Articles Posted in Cerebral Palsy

Two weeks after Baby Doe’s premature birth, she developed signs of jaundice. Seven hours later, a check of her bilirubin revealed a severely elevated level of 29. The attending doctor ordered retesting of the bilirubin level but did not order any treatment.

Hours later, when a second bilirubin test showed a level of 27.1, the same doctor was notified by nurses of the out-of-balance level. By the next morning, the child’s bilirubin level increased to 32.1. Another physician began treating Baby Doe the next morning and ordered phototherapy, which began more than 17 hours after Baby Doe’s first bilirubin test was reported to the first doctor. Phototherapy is the usual treatment for jaundiced newborns.

Baby Doe suffered kernicterus resulting from severe jaundice. Kernicterus is a kind of brain damage caused by excessive jaundice, just as Baby Doe had endured. Baby Doe is now 10 years old. She suffers from cerebral palsy and cannot speak or walk. The Doe family sued the health system that employed the doctors involved alleging that they chose not to timely test Baby Doe’s bilirubin level at the first signs of jaundice and chose not to timely treat the jaundice. That failure caused the child’s permanent and severe injuries.
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Illinois is not one of the many states that have enacted non-economic damage caps on medical malpractice lawsuits. However, Illinois lawmakers have three times voted to enact such laws; each was found unconstitutional for a variety of reasons.

According to a paper completed by Rutgers Law School Professor Sabrina Safrin, caps on non-economic damages in medical malpractice cases have no effect on a procedure that’s among the most commonly undertaken in operating rooms across the United States: cesarean sections. “C-sections are arguably the poster child for so-called-defensive medicine,” the professor wrote in her paper.

C-sections involve cutting through a mother’s abdomen and uterine wall to remove the fetus. In many cesarean delivery cases, the fetus may have been observed to be in distress. By delivering an emergency C-section child, the purpose is preventing brain damage, cerebral palsy and other life-altering birth injuries.
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During the delivery of the newborn in this case, the fetal monitor of the fetus indicated non-reassuring signs over the course of several hours, including heart rate abnormalities. In this summary of the case, the baby is Baby Doe. This was a confidential settlement in which the parties were identified as Doe, being the mother of the newborn, Baby Doe and Roe, being the physician, the obstetrician and hospital that were sued.

The mother of Baby Doe experienced uterine tachysystole. Uterine tachysystole is defined as six contractions in a ten-minute period.There have been many studies as to whether more than six contractions over a ten-minute period within the first four hours of labor induction is associated with adverse infant outcomes. However, six more contractions in ten minutes were significantly associated with fetal heart rate decelerations.

A nurse at the Roe hospital notified the treating obstetrician who allegedly reviewed the monitor strips but did not re-examine Baby Doe’s mother.Baby Doe was born in a depressed condition with Apgar scores of 3 at one minute and 6 at five minutes.
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Rebecca Kerrins, the mother of now 5-year-old Drew Kerrins, sued Palos Community Hospital, Dr. Thomas Myers and Renaissance Medical Group alleging that Dr. Myers chose not to make himself available to take care of Drew’s emergency soon after the baby was delivered.

After a bench trial, a Cook County judge entered a judgment for more than $23 million to the family of Drew Kerrins because of the delay in providing a blood transfusion, which led to the child’s development of cerebral palsy and other cognitive injuries.

Rebecca Kerrins was admitted to Palos Community Hospital to deliver her baby in June 2011. Unfortunately, her placenta separated from her uterine wall at the time of delivery, which caused the baby to lose as much as half of her blood by the time she was delivered.
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At the moment of birth, the most objective method of assessing a newborn’s metabolic condition is by analyzing umbilical cord blood gas. To be specific, arterial cord pH and base deficit can determine perinatal hypoxia and be an insight into causes of fetal distress.

Umbilical cord blood gases are most likely interpreted in situations of high risk pregnancies when there are abnormal fetal heart rate patterns, when there is an intrapartum fever, emergent C-section for a fetal compromised, low Apgar scores (less than 3) or when there are multiple fetal births.

There are three most common causes of neonates hypoxia or asphyxia, which are when the mother is oxygen compromised, when there is preeclampsia, chronic hypertension, hypotension, hypovolemia or cyanotic heart disease. Another type of condition that causes hypoxia or asphyxia is when the oxygen flow from the placenta to the fetus is obstructed or impaired. This could be caused by a placental abruption, a cord prolapse, or repetitive cord blockage.
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The birth injury to a newborn is perhaps the most heartbreaking injuries that human beings face. The birth of a newborn child is a remarkable event by itself. It comes with the promise of a long and healthy life. However, when an obstetrician, nurse midwife or labor and delivery nurse are negligent, this can cause a birth injury, brain damage or birth trauma. The results are devastating to the baby as well as to the parents and siblings.

In particular, the birth injury to a newborn child who has been injured permanently by the negligence of a labor and delivery team has long-term effects on the mother. In fact, too often mothers are injured during child birth; this may well play a role in their ability to bear more children.

The physical effects on a mother who gives birth to a newborn child coupled with a traumatic labor and delivery injury are easily recognized. The mother may suffer from uterine bleeding, bone fractures and bruising, a uterine rupture that may have been caused by an error in the Cesarean delivery, fissures, infection, pre-eclampsia or eclampsia, uterine hyper-stimulation, vaginal tears or even the wrongful death of the mother. Maternal deaths are much more common than one would expect.
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According to the World Health Organization (WHO), the United States maternal mortality ratio has increased between 1990 and 2013 by 136%. Between 2003 and 2013, there were 7,210 maternal deaths in the U.S., according to the Center for Disease Control’s (CDC) database. The rise in maternal deaths is stunning compared to the rest of the world where the maternal mortality rates have decreased by 45% between 1990 and 2013. Compared to other developed regions of the world, the U.S. is lagging far behind in this area. In developed regions of the world, the maternal mortality ratio was down 38%.

Furthermore, neonatal deaths between 2003 and 2013 numbered 277,886 in the U.S. That number of neonatal deaths compared to Sweden, Iceland and the United Kingdom was significantly higher. The birth trauma injuries for neonates for the year 2004, for example, were 1.1-7.5/1,000 births.

Also alarming is the fact that in the U.S., the likelihood of maternal death in high-poverty areas of the country are twice as high as other areas. The maternal mortality rates per 100,000 live births by race or ethnicity was highest among non-Hispanic black women. The next highest, which was less than half, were of American Indians/Alaska native Americans. In short, African-American women are three times more likely to die from pregnancy-related causes than white women.

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This was a birth injury case in which the jurors were asked to award up to $7.5 million for a life care plan for the baby girl, Jill Todd, as well as $1.4 million in lost wages and an unspecified amount of damages for pain and suffering. The issue in this case was whether the University of Iowa’s Health Center physicians and staff provided proper care to Jill Todd in November 2010.  After two days of deliberation, the jury returned a 9-1 verdict finding that the University of Iowa Health Center was negligent but that negligence wasn’t “a cause of damage” to the child. This was an odd verdict or at least one that most would consider inconsistent.

Investigators confirmed that they were looking into an unusual claim of jury tampering in this medical malpractice, birth injury case involving the University of Iowa Hospitals and Clinics. As a result of the jury’s unusual verdict, the University of Iowa Hospitals and Clinics paid nothing for the injured child.

After a 3-week trial, the jury found that the hospital was negligent in caring for a mother who suffered complications before giving birth in 2010. But the jurors found that negligence was not a cause of damage to the child. The baby suffered brain damage and is severely disabled. The jury awarded no compensation to the family.

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In a recent report it was stated that cerebral palsy affects nearly 10,000 newborns every year. The statistics are more troubling in that research shows that 25-35% of all cerebral palsy cases could have been prevented. It has been reported that medical errors during or after the delivery of a child was the cause of cerebral palsy in 35-45% of deliveries.

The diagnosis of cerebral palsy occurs usually by 18 months of age. One in 323 children has been identified with cerebral palsy. The malady is more common in boys than in girls. In addition, cerebral palsy is found more often in children of African-American descent than in Caucasian, Asian or Hispanic children.

The medical costs of caring for and treating a child with cerebral palsy are enormous. According to the study, the lifetime cost of care for an individual with cerebral palsy is almost $1 million.

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When an infant is tragically injured during childbirth by the negligence of an obstetrician, nurse wife or nurse, the defense, with few exceptions, relies on medical publications. Most of these publications come from the American College of Obstetricians and Gynecologists (ACOG). On the other hand, a plaintiff’s neuroradiology expert would be called to testify about the baby’s time of injury. ACOG has taken most birth trauma injury cases as having occurred in the prenatal stages of childbirth. In other words, during labor and delivery the HIE injury (hypoxic ischemic encephalopathy), which is the basis for the lawsuit, didn’t occur during labor and delivery, but instead occurred as a matter of course during the time prenatally. That’s the standard defense.

ACOG published in January 2003 a document that created strict criteria for establishing the existence of intrapartum HIE. Applying this stringent criteria, ACOG defenders argued that the injury to the baby occurred not during labor and delivery but prenatally. The claim that the baby was asphyxiated intrapartum, that is during labor and delivery, could not have happened because the strict criteria were not met.

The published paper by ACOG took the position that 4-10% of moderate to severe neonatal encephalopathy occurred as a result of hypoxia in the intrapartum period.

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