The Superior Court of New Jersey Appellate Division (“Appellate Court”) affirmed the dismissal of a New Jersey birth injury medical malpractice case in an unpublished opinion on July 14, 2017 because the plaintiffs did not produce any expert report to articulate the standard of care applicable to their direct claims against the defendant hospital alleging that the hospital breached its duty to select only competent physicians to appoint to its medical staff and to sufficiently oversee the physician’s care within the walls of its facility, and the trial court did not err in granting summary judgment to the defendant nurses based upon its determination that the plaintiffs failed to establish proximate causation.
The Alleged Underlying Facts
The New Jersey medical malpractice plaintiffs (husband and wife) alleged in their birth injury medical malpractice lawsuit that the defendants were negligent during the wife’s labor and the delivery of the plaintiffs’ baby, causing extensive, permanent neurological injuries to their child.
On September 7, 2009 at approximately 8:30 a.m., the wife was admitted to the defendant hospital at which time one of the defendant physicians and one of the defendant nurses were assigned as the attending physician and nurse for the labor and delivery. The defendant nurses assessed the wife and baby in approximately 30-minute intervals throughout the entire day, including checking the wife’s blood pressure and the baby’s fetal heart rate (“FHR”), including any variability, accelerations or decelerations. One of the defendant physicians personally assessed the wife and baby approximately every two hours or as needed.
The wife was given morphine and an epidural over the next six hours, and her membranes were artificially ruptured. Variable decelerations in the baby’s FHR were consistently noted beginning at 11:30 p.m.
At 2:40 p.m., the defendant OB gave orders to begin inducing labor by administering Pitocin, with a beginning flow rate of one milliunit per minute (mu/min). Before Pitocin was administered, preeclampsia labs were drawn. The urinalysis revealed protein in the wife’s urine, which is a sign of pregnancy induced hypertension and/or preeclampsia. The defendant OB then ordered that magnesium sulfate be administered.
At 3:00 p.m., one of the defendant nurses began administering Pitocin at the rate ordered by the defendant OB, which was increased to two mu/min at 5:30 p.m., and then, per the defendant OB’s order, to four mu/min. at 6:00 p.m.
At 6:10 p.m., the FHR decelerated to seventy-five, which constituted fetal bradycardia. Pitocin was turned off four minutes later at 6:14 p.m. due to the persistent late decelerations.
At 6:30 p.m., a severe bradycardia episode occurred and the defendant OB determined that an emergency cesarean section (“C-section”) was necessary. The wife was rushed to the operating room. At the time the baby was delivered at 6:43 p.m., she was described as lifeless, limp, apneic, and pale with no heart rate. Apgar scores were 0, 0 and 3 at one, five and ten minutes after birth, respectively. The diagnosis was severe asphyxia.
The New Jersey medical malpractice lawsuit alleged that the defendant hospital was negligent in credentialing and retaining the defendant OB, and that the defendant nurses were negligent in treating both the wife and the baby.
Because the plaintiffs did not produce any expert report to articulate the standard of care applicable to their direct claims against the defendant hospital, the trial court granted the hospital’s motion for summary judgment. The Appellate Court affirmed the trial court, finding that expert testimony was necessary to support the plaintiffs’ claims, and because the plaintiffs could not sustain their burden of establishing both a duty and the breach of that duty, the defendant hospital was entitled to judgment as a matter of law.
The Appellate Court also affirmed the trial court granting summary judgment to the defendant nurses because the plaintiffs had failed to present an admissible expert opinion on causation: their physician expert had not rendered such an opinion, and their nurse practitioner expert could not establish medical causation (the nurse practitioner’s opinion that the defendant nurses’ actions increased the risk of harm to the baby was a medical diagnosis she was not qualified to make).
The Appellate Court stated that it is undisputed that the causation issue in this case requires sufficient knowledge, training and experience to determine the cause of a complex neurological injury in the context of labor and delivery. The Appellate Court held: “Given the complexity of the medical causation in this case and the limits upon [the nurse practitioner’s] scope of expertise, we cannot conclude the trial court abused its discretion in concluding she was not qualified to render the requisite opinion on causation. ”
Source Hunt v. Virtua Health, Inc., A-4196-14T1
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