Articles Posted in Birth Injury

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this medical malpractice/birth injury case and its proceedings.)

UNIVERSAL HOSPITAL IS NOT LIABLE FOR THE CONDUCT OF SUBSEQUENT TORTFEASORS AND, THEREFORE, PLAINTIFFS’ DOUBLY-IMPUTED LIABILITY THEORY LACKS MERIT

As stated above, plaintiff’s contend that not only is Dr. Brown’s conduct imputed to Universal Hospital but the conduct of all subsequent tortfeasors should be imputed as well. Their contentions are incorrect.

The seminal case for subsequent medical treatment liability is Ash v. Mortensen (1944) 24 Cal.2d 654. The California Supreme Court in Ash held that the tortfeasor responsible for the original injury to plaintiff remained jointly and severally liable for injuries occurring during subsequent medical treatment for those injuries. This determination was based on a proximate cause analysis whereby the aggravated injury resulting from subsequent negligent medical treatment was considered foreseeable and a “normal part of the aftermath” of the original injury. (Id. at p. 657; Maxwell v. Powers (1994) 22 Cal.App.4th 1596, 1606.) As a consequence, the original tortfeasor becomes jointly and severally liable to plaintiff for those additional, subsequent injuries. (Blecker v. Wolbart (1985) 167 Cal.App.3d 1195, 1201-1203.)

In that regard, CACI Instruction No. 3929 provides:

If you decide that [defendant] is legally responsible for [plaintiff]’s harm, [he/she/it] is also responsible for any additional harm resulting from the acts of others in providing aid that [plaintiff]’s injury reasonably required, even if those acts were negligently performed. (Emphasis added.)

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(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this medical malpractice/birth injury case and its proceedings.)

PRINCIPLES REGARDING OSTENSIBLE AGENCY

In California, an agency relationship between a principal and an agent can be actual or ostensible. (Civ. Code, § 2298.) An example of an actual agency relationship is the relationship between an employee (the agent) and an employer (the principal). (Civ. Code, § 2299.)

An agency is ostensible where the principal causes a third person – intentionally or through negligence – to reasonably believe that the agent is acting on the principal’s behalf. (Civ. Code, § 2300.) Under Civil Code section 2334, a principal is bound by the acts of his ostensible agent but only to those persons, without fault, who have acted in good faith on the conduct of the agent. (Civ. Code, § 2334.) The issue of ostensible agency is normally a question of fact and the burden of proof rests with the party asserting the existence of that type of relationship. (Mejia v. Community Hospital of San Bernardino (2002) 99 Cal.App.4th 1448, 1458; Ermoian v. Desert Hospital (2007) 152 Cal.App.4th 475, 502-503.)

In Mejia, the California Supreme Court addressed the principle of ostensible agency in the context of patients at hospitals. In Mejia, plaintiff sought treatment in an emergency room at Community Hospital of San Bernardino for neck pain and stiffness. Following X-rays, the radiologist reported that he saw a congenital fusion of the neck but nothing more. It was later discovered plaintiff’s neck was actually broken and she was paralyzed. The hospital, who was not the radiologist’s employer, obtained a nonsuit and Fourth District Court of Appeal reversed.

The Mejia Court examined prior judicial decisions and existing statutes applicable to ostensible agency and recognized that plaintiff must establish at least three elements in order to prove ostensible agency: (1) The patient deals with the physician with the belief that the physician is authorized to action on behalf of the hospital and the belief is a reasonable one; (2) The patient’s belief is generated by some act or neglect of the principal/hospital; and (3) The patient relying on the agent’s apparent authority is not guilty of negligence. (Id. at p. 1456-1457.)

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(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this medical malpractice/birth injury case and its proceedings.)

The Barragan Court recognized that a wrongful life action exists in favor of the plaintiff child where the child proves the defendant negligently failed to diagnose and warn the parents that their baby had a probability of being born with a genetic ailment or disability and where the baby is in fact born with that ailment or disability. (Id. at p. 1004.) In that case, however, neither element existed.

During the period of time where the mother had the right to abort her pregnancy, the pregnancy was progressing normally and there was no indication that the plaintiff twins had any defects that were substantially certain to occur. (Id. at p. 1005.) Therefore, Dr. Lopez had no duty to advise the mother that she had a right to abort her child. Stated differently, Dr. Lopez had no duty to advise the mother of a non-existent probability of harm to the twins. Once the mother began experiencing complications with her pregnancy, the twin fetuses were already viable and it would have been a breach of the standard of medical care to offer an abortion to the mother. (Id. at p. 1006.)

In addition, the medical expert testimony established that nothing done by Dr. Lopez caused any injury to the plaintiff twins. The expert testimony established both that cerebral palsy occurs in the absence of professional negligence and there was no test Dr. Lopez could have performed that would have predicted the twins would be born impaired. (Id. at p. 1006.) (See Part 7 of 10.)

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(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this medical malpractice/birth injury case and its proceedings.)

The Elements That Plaintiffs Must Prove To Establish A Prima Facie Case.

In CACI No. 513, the elements for proving a wrongful life claim are virtually identical to the elements required for proving a wrongful birth claim (CACI No. 512). The wrongful life elements are as follows:

[Plaintiff] claims that [defendant physician] was negligent because [he/she] failed to inform [p]laintiff]’s parents of the risk that [he/she] would be born [genetically impaired/disabled]. To establish this claim, [plaintiff] must prove all of the following:

1. That [defendant] negligently failed to diagnose and warn [plaintiff]’s parents that their child would probably be born with a [genetic impairment/disability];
2. That [plaintiff] was born with a [genetic impairment/disability];
3. That if [plaintiff]’s parents had known of the hereditary ailment or disability, [his/her] mother would not have conceived [him/her][or would not have carried the fetus to term]; and
4. That [plaintiff] will have to pay extraordinary medical or training expenses because of [his/her][genetic impairment/disability]. (CACI No. 513.)

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(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this medical malpractice/birth injury case and its proceedings.)

THE NATURE OF WRONGFUL LIFE/ WRONGFUL BIRTH ACTIONS

Wrongful Life And Wrongful Birth Actions Are Forms Of Professional Negligence Claims.

The courts in California recognize wrongful life and wrongful birth as a particular variety of the more common cause of action for professional or medical malpractice. (Barragan v. Lopez (2007) 156 Cal.App.4th 997, 1004.) The plaintiff in a wrongful life or wrongful birth action, like the plaintiff in a garden-variety professional negligence claim, must prove the following elements: (1) Defendant owed plaintiff a duty to use such skill, prudence and diligence of other members of his profession; (2) Defendant breached that duty; (3) A causal connection between the breach and any injury; and (4) Actual loss or damage resulting from the professional negligence. (Ibid.)

But the gravamen of the wrongful life/ wrongful birth claim is the claim that the child is born impaired with a genetic defect or medical condition and but for the defendant’s negligence, the child would not have been born to suffer the defect. (Ibid.) Stated differently, wrongful life/ wrongful birth actions are essentially actions for malpractice based on negligent genetic counseling and testing. (Gami v. Mullikin Medical Center (1993) 18 Cal.App.4th 870, 883.)

The term wrongful life generally refers to an action brought by the child to recover damages incurred as a result of being born with the medical condition. (Turpin v. Sortini (1982) 32 Cal.3d 220, 225.) The term wrongful birth generally refers to an action brought by the parents to recover damages allegedly incurred as a result of the child being born impaired. (Turpin v. Sortini (1982) 31 Cal.3d 220, 225.) Here, this is a wrongful life action brought by the child plaintiff although the mother plaintiff also sues for negligence.

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(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this medical malpractice/birth injury case and its proceedings.)

It is worth noting that situations similar to those described in this case could just as easily occur at any of the healthcare facilities in the area, such as Kaiser, U.C. Davis Medical Center, Mercy, or Sutter.

SUMMARY OF PLAINTIFFS’ INCORRECT THEORIES OF LIABILITY

Plaintiffs’ primary theory of liability against Universal Hospital Medical Center is one of imputed liability based on an incorrectly collapsed theory of two separate and distinct tort principles: (1) Ostensible agency; and (2) Liability for subsequent negligent medical treatment.

Plaintiffs will begrudgingly admit that Dr. Brown was not an employee of Universal Hospital but they claim he was the ostensible agent of Universal Hospital Medical Center. According to plaintiff’s, Universal Hospital is therefore liable for the wrongful acts and omissions of Dr. Brown. In addition, however, plaintiff’s also take the position that because Dr. Brown’s liability for plaintiff’s’ damages is imputed to Universal Hospital under ostensible agency concepts, Universal Hospital becomes an original tortfeasor who is then also liable for the injuries allegedly incurred as a result of all subsequent negligent medical treatment.

Plaintiffs claim, in effect, that even in the absence of actual fault, Universal Hospital Medical Center becomes vicariously, vicariously liable for the injuries allegedly caused by all defendants other than Dr. Brown, too.

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(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this medical malpractice/birth injury case and its proceedings.)

SUMMARY OF FACTS

The undisputed facts follow. Patty Smith was a 36-year-old female who was three months pregnant when she came to the emergency department within Universal Hospital. This was not Mrs. Smith’s first pregnancy, she had two children previously. Mrs. Smith underwent genetic counseling and testing, including AFP and amniocentesis, for advanced maternal age and Down Syndrome pregnancy a year or so before this pregnancy.

At the emergency department on May 5, 2005, Mrs. Smith complained of bleeding, cramping and the passage of a large blood clot. An ultrasound was performed and disclosed an almost 14-week pregnancy – a normal pregnancy. Mrs. Smith was so informed.

The emergency department physician, defendant Steven Brown, M.D. – not an employee of Universal Hospital Medical Center – then incorrectly informed Mrs. Smith that the ultrasound was negative for pregnancy, apparently telling her that there was a complete abortion. Mrs. Smith was discharged home with instructions to see her private physician within 24 hours for a re-evaluation.

Mrs. Smith went to Sacramento Medical Center the same morning of her discharge from the hospital. She saw defendant Ava Green, P.A. Mrs. Smith told Ms. Green that she was seen at Universal Hospital, had an ultrasound and was told that she had a complete abortion. Ms. Green advised pelvic rest for Mrs. Smith and asked Mrs. Smith to return in 10 days for family planning. When Mrs. Smith returned on May 16, 2005, Ms. Green performed a physical examination. She did not detect the ongoing pregnancy, which was obvious. Ms. Green did not order an ultrasound.

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(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this medical malpractice/birth injury case and its proceedings.)

UNIVERSAL HOSPITAL’S TRIAL BRIEF REGARDING PRINCIPLES OF WRONGFUL BIRTH, OSTENSIBLE AGENCY, AND APPORTIONMENT OF FAULT
MEMORANDUM OF POINTS AND AUTHORITIES
SUMMARY OF ALLEGATIONS

Plaintiff Oliver Smith, a minor, by and through his guardian ad litem, Mike Smith, (“plaintiff Oliver”) and plaintiff Patty Smith (“Mrs. Smith”) seek damages for injuries allegedly resulting from the provision of medical care and treatment to Mrs. Smith during her pregnancy with her son. Specifically, plaintiff’s allege the defendants were negligent in the pre-natal care of Mrs. Smith and, as a consequence, the baby was born with Down Syndrome.

The operative complaint states two causes of action by plaintiff Oliver and against Universal Hospital: (1) Professional negligence; and (2) Wrongful birth. Plaintiff Oliver alleges that Mrs. Smith hired the defendants to diagnose and treat her pregnancy and to provide pre-natal care, testing and advice. According to the allegations, the defendants were so negligent in the provision of care to Mrs. Smith that: (1) Mrs. Smith was not given the opportunity for MS-AFP testing; (2) Mrs. Smith was not offered the option of terminating the pregnancy; and (3) Plaintiff Oliver was born a Down Syndrome baby. According to the allegations of the complaint, but for the negligence of defendants, plaintiff Oliver would not have been born at all.

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The following blog entry is written from a defendant’s position as trial approaches. Reviewing this kind of briefing should help potential plaintiffs and clients better understand how parties in personal injury cases present such issues to the court.

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury/medical malpractice case and its proceedings.)

It is worth noting that situations similar to those described in this case could just as easily occur at any of the healthcare facilities in the area, such as Kaiser, U.C. Davis Medical Center, Mercy, or Sutter.

PAUL GREEN MAY NOT MAINTAIN A CAUSE OF ACTION FOR LOSS OF CONSORTIUM BASED ON ABBEY’S INJURIES

This motion does not challenge that determination, and there seems to be little question that Mr. Green would be permitted to maintain a cause of action for loss of consortium pertaining to his wife’s physical injuries.

However, Mr. Green’s loss of consortium claim reaches well beyond that, to claims for emotional distress suffered as a consequence of having to take care of Abbey. Ms. Green stated in her deposition that any negative impacts to the quality of her marriage are attributable entirely to Abbey ‘s problems as opposed her own physical injuries. Thus, it is undisputed that there are no recoverable loss of consortium damages based on Ms. Green physical injuries. This is, of course, consistent with common sense, and entirely what one would expect where the mother recovered completely within a few weeks and the child has severe and permanent injuries to her brain.

The issue before the court with respect to the fifth cause of action is whether Paul Green, under his claim for loss of consortium, is entitled to recover any damages other than those relating to his wife’s physical injuries; and the answer is no. Clearly, Mr. Green has suffered profoundly as a result of his daughter’s injuries, not only in the loss of Abbey ‘s love and affection, but also the impact of Abbey ‘s injuries on the quality of their marriage. However, this latter source of suffering is not compensable, because it does not flow directly from a compensable injury suffered by his wife, and the former is not compensable because in California there is no cause of action for loss of filial consortium.

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The following blog entry is written from a defendant’s position as trial approaches. Reviewing this kind of briefing should help potential plaintiffs and clients better understand how parties in personal injury cases present such issues to the court.

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury/medical malpractice case and its proceedings.)

It is worth noting that situations similar to those described in this case could just as easily occur at any of the healthcare facilities in the area, such as Kaiser, U.C. Davis Medical Center, Mercy, or Sutter.

The Court raised a question regarding circumstantial evidence that something had been done wrong, namely the birth of a blue baby, which was precisely the issue confronted by the Hurlbut and Justus courts. However, the law is clear that circumstantial evidence is not enough: evidence of severe injury from an overdose of radiation (Golstein), a baby born dead (Justus), a child who deteriorates in the hospital (Jansen), a brain injury during labor and delivery (Hurlbut), a child covered with blood with a doctor leaning over him (Breazeal), or a severed artery during surgery (Bird), all amount to circumstantial evidence of negligence, and circumstantial evidence of a connection between the observed negligence and the injury.

However, as the courts correctly found in each one of these cases, such evidence is still not enough. Under Ochoa, and every factually apposite case to come down since then, there must be an observed connection between the accident and the resulting injury, a witnessing, with knowing comprehension. Thus, observing a baby born blue, or worse, even after observing concerning events during labor, is not enough, and the unbroken line of cases before us, including Ochoa, so hold.

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