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By Damian D. Capozzola, Esq.
Law Offices of Damian D. Capozzola
Jamie Terrence, RN
President and Founder, Healthcare Risk Services
Former Director of Risk Management Services (2004-2013)
California Hospital Medical Center
Angelina Gratiano, Esq.
News: A mother gave birth to a premature child with multiple physical and cognitive impairments after physicians failed to timely admit the mother to the hospital and subsequently failed to administer treatment that would have prevented brain damage and respiratory distress. The mother alleged that the physicians failed to realize that the woman was in labor at 25 weeks gestation. As a result, the hospital physicians failed to take the necessary steps to protect the child from physical and cognitive impairments. Ultimately, the jury awarded a verdict of $42. 9 million for the parents. The hospital and treating obstetricians were held jointly and severally liable for the child’s permanent injuries.
Background: A pregnant woman in her late 20s attended a regularly scheduled prenatal examination at a local hospital for ultrasound examinations and monitoring of her pregnancy. This was not the woman’s first pregnancy, and she had experienced a pre-term pregnancy before. During her initial visit with the first evaluating obstetrician, the mother was given a gestational age approximation of 11 weeks. The obstetrician recommended that the woman receive steroid injections, specifically progesterone, starting at week 16 to week 36 of the pregnancy. Additionally, the doctor recommended that the woman’s baseline cervix length be measured at week 14 and at week 17 if the cervix length was unusually short.
At the next evaluation by the obstetrician, the woman’s cervix was growing at a normal rate and was measured at 4.84 cm long. Unfortunately, six weeks later the cervix had decreased to 2.4 cm. Based on the decreasing length of the woman’s cervix, the obstetrician recommended a cerclage to sew together the woman’s cervix during the remainder of the gestation period to prevent another pre-term pregnancy. A cerclage was performed for the woman shortly thereafter without any problems or complications.
At about four months gestation, the mother returned to the hospital complaining of pelvic pressure. After examination by a doctor, it was discovered that the woman’s cervix measured only 1.13 cm in length and additionally physiological changes, namely funneling, were noted. A subsequent ultrasound revealed the presence of excessive accumulation of amniotic fluid within the woman’s amniotic sac. These facts were critical in light of the fact that the mother had previously experienced a pre-term pregnancy and delivery at 26 weeks gestation. The excessive amniotic fluid resulted in uterine distention, leaving the woman at a high risk for premature delivery.
After their examination, the doctors ultimately decided not to provide the woman with any specific instructions regarding bed rest or pelvic rest to ease the pressure in her pelvis. Most notably, however, the doctors also failed to provide steroid treatment for the mother.
On July 2, 2007, in the 25th week of her pregnancy, the woman was admitted to the local hospital and placed on a fetal heart monitor after experiencing frequent severe abdominal pain. However, after three and one-half hours of monitoring, the woman was discharged from the hospital, once again without any special instructions or any course of treatment. Two days later, the woman was admitted to the hospital again after experiencing severe abdominal pain and contractions every 10 minutes. Shortly thereafter, the doctors made the decision to perform an emergency cesarean section.
Although the infant survived the emergency cesarean section, the child was born with many complications. At only 1 pound, 13 ounces, the infant suffered from respiratory distress syndrome, a brain hemorrhage, hearing problems, developmental delay, and gastrointestinal reflux. Over the following two years, the young child required multiple surgeries, various shunt procedures, and insertion of a gastronomy tube (G-tube). To this day, the child requires nutritional care, occupational therapy, physical therapy, and sensory therapy.
The child’s mother and father filed suit against the hospital, the obstetrics department of the hospital, the obstetrician responsible for the patient’s care, and two other treating physicians. Noting the permanent injuries suffered by the child, the parents alleged joint and several liability against all defendants based on medical negligence. Most notably, the parents alleged that the hospital and treating physicians failed to abide by the required standard of care and course of treatment for a mother who presented pre-term pregnancy symptoms. The jury awarded $42. 9 million in damages after finding the hospital and treating obstetricians liable for medical negligence.
What this means to you: While no case is exactly the same and neither is each patient, it is still extremely important for hospitals to establish protocols for evaluating patient symptoms and diagnoses. In this case, the mother presented with a history of a pre-term pregnancy. Based on this history, the evaluating obstetricians at each point of the woman’s second pregnancy should have been on high alert for additional symptoms that could further endanger the woman and her unborn child. This is why organizations such as the American College of Obstetricians and Gynecologists (ACOG) publish standards of care that hospitals and physicians should adhere to.
In this case, the professional standard of care was established by ACOG. It is an established standard of care that a course of steroids is to be administered to a woman who is admitted for early labor or who is at a high-risk pregnancy at 24-34 weeks gestation. It appears that the obstetricians who evaluated the woman were required to ask themselves two questions: one, was the woman in labor and if not, two, is this a high-risk pregnancy at 24-34 weeks gestation? Here, each obstetrician who evaluated the woman after 24 weeks gestation correctly realized that the woman was not in labor. However, the obstetricians failed to consider the next important question in determining how to treat the patient. Consequently, each obstetrician failed to recommend or provide steroid treatment to the woman despite her being within the 24-34 week gestation window during multiple hospital visits.
Had the woman been prescribed steroids by one of the evaluating obstetricians, this prescription would have helped prevent the pre-term labor and possibly could have prevented the permanent injuries suffered by the child. By failing to consider both critical questions, the obstetricians and the hospital fell below the established standard of care and were liable for negligence. This case vividly illustrates how crucial it is for medical professionals to be well aware of the required standards of care in light of their individual specialties.
Another important aspect of this case to highlight is the significant damages awarded and what drove the particularly large jury verdict award. Cases involving catastrophic problems to children lend themselves to extremely high damage computations. The cost of future healthcare comprises a large portion of the economic damages in medical malpractice cases. To estimate the total cost of these damages, attorneys must create a life care plan: a detailed evaluation of the anticipated type of care the plaintiff will need in the future, what quality of care the plaintiff will need, how long the care will need to be provided, and what the estimated cost of this care will be.
These life care plans often are prepared by certified life care planners who create the life care plan estimates and then determine the amounts discounted to present value. Extensive documentation and research is required to prepare these plans, including evaluations of alternative options for care and options for future independent living in light of the plaintiff’s injuries. In some applicable cases involving children, estimations of how much it would cost to provide education in light of necessary physical accommodations are calculated. Also, the life care planner typically discounts the plaintiff’s award to present value, which is the value of the funds paid to the plaintiff today which, if invested, would generate returns in an amount equivalent to the total future compensation required by the life care plan.