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L.T., a minor v Kaiser

Dr. Fagel obtained a settlement of $2,780,000 on the behalf of a child who sustained severe brain damage after hospital staff failed to diagnose a placental abruption and perform a timely Cesarean Section. There were no problems in the pregnancy until, at 38 weeks gestation, the mother experienced a sudden onset of vaginal bleeding. She was admitted to the labor and delivery unit at 6 p.m., where doctors confirmed mild vaginal bleeding with irregular contractions. At a 9 p.m. shift change, the mother was placed in the care of a recent OB residency graduate. A regular Kaiser OB was on call until 2 a.m. At 10 a.m., the fetal heart rate dropped below 100 for several minutes but returned to normal when the mother was turned on her side. Oxygen and IV fluids were also started and the in house anesthesiologist saw the patient for a pre-operative evaluation for a possible C-section. However, the OB decided against a C-section because the amount of bleeding was mild and the fetal monitor strip did not show any evidence of distress. At 12 a.m., a nurse noted abdominal tenderness and a decrease in variability on the fetal heart monitor. However, the OB then examined the patient and determined that there was no tenderness or evidence of fetal distress. At 1:45 a.m., the nurse again noted abdominal tenderness and signs of fetal distress and called the OB. After visiting the patient and viewing the fetal monitor, the OB finally ordered a C-section. The regular Kaiser OB was then called, and, after being told the fetal heart rate had dropped below 100, he ordered a crash C-section. The minor plaintiff was eventually delivered at 2:10 a.m. with critically low vital signs. The fetal monitor strip showed that the fetus endured a terminal bradycardia (extremely low heart rate) for 17 minutes prior to delivery and doctors determined that the cause of fetal distress was a placental abruption. As a result of injuries sustained in the birth process, the child now suffers from cerebral palsy and mental retardation.

The defense contended that all care was well within standard, as the mother condition and amount of vaginal bleeding did not require a diagnosis of a placental abruption. In addition, they argued that it was appropriate to anticipate a vaginal delivery as long as the fetal strip was normal- the monitor was completely normal until the terminal bradycardia that occurred because of an unpredictable, acute placental abruption. The defense also claimed that the final period of oxygen deprivation was not sufficient to cause the child’s injuries and that an earlier hypoxic event must have caused the brain damage.

However, Dr. Fagel contended that hospital staff failed to recognize that the mother’s symptoms shortly after admission clearly indicated a placental abruption. Furthermore, since she made relatively no progress in labor over a five hour period, a Cesarean section was required to ensure the safety of the mother and child. Although the fetal monitor strip did not show fetal distress until near the end, there were numerous indications that the fetus was not tolerating the labor and there was no need to delay the cesarean delivery. Finally, Dr. Fagel argued that the 17 minute bradycardia prior to delivery was indeed sufficient to cause the child’s permanent brain injuries. All in all, with proper treatment and a more timely delivery, the unfortunate outcome could have been avoided.