Fatima E. Belhak and Abdellatif Elfila v. Denice Smith and Women's Care Specialists

Davenport, Iowa personal injury lawyers represented the Plaintiff who sued on medical malpractice theories.



In 2014, Fatima Belhak and her husband were expecting their first child. When Belhak went into labor, she and her husband went to Trinity Medical Center in Bettendorf, where Belhak had been seeing an obstetrician named Dr. Mona Alqulali. But because Alqulali was unavailable, another obstetrician, Dr. Denice Smith, stepped in.



Complications arose during the delivery. Smith eventually determined that she needed to perform an episiotomy to expand the birth canal. An episiotomy is a procedure in which a small pair of scissors is used to make an incision from the vagina into the perineum, referring to the area between the vagina and anus. Soon after performing the episiotomy, Smith was able to deliver Belhak's baby. After the delivery, Smith concluded that the episiotomy resulted in a second-degree laceration. She used synthetic surgical sutures with a tensile strength labeled "4-0" to repair the incision.



While she was still in the hospital, Belhak began to have pain in her rectum and noticed stool and blood on her postpartum pad. She reported this to her nurse, who then examined her. Belhak was told that nothing was out of the ordinary, and she was given an ice pack and additional medicine for the pain. Belhak went home after two days in the hospital.



Shortly after her discharge, Belhak observed stool coming out of her vagina. She and her husband called the hospital to report the issue. Smith told her to come to the clinic the next day, but Belhak instead went to the emergency room at a different hospital. The emergency room doctors sent her to the University of Iowa Hospitals and Clinics in Iowa City. The University's doctors diagnosed Belhak with a fourth-degree laceration and a rectovaginal fistula-a hole between the rectum and vagina that allowed for stool and gas to pass through her vagina. Belhak had also developed an infection, which is a common symptom when a rectovaginal fistula is not promptly treated. Because she had an infection, Belhak needed to wait for it to clear before undergoing reconstructive surgery to repair the fistula.



The infection took five months to clear. In those five months, Belhak had to take thirty-minute sitz baths every time she used the bathroom to disinfect the wound. The physical pain made it more difficult to walk, care for her newborn child, lift heavy objects, and sit or sleep in certain positions. Smith's social life diminished as she couldn't control her bowels because of the fistula. She also began to restrict her diet to avoid diarrhea, which she couldn't easily control.



Some of Belhak's symptoms did not improve immediately after the surgery. At times, she had embarrassing uncontrolled gas, making her not want to leave the house. She began physical therapy, but her pelvic pain wouldn't go away. Belhak's fear of reopening the wound changed her sexual relationship with her husband. Her doctors tried a variety of medications but eventually turned to nerve blockers that needed to be injected into her vagina.



Belhak and her husband ultimately sued Smith and her employer for negligence and loss of consortium. The parties presented evidence and argument in a seven-day jury trial. Their respective theories of the case were relatively straightforward. Belhak asserted that her injuries were caused when Smith either (1) failed to perform a rectal examination after the episiotomy, (2) failed to diagnose her with a fourth-degree laceration, or (3) used too small a suture on the laceration. Smith's theory was that the episiotomy itself resulted in only a second-degree laceration but that the laceration expanded after Belhak left the hospital from some strain on her rectum. Before trial, Smith suggested that the strain on Belhak's rectum could have resulted from either a difficult bowel movement or anal intercourse, but the district court granted a pretrial motion in limine preventing evidence or argument about the anal intercourse theory.



At the end of Belhak's case, Smith moved for a directed verdict, arguing that Belhak's medical expert, Dr. Gregory Chen, failed to establish a causal link between Smith's conduct and Belhak's harm. The court denied the motion. Because the witnesses were called out of order, Smith had already presented all her evidence before making this motion, so both parties rested.



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The jury entered a verdict finding Smith liable and awarded Belhak $3.25 million in damages.



Affirmed