Birth Injury

Roseville Child Born With Catastrophic Brain Injury, Part 8 of 11

June 19, 2009 | by Moseley Collins

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the proceedings.)

LIABILITY:

Regional Medical Center: Hospital nursing personnel fell below the standard of care in the following areas:

1) Regardless whether Ms. Cruz or the breech patient arrived at the hospital first, once the second of the two arrived, hospital nursing personnel had a duty to obtain a third OR crew, which would, at a minimum, have necessitated phone calls to obtain a third anesthesiologist STAT. Assuming that the second OR crew was called for Ms. Cruz, as was suggested by the timing of Dr. U.’s call to house supervisor Nurse F., an OR crew had not been called for the breech patient which, under the circumstances was below the standard of care. The hospital made no provision for two simultaneous Cesarean deliveries under circumstances in which a scheduled surgery had also been planned. There were three operating rooms in the main OR, but the hospital only had 2 OR crews. No calls were ever made to obtain a third anesthesiologist, who was then available.

2) Failure to transfer Ms. Cruz directly to the main OR with fetal monitor and L&D nursing personnel at 9:20 am, and to monitor the patient at that location until surgery could begin, thereby avoiding the delay of delivery which occurred between 10:52 am and 11:15 am.

Further, at 9:34 am, the FHR baseline was noticeably smoother than it was at 9:10 am, which failed to get the attention of L&D nursing personnel or to form an additional basis on which to prompt immediate transfer to the main OR. There is nothing in the chart indicating that Dr. U. was ever made aware of these changes of the FHR.

Surgical Confusion Leads To Malpractice At West Sacramento Hospital, Part 7 of 11

June 16, 2009 | by Moseley Collins

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the proceedings.)

Nursing notes picked up again in the OR. The first reference after 10:52 am was at 11:05, with Ms. Cruz in the OR. The anesthesia record of Dr. X. referred to fetal distress. Thus far, no one has testified to what occurred between 10:52 and 11:05 am. Dr. U. testified that he was present when Ms. Cruz arrived in the OR and that he left the breech patient to Dr. V. to sew up the initial skin incision. The surgery schedule indicated that the surgery stop time for the breech case was not until 11:15 am. The anesthesia record and Dr. X. testified that his spinal anesthesia began at 11:08 am. At 11:09 a.m., the fetal heart rate could not detected on Ms. Cruz’ baby. The spinal was said to have taken effect by 11:10 am – the time of the start of surgery for Ms. Cruz. At 11:10 am, a nursing progress note indicated that the spinal was completed and that the FHR (by hand-held doppler) on Martha was absent. In his operative report, Dr. U. reported that the surgery was rushed with a single shot of spinal analgesia, that there was massive intra-uterine bleeding” (estimated at 1800 cc), that a nuchal cord was present and 1200 cc of clots were found. Martha was delivered at 11:15 am.; she was born clinically dead with no signs of life. Dr. W. testified that he believed that the child probably had been dead for at least 8 minutes, from the time that nursing noted the absence of a heart rate at 11:10 am, until 3 minutes following the birth, when the first signs of life appeared. The placenta was sent to pathology and found to be normal.

Roseville Family Suffers With Brain Damaged Newborn, Part 6 of 11

June 14, 2009 | by Moseley Collins

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the proceedings.)

After her second call to the main OR, charge Nurse E. went to the main OR herself to see what could be done to expedite the delivery for Ms. Cruz, who was still upstairs in L&D. Nurse E. reported again to Dr. U. and to the main OR nurse the emergency circumstances involving Ms. Cruz. No one volunteered any information as to how best to resolve the situation. There was no discussion about the use of other OBs, or about informing the OR crew that was on the unit, though still in surgery in OR #1.

At 10:10 am,, anesthesia began on the breech patient. At 10:15 am, the FHR baseline on Ms. Cruz dropped to 100 bpm. At 10:20 am, L&D nursing documented absent variability with bradycardia.” The L&D nursing staff communicated this information to Dr. U. while he was operating on the breech patient. In turn, Dr. U. testified that he called for a crash Cesarean section on Ms. Cruz but he gave no further instructions as to how this order would be carried out. After 10:20, Dr. U. testified that he was not further advised of Ms. Cruz’ status.

At 10:25 am, Drs. Z. and C. completed the scheduled abdominal hysterectomy in OR #1. The surgery had begun before Ms. Cruz had even arrived at the hospital. Based on their deposition testimony, neither could recall anyone having advised them during that surgery that an emergency was unfolding either with the breech patient or with Ms. Cruz. Even after the procedure was completed, neither could recall anyone having advised them to stay or to assist with either patient and Dr. U. testified that no one advised him that other OB/GYNs were in the main OR area during this time.

The anesthesia stop time for the hysterectomy patient was 10:30 am. At that approximate time, Dr. X. has testified and provided a declaration under penalty of perjury, that he was the primary anesthesiologist in the OR that morning and that he was to stay in the hospital, but claimed to have been given no further instructions. Ms. Cruz remained upstairs in the L&D unit. Dr. .X. was in fact available at 10:30 a.m. to start anesthesia for Ms .Cruz. Shortly thereafter, pediatrician Dr. W. arrived and waited with Dr. X. for further instructions. At 10:32 am however, nursing notes on the fetal monitoring tracing of Ms. Cruz documented that Dr. X. was at her bedside in L&D.

Sacramento-area Hospital Sued For Birth Injury, Part 3 of 3

June 13, 2009 | by Moseley Collins

IN AN ACTION TO RECOVER FOR PERSONAL INJURIES TO A CHILD, SPECIAL DAMAGES INCLUDE THE REASONABLE VALUE OF HOME ATTENDANT CARE PROVIDED BY THE CHILD’S PARENTS

The defense cannot bring up the quality of the care given to the minor by the parents in order to reduce the damages. The parents are entitled to reimbursement for the reasonable value of attendant care provided directly from the brain damaged child under the minor Plaintiff’s cause of action for economic damages. In an action to recover for personal injuries to a child, special damages include the reasonable value of home attendant care provided by the child’s parents.

In the case of Hanif v. Housing Authority (1988) 200 Cal. App.3d 635, the Court of Appeal held that, “It is established that the reasonable value of nursing services required by the defendant’s tortious conduct may be recovered from the defendant even though the services were rendered by members of the injured person’s family and without an agreement or expectation of payment. Where services in the way of attendance and nursing were rendered by a member of the Plaintiff’s family, the amount for which the defendant is liable is the amount for which reasonably competent nursing and attendance by others could have been obtained.” (Id. at 644.)

In the case of Rodriguez v. McDonald Douglas Corporation (1978) 87 Cal. App.3d 626, the Plaintiff was entitled to recover the reasonable value of 24-hour home attendant care provided by his spouse and necessitated by the defendant’s tortious conduct. The Court held that,

“We reject the premise that the cost of attendant care, past or future, should not have been an item for consideration by the jury because of the presence of (the Plaintiff’s wife). It is not part of her duties as a wife to render 24-hour-a-day attendant care.” (Id. at p. 661.)

Thus, in this case, any attendant care provided by the parents in the past or which could be provided in the future must be compensated for at the reasonable rate which would be charged by a competent nursing attendant. Based upon evidence and testimony of various witnesses, the jury can properly determine the cost of such attendant care, regardless of who would provide it.

Botched Emergency C-Section Causes Catastrophic Birth Injury At Sacramento-area Facility, Part 5 of 11

June 12, 2009 | by Moseley Collins

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the proceedings.)

According to the deposition testimony of nurses E. and F., the breech patient arrived after Ms. Cruz in L&D. Nurse E. did a physical examination and found the patient to be a term footling breech with bulging membranes and completely dilated. She considered her to be in need of an emergency Cesarean section, due to the threat of cord prolapse if her membranes ruptured spontaneously. She assigned the breech patient to L&D nurse, Nancy G.. At approximately 9:30 am, nurse G. called Dr. D. to advise him of his need to come in for his patient due to the breech emergency. Dr. D. informed nurse G. that he was out of town, two hours away, and asked whether there was another physician in-house who could deliver his patient. Nurse G. told him that Dr. U. was either coming in or already was in. She did not mention that he had an emergency patient of his own. There was no further contact with Dr. D.. According to charge nurse E., Dr. U. was made aware of the breech patient upon his arrival and that he agreed to deliver that patient. At 9:30 am, house supervisor Nurse F. called the members of the second-call OR crew as requested by Dr. U., and within 5 minutes, all team members had been contacted. Nurse F. then called L&D to confirm that the crew was on their way in. Sometime between 9:30 am and 10:00 am, the breech patient was taken down to the main OR on the orders of Dr. U., though the OR crew, called by Nurse F., had actually been initially requested for Ms. Cruz.

At 9:30 am, the systolic pressure on Ms. Cruz reached 150. Magnesium sulfate was started at 9:42 am. At 9:46 am, the FHR dipped to 110 beats per minute (bpm). At approximately 10:00 am, Dr. U. went to the basement to see about the status of the OR crew. At that time, Ms. Cruz’s systolic pressure rose to 164. There were no orders for anti-hypertensive medications. There is no documentation in the patient’s chart to indicate that Dr. U. was told about the rising systolic pressures.

Parents Of Brain Damaged Roseville Boy Sue Physician, Part 2 of 3

June 11, 2009 | by Moseley Collins

THE PARENTS’ QUALITY OF CARE FOR THE CHILD IS IRRELEVANT

The defense has no admissible testimony that the quality of care given to the minor child by his parents has in any manner contributed to the condition from which the child suffers. The child’s suffering and severe brain damage has not been caused or contributed to by the care of the parents.

Further, it is irrelevant whether the parents provide the extraordinary care necessary for this child or hire an outside attendant to do so. The fact that the parents may voluntarily choose to devote some or all of their lives to providing the extraordinary level of attendant care services required by the minor Plaintiff in this case does not, and should not, insulate the defendant from being liable for the reasonable value of nursing attendant care services required by this child solely as the result of the defendant’s negligence.

It would be confusing for the defense to suggest to the jury that the parents/relatives may, at no cost, provide those services and misleading to the jury in view of the current state of the law regarding Plaintiff’s damages as referred to earlier under the case of Hanif v. Housing Authority, supra, 200 Cal. App.3d at 644 (see discussion below).

Additionally, requiring the jury to deliberate in order to calculate the number of hours of future care that would be provided by the relatives versus an outside hired nurse [where both are entitled to the same compensation] would necessitate an undue and totally unnecessary consumption of time.

Operating Room Mismanagement Results in Roseville Child’s Birth Injury, Part 4 of 11

June 10, 2009 | by Moseley Collins

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the proceedings.)

On arrival at Regional Medical Center, the systolic pressure on Ms. Cruz was 138. Her blood sugar was relatively low. Nursing personnel were aware of a history of pregnancy-induced hypertension (PIH) but it had not been treated earlier by anyone. A fetal monitor was placed at 9:00 am. L&D nursing wrote that variability is non-reassuring and referred to the contraction pattern as very irritable.” The fetal heart baseline was holding just at 120 beats per minute (bpm). By 9:10 am, Ms. Cruz was placed on oxygen by mask and changes in position were made in order to better oxygenate the fetus. In anticipation of Cesarean delivery, nursing personnel had Ms. Cruz sign a consent for Cesarean section at 9:10 am. At 9:15 am, nursing personnel called Dr. U. and reported their concerns. Dr. U. ordered an emergency Cesarean section (per L&D nurses) and a STAT Cesarean section (per his own notes) over the telephone and indicated he was en-route. He asked for a PIH panel (blood test) and requested that the patient be placed on magnesium sulfate to avoid seizing. L&D charge nurse, Gabrielle E., RN, testified that she spoke with personnel in the main OR at 9:15 am and gave them a heads-up for an anticipated Cesarean section, but never mentioned the name of the patient. At the time, the hospital had two OR teams available on-call. One was already attending to the hysterectomy which began during the 8 o’clock hour. The other would need to be called in not by the OR, but by the relief house supervisor, Olivia F., RN.

L&D nursing personnel never documented when Dr. U. arrived at bedside. Dr. U. wrote a progress note, timed at 9:20 am, in which he indicated that he had reviewed the tracing. He testified in deposition that he expected that Ms. Cruz would be delivered within 30 minutes; his orders relative to the urgency of the situation had not changed.

Roseville Child Suffers Birth Injuries, Part 1 of 3

June 9, 2009 | by Moseley Collins

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the proceedings.)

Plaintiffs’ Trial Brief on the Quality of Parents’ Care (Hanif)

MEMORANDUM OF POINTS AND AUTHORITIES
INTRODUCTION

This is a medical negligence action wherein the minor Plaintiff, DANIEL YAMAMOTO, a Roseville resident, suffered severe birth injuries. Each Defendant and their witnesses have no basis for making any reference to (1) the issue of the parents’ quality of care or (2) to a claim that the minor Plaintiff’s damages may be limited by the fact that the parents or relatives of the minor Plaintiff have in the past provided, and may in the future continue to provide, some attendant care for the minor Plaintiff.

1. The quality of the parents’ care is irrelevant. The defense has no admissible testimony that the quality of care given to the minor child has in any manner contributed to the brain damaged condition from which the child suffers. Such testimony is excludable as irrelevant (Evid. Code § 210) and unduly time consuming and prejudicial (Evid. Code § 352).

2. The cost of the minor’s care is not reduced because the parents may provide some care. Further, the defense cannot bring up the issue of the quality of the care given to the minor by the parents in order to reduce the damages. Where it is undisputed that the minor Plaintiff will require attendant care for the rest of his life, the jury’s function is to determine the reasonable level and cost of such care to be included as plaintiff’s damages. The jury function is not to determine who will provide the care (Hanifv. Housing Authority (1988) 200 Cal. App.3d 635, 644). Based upon this clear authority, Plaintiffs attach a proposed jury instruction regarding the holding in Hanif.

OB/GYNs At West Sacramento Hospital Cause Birth Injury, Part 3 of 11

June 8, 2009 | by Moseley Collins

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the proceedings.)

FACTS:

Due to absence of comprehensive nursing notes on Ms. Cruz while she was in L&D, exceedingly poor memories of the witnesses whose depositions have been taken to date, and a lack of access to the chart on the breech patient, the facts relating to both Ms. Cruz and the breech patient while each were in L&D and the OR remain somewhat uncertain.

Ms. Cruz was a 42-year-old mother of six when she first began receiving prenatal care from Dr. U. at Universal Health Clinic on April 18, 2002. An OB sonogram revealed a due date of October 23. Ms. Cruz had no complaints until August, 2002. During the month of August, Ms. Cruz developed headaches, weakness and sweats. Later that month, a 3-hour glucose tolerance test (GTT) found excess sugar so she was referred to a high-risk OB to manage those problems. During the months of August and September her systolic blood pressure rose to 140. Late in September, Ms. Cruz was seen by a high-risk OB and ante-partum testing was begun on October 1. On October 1, a non-stress test (NST) revealed a healthy, reactive fetus. The systolic pressure on Ms. Cruz remained borderline at 140. No physician thought it necessary to place Ms. Cruz on anti-hypertensive medication or on magnesium sulfate based on these borderline values. Her pressures never increased from that level for any significant period of time.

Roseville Family Files Action For Medical Malpractice, Part 2 of 11

June 6, 2009 | by Moseley Collins

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the proceedings.)

At 10:20 am, Dr. U. was informed by L&D personnel (while operating on the breech patient) that the FHR on Ms. Cruz had fallen further. As a result, Dr. U. called for a crash Cesarean section on Ms. Cruz. Dr. U. gave no instructions as to who would deliver Ms. Cruz or how. If there was no one to deliver Ms. Cruz sooner than he, Dr. U. expected that he would leave the breech patient to her assistant surgeon, Dr. V., toward the end of surgery in order to attend to Ms. Cruz.

At 10:25 am, OB/GYN’s, Ralph Z., MD and Erica C., MD, had completed the scheduled hysterectomy in OR #1. However, no one informed them that there was another patient, Ms. Cruz, awaiting an emergency c-section, and thus they left the hospital at that time. The anesthesiologist from the hysterectomy, Stuart X., MD, became available at 10:30 am, and he remained in the hospital. At 10:30 a.m., surgery for the breech case began in OR #2.. At 10:32 a.m., Dr. X. was noted to be at the bedside with Ms. Cruz. For the next 35 minutes, until 11:05 am, Dr. X. and Dr. W. waited until Ms. Cruz arrived in OR #3 and Dr. U. became available for the surgery. They had been given no specific instructions by the nurses or hospital supervisor. It was not until close to 11:05 am that Dr. U. emerged from the surgery with the breech patient and attended to Ms. Cruz again. At 10:40 a.m., the breech case delivered without complication. Also at 10:30 a.m., no more could be heard of the fetal heart rate on Ms. Cruz’s baby.The breech patient’s OB/GYN, Maria D., MD, was never informed that Dr. U. had an emergency case of his own and, even after the crash Cesarean for Ms. Cruz was called by Dr. U., Dr. D. was not contacted again to assist in any way. Dr. Z. and Dr. C. were never asked by anyone to operate on Ms. Cruz, or assist in any way. The OB/GYN physician scheduled by the hospital to be on-call in the ER for emergencies that morning, was never contacted.