Medical Malpractice Case Report: $5 million settlement for failure to properly monitor maternal and fetal status

Reached a $5 million medical malpractice settlement in a case involving a failure to properly monitor maternal and fetal status resulting in catastrophic injuries.  Read the following Minnesota Case Report from the Minnesota Association of Justice (MAJ) Minnesota Case Report:

Selected Results*  

(Excerpts taken with permission from Minnesota Association for Justice (MAJ) “Minnesota Case Reports”)

This is a medical malpractice case concerning a baby born with catastrophic injuries following her mother’s uterine rupture. In June 2003, plaintiff patient was pregnant, having delivered two previous children by cesarean section. One week before her scheduled repeat cesarean section, she was admitted to hospital’s family practice service at about 9:30 p.m. with painful contractions about 3 minutes apart but with only 1 cm cervical dilation. The OB service was consulted and planned to monitor cervical dilation, and proceed to cesarean section if mother’s cervix dilated, confirming active labor.

She was monitored intermittently by external fetal monitoring throughout that evening and into the early morning hours of the next day. Her contractions continued, she continued to complain of pain, and repeatedly requested a cesarean section. After she complained of pain at “10+” despite pain medication, nursing staff paged the family practice physician at about 2:30 a.m. Family practice examined mother and then called OB. By about 3:00 a.m., the nurses were having difficulty monitoring the baby and mother was complaining of unbearable pain. An emergency cesarean section delivery was begun at about 3:15 a.m. The baby was found floating freely in her mother’s abdominal cavity as the result of a ruptured uterus at 3:18 a.m.

Plaintiff retained a maternal fetal medicine expert who opined that once it became clear that mother had persistent uterine activity and pain, the decision to allow labor to continue was a departure from accepted standards of practice. A spontaneous uterine rupture can be life-threatening to both mother and baby and is an is an obstetric emergency. Pain is a diagnostic sign of uterine rupture. Plaintiff’s expert opined that mother’s pain was out of proportion with her contractions and required further assessment and moving to a cesarean section. A non-reassuring fetal heart rate pattern with decelerations or bradycardia is another sign of uterine rupture.

Although the initial monitoring strips show a healthy fetus, plaintiff’s expert opined that the fetal monitor strip from 02:15 until the time of the delivery was not reassuring and demonstrated both decelerations and fetal bradycardia. Plaintiff’s expert opined that the uterine rupture occurred at or around 02:35, and it was below accepted standards of practice not to perform a cesarean before 03:18. If delivery would have been accomplished by about 02:49, it is more probable than not that baby would not have suffered the significant asphyxial injury that led to her permanent neurological disability.

Plaintiff also retained an expert perinatal clinical nurse specialist to review the nursing care. This expert opined that the nursing care fell below accepted standards of practice. This high risk pregnancy required that nursing staff leave the external fetal monitor on mother to fully evaluate and assess her contractions and the fetal heart rate. Further, when mother requested a second shot of Vistaril at 01:30 a.m., nursing staff were required to notify the physicians of mother’s pain. If the physicians did not respond, then nursing staff should have instituted the chain of command per the hospital policy. Mother’s pain was out of proportion to her stage of labor. The nurses failed to recognize signs of uterine rupture, and failed to appropriately monitor and communicate information to the health care providers to allow them to reassess mother in a timely manner.

Plaintiff also retained a pediatric neurology expert to testify regarding causation and damages. This expert opined that baby sustained a hypoxic-ischemic brain injury at or around the time of birth, and that baby’s injury will affect her for life. Minor will require assistance in all activities of daily living and will not live independently. With good medical care and treatment, minor could live into her adult years. Had minor not suffered a hypoxic-ischemic brain injury, her neurological condition would likely be normal.

Plaintiff also retained a pediatrics expert to testify regarding damages. This expert opined that minor suffered a severe and permanent neurological injury resulting in life-long disabilities, and requiring significant life-long medical and physical care. Minor will never independently walk, never be able to support herself, and never be independent in her activities of daily living. She will continue to require 24-hour care, life-long therapies, interventions, and other assistance. With appropriate care, it is more likely than not that minor will live well into her adult years. Plaintiff also retained a Life Care Planner and an economist to calculate minor’s loss of earning capacity and to reduce to present value the future costs set forth in plaintiff’s Life Care Plan.

The case was vigorously defended on liability, causation and damages.  Defendants obtained supportive opinions from multiple well-respected physicians, including a local board certified OB/GYN, a maternal fetal medicine specialist, a pediatrician, a life care planner, and an economist.  Defendants’ liability experts all opine that defendants’ care comported with accepted standards of medical practice, and that any alleged departures from accepted standards of medical practice were not causally related to minor’s injury. 

Specifically, defendants’ maternal fetal medicine expert opined that it was within the standard of care to wait for evidence of active labor, demonstrated by cervical dilation, before proceeding to cesarean section.  This expert also opined that it was not until the fetal monitor tracing became non-reassuring at about 2:40-50 a.m. and mother had bleeding suggesting uterine rupture that there would be consensus among physicians that a cesarean section should be performed.  This was the time at which the defendant OB/GYN called for a stat cesarean section, and the delivery was then accomplished within an acceptable time.  Defendants’ local OB/GYN opined that the treatment plan, as well as the communications between physicians, met the standard of care.  

Defendants’ pediatrics expert conducted a defense medical exam in conjunction with Defendants’ Life Care Planner.  Defendants’ expert pediatrician opined that minor’s life expectancy was less than 7 to 10 years, citing tracheostomy dependence, significant difficulties clearing secretions, recurrent aspiration, and dependence on gastrostomy tube feeding.  The expected costs of future care per Defendants’ Life Care Plan were a fraction of  those Plaintiff suggested, in part due to their very limited life expectancy.  

Past medical expenses totaled over one million dollars.  Plaintiff’s estimate of future care costs reduced to present value were in the millions of dollars.  Minor’s loss of future earning capacity, including fringe benefits, was projected to be just over one million dollars assuming a normal life expectancy.  Defendants’ economist challenged Plaintiff’s assessment as to of loss of earning capacity, and offered a figure under $300,000 for the same life expectancy.  Defendants’ economist further reduced damages through a restrictive present value calculation as to future medical expenses.

The parties participated in two rounds of mediation.  The case settled following the second mediation and prior to trial.  A portion of  the settlement was used to purchase an annuity that will yield in excess of $18,000,000 should minor live a normal life expectancy.  A substantial portion of the recovery was placed in a Supplemental Needs Trust.