Case # 4061 Brain Injury Resulting from Delayed Cesarean Section
On May 20, 2010 at approximately 10:30 a.m., the Plaintiff was pregnant with twins and was transferred to the Defendant Hospital from an outside hospital where she was diagnosed with pre-eclampsia and a HELLP Syndrome requiring stabilization and delivery. She was 27 weeks through her gestation which rendered her twins viable, but had not received any prenatal care. The outside hospital lacked a NICU, thus leading to the transfer to the Defendant Hospital.
After admission, the Defendant’s personnel began external fetal monitoring. Additionally, the Plaintiff was treated for pre-eclampsia and/or HELLP Syndrome, and continued in labor with fetal monitoring showing reassuring fetal heart tones. At 8:45 p.m., the first year resident and the attending OB/GYN were called to the bedside due to absence of one fetal heart tone and minimal variability in the remaining heart rate. One of the twins died in utero. At 10:30 p.m., the labor and delivery nurse noted the absence of variability and late decelerations on the fetal monitoring strip and promptly notified the attending obstetrician of loss of beat-to-beat variability and repetitive late decelerations. The Plaintiff alleged that when she did so, the national standards of care required the attending physician to immediately appear at the bedside, evaluate the Plaintiff and call for a STAT (emergency) cesarean section if intrauterine resuscitative efforts failed. He negligently failed to do so. He merely ordered an increase in the patient’s magnesium sulfate, administration of betamethasone to promote lung maturity, and oxygen.
The attending obstetrician did not appear at the bedside until 11:30 p.m. — over one hour after it was required by the national standards of care. Amazingly, although the STAT cesarean section was finally called for at 11:30 p.m., no cesarean section was begun until 12:55 a.m. The Plaintiff alleged that the national standards of care required the STAT cesarean section be carried out within minutes of being called, not hours.
The Infant Plaintiff was delivered at 1:07 a.m., with no respiratory effort until 10 minutes post-delivery. The baby’s APGAR scores were 2, 5, and 6 and she had an abnormally low cord pH. The other twin was delivered stillborn.
Following delivery, the Infant Plaintiff was transferred to the Neonatal Intensive Care Unit (NICU) for further care. She remained in the NICU for 77 days. Upon discharge, her diagnosis included brain injury. Notwithstanding that diagnosis, the Infant Plaintiff attends normal schools in an age appropriate classroom. She avoided profound neurological and/or cognitive deficits, but has attention deficit hyperactivity disorder.
The Defendant denied all allegations of negligence, causation and harm.