Articles Posted in Obstetrics

A West Philadelphia abortion clinic was closed after investigators accused Dr. Kermit B. Gosnell of killing babies born alive during late-term abortions and allowing untrained non-medical staff to medicate a patient who died after the procedure. The 69 year old doctor also worked for some years at a Delaware clinic and is alleged to have told women at that clinic who were too far along in their pregnancies to obtain an abortion under Delaware law (which has a 20 week or 5 month cut-off) to come to his Philadelphia office where he would charge them more money, but where abortions are legal up to 24 weeks (6 months) of pregnancy. Gosnell has been charged along with with 2 staff people of the Philadelphia clinic and all are currently incarcerated pending further criminal proceedings, which could include the risk of death penalty for Gosnell.

The charges include allegations that babies who Gosnell aborted lived for up to 20 minutes after the procedure, at which time Gosnell or a staff member would murder the babies. Further, it is alleged that Gosnell allowed the two charged staff members, who were not medically trained, to adminster anesthesthia and perform ultrasoundes. One staff person is reported to have created her own drug “cocktails” for patients and, in the case of the patient who died, altered medical records so that later treating physicians would not know how much of what drug she had been given. Finally, it is alled that one staff member who routinely treated patients had hepatitis, but did not take precautions, including wearing gloves, to protect patients from contracting the disease.

While Dr. Gosnell’s criminal charges are certainly a huge problem for him, it is likely that civil medical malpractice lawsuits will soon be filed by patients who treated at Gosnell’s Women’s Medical Society clinic in West Philadelpia. As a licensed pediatrician who spent years practicing in a neonatal intensive care unit for infants and attending hundreds of deliveries, Dr. Aussprung is in a particularly unique position to evaluate the claims of women who received treatment at the hands of Dr. Gosnell or his employees. Dr. Aussprung has been trained to deal with newborn complications, premature birth and fetal demise, which are all issues that will likely arise in any cases filed against Dr. Gosnell.

A Passaic County, New Jersey jury found for the plaintiff in a case involving an obstetrician’s failure to diagnose placental abruption (separation of the placenta from the uterus). Sigismondi v. Greene, PAS-L-3055-05 (N.J. Super. Ct. 2007). Plaintiff, a husband whose wife and newborn son died as a result of the doctor’s negligence, argued that the OB (Dr. Jennifer Greene) failed to perform tests to determine the cause of his wife’s abdominal pain complaints. Plaintiff further argued that given his wife’s history of a gallbladder surgery when she was 7 months pregnant, during which surgery her uterus was moved, required the OB to seriously evaluate his wife’s report of pain and pressure in her pelvis, as well as nausea and vomiting, just 3 weeks after surgery. Dr. Greene did order some tests over the phone, but did not order an ultrasound or blood tests.

Plaintiff’s wife died less than 24 hours after being sent home from the hospital after limited tests were run in response to her complaints. Plaintiff’s son was delivered by an emergency caesarian section not long after his mother collapsed from bleeding caused by the separation of the placenta from the uterus wall. Unfortunately, the ruptrue of the placenta caused deprivation of oxygen to the newborn, who suffered from seizures and was significantly brain damaged and survived after birth for a few days only because he was on life support systems. When the life support was removed, Plaintiff’s son died.

Dr. Greene argued that she ordered appropriate testing and that the Plaintiff’s wife had normal findings that suggested it was reasonable to discharge her to home, including stable fetal monitoring results and no evidence that amniotic fluid was leaking or that she was bleeding vaginally. Dr. Greene argued that the placenta had ruptured suddenly just before the Plaintiff’s wife collapsed, but an expert for Plaintiff testified that findings during the caesarian section were more consistent with a tear in the placenta occuring a day before she collapsed.

A 13 1/2 hour delay in the delivery of a baby girl who was stuck in the birth canal resulted in brain injuries from both the delay in delivery and from the mother’s uterus repeatedly contracting on the baby’s head because of medications given to the mother to encourage labor. Testimony during the 5 week trial demonstrated that the treating OB/GYN knew prior to delivery that the mother had a narrow pelvic arch and that the baby was approximately 9 pounds. Notwithstanding these two contradictory facts, the doctor allowed the mother to attempt a vaginal delivery when a cesarean section was indicated. The doctor not only attempted a vaginal birth, but then allowed it to continue for 13 1/2 hours, during which the mother was having contractions every 1-2 minutes for many hours.

Because the baby’s head was squeezed so many times during the long delivery by the frequent contractions, the now-10 year old suffered brain damage that resulted in permanent injuries. She has been diagnosed as spastic guadriplegic, which means she has only limited use of her arms and legs. She is limited to walking short distances and only with the use of a walker, she can ee but because the part of her brain that processes what she sees was damaged, she can’t interpret what she is seeing, she is mildly retarded and she has difficulty utilizing her hands.

After hearing all the testimony, the jury in this Ohio case awarded almost $8M for future medical care, over $7M for the inability to perform normal activities, and $3M for pain and suffering. Grow v. Yang, Hamilton County, Ohio.

Brandon, a 10 year old boy who suffers from cerebral palsy, severe brain damage and blindness as a result of an obstetrician delaying in the diagnosis of his mother’s pregnancy complications in 1997 was awarded $19M by a Monmouth County Jury after 2 days of deliberations. The jury heard evidence that Brandon’s mother, Bonnie, was 30 weeks pregnant when she began complaining of abdominal pain. Bonnie called her OB/GYN after the pain started and was instructed to go to Riverview Medical Center in Red Bank, where her OB/GYN concluded she was likely suffering from appendicitis. The OB/GYN requested that a general surgeon remove the appendix before the OB/GYN ran tests to determine the cause of her abdominal pain and despite readings on a fetal monitor attached to Bonnie that showed the baby was in distress.

More disturbing, the jury heard testimony that a nurse on duty at the time the appendix removal surgery was being planned and performed warned the OB/GYN that the monitoring strips showed a problem with the baby. Further, the nurse felt so strongly that the baby was in danger that when the doctor refused to listen to her concerns, she went to to her charge nurse and then to the hospital’s nursing supervisor seeking to have an emergency Cesarean section performed on Bonnie to save the baby. Instead of listening to the nurse, the OB/GYN and the general surgeon removed the appendix, only to find that it was normal, but Bonnie’s abdomen was filled with 3.5 liters of blood, which is half the amount of blood an average woman has in her entire body.

Ultimately, a c-section was performed to deliver Brandon more than one and a half hours after the appendix surgery began. At birth, Brandon had no muscle tone and required extensive medical intervention to live, including a four month hospitalization in the neonatal intensive care unit. An expert medical witness testified to the jury that if Brnadon had been delivered even half an hour sooner, he would have been medically normal. The OB/GYN continues to assert that his care was appropriate and that Bonnie’s complication was “incredibly rare” and is seeking a new trial and possibly an appeal.

A full term preganancy was not properly monitored by an obstretrics resident during an induction of labor causing the infant to suffer a hypoxic brain injury resulting in cerebral palsy and spastic quadriplegia. The case against a resident physician and Evanston Hospital resulted in a $15 million settlement for the plaintiffs before the trial began. The child, now eight (8) years old, has severe disabilities as a result of oxygen deprivation during the labor and delivery. The child has seizures, impaired vision and severe global developmental delays.

This case is a classic example of obstetrical malpractice. An uneventful pregnancy and a routine induction of labor ended in catastrophe for the child. Abnormalities were noted on routine fetal monitoring during the night and the mother developed a fever. However, the resident failed to inform any attending obstetrician of these changes. The resident noted maternal fever, hyperstimulation of the fetus and an increase in the fetal heart rate. The fetal heart rate pattern progressed into one of variable decelerations with late recovery, which soon further progressed into a late deceleration pattern. This pattern of fetal heart monitoring is typical of significant fetal distress and an infant suffering hypoxia. Although some of these abnormalities were noted, the resident was inexperienced and failed to notify an attending obstretrician of these findings.

Shortly after birth, the child developed seizure activity, which is also a sign of a hypoxic brain injury. A CT scan demonstrated difuse bilateral brain injury. The child will undoubtedly suffer from severe and devastating disabilities for the remainer of his life.

The Food and Drug Administration (FDA) has issued a warning concerning the use of Codeine, Morphine and related pain and cough medications in nursing woman because of concerns of injury to their infants. This new warning was prompted by the death of an infant in 2006 from an overdose of narcotic (from maternal Codeine) that the infant received through the mother’s breast milk. It is now well-described that some mothers have a genetic mutation that affects the way their bodies metabolize codeine and related narcotics. These mother’s will change Codeine and related drugs into Morphine at an abnormally rapid rate and then the Morphine is secreted into their breast milk. The infant’s then swallow the Morphine filled breast milk resulting in an overdose to the infant that can cause death.

The symptoms of a narcotic (Morphine) overdose in infants and children can include: difficulty breathing, excessive sleepiness, difficulty feeding, constipation and limpness. Mothers with this genetic variation causing the abnormally high levels of Morphine may experience: confusion, constipation, sleepiness and shallow breathing. The risk of having the genetic mutation that affects narcotic metabolism varies based on the race of the mother. It is thought that 16% to 28% of North Africans, Saudis and Ethiopians have the defect, whereas 3% of African Americans are affected, 1% to 10% of Causcasians have the mutation, but only about 1% of Hispanics, Chinese and Japanese are affected.

Although this genetic variation is not common, it does involve a significant number of nursing mothers. This concern has been most commonly raised with the use of Codeine, because this drug is the most commonly prescribed narcotic pain medicine after child birth. Codeine is also commonly used for severe cough. It must be noted that this genetic variation will also change the way these mother’s metabolize any narcotic medication, which places their nursing infants at significant risk. If you have ever had any troubles with anesthesia or pain medication use, you should speak to your physician before taking such medications and nursing your child.

A Boston jury recently awarded $26.5 million to a 10 year old child who was injured at birth because of two doctors’ failure to recognize fetal distress during labor and their delay in carrying out an emergency ceasarean section. Jose Bejarano, Jr. is a severly handicapped child with devastating cerebral palsy and mental retardation. He requires a feeding tube and around-the-clock nursing care for the remainder of his life. Although the child cannot talk, the family insists that he is able to express pain and happiness through his eyes. The award will assist the family in providing all the medical and nursing care that this unfortunate child will require. This verdict is thought to be one of the largest in Massachusetts history and is the biggest verdict in 2007.

The verdict for the Bejarano family was against two obstetrical physicians (OB/GYN) who provided care at Brigham and Women’s Hospital, which is affiliated with Harvard Medical School. Although the negligent care was provided over 10 years ago, because Jose Bejarano was a minor, his statute of limitations (the length of time during which he is permitted to file a lawsuit) extends until his 20th birthday. This is identical to the law in Pennsylvania, which permits minors to bring a lawsuit for their injuries until they reach their 20th birthday (until they become an adult at age 18 and then 2 additional years).

Verdicts of this size are unusual even in medical negligence cases involving horribly injured individuals. Two factors are the predominant determinents of a verdict’s size. First, the amount of money that will be needed to provide proper medical and nursing care to the injured person for the remainder of their life is the single most imprtant factor to the size of a verdict. Children who have long life-spans left ahead of them and have high yearly costs for feeding tubes and nursing care, such as in this case, have very large economic damages. These damages are quantifiable and are presented to the jury. I have been involved in cases where the future medical expenses for a child have been estimated in excess of $40 million dollars. The second factor having the greatest impact on a verdict is the length and amount of pain and suffering that an injured person endures. When there is horrible suffering for long periods of time, juries are more likely to award very significant non-economic damages. This case demonstrates how economic and non-economic damages can combine to sometimes create extremely large jury awards. However, the overwhelming majority of awards and settlements are considerably smaller then in this case. Additionally, this family will likely get only a very small portion of the $26.6 million award because there is likely not enough insurance coverage to pay this large verdict. Getting the verdict is only one issue in the battle to actually get paid the money.