On September 25, 2014, the Court of Special Appeals of Maryland (“CSA”), in an unreported opinion, upheld a Maryland medical malpractice judgment in the amount of $20,605,000 against the defendant hospital and defendant obstetrician.
The jury had returned its verdict in the amount of $21,000,000 ($18,000,000 for future medical expenses, $2,000,000 for future lost wages, and $1,000,000 in noneconomic damages, which the trial judge reduced to $605,000 after applying Maryland’s cap on noneconomic damages in effect at the time) in favor of a now nine-year-old boy who was born at the defendant hospital and delivered by the defendant obstetrician, and allegedly suffered severe and permanent neurological injuries during labor and delivery as a result of medical negligence.
The defendants argued in their appeal that there was legally insufficient evidence at trial to prove that the newborn suffered his injury during delivery and that the trial judge should not have permitted the plaintiff to introduce evidence regarding informed consent – they did not, however, challenge the amount of the verdict as excessive.
The CSA determined in its 74-page unreported opinion that there was legally sufficient evidence presented to the jury that the plaintiff had been injured during delivery and that the alleged injuries were the cause of his neurological and physical conditions. The CSA also held that the defendants had failed to preserve for appellate review the trial court’s alleged errors with regard to an informed consent issue.
The Underlying Facts
A pregnant woman went to the defendant hospital in early September 2002, which was two months before her due date, where she was diagnosed with preeclampsia and the potential to develop HELLP syndrome. A physician determined that the baby could be delivered vaginally with a trial of labor but if either the mom-to-be or the baby-to-be became distressed, delivery would be accomplished by Cesarean section. The pregnant woman signed an informed consent, agreeing to a Cesarean section delivery, if it became necessary.
The woman was later given Pitocin to induce labor, as well as other medications, and the fetus was externally monitored. Later, a physician ruptured the woman’s membrane to speed up the labor and delivery process. Fetal monitoring was switched from external to internal monitoring. When the fetal monitoring strips indicated some degree of possible fetal distress later that afternoon, the Pitocin was stopped and the woman was instructed to lie on her side. Later, the Pitocin was re-started at a lower dose, after which the woman delivered vaginally.
The baby was born with a nuchal cord (the umbilical cord was wrapped tightly around his neck) that had to be clamped and cut to remove it from around the baby’s neck. The baby weighed 3 pounds, 12 ounces at birth and was pale, limp, had poor muscle tone, and his heart rate was less than 100, requiring resuscitation and transfer to the NICU.
An umbilical cord gas analysis was reportedly within normal range. A blood gas analysis from blood taken directly from the baby shortly after birth was abnormal but subsequently improved. However, the baby was later diagnosed with periventricular leukomalacia (“PVL”) – death of white matter in the brain due to softening of the brain tissue – which is caused by the lack of oxygen or blood flow to the area. The child developed spastic diplegia, which is a form of cerebral palsy. He requires assistance with all activities of daily living, needs assistive devices to walk, has had surgical and other medical treatments related to his conditions, and will require same in the future.
The child’s parents filed a Maryland medical malpractice case on his behalf, alleging that the defendants negligently failed to deliver their child by Cesarean section when the fetal monitoring strips indicated that he was in distress. As a result, he suffered a nuchal cord that pulled taut as he proceeded down the birth canal, which led him to suffer hypoxia.
The defendants countered that the baby was not injured at birth based on the normal range of the umbilical cord blood gas analysis, an ultrasound nearly three days after birth that did not show signs of PVL, the Apgar scores that were reported as normal, and the fact that the baby’s organs did not show any injury that would be expected if the newborn had suffered an ischemic brain injury. They further argued that the baby developed PVL as a result of his prematurity and the magnesium that his mother received at the hospital to prevent seizures that may occur with preeclampsia.
After discussing at length the trial testimony of the parties’ expert witnesses, the CSA concluded that the baby’s injury was among the potential class of injuries foreseeable as a result of a health care provider’s failing to respond to severe non-reassuring fetal heart tracing data and a potential nuchal cord, and that the plaintiff presented legally sufficient evidence that the defendants’ breach of duty was the proximate cause of the plaintiff’s injury (proof of proximate cause does not require evidence that the precise mechanism of injury was foreseeable but rather that the injury suffered is within the general harm or zone of danger reasonably foreseeable as a result of the negligent act).
The CSA therefore affirmed the judgment entered in favor of the child in the Circuit Court for Baltimore City.
Harbor Hospital, et al., v. Jaylan Norfleet, a minor by and through his parents, Shantiah Moore-Norfleet and Joel Norfleet, Court of Special Appeals of Maryland, No. 1805 (unreported).
If you or a family member suffered injuries during labor or delivery that may be due to medical negligence in Maryland or in another U.S. state, you should promptly find a Maryland medical malpractice attorney or a medical malpractice attorney in your state who may investigate your birth injury claim for you and represent you in a medical malpractice case, if appropriate.
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