Malpractice plaintiff awarded $12 million verdict

When Michelle DiLieto agreed to major surgery in 1995, she thought she had been diagnosed with endometrial stroma sarcoma, a rare and potentially fatal cancer of the reproductive organs. But it turned out that she'd never had cancer—and a court has found that her gynecologist and her doctors at Yale performed unnecessary surgeries that left her infertile and caused nerve damage leading to chronic pain. After the surgery, DiLieto says, a Yale surgeon—who would later testify that he knew by then she did not have cancer—told her, "We got it all."

It took nine months before DiLieto learned about her misdiagnosis, and nearly 15 years before the resulting malpractice case was resolved. But in June, in a unanimous 38-page decision, the Connecticut Supreme Court affirmed a lower court's ruling that DiLieto's gynecologist and the Yale School of Medicine had behaved negligently. A jury awarded her $5.2 million; her total award, with interest, will be more than $12 million.

DiLieto says that she might not have sued if her doctors had been honest and apologized after the surgery. "When I realized all the things they were supposed to do but didn't do, that was bad," she says. "But not as bad as the cover-up."

DiLieto, of North Branford, Connecticut, was 43 years old when she was scheduled for surgery after a preliminary biopsy of tissue in her uterus suggested sarcoma. But a subsequent review by Yale medical school pathologists and other specialists, completed before her surgery, showed that she might instead have a benign fibroid. According to court records, Scott Casper, her Branford gynecologist, never requested the notes from the specialists. A second surgeon, Yale's Peter E. Schwartz, read the notes but misunderstood the findings.

During the surgery, Casper removed DiLieto's uterus and ovaries, and her tissue was sent for analysis while she was still under anesthesia. Although the pathology report showed no cancer, Babak Edraki, a first-year fellow at the medical school, then proceeded directly with a second surgery, to remove lymph nodes from DiLieto's pelvis. Operating without the supervision of Schwartz, who as senior surgeon was required to be present, Edraki placed 30 to 40 clips along the pathway of DiLieto's pelvic nerves, more than triple the number Schwartz testified he typically uses. An expert witness testified that the number and location of clips was likely responsible for DiLieto's subsequent chronic pain, which she described as like a "scissor" inside her.

The defense claimed DiLieto had been informed about her pathology results, but the court found that she was not. Instead, her doctors told her the surgery had successfully removed her tumor. They advised against hormone replacement therapy, saying that estrogens could cause a recurrence of the cancer.

DiLieto's case has been wending its way through the courts for years, involving two jury trials and two appeals to the Connecticut Supreme Court. Yale won in the initial trial, but has lost every major decision since; the recent ruling finally resolves the case.

Steve Ecker '84, DiLieto's lawyer, says Yale could have settled the case for "a fraction" of the jury's verdict. "Now, they have preserved for posterity this terrible story of medical care-giving, and they can't rebut it," he adds.

Tom Conroy, a Yale spokesman, wrote in an e-mail that the university recognizes that the case "stemmed from an unfortunate incident," but is "disappointed regarding the final legal outcome." He added, "There were reasons why early settlement didn't occur—including differing views of the value of the claim." By the time of the second trial, "the case had come under the oversight of the excess insurance carrier, who had authority to evaluate it and make decisions on whether to litigate or settle."

In Ecker's view, the unnecessary surgeries and resulting injury were largely the result of a lack of communication—a problem he believes is systemic in hospital environments. He hopes the large judgment highlights the issue. "It would be really a great relief and outcome if Yale paused for a moment and actually tried to learn something about itself from the outcome," he says.