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M. G., a minor v Kaiser

Dr. Fagel achieved a settlement of $4,150,000 on behalf of a child who now suffers from cerebral palsy and developmental delays due to a series of errors committed by physicians during the birth process. There were no problems in the pregnancy until Dec. 10, 1998, when the mother was admitted to the hospital with high blood pressure. She was then discharged after four days of bed rest and the fetal monitor showed fetal wellbeing. On December 16, the mother’s high blood pressure returned so she returned to the hospital and was seen by the on call obstetrician, OB 1. She decided to obtain fluid for a fetal lung maturity test, so male OB 2 attempted an amniocentesis through the placenta, but his needle tap only drew blood. Another OB, female OB 3, then performed another amniocentesis without an ultrasound, claiming she could “do this by feel.” OB 3 obtained blood tinged with fluid, which she sent for a lung maturity profile, the results of which showed that the fetal lungs were “mature with caution.” No other tests were performed, and another OB, male OB 4, assumed responsibility for the patient’s care. He was never aware of the bloody amniocentesis or the mother’s elevated blood pressure, so he discharged the mother with instructions to return in two days for a fetal Non-Stress Test (NST). At 9 a.m. on December 18, the mother returned and the NST showed a non-reactive tracing. She was transferred to the L&D unit and seen by OB 1. OB diagnosed severe pregnancy induced hypertension and decided to induce labor with Pitocin and Magnesium Sulfate. Similar to OB 4, OB 1 was not aware of the bloody amniocentesis. At 6 p.m. there was a shift change and the on call OB, a fourth-year resident, assumed responsibility for the patient, while the attending OB remained in the hospital. It was L&D unit policy that the attending OB would only respond if called by the resident, so the attending OB did not see the patient for 2 hours. By the time he visited the patient, the fetal monitor showed fetal distress with heart decelerations. After an amnioinfusion failed, the attending OB performed a C-section and the baby was delivered at 8:51 p.m., with critically low vital signs. Due to injuries sustained in the birth process, the plaintiff has cerebral palsy and developmental delays.

The defense contended that the baby was injured due to severe blood loss related to an umbilical cord tear just prior to delivery. The defense continued by claiming that the fetus was not likely injured before the decision was made for a C-section and that the baby was delivered within 30 minutes of the decision, which is within the standard of care. However, Dr. Fagel and his team of experienced attorneys argued that the plaintiff’s injuries were caused by blood loss from the amniocentesis and unnecessary delays in performing the C-section. Once the first amniocentesis drew blood, further tests should have been done to determine if the source was fetal (which they in fact were), which would have required an immediate C-section. In addition, the mother never should have been sent home with elevated blood pressure, and upon admission on December 18, the mother should not have been induced with Pitocin while the NST was non-reactive. The baby was healthy until the last hour before delivery, when the fetus went into shock from blood loss. A C-section should have occurred at least 45 minutes earlier, but really should have been performed two days earlier. All in all, a series of miscommunications between the obstetricians led to substandard care, prolonged delays in delivery and ultimately, the plaintiff’s neurologic injuries.