11/20/2013 // Concord, CA, USA // Vaginal Mesh Website (Press Release) // Greg Vigna, MD, JD, Eva Hvingleby, RN, Ph.D // (press release)
Contributor: #Greg Vigna, MD, JD, #Eva Hvingleby, RN, Ph.D
The recently announced Johnson & Johnson Settlement for its defective metal-on-metal hip prosthetic implant will pay roughly $250,000 to each patient sustaining injuries related to this defective device. How this case compares to the 100,000 or so transvaginal mesh (#TVM) suits being filed against the various TVM manufacturers is open to debate. As a rehabilitation physician, life care planner, and attorney I will compare the two.
For a vast majority of patients sustaining injuries from the defective J & J hip replacement device, the medical remedy is a hip revision whereby the defective hip implant is removed and a new one is implanted. The pain caused by the defective hip prosthetic usually improves or resolves following this revision. Aside from the catastrophic complications that may occur from infection or fractures of the femoral shaft during revision surgery, the outcomes are generally good and fairly uniform. In addition, outcomes from hip revision surgery have been well studied in broad populations not involved in litigation. This means functional outcomes, life care costs, and future reasonable and appropriate medical care can be accurately testified to by experts in the field without the bias of litigation.
In the #transvaginal mesh debacle the injuries sustained, the functional outcomes, the medical treatment required, and the future reasonable and appropriate medical care that is necessary, is much more ill defined and variable compared to the defective hip situation.
The injuries caused by the transvaginal mesh debacle are more diverse than of the defective hip implant. Injuries from the mesh cause a variety of problems including erosions, recurrent infections, recurrent incontinence, recurrent prolapse, painful sexual intercourse related to pelvic myofascial pain, painful sexual intercourse related to pudendal neuralgia, ano-rectal pain related to pelvic myofascial pain, ano-rectal pain related to pudendal neuralgia, vulvodynia related to pelvic myofascial pain, vulvodynia related to pudendal neuralgia, and obturator neuralgia. All of these pain syndromes and functional problems may coexist and each patient is truly unique regarding how these pain generators affect mobility, sexual function, bowel evacuation, and bladder excretion.
The medical remedy for a mesh related complication is much less defined, poorly studied, and is developing as the mesh debacle unfolds. Remember, the most catastrophic complication of the transvaginal mesh debacle is pudendal neuralgia. This was such a rare complication prior to the defective TVM device that few physicians had either the knowledge to diagnose, or the skills to treat the condition. Best practice management of mesh related complications have recently been developed by the likes of Dr. Michael Hibner and clinicians across the country, who are proceeding with the best practice management of complete mesh removal if necessary for pain. Unfortunately, there are many women who have undergone partial mesh removal and experience ongoing pudendal neuralgia because the arms of the mesh are still retained in proximity to the pudendal nerve. Then there are women who continue to have the diverse symptoms of pudendal neuralgia and intractable pain without a definitive diagnosis, and without any available treatments. It is my opinion from talking to women across the country that just a small fraction of these most catastrophic patients have been referred for pudendal neurolysis, which is often necessary the treat the nerve damage.
Future reasonable and necessary medical care is also much more variable in the transvaginal mesh population. Future treatments include Botox, pudendal nerve block, ongoing physical therapy for #pudendal neuralgia or #myofascial pain, #pudendal neurolysis, revision #pudendal neurolysis, #ketamine for the #vulvadynia, #neuromodulation, #psychological treatments for pain and depression, and ongoing medications.
In the case of the defective hip replacement it is fairly easy to shape a reasonable settlement because of the relative uniformity among the plaintiffs. That is not the case in the transvaginal mesh client where each patient’s symptoms, functional loss, and required treatment plan is absolutely unique.
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