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    Legally Speaking: Pre-trial agreements alter monetary awards

     

    Delay in performing cesarean blamed for CP

    A California woman presented to the hospital in 2012 in labor at term. The FHR tracing was initially a category I but became a category II about 5 hours later, with some decelerations but moderate variability. A few hours later the physician came in for delivery, anticipating a vaginal delivery within an hour. He found the patient was fully dilated and started her pushing. An hour later he decided to perform a cesarean and called for an assistant and a surgical tech. Fifteen minutes later the FHR was absent, the patient was given a general anesthesia, and the infant delivered 13 minutes later. The umbilical cord was around the infant’s neck and a full resuscitation with intubation and epinephrine was performed. The infant was transferred to another hospital for brain cooling. She spent 5 weeks in the hospital and was subsequently diagnosed with cerebral palsy, blindness, emotional distress, seizure disorder, and speech/language impairment.

    In the lawsuit that followed the delivery, the patient claimed that the standard of care required the physician to deliver the baby 90 minutes earlier and it was negligent for him to wait so long before ordering a cesarean. In addition she claimed that care involved with the resuscitation efforts was negligent. The child was 3 1/2 years old at the time of trial. She continues to require frequent suctioning and suffers from occasional seizures. Because of her injury she will never be able to walk, talk, or care for herself. She is fed through a feeding tube and will require 24-hour licensed occupational nursing care for the rest of her life, which is projected to be only 20 more years.

    More: Enhanced FHR monitoring

    The physician contended that the standard of care did not require a cesarean before he ordered it because the FHR variability indicated that the fetus was not acidotic during that time. He also argued that the delivery occurred within 30 minutes of the decision to operate and that the infant’s injury was due to the cord accident and not any delay in delivery. The defense concluded that the resuscitation was performed in a timely manner, ultimately saving the infant’s life.

    The verdict

    The judge awarded the infant $9.6 million.

    CP blamed on delay in performing cesarean delivery

    A Virginia woman presented to the hospital for labor induction at 39 weeks’ gestation. She was admitted in the evening and placed on a FHR monitor and was monitored throughout the next day into the evening, at which point she had an elevated temperature and FHR tachycardia. The obstetrician was notified and prescribed antibiotics, and about an hour later, the woman’s temperature decreased. After another hour the patient was fully dilated and started pushing. About 20 minutes later, the obstetrician was notified that the FHR showed variable decelerations; on arrival 30 minutes later, he ordered a cesarean. The infant was delivered 24 minutes later. At 10 hours of life, he began to have seizures and was transferred to another hospital, where he remained in the neonatal intensive care unit for 15 days. He was subsequently diagnosed with cerebral palsy.

    The patient sued the obstetrician, claiming that the infant suffered an acute hypoxic ischemic injury, and that an earlier cesarean would have avoided the brain injury.

    The obstetrician argued there was no breach in the standard of care and that the infant did not meet all the criteria for an acute hypoxic ischemic injury. He claimed that, based on the computed tomography scan, the infant’s brain injury most likely occurred at least 7 hours before delivery.

    The verdict

    The jury returned a defense verdict.

    NEXT: Complications during prolapse repair surgery

    1 Comment

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    • UBM User
      After years of reading about trial and settlement results, it strikes me that there is no real educational purpose reading about the cases selected. Clearly, as readers not privy to the additional details necessary to render a peer-reviewed opinion, we are left with a recurring theme. What are we supposed to conclude? Let's be frank - it is simply that our current tort system is incapable - by its own design - to render a predictable outcome. Attempts to rationalize this are disingenuous, at best. This is a national disgrace and our respective physician representative organizations have been frustrated for decades at every attempt to reform it by making the system fairer to the alleged injured party and to the providers who render care. OBGs and our specialty have taken many direct hits as a result. So, why do keep reading about these cases? Why are we even considering a strategy where the physician is put in a "catch-22" and loses each time? It may have something to do with the fact that the people in control of the system like it that way because they benefit? If they were actually concerned about the unreliable results of "their system" and if they had a conscious they would be proponents for an alternative system where justice could be reliably metered out.

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