Date of Incident: March 2, 2006 (date of birth)
Injuries: Plaintiff baby: (1) suffered neonatal encephalopathy with initial Apgars of 0 at 1 minute, 3 at 5 minutes, 4 at 10 minutes and 7 at 15 minutes; (2) experienced seizures within the first 24 hours of life; (3) exhibited other organ dysfunction; and (4) met all ACOG criteria for an HIE diagnosis. The baby's CT and MRI brain scans were also diagnostic for birth-related HIE. Plaintiff’s medical experts were in total agreement on the negligence of the medical/nursing team, and causation. The baby will require attendant care for the rest of his life. He will never be able to attend school, hold a job, move without assistance, or live independently.
Medical Expenses: Medical expenses were $86,000.
Settlement: $3,200,000.00
Report Submitted By: Ron Perey
Facts: Defendant Confidential Hospital is a large urban hospital with a busy labor and delivery department. It operates a clinic and a residency program for prospective family practice physicians.
This case involved 19 year-old Mom Doe and her son, Baby Doe, who sustained severe brain damage at birth due to hypoxic-ischemic encephalopathy related to a botched delivery by an inexperienced first year family practice resident physician on March 2, 2006. Mom Doe became pregnant with her first child, and had a due date of February 26, 2006. She received her prenatal care from a first year family practice resident physician (R1) John Smith, M.D. Dr. Smith was a hospital employee and was subject to continuing oversight by board-certified family-practice physicians, including Jim Jones, M.D., the attending physician, Dr. Smith, as an R1, was obligated to report to the attending physicians even with respect to routine prenatal issues. It was expected, though not required by hospital protocol, for the attending physician to be present during the active phase of labor and certainly to be present at birth.
Mom Doe had mildly elevated blood pressure and maternal discomfort at the end of the pregnancy, but her pregnancy otherwise involved no serious complications. Nevertheless, she wanted to have an elective C-section. That request was conveyed to Dr. Smith, the R1, several times, including four days before delivery on Sunday, February 26, 2006. Dr. Smith declined that request. Moreover, Dr. Smith did not consult with an obstetrician, who unlike Dr. Smith had the requisite privileges to perform a C-section; nor did he consult with Dr. Jones, the attending.
Two days later, on February 28, 2006, Mom Doe noted decreased fetal movement. That same day, she had a fetal non-stress test performed (NST) at the hospital. That test was nonreactive meaning the fetus was not doing well. Her subsequent biophysical profile (BPP) confirmed a low level of amniotic fluid and low fetal tone (6 of 8 total score), both worrisome findings. Dr. Smith and Dr. Jones decided to hospitalize her on the L & D floor and readied her for Pitocin induction. On February 28, 2006, the hospital physicians again failed to offer Mom Doe the option of a C-section even though (1) it was readily foreseeable that the fetus’ fetal reserve was low, and (2) Mom Doe likely would have a long labor. Mom Doe was administered Pitocin (oxytocin) to stimulate uterine contractions. The baby's fetal heart rate (FHR) thereafter experienced intermittent decelerations and diminished variability. Nevertheless, Dr. Smith continued with his vaginal trial right through delivery at 7:23 a.m. on March 2, 2006. At no time did Dr. Smith discuss delivery by C-section.
During the morning of March 2, 2006, Mom Doe progressed into active labor, making more rapid cervical changes as the day dawned. Nevertheless, neither the attending, Dr. Jones, nor any other “real” physician came to Mom Doe’s bedside at any time until after the baby's birth at 7:23 a.m. At 6:08 a.m. when she was 8-9 cm dilated, Dr. Smith, the R1, called Dr Jones, the attending physician. Dr. Jones said that he would soon leave his home which was a 40 minute drive from the hospital. At 6:40 a.m., Dr. Smith again contacted Dr. Jones who was still at home. At that point, the mom was completely dilated and beginning to push. Dr. Smith, the inexperienced R1, remained the only physician caring for the mom as pushing (second stage labor) began. Tragically, Dr. Smith, the R1, had only completed one obstetrics rotation during his first year as a family practice resident and he received a negative review.
Although Dr. Smith knew that the attending physician was not at the hospital, he failed to request that a more experienced physician assist him. He continued on that negligent course even after the baby's electronic fetal monitor (EFM) strip became more and more worrisome. Dr. Smith could not interpret the strips correctly, was wholly unaware that the baby's condition was deteriorating, and failed to consider a C-section. Later, the EFM tracing was lost completely. The L&D nurse also failed to summon another physician, even though she knew Dr. Smith was in “way over his head” and a more experienced physician was physically present and only a few steps away in the L & D Department. Dr. Smith waited another 30 critical minutes before requesting assistance from another resident physician. During 20 of those minutes, there was no fetal heart rate shown on the EFM whatsoever. Dr. Smith finally decided to get help, but only after the baby’s head was partially protruding for 5 minutes and he noticed the baby’s umbilical cord tightly wrapped around his neck (a/k/a/ a nuchal cord). In fact, he inexplicably clamped and cut the umbilical cord—the baby’s only lifeline—before he called for help from the chief resident.
Once summoned, the chief resident immediately came to the L&D room and took control of the delivery. Though Dr. Smith later “documented” a shoulder dystocia to explain his delay and inability to deliver the baby, the chief resident easily rotated the posterior shoulder and completed the delivery within 2 minutes after entering the room. Unfortunately, it was too late to avoid hypoxic-ischemic encephalopathy (brain damage).
Baby Doe was born blue and lifeless at 7:23 p.m. Shockingly, a full neonatal resuscitation team was not present at the time of delivery. As a result, the baby was not intubated until 4 minutes of life. Dr. Jones, the attending physician, did not attend the birth; arriving 5 minutes after the delivery, 43 minutes after the mom began pushing and 1 hour and 15 minutes after being called at 6:08 p.m.
Baby Doe suffered catastrophic brain damage, the direct result of hypoxic-ischemic encephalopathy (HIE). The brain damage did not occur until just prior to the 7:23 a.m. delivery. The baby's profound and irreversible brain damage was the result of the joint negligence of Dr. Smith (family practice resident physician), Dr. Jones (family practice attending physician), and the labor and delivery nurse all of whom were employees of defendant Confidential Hospital.
This settlement is a partial settlement and claims against the labor and delivery nurse (who was a traveling nurse employed by a separate agency) are pending.
County: King County
Trial Judge: Deborah Fleck
Plaintiffs: Mom and Baby Doe.
Defendants: Confidential Hospital; Dr. John Smith (first-year family practice medicine resident physician) and Dr. Jim Jones (family practice attending).
Trial date: November 5, 2007
Date of Settlement: January 30, 2007 (when Baby Doe was just short of 11 months of age).
Plaintiff's Attorneys: Law Office of Ron Perey, Seattle, Washington
Ron Perey and Doug Weinmaster
Defendants' Attorneys: Confidential.
Plaintiff's Experts: Howard Mandel, M.D., Los Angeles, CA (OB/GYN);
Camille DiCostanzo, R.N., Chicago, IL (neonatal nurse practitioner);
Evelyn Hom, R.N., Tacoma, WA (labor & delivery nurse);
Barry Pressman, M.D., Los Angeles, CA (neuroradiology);
Thomas Collins, M.D., Bellevue, WA (pediatric neurology);
Anthony Choppa, M. Ed., Bothell, WA (life care planner);
Lowell Bassett, Ph.D, Seattle, WA (economist);
Terry Tainter, Seattle, WA (videographer/producer–"Day-in-the-life” film);
William L.E. Dussault, J.D., Seattle, WA (special needs trust);
Alan "Buzz" Robinson, Seattle, WA (annuity trust specialist).
Defendants' Experts: Stephen Glass, M.D., Kirkland, WA (Pediatric Neurology)
David Knowles, Ph.D, Seattle, WA (Economist)
Mediator: Hon. Charles Burdell, Jr. (Ret.)
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