CASE: Fetal Monitoring
FACTS/LIABILITY: This is a medical malpractice claim in which the decedent suffered birth injuries resulting in her death at one month of age. The defendant obstetrician provided prenatal care during which he diagnosed the decedent’s mother as suffering from chronic hypertension and prescribed Atenolol as a treatment for that condition. The plaintiffs alleged that she was misdiagnosed; and that even if she had chronic hypertension, Atenolol is contraindicated during pregnancy.
A labor check performed on the morning the labor commenced revealed a “non-reactive” fetal heart rate tracing. The defendant obstetrician and hospital inappropriately attributed the non- reactivity to the Atenolol, which had been inappropriately prescribed for the misdiagnosed condition, and treated the labor and delivery as being low risk.
During labor and delivery, a trainee nurse managed most of the care with little supervision. There was evidence that the defendants failed to comply with their own protocol regarding the frequency and manner of assessment of a laboring patient. Despite evidence of fetal distress, including bradycardia and loss if variability, the defendants failed to continuously monitor the fetus, apply a fetal scalp electrode, or expedite her delivery.
DEFENSE: The defendants contended that the decedent was born with a “nuchal arm” which could not have been anticipated and resulted in sudden and profound fetal asphyxia. The defendants also claimed lack of causation, lack of negligence, and a general denial.
INJURIES: The plaintiff’s decedent was born with APGAR scores of 1, 2, and 3 at 1, 5, and 10 minutes of age. She died at one month of age as a result of her neurologic injuries, which included hypoxic ischemic encephalopathy, edematous brain injury, seizures, multi-organ injury, and enormous physical and emotional pain and suffering.
SPECIAL DAMAGES:
Medical bills: $177,586.89
Lost earning capacity was estimated at: $392,677.00
Loss of enjoyment of life, loss of familial relationship, and negligent infliction of emotional distress were also incurred.
VERDICT/SETTLEMENT: The parties agreed to settle for a confidential amount.
PLAINTIFF’S COUNSEL: Randolph J. Reis, Esquire (Reis Law, PLLC)
NAMES/COUNTY: Anonymous v. Anonymous
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Case: Fetal Ultrasound / Shoulder Dystocia
FACTS/LIABILITY: The minor plaintiff weighed 11 lbs. 7 oz. at birth. His mother had previously delivered two large babies, one at 36.5 weeks weighing 8 lbs. 5 oz., and the other at 38 weeks weighing 9 lbs. 8 oz. The second of the prior deliveries was complicated by a failure of the shoulders to deliver on the first attempt. As a result of concerns about macrosomia and the risk of shoulder dystocia, the treating obstetrical care providers ordered three ultrasounds for estimated fetal weight (EFW).
The defendant radiologist interpreted and reported on the ultrasounds for EFW taken at 34 and 40 weeks. Although the 34th week ultrasound placed the minor plaintiff in the 95th percentile for fetal weight, that fact was not included in the defendant’s narrative report. The defendant indicated that this ultrasound showed “appropriate interval growth” from the last ultrasound and he substituted a new gestational age based on that ultrasound, nearly 2 weeks older than the true age.
The last ultrasound for EFW was taken 4 days prior to delivery. The defendant reported an estimated fetal weight that was more than 2 lbs. less than the actual birth weight.
The quality of the imaging was so poor that any estimate would have been unreliable. It was taken at the wrong level and failed to include the entire fetal abdomen, which would have made any EFW based on that imaging a gross under-estimate of actual fetal weight. The plaintiff’s radiology expert testified that the standard of care required the defendant to obtain more imaging on which an accurate EFW could be obtained, or to communicate with the clinicians that if another ultrasound was not possible that the EFW was approximately 11 lbs.
The obstetrical care providers relied on those estimates in the management of this delivery and were falsely reassured that the risk of shoulder dystocia was minimal. The delivering midwife indicated “surprise” at the plaintiff’s actual birth weight because the EFW from only 4 days earlier underestimated the birth weight by 2 lbs. The contemporaneous medical records repeatedly reference the defendant’s EFW by ultrasound and the fact that the plaintiff’s mother had previously delivered a healthy baby of 9.5 lbs.
During labor, after delivery of the head, severe shoulder dystocia was encountered. The plaintiff’s mother was placed in the McRoberts position and downward pressure, followed by suprapubic pressure were applied, unsuccessfully. She was then placed in the hands and knees position during which the posterior arm was delivered. After upward pressure on the head was applied the anterior arm and then the infant were delivered.
DEFENSE: General denial of liability. EFW by ultrasound is imprecise. The treating midwives care would not have changed even with an EFW of 11 lbs.
INJURIES: The minor plaintiff’s arm was flaccid at birth. He was diagnosed with Erb’s palsy. He suffers from mal-development of the glenohumeral joint, right arm weakness, glenoid dysplasia, atrophy of the infraspinatus and supraspinatus, winging of the scapula, weakness of the bicep muscle. He has significant impairment of arm strength, muscular endurance, and gross and fine motor skills. He has trouble running, demonstrates decreased postural stability, range of motion, balance and coordination.
SPECIAL DAMAGES: The plaintiff incurred medical bills totaling $43,527.55.
VERDICT/SETTLEMENT: The parties agreed to settle for a confidential amount.
POINTS OF INTEREST: The midwives providing prenatal and intrapartum care were not defendants. Despite the midwives repeated references in the medical records to the EFWs by ultrasound as a reason for their surprise at the minor plaintiff’s birth weight, they testified at deposition that even if they had been provided with an EFW of 11 lbs. at, or shortly before the date of, delivery they would not have recommended a cesarean section to the plaintiff’s mother. Thus, causation was complicated by a factual dispute as to whether an accurate EFW would have even been communicated to the plaintiff’s mother, and whether a cesarean section would have been recommended, or chosen.
PLAINTIFF'S COUNSEL: Randolph J. Reis, Esquire and Kimberly Kirkland, Esquire (Reis Law, PLLC)
NAMES/COUNTY: Anonymous v. Anonymous
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CASE: Hyperstimulation / Fetal Hypoxia
FACTS/LIABILITY: This is a medical negligence case relating to the obstetrical and nursing care provided to a woman during labor and delivery of her full-term baby. The defendant obstetrician and defendant nurse failed to investigate the cause of numerous non-reassuring signs of fetal well-being that were indicative of fetal hypoxia, resulting in devastating neurologic injury to the baby caused by lack of oxygen.
The plaintiff, having experienced an uncomplicated pregnancy, was admitted to the hospital for routine labor management and was placed on external electronic fetal monitoring (EFM). EFM strips, both those taken upon admission and when the plaintiff had presented in early labor the previous day, were reassuring and indicated no signs of fetal distress. During labor, the defendant nurse observed and palpated numerous prolonged contractions, which were indicative of hyperstimulation of the plaintiff’s uterus and increased uterine activity. The defendant obstetrician did nothing to investigate or remedy the plaintiff’s prolonged contractions, despite testimony that they represented a cause for concern. Both defendants failed to respond to non-reassuring signs of increased uterine activity, minimal (or decreased) fetal heart rate variability, and the combination of an absence of fetal heart rate accelerations and recurring variable decelerations. Moreover, the defendants ignored evidence of fetal tachycardia, although present up to the time of delivery.
Despite options for intrauterine resuscitation, the defendants chose to intervene only once by repositioning the plaintiff in an unsuccessful attempt to alleviate recurring variable fetal heart rate decelerations. Even faced with multiple continuing signs that should have raised concern, nothing more was done to assess fetal well-being or to expedite delivery.
DEFENSE: General denial.
INJURIES: After the plaintiff’s baby was born, it became obvious that he had suffered hypoxic ischemic encephalopathy, multi-organ injuries including renal injury, hematologic injury, and compromise of the endocrine system. In addition, he is deaf and suffers from cortical blindness.
SPECIAL DAMAGES: Medical bills total $2,101,578.89. Future damages, including present value of home and institutional care and lost earning capacity, were estimated to total between $5,284,383 and $13,949,308. Physical and emotional suffering and loss of enjoyment of life were also incurred.
VERDICT/SETTLEMENT: The parties agreed to settle for a confidential amount.
PLAINTIFF’S COUNSEL: Randolph J. Reis, Esquire (Reis Law, PLLC) and Karen S. Allen, Esquire (Law Office of Karen S. Allen, PC)
NAMES/COUNTY: Anonymous v. Anonymous
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CASE: Maternal Respiratory Distress
FACTS/LIABILITY: This is a medical negligence case relating to the obstetrical and nursing care provided to a woman during her 36th week of pregnancy. She was considered a “high risk” obstetrical patient because of her medical history, which included among other things, a prior cesarean section and post partum pneumonia.
Following admission to the defendant hospital due to fever, headache, cough and difficulty breathing, the defendants provided supplemental oxygen at increasing levels for respiratory support; however, her respiratory status continued to decline. Her oxygen saturation levels were consistently measured in the 80’s, her pulse was elevated and her respiratory rate remained highly elevated in the 50’s, 60’s and 70’s. Despite the defendants’ lack of experience in providing care for patients suffering from respiratory distress, they continued their attempts to manage her care for approximately 36 hours, without consulting any physicians with experience in the management of respiratory distress, without transferring her to a tertiary center in a timely manner, without intubating her, without performing an emergency cesarean section, and without otherwise properly handling the medical emergency with which they were presented.
As a result, the plaintiff’s respiratory condition continued to deteriorate until her transfer to another hospital. The plaintiff was not intubated until she was already in transit to the second hospital, despite the “suggestion” by the receiving obstetrician that intubation take place prior to transfer. Due to her ongoing respiratory decline, both mother and child suffered severe hypoxic injuries. The decedent child was delivered by emergency cesarean section and survived for five weeks.
DEFENSE: General denial. There were some reassuring signs suggesting that earlier intervention was unnecessary. The plaintiff’s condition worsened while in transit.
INJURIES: The decedent child suffered profound hypoxic brain injuries and death after discontinuance of her life support. The plaintiff mother sustained hypoxic injuries secondary to her respiratory distress, underwent a stat c-section leaving her with a significant transverse scar, and was placed into an induced coma for two (2) weeks. Both she and her husband suffered severe emotional distress related to their grief associated with the loss of their child.
SPECIAL DAMAGES: Medical bills: $171,013.00
VERDICT/SETTLEMENT: Settled at mediation after suit for a confidential amount.
PLAINTIFF’S COUNSEL: Randolph J. Reis, Esquire (Reis Law, PLLC)
NAMES/COUNTY: Anonymous v. Anonymous
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CASE: Midwife Provider / High Risk Delivery
FACTS/LIBILITY: Defendant is a Certified Professional Midwife (CPM). After relocating, the plaintiff transferred her prenatal care from an obstetrician to the defendant. A home birth was discussed among and planned by the parties. Pursuant to statute and regulations a CPM is prohibited from providing obstetrical care for any patients who are not considered low risk. Plaintiff was not a low risk patient, yet defendant failed to transfer her care to an obstetrician, have her transferred to a hospital during labor, or advise the plaintiffs of the risks of a home birth under the circumstances.
Plaintiff was thirteen days post her due date on the date of delivery of the minor plaintiff. Upon rupture of the plaintiff’s membranes the presence of meconium was noted; defendant was anticipating the delivery of a baby that was large for gestational age; and during labor the defendant had difficulty or was unable to obtain fetal heart tones. For those and other reasons a home birth by a CPM was inappropriate; nevertheless, the defendant allowed a home labor and delivery to take place, without consulting other providers.
Upon delivery, the minor plaintiff, was born without a heartbeat, was floppy, pale and had an Apgar Score of 0. Despite the absence of necessary equipment and personnel for neonatal resuscitation the defendant allowed a midwife trainee to manage the resuscitation of the critically ill infant, and failed to promptly call for emergency transportation to the hospital, despite repeated suggestions from the plaintiff’s husband.
DEFENSE: The defendant denied negligence or breaches in the standard of care.
INJURIES: The minor plaintiff suffered hypoxic ischemia encephalopathy caused by birth hypoxia and ischemia. Plaintiff also suffers from permanent and profound injuries, including neurologic deficits, cerebral palsy, seizures, development delays, microcephaly and other injuries.
SPECIAL DAMAGES: Medical bills: $309,472.23
VERDICT/SETTLEMENT: The case settled after suit for a confidential amount.
PLAINTIFF’S COUNSEL: Randolph J. Reis, Esquire (Reis Law, PLLC)
NAMES/COUNTY: Anonymous v. Anonymous
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CASE: Pregnancy Induced Hypertension
FACTS/LIABILITY: This is a wrongful death birth injury case relating to the obstetrical and nursing care provided to the plaintiff during the labor and delivery of her full-term baby. The defendant nurse midwife and defendant hospital nurses failed to appreciate that the plaintiff and her unborn child were high-risk patients because of pregnancy-induced hypertension and a prolonged second stage of labor. The defendants incorrectly assumed that they were handling an “uncomplicated” labor and delivery, and they used inaccurate and faulty methodology in assessing the fetal heart rate and fetal wellbeing. The defendants never consulted with the supervising Obstetrician and continued to monitor fetal wellbeing with intermittent auscultation, rather than with a fetal scalp electrode. Furthermore, their method of calculating the fetal heart baseline inappropriately included periodic fetal heart rate changes.
According to the defendant hospital’s own protocol, two successive maternal blood pressure readings were hypertensive. However, the nurse midwife and obstetrical nurse incorrectly assumed that the plaintiff’s blood pressure was normal and they discontinued monitoring her blood pressure. The defendant nurse midwife testified that she felt fully capable of handling this labor and delivery, despite the indications that it was high risk. The defendant nurse midwife also testified that she saw no need to call a pediatrician to attend to the baby’s birth because she did not anticipate any problems and considered the labor to be reassuring.
The baby was born without reflex, muscle tone, respiratory effort or grimace and had APGAR scores of 3 and 4 at 1 minute and 5 minutes. The umbilical cord blood gases revealed a pH of less than 6.80 as did the arterial blood gases taken at approximately 1 and 1/2 hours after birth. The pediatrician who took over resuscitation after birth assessed the newborn’s condition as “profound asphyxia with severe metabolic acidosis.” The newborn was transferred to another hospital by helicopter where multi-organ failure was noted and a very poor prognosis was given. The next day, following consultation with her treating physicians, life support was withdrawn and 20 minutes later the baby was pronounced dead.
DEFENSE: General denial.
INJURIES: The decedent child suffered profound hypoxic brain injuries and death after discontinuance of her life support. The plaintiff mother and father both suffered severe emotional distress related to their grief associated with the loss of their child.
SPECIAL DAMAGES: Medical bills: $31,957.71
VERDICT/SETTLEMENT: Settled at mediation after suit for a confidential amount.
PLAINTIFF’S COUNSEL: Randolph J. Reis, Esquire (Reis Law, PLLC)
NAMES/COUNTY: Anonymous v. Anonymous
Reis & Kirkland, PLLC
66 Hanover St. Suite 203
Manchester, NH 03101
Ph: 603-792-0800
FACTS/LIABILITY: This is a medical malpractice claim in which the decedent suffered birth injuries resulting in her death at one month of age. The defendant obstetrician provided prenatal care during which he diagnosed the decedent’s mother as suffering from chronic hypertension and prescribed Atenolol as a treatment for that condition. The plaintiffs alleged that she was misdiagnosed; and that even if she had chronic hypertension, Atenolol is contraindicated during pregnancy.
A labor check performed on the morning the labor commenced revealed a “non-reactive” fetal heart rate tracing. The defendant obstetrician and hospital inappropriately attributed the non- reactivity to the Atenolol, which had been inappropriately prescribed for the misdiagnosed condition, and treated the labor and delivery as being low risk.
During labor and delivery, a trainee nurse managed most of the care with little supervision. There was evidence that the defendants failed to comply with their own protocol regarding the frequency and manner of assessment of a laboring patient. Despite evidence of fetal distress, including bradycardia and loss if variability, the defendants failed to continuously monitor the fetus, apply a fetal scalp electrode, or expedite her delivery.
DEFENSE: The defendants contended that the decedent was born with a “nuchal arm” which could not have been anticipated and resulted in sudden and profound fetal asphyxia. The defendants also claimed lack of causation, lack of negligence, and a general denial.
INJURIES: The plaintiff’s decedent was born with APGAR scores of 1, 2, and 3 at 1, 5, and 10 minutes of age. She died at one month of age as a result of her neurologic injuries, which included hypoxic ischemic encephalopathy, edematous brain injury, seizures, multi-organ injury, and enormous physical and emotional pain and suffering.
SPECIAL DAMAGES:
Medical bills: $177,586.89
Lost earning capacity was estimated at: $392,677.00
Loss of enjoyment of life, loss of familial relationship, and negligent infliction of emotional distress were also incurred.
VERDICT/SETTLEMENT: The parties agreed to settle for a confidential amount.
PLAINTIFF’S COUNSEL: Randolph J. Reis, Esquire (Reis Law, PLLC)
NAMES/COUNTY: Anonymous v. Anonymous
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Case: Fetal Ultrasound / Shoulder Dystocia
FACTS/LIABILITY: The minor plaintiff weighed 11 lbs. 7 oz. at birth. His mother had previously delivered two large babies, one at 36.5 weeks weighing 8 lbs. 5 oz., and the other at 38 weeks weighing 9 lbs. 8 oz. The second of the prior deliveries was complicated by a failure of the shoulders to deliver on the first attempt. As a result of concerns about macrosomia and the risk of shoulder dystocia, the treating obstetrical care providers ordered three ultrasounds for estimated fetal weight (EFW).
The defendant radiologist interpreted and reported on the ultrasounds for EFW taken at 34 and 40 weeks. Although the 34th week ultrasound placed the minor plaintiff in the 95th percentile for fetal weight, that fact was not included in the defendant’s narrative report. The defendant indicated that this ultrasound showed “appropriate interval growth” from the last ultrasound and he substituted a new gestational age based on that ultrasound, nearly 2 weeks older than the true age.
The last ultrasound for EFW was taken 4 days prior to delivery. The defendant reported an estimated fetal weight that was more than 2 lbs. less than the actual birth weight.
The quality of the imaging was so poor that any estimate would have been unreliable. It was taken at the wrong level and failed to include the entire fetal abdomen, which would have made any EFW based on that imaging a gross under-estimate of actual fetal weight. The plaintiff’s radiology expert testified that the standard of care required the defendant to obtain more imaging on which an accurate EFW could be obtained, or to communicate with the clinicians that if another ultrasound was not possible that the EFW was approximately 11 lbs.
The obstetrical care providers relied on those estimates in the management of this delivery and were falsely reassured that the risk of shoulder dystocia was minimal. The delivering midwife indicated “surprise” at the plaintiff’s actual birth weight because the EFW from only 4 days earlier underestimated the birth weight by 2 lbs. The contemporaneous medical records repeatedly reference the defendant’s EFW by ultrasound and the fact that the plaintiff’s mother had previously delivered a healthy baby of 9.5 lbs.
During labor, after delivery of the head, severe shoulder dystocia was encountered. The plaintiff’s mother was placed in the McRoberts position and downward pressure, followed by suprapubic pressure were applied, unsuccessfully. She was then placed in the hands and knees position during which the posterior arm was delivered. After upward pressure on the head was applied the anterior arm and then the infant were delivered.
DEFENSE: General denial of liability. EFW by ultrasound is imprecise. The treating midwives care would not have changed even with an EFW of 11 lbs.
INJURIES: The minor plaintiff’s arm was flaccid at birth. He was diagnosed with Erb’s palsy. He suffers from mal-development of the glenohumeral joint, right arm weakness, glenoid dysplasia, atrophy of the infraspinatus and supraspinatus, winging of the scapula, weakness of the bicep muscle. He has significant impairment of arm strength, muscular endurance, and gross and fine motor skills. He has trouble running, demonstrates decreased postural stability, range of motion, balance and coordination.
SPECIAL DAMAGES: The plaintiff incurred medical bills totaling $43,527.55.
VERDICT/SETTLEMENT: The parties agreed to settle for a confidential amount.
POINTS OF INTEREST: The midwives providing prenatal and intrapartum care were not defendants. Despite the midwives repeated references in the medical records to the EFWs by ultrasound as a reason for their surprise at the minor plaintiff’s birth weight, they testified at deposition that even if they had been provided with an EFW of 11 lbs. at, or shortly before the date of, delivery they would not have recommended a cesarean section to the plaintiff’s mother. Thus, causation was complicated by a factual dispute as to whether an accurate EFW would have even been communicated to the plaintiff’s mother, and whether a cesarean section would have been recommended, or chosen.
PLAINTIFF'S COUNSEL: Randolph J. Reis, Esquire and Kimberly Kirkland, Esquire (Reis Law, PLLC)
NAMES/COUNTY: Anonymous v. Anonymous
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CASE: Hyperstimulation / Fetal Hypoxia
FACTS/LIABILITY: This is a medical negligence case relating to the obstetrical and nursing care provided to a woman during labor and delivery of her full-term baby. The defendant obstetrician and defendant nurse failed to investigate the cause of numerous non-reassuring signs of fetal well-being that were indicative of fetal hypoxia, resulting in devastating neurologic injury to the baby caused by lack of oxygen.
The plaintiff, having experienced an uncomplicated pregnancy, was admitted to the hospital for routine labor management and was placed on external electronic fetal monitoring (EFM). EFM strips, both those taken upon admission and when the plaintiff had presented in early labor the previous day, were reassuring and indicated no signs of fetal distress. During labor, the defendant nurse observed and palpated numerous prolonged contractions, which were indicative of hyperstimulation of the plaintiff’s uterus and increased uterine activity. The defendant obstetrician did nothing to investigate or remedy the plaintiff’s prolonged contractions, despite testimony that they represented a cause for concern. Both defendants failed to respond to non-reassuring signs of increased uterine activity, minimal (or decreased) fetal heart rate variability, and the combination of an absence of fetal heart rate accelerations and recurring variable decelerations. Moreover, the defendants ignored evidence of fetal tachycardia, although present up to the time of delivery.
Despite options for intrauterine resuscitation, the defendants chose to intervene only once by repositioning the plaintiff in an unsuccessful attempt to alleviate recurring variable fetal heart rate decelerations. Even faced with multiple continuing signs that should have raised concern, nothing more was done to assess fetal well-being or to expedite delivery.
DEFENSE: General denial.
INJURIES: After the plaintiff’s baby was born, it became obvious that he had suffered hypoxic ischemic encephalopathy, multi-organ injuries including renal injury, hematologic injury, and compromise of the endocrine system. In addition, he is deaf and suffers from cortical blindness.
SPECIAL DAMAGES: Medical bills total $2,101,578.89. Future damages, including present value of home and institutional care and lost earning capacity, were estimated to total between $5,284,383 and $13,949,308. Physical and emotional suffering and loss of enjoyment of life were also incurred.
VERDICT/SETTLEMENT: The parties agreed to settle for a confidential amount.
PLAINTIFF’S COUNSEL: Randolph J. Reis, Esquire (Reis Law, PLLC) and Karen S. Allen, Esquire (Law Office of Karen S. Allen, PC)
NAMES/COUNTY: Anonymous v. Anonymous
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CASE: Maternal Respiratory Distress
FACTS/LIABILITY: This is a medical negligence case relating to the obstetrical and nursing care provided to a woman during her 36th week of pregnancy. She was considered a “high risk” obstetrical patient because of her medical history, which included among other things, a prior cesarean section and post partum pneumonia.
Following admission to the defendant hospital due to fever, headache, cough and difficulty breathing, the defendants provided supplemental oxygen at increasing levels for respiratory support; however, her respiratory status continued to decline. Her oxygen saturation levels were consistently measured in the 80’s, her pulse was elevated and her respiratory rate remained highly elevated in the 50’s, 60’s and 70’s. Despite the defendants’ lack of experience in providing care for patients suffering from respiratory distress, they continued their attempts to manage her care for approximately 36 hours, without consulting any physicians with experience in the management of respiratory distress, without transferring her to a tertiary center in a timely manner, without intubating her, without performing an emergency cesarean section, and without otherwise properly handling the medical emergency with which they were presented.
As a result, the plaintiff’s respiratory condition continued to deteriorate until her transfer to another hospital. The plaintiff was not intubated until she was already in transit to the second hospital, despite the “suggestion” by the receiving obstetrician that intubation take place prior to transfer. Due to her ongoing respiratory decline, both mother and child suffered severe hypoxic injuries. The decedent child was delivered by emergency cesarean section and survived for five weeks.
DEFENSE: General denial. There were some reassuring signs suggesting that earlier intervention was unnecessary. The plaintiff’s condition worsened while in transit.
INJURIES: The decedent child suffered profound hypoxic brain injuries and death after discontinuance of her life support. The plaintiff mother sustained hypoxic injuries secondary to her respiratory distress, underwent a stat c-section leaving her with a significant transverse scar, and was placed into an induced coma for two (2) weeks. Both she and her husband suffered severe emotional distress related to their grief associated with the loss of their child.
SPECIAL DAMAGES: Medical bills: $171,013.00
VERDICT/SETTLEMENT: Settled at mediation after suit for a confidential amount.
PLAINTIFF’S COUNSEL: Randolph J. Reis, Esquire (Reis Law, PLLC)
NAMES/COUNTY: Anonymous v. Anonymous
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CASE: Midwife Provider / High Risk Delivery
FACTS/LIBILITY: Defendant is a Certified Professional Midwife (CPM). After relocating, the plaintiff transferred her prenatal care from an obstetrician to the defendant. A home birth was discussed among and planned by the parties. Pursuant to statute and regulations a CPM is prohibited from providing obstetrical care for any patients who are not considered low risk. Plaintiff was not a low risk patient, yet defendant failed to transfer her care to an obstetrician, have her transferred to a hospital during labor, or advise the plaintiffs of the risks of a home birth under the circumstances.
Plaintiff was thirteen days post her due date on the date of delivery of the minor plaintiff. Upon rupture of the plaintiff’s membranes the presence of meconium was noted; defendant was anticipating the delivery of a baby that was large for gestational age; and during labor the defendant had difficulty or was unable to obtain fetal heart tones. For those and other reasons a home birth by a CPM was inappropriate; nevertheless, the defendant allowed a home labor and delivery to take place, without consulting other providers.
Upon delivery, the minor plaintiff, was born without a heartbeat, was floppy, pale and had an Apgar Score of 0. Despite the absence of necessary equipment and personnel for neonatal resuscitation the defendant allowed a midwife trainee to manage the resuscitation of the critically ill infant, and failed to promptly call for emergency transportation to the hospital, despite repeated suggestions from the plaintiff’s husband.
DEFENSE: The defendant denied negligence or breaches in the standard of care.
INJURIES: The minor plaintiff suffered hypoxic ischemia encephalopathy caused by birth hypoxia and ischemia. Plaintiff also suffers from permanent and profound injuries, including neurologic deficits, cerebral palsy, seizures, development delays, microcephaly and other injuries.
SPECIAL DAMAGES: Medical bills: $309,472.23
VERDICT/SETTLEMENT: The case settled after suit for a confidential amount.
PLAINTIFF’S COUNSEL: Randolph J. Reis, Esquire (Reis Law, PLLC)
NAMES/COUNTY: Anonymous v. Anonymous
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CASE: Pregnancy Induced Hypertension
FACTS/LIABILITY: This is a wrongful death birth injury case relating to the obstetrical and nursing care provided to the plaintiff during the labor and delivery of her full-term baby. The defendant nurse midwife and defendant hospital nurses failed to appreciate that the plaintiff and her unborn child were high-risk patients because of pregnancy-induced hypertension and a prolonged second stage of labor. The defendants incorrectly assumed that they were handling an “uncomplicated” labor and delivery, and they used inaccurate and faulty methodology in assessing the fetal heart rate and fetal wellbeing. The defendants never consulted with the supervising Obstetrician and continued to monitor fetal wellbeing with intermittent auscultation, rather than with a fetal scalp electrode. Furthermore, their method of calculating the fetal heart baseline inappropriately included periodic fetal heart rate changes.
According to the defendant hospital’s own protocol, two successive maternal blood pressure readings were hypertensive. However, the nurse midwife and obstetrical nurse incorrectly assumed that the plaintiff’s blood pressure was normal and they discontinued monitoring her blood pressure. The defendant nurse midwife testified that she felt fully capable of handling this labor and delivery, despite the indications that it was high risk. The defendant nurse midwife also testified that she saw no need to call a pediatrician to attend to the baby’s birth because she did not anticipate any problems and considered the labor to be reassuring.
The baby was born without reflex, muscle tone, respiratory effort or grimace and had APGAR scores of 3 and 4 at 1 minute and 5 minutes. The umbilical cord blood gases revealed a pH of less than 6.80 as did the arterial blood gases taken at approximately 1 and 1/2 hours after birth. The pediatrician who took over resuscitation after birth assessed the newborn’s condition as “profound asphyxia with severe metabolic acidosis.” The newborn was transferred to another hospital by helicopter where multi-organ failure was noted and a very poor prognosis was given. The next day, following consultation with her treating physicians, life support was withdrawn and 20 minutes later the baby was pronounced dead.
DEFENSE: General denial.
INJURIES: The decedent child suffered profound hypoxic brain injuries and death after discontinuance of her life support. The plaintiff mother and father both suffered severe emotional distress related to their grief associated with the loss of their child.
SPECIAL DAMAGES: Medical bills: $31,957.71
VERDICT/SETTLEMENT: Settled at mediation after suit for a confidential amount.
PLAINTIFF’S COUNSEL: Randolph J. Reis, Esquire (Reis Law, PLLC)
NAMES/COUNTY: Anonymous v. Anonymous
Reis & Kirkland, PLLC
66 Hanover St. Suite 203
Manchester, NH 03101
Ph: 603-792-0800