Monday, December 8, 2014

OB/GYN failed to do a c-section on time

Non-Disclosure Co-Next Friends of Plaintiff-Minor vs Defendant Hospital, OB/GYN M.D. and NNP Settlement: Case settled at facilitation for $1.25 Million Dollars Facts: This is a claim of medical negligence in the management of the delivery of Plaintiff-Minor at Defendant-Hospital by Defendant OB/GYN M.D. and also in the management of Plaintiff-Minor’s post-natal care by Defendant NNP. This is a case adding insult to injury; first, for failing to detect progressively worsening fetal heart tones and to timely deliver this child by C-section; and, second, in failing to recognize and appreciate seizure activity with significant apnea for the first 3-1/2 hours of this child’s life. As a result, Plaintiff-Minor was diagnosed with significant global hypoxic ischemia. Mother of Plaintiff-Minor was known to Defendant OB/GYN M.D. with a significant gynecological history which included a procedure that left scarring on her cervix. At 6:00 a.m. the day before delivery, there was spontaneous rupture of the membranes and noted to be green in color. Plaintiff-Minor’s mother presented to Defendant-Hospital at approximately 7:30 a.m. The first admitting nurse was unable to locate the cervix and noted moderate amounts of meconium stained fluid. A second nurse performed a vaginal exam and noted anterior lip 100 per cent effaced and a -1 station. Defendant OB/GYN M.D. was informed at approximately 7:45 a.m. The records indicate that Defendant OB/GYN M.D. performed a vaginal exam at approximately 10:30 a.m. which showed no anterior lip or no effacement as the scar was keeping the cervix closed. Defendant OB/GYN M.D. discussed with Plaintiff-Minor’s mother her options based on the presence of the scar: (1) to attempt to tease the scar open with her fingers and (2) a Cesarean section if that did not work. Plaintiff-Minor’s mother was hooked up an external fetal monitor which persistently showed decelerations from approximately 8:17 a.m. until 10:59 a.m. with periods of loss of pattern erratic heartbeat and late decelerations. Plaintiff-Minor was born by C-section at 11:33 a.m. with a weak cry, blue extremities, decreased reflexes and decreased tone. Despite his presentation, Plaintiff-Minor was given apgar scores of 6, 7 and 8. However, even Defendants’ nurse expert agreed that his first apgar score should have been a 4 and his subsequent apgar scores may have been 7 and 8, however, that was with resuscitation. Plaintiff-Minor required bulb and intubation, suction, tactile stimulation and blow-by oxygen. He was also given Narcan for nasal flaring, a sign of respiratory distress, all within the first eight minutes of life. At approximately 1:30 p.m., two hours after birth, Plaintiff-Minor’s blood glucose was drawn and determined to be 32. He was fed and a repeat blood sugar at approximately 2:00 p.m. was 31. At approximately 2:10 p.m., Plaintiff-Minor’s respiratory rate decreased to 36 and his 02 saturation was noted to be 60 to 70 per cent and he was dusky. Between 2:16 p.m. and 5:44 p.m., Plaintiff-Minor was noted to have 11 apneic, bradycardic and/or desaturation events. Each required stimulation for recovery and/or stimulation with bagging. One of the attending nurses testified that if Plaintiff-Minor was not being stimulated by a medical procedure, i.e., IV starts and/or lab draws, he required stimulation to continue to breathe from approximately 2:00 p.m., until he was transferred at approximately 6:00 p.m. At the transferring hospital, an MRI was performed after 24 hours of age reported significant supratentorial bilateral defusion abnormalities consistent with global hypoxic ischemic injury. At the time of settlement, Plaintiff-Minor was totally dependent. He did not walk, did not sit, had no head control, had no extremity control, was tube fed, there was no cognitive recognition and continued to have multiple seizures a day, even on medication and cortical vision impairment. Plaintiffs relied on the expertise of an OB/GYN physician, a neonate nurse practitioner, a neurologist, a neonatologist, a vocational rehabilitationist, a life-care planner and an economist. Plaintiffs’ OB/GYN physician’s opinion was that based on the fetal monitor strips, this should have been an emergency Cesarean section and should have been performed at 9:45 a.m. It is the opinion of Plaintiffs’ neonate nurse practitioner that this infant needed a blood sugar check within a half an hour of delivery and also required earlier intervention, given the repetitive episodes of apnea and desats, including intubation and Phenobarbital. The Defendants set forth a defense that the fetal monitoring strips did not reveal signs and symptoms of fetal distress. Their main defense was that the cord blood gas, which reported out as pH of 7.24, a PC02 of 60, a P02 of less than 5, a bicarb of 26, an 02 saturation unable to calculate due to the decreased P02 level and a base excess of -2 indicated that the child did not have metabolic acidosis and, therefore, the care was appropriate and the damages occurred prior well before delivery. The settlement was reached through the assistance of a facilitator with a non-disclosure agreement. Mary Pat Rosen 313-875-8080

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