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Cavness v. Ethicon, Inc.

Dr. Jaime Sepulveda’S Explanation of Pelvic Mesh Placement Leads to Defense Verdict in Product Liability Case.

The Expert: Dr. Jaime Sepulveda, an obstetrician-gynecologist in South Florida, outlines his belief that pelvic mesh did not cause the issues that the plaintiff complained of.

By Dr. Gary F. Gansar, MD, FACS
Senior Physician Medical Director, AMFS

During a 2015 product liability trial in Dallas, Dr. Jaime Sepulveda, a South Florida obstetrician and urogynecologist, testifies for the defense. The plaintiff claimed that a defective mesh device deteriorated causing her chronic pain.

The expert’s testimony begins by using a demonstrative to explain how the mesh is placed within the pelvis. He spotlights the employment of particular sutures that are key to holding the mesh in position until surrounding tissues can be incorporated into that mesh over time.

The plaintiff had claimed that a portion of the mesh may have not been removed or had somehow been lost and embedded within her pelvis. Sepulveda again effectively uses a demonstrative to show that the mesh placement could not have been deeper than the length of the fingers that are used to remove it. The length of the mesh inserter limits the depth of the mesh placement, and that depth is well within the reach of a surgeon’s fingertips. Sepulveda opines that the full mesh would have been palpably accessible to the surgeon removing it, so it is very unlikely any of it was left behind.

In answer to the attorney’s question concerning the discrepancy in the size of the mesh removed (according to the pathologist’s examination) compared with the size of the mesh originally placed, the doctor explains that this is the result of shrinkage of the organic materials that have grown into into the mesh by the preservative Formalin. This is a desiccating agent used to store the mesh throughout the day before it was examined by the pathologist. He testifies that storage for this amount of time in Formalin would result in a 50% reduction in the apparent size of the mesh. Therefore, he was not surprised by the removal of less mesh by size than had been originally placed. He concludes this clip by reinforcing his belief that the patient continued to have pelvic pain after the mesh removal, but that she had no further problems with the mesh.

The jury was persuaded and ruled for the defense.

About the Author Dr. Gary F. Gansar, MD, FACS

Gary Gansar, MD, is residency-trained in general surgery. He served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Touro Infirmary and Mercy Hospital in New Orleans, LA. Dr. Gansar was Board Certified in general surgery while in active practice. He joined AMFS in 2015 as a Physician Medical Director.

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