, therefore, gave the defendant’s expert’s testimony “significant weight.” However, the judge gave the plaintiff’s expert’s opinions for the plaintiffs’ case more weight.
The court also noted in her finding the army doctors failed to adhere to medical standards with the too early fistula surgery that “[e]ven the government’s expert agreed that, if performed properly, the success rate for this surgery was higher than 90%. Here, however, the surgery was unsuccessful.”
Judge Slaps Down Defendant’s Expert Witness Challenges
The U.S. raised objections to the admissibility of the plaintiff’s expert’s testimony during the damages phase of the trial when Judge McCafferty had requested briefs. In denying the defendant’s effort to knock out the plaintiff’s expert witness testimony, the judge cited United States v. Beras, 183 F.3d 22, 27 n.3 (1st Cir. 1999); Reagan v. Brock, 628 F.2d 721, 723-24 (1st Cir. 1980) that stand for the proposition that a failure to object at the appropriate time during trial waives the objection.
Takeaways for Medical Malpractice Cases in New Hampshire
Medical malpractice lawyers in New Hampshire would do well to take note of a few takeaways from this case.
One, the credibility of your expert witness is extremely important in a bench trial. During bench trials, discerning judges make the call on which witnesses to give more weight to in their findings. Judge McCafferty stressed that the plaintiff’s expert’s testimony was more comprehensive and persuasive than the other side’s specialist expert.
Two, it’s critical to raise any objections you have to the admissibility of the opposing side’s expert during the trial. Here, the plaintiff’s expert’s testimony—which established that the medical standard is to wait an additional six weeks to six months to perform a rectovaginal fistula repair when a mother is breastfeeding and experiencing severe pain—proved determinative. The defendants lost their chance to have this testimony thrown out when they failed to object at the right time. And the testimony was likely critical in the District Court’s finding the army doctors were culpable in their handling of Woodman’s fistula repair.
The last takeaway is a practical point. When looking at venues in New Hampshire, be aware of the federal limit of 25% for attorney compensatory fees as compared to the sliding scale in New Hampshire state proceedings governed by New Hampshire 507-C:8.