An Oregon hospital (as ranked by Consumer Reports) is being sued by 3 families whose children suffered very similar birth injuries and have been diagnosed with cerebral palsy. The hospital, Silverton Hospital, was one of the most penalized medical centers in Oregon, with federal penalties issued by the Centers for Medicare and Medicaid for high death rates and low patient satisfaction.
The 3 families have similar birth stories, and two of the injured babies were delivered by the same physician. One lawsuit has been made public. Elizabeth Ramseyer gave birth to her first son, Maverick, in 2007. The labor was prolonged, and the medical team gave her labor induction drugs (Pitocin or Cytotec) to speed up delivery of the 10 pound baby. The drugs did not help, and hours later, the physician finally decided to perform a C-section delivery.
When Maverick was delivered, he appeared limp and lifeless. His arms fell at his sides as the medical team picked him up. There was a delay in getting proper equipment to resuscitate the little boy, and when he finally was revived, brain damage had already occurred. At two years of age, Maverick was diagnosed with cerebral palsy. He has very little function of his right arm and leg, and he has speech problems and rage tantrums. Physicians say that Maverick will spend the rest of his life wearing leg braces and having surgeries.
Maverick’s parents are devastated because they feel that the brain damage could have been prevented if a C-section would have been performed hours earlier and if there had been proper resuscitation equipment at the bedside and staff available to help in the code situation. Indeed, the physician who performed the C-section stated that his duty was only to care for the mother.
THE IMPORTANCE OF C-SECTION DELIVERY AND PROPER CARE FOR THE MOTHER AND BABY
The events that occurred during this delivery are completely outside the standard of care. Firstly, if a hospital holds itself out as a labor and delivery unit, it must have the capacity to quickly and properly perform an emergency C-section if the baby is in distress. This means that there must be adequate staff to care for the mother and the baby. During a C-section it is the standard of care to have at least one physician caring for the mother, who is undergoing risky surgery, and one physician caring for the baby, who is not only going through the trauma of delivery, but who also is likely in distress, which is usually the reason an emergency C-section is performed. Even if the C-section is a non-emergent surgery, it is the standard of care to have 2 physicians involved in the procedure because there are two separate persons undergoing a procedure. If there is not a separate physician at the bedside to care for the baby, it is negligence.
It is crucial to properly monitor a mother and baby during delivery. One component of adequate monitoring is use of a fetal heart rate monitor that monitors the baby’s heart beat in response to contractions. When the heart tracings are abnormal or non-reassuring, it means the baby is in distress. The medical team must pay close attention to these tracings so they notice even subtle changes in the tracings. When the heart tones are non-reassuring, it means the baby is being deprived of oxygen. In most cases, this means that the baby must be delivered right away, and a C-section is usually the fastest and safest way to accomplish this. A baby should never be left in oxygen depriving conditions because this can cause permanent brain damage. Failing to notice non-reassuring heart tones or failing to quickly act when heart tracings are non-reassuring is negligence.
LABOR AND DELIVERY UNITS MUST HAVE PROPER STAFF AND EQUIPMENT AVAILABLE FOR RESUSCITATION OF A NEWBORN
It also is against the standard of care for a hospital to hold itself out as a labor and delivery unit and not have adequate staff and equipment available to resuscitate a baby at birth. In the womb, the baby receives her oxygen through the umbilical cord. At birth, the baby must switch to mouth breathing for all her oxygenation and ventilation. Sometimes a baby doesn’t breathe or the heart rate is too slow or not even beating at all. Often, a little stimulation is all a baby needs. But if this doesn’t work, the medical team must act quickly so that the baby’s brain is not deprived of oxygen for too long. Physicians can use equipment to “breathe” for the baby until the baby can adequately oxygenate and ventilate herself. Medications can be administered, if needed, to help establish a regular heart rate, and sometimes the tiny baby needs chest compression to not only try and get the heart on a regular rate and rhythm, but also to keep blood moving through the body. A delay in chest compressions can cause a delay in blood going to vital organs, such as the brain. In some instances, a defibrillator has to be used to achieve normal heart function. Resuscitation requires skill and timing, and there must always be a resuscitation expert immediately available for every delivery. Delayed or improper resuscitation can cause death or permanent brain damage in a baby.
PROLONGED LABOR AND DELAYED C-SECTION DELIVERY
When a baby is in distress and has to be delivered immediately, a prompt C-section is crucial if vaginal delivery cannot take place right away. But there are other instances in which a C-section is indicated and a vaginal delivery should not be attempted. In cases of placenta previa at delivery, malpositions of the baby (such as some types of breech), and cephalopelvic disproportion (CPD) a baby must be delivered by C-section.
It sounds as if Elizabeth had CPD, which is when the mother’s pelvis is too small to accompany the baby, thereby making it impossible for the baby to navigate the birth canal. Maverick was 10 pounds, which means he was likely macrosomic. Macrosomia means that a baby is very large for her gestational age, and macrosomia is a cause of CPD. One condition that can cause macrosomia is gestational diabetes.
C-section is often the best method of delivering a macrosomic baby, but if vaginal delivery is attempted, very close monitoring must occur because macrosomia increases the likelihood that the baby’s shoulder will get stuck on the mother’s pelvis during delivery (shoulder dystocia) as well as the likelihood of umbilical cord problems.
When CPD is present, a C-section delivery is mandatory. It is very dangerous when CPD is present and physicians keep attempting vaginal delivery. When physicians are reluctant to move on to a C-section delivery, they often use delivery assistance devices, such as forceps and vacuum extractors, which are risky for the baby because they can cause brain bleeds and skull fractures (fractures are more likely with forceps use). Prolonged labor and delivery in general is risky for a baby because it increases the likelihood that the baby will experience oxygen deprivation and fetal distress.
TIPS TO ENSURE A SAFE AND HEALTHY LABOR AND DELIVERY
Listed below are some questions expecting parents should ask their prospective physicians in order to help find a skilled physician and safe hospital.
1.) How many deliveries have you performed?
2.) Will you be continuously monitoring my baby’s heart rate when I go into labor?
3.) Are you skilled at interpreting fetal heart rate tracings?
4.) Will someone skilled in fetal heart rate interpretation be present at all times when I’m in labor?
5.) If my baby shows signs of distress and I cannot quickly deliver her, do you and the hospital have the capacity to quickly deliver my baby by emergency C-section? Will I be in or next to a room where a C-section can quickly be performed?
6.) Will there be a second physician immediately available so that if both my baby and I are in distress, there is one physician caring for me and one caring for my baby?
7.) Will you please thoroughly explain the risks and benefits of – and alternatives to – any medications (such as Pitocin / Cytotec to speed up labor) or delivery instruments you are going to use (such as forceps or vacuum extractors)? ** If a physician decides to utilize drugs or delivery instruments, it is crucial to ask the physician how much experience she has with using the drugs or forceps / vacuum extractors. C-section risks and benefits must also be thoroughly discussed.
HELP FOR CHILDREN WITH CEREBRAL PALSY
When physicians and hospitals fail to follow standards of care and have appropriate staff and equipment, a baby can be deprived of oxygen, which can cause neonatal encephalopathy (NE), hypoxic ischemic encephalopathy (HIE), cerebral palsy, periventricular leukomalacia (PVL), seizure disorders, intellectual disabilities and developmental delays.
Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been helping and advocating for children for over two decades. Jesse Reiter, the president and co-founder of the firm, has been focusing solely on birth injury cases for over 25 years. He is currently recognized as one of the best medical malpractice attorneys in America by U.S. News and World Report 2014, which also recognized ABC Law Centers as one of the best law firms in the nation. The attorneys at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).
If your child was diagnosed with a permanent disability, such as cerebral palsy, HIE, PVL, intellectual disabilities or developmental delays, the award winning attorneys at ABC Law Centers can help. We have helped children throughout the country obtain compensation for lifelong treatment, therapy and a secure future, and we give personal attention to each child and family we represent. Our nationally recognized firm has numerous multi-million dollar verdicts and settlements that attest to our success and no fees are ever paid to our firm until we win your case. Email or call Reiter & Walsh ABC Law Centers at 888-419-2229 for a free case evaluation.