The Case of the Brain Damaged Infant
In the early morning hours of March 20, Jackie* presented for labor and delivery to a large Dallas medical center. At that time, she was a 19-year old woman with an estimated due date (EDD) of March 20. She was married, did not smoke or drink, and her only medical condition was asthma, treated with an Albuterol inhaler. She began her prenatal care with the same large Dallas medical center on the previous July, at 7 weeks gestation. Her prenatal care was provided by an obstetrician who has highly recommended. Jackie went to every scheduled prenatal visit. A posterior low-lying placenta was seen during an ultrasound examination in November, but resolved on a follow up ultrasound examination a month later. All other ultrasound findings were unremarkable. Gestational diabetes was diagnosed with a three-hour glucose tolerance test (GTT) in December and was controlled with diet changes. No diabetic medications were required. In March, at 40 weeks gestation, her cervix was dilated 2-3 cm, effaced 50%, and the presenting part was at -1 station. Accelerations and no decelerations of the FHR were documented.
Jackie was admitted to the Labor and Delivery Unit of this large Dallas medical center on March 21, for the purpose of inducing labor. Electronic FHR monitoring confirmed uterine contractions every 2-4 minutes, accompanied by late and prolonged FHR decelerations which required change of maternal position, IV fluid bolus, and O2 administration by mask. Late FHR decelerations warn of the presence of fetal hypoxemia, and prolonged decelerations of the FHR place the fetus at risk of ischemic organ injury. Her cervix was 2 cm dilated, 50% effaced and the presenting part was -1 station, not yet in the maternal pelvis. The doctor was notified. Although the uterine contractions continued, along with the abnormal FHR decelerations and episodes of minimal FHR variability, Cytotec, an irretrievable uterine stimulant, was ordered by the doctor and administered by Nurse Juan [only 2 years out of school] about 1005 hours on March 20. Abnormal heart rate changes, consisting of frequent late, prolonged and occasional variable FHR decelerations continued and worsened. The last clearly identifiable FHR acceleration, indicative of fetal well-being, occurred at 1210 hours. Amniotomy was performed at 1323 hours, releasing thin meconium-stained amniotic fluid. A fetal scalp electrode and an intrauterine pressure catheter were placed. Her cervix was 3 cm dilated, 75% effaced and the fetal head was still -1 station at this time. An epidural was placed at about 1514 hours by the CRNA. Shortly after this, the cervix was 4.5 cm dilated, 90% effaced, and still -1 station. Hyperstimulation of the uterus was first documented shortly after 1600 hours. By this time, abnormal FHR changes were occurring with virtually every uterine contraction, and periods of minimal variability were frequent.
At 1837 hours on March 20, after more than 10 hours of unrelenting abnormal FHR monitoring, Jackie became completely dilated and began to push. The FHR tracing immediately worsened in response to this new stress, becoming tachycardic. Fetal distress, manifested by the absence of FHR variability and identifying the onset of fetal academia, began at 1858 hours on March 30. Meanwhile, Nurse Juan left and Nurse Too took over. Nurse Too was out of nursing school only 1 year and failed to recognize the disaster that she was stepping into. By 1908 hours, permanent and irreversible neurologic injury was occurring in baby. This also marked the beginning of FHR bradycardia, which continued until delivery. But, at this time, the doctor was delivering another baby in another room and was unavailable to attend the delivery at that time. When doctor came in, she applied a vacuum extractor and baby was finally delivered at 1934 hours on March 30 but was lifeless until vigorous and lengthy resuscitation efforts revived the child.
Baby weighed 3600 grams at birth. Apgar scores assigned by the attending neonatologist were 0, 2 and 3 at 1, 5 and 10 minutes, respectively. A heart rate was not detected until 5 minutes after birth. Cord pH was 6.908 with a base excess of -16.9. Hypoxic-Ischemic Encephalopathy was diagnosed, and the newborn was transferred to a different medical center for hypothermic therapy.
Upon arrival at the second medical center, baby was seizing. On April 25 she was discharged with severe residual neurological dysfunction, probably static, and at risk for profound retardation. Among other things, baby was receiving tube feedings and airway care for poor swallowing of secretions.
When the child was born she was not breathing and had no heart rate, which required extensive resuscitation. Baby suffered devastating neurological damage and will require a lifetime of special needs as a result.
Suit was brought against the medical center and the obstetrician. The medical center was negligent for failing to have an appropriate patient safety program in place and failed to have in place the proper policies and procedures that had been recommended for years by numerous patient safety organizations. The medical center was also responsible for the negligence of Nurse Juan and Nurse Too as their employer. And, the medical center failed to have a system in place to assure that there was adequate physician back-up when a delivery was imminent.
Suit was also brought against the doctor because the doctor failed to recognize very clear signs of increasing fetal distress and failed to deliver baby timely by cesarean section.
The medical center and doctor mounted a vigorous defense that included claims based on evidence of a defective placenta, and pre-existing injuries proven by liver enzyme derangement. They also claimed the child was so neurologically devastated that baby is not going to live beyond 8 years.
On the morning of trial, a settlement was reached sufficient to care for baby for her entire life no matter how long she lives, including a special needs trust and multiple annuities.
* Jackie is a real person and this is a true story. The names have been changed in order to protect their privacy.
Our Office Hours
- Sunday 8am - 5pm
- Monday 8am - 5pm
- Tuesday 8am - 5pm
- Wednesday 8am - 5pm
- Thursday 8am - 5pm
- Friday 8am - 5pm
- Saturday 8am - 5pm
Why Choose Us?
- Voted Texas Super lawyer From 2004-Present by Texas Monthly
- Board Certified In Personal Injury
- Texas Trial Lawyers Association
- Dallas Trial Lawyers Association