Brain Injury After Baby Goes Undiscovered in Bed Following Precipitous Birth
Case Summary
This case was about the Defendant’s failure to adequately and appropriately monitor the labor and delivery of a 28 year-old patient, which ultimately resulted in the unwitnessed, precipitous delivery of her newborn son at 27-weeks gestation. Since the delivery of the infant was unwitnessed, the infant went an extended period of time without being found and without receiving the appropriate resuscitative measures. By the time the baby was found, he needed to be resuscitated with chest compressions, was intubated, and was admitted to the NICU for approximately 2½ months following his delivery. The Minor-Plaintiff now suffers significant cognitive deficits as a result of asphyxia at birth due to the amount of time he was in bed without being discovered.
Case Details
Ms. Coller was 28 years-old when she presented to the Defendant Hospital at 22 weeks 4 days gestation and was found to have preterm premature rupture of membranes. At the time of presentation, the baby was previable, so it was decided that she would receive two days of IV latency antibiotics before being discharged home to complete the week on oral latency antibiotics. She represented to the Hospital at 23 5/7 weeks and 23 6/7 weeks for her first course of Betamethasone, a corticosteroid used to help preterm infants mature.
On February 7, 2017, Ms. Coller presented to the Hospital at 24 weeks gestation for admission until delivery. While hospitalized, Ms. Coller received daily non-stress tests that were interpreted as reactive. In the third week of the admission, she was diagnosed with gestational diabetes. The biophysical profile at that time was scored at 8/8 with an amniotic fluid index of 4.82. In the fourth week of the admission, she received a second course of Betamethasone, and she was determined to be stable and afebrile.
On February 28, 2017, at 27 weeks gestation, Ms. Coller developed elevated temperatures of 38.1°C (100.6°F) and 38.2°C (100.8°F) and an elevated white blood count of 22.31. The decision was made to proceed with induction, and Ms. Coller was given penicillin for a positive GBS with ampicillin and gentamicin for suspected chorioamnionitis in the setting of preterm premature rupture of membranes. Ms. Coller received 2 doses of Cytotec to begin the induction process, and Magnesium sulfate IV was administered for neuroprotection. A foley catheter bulb was placed 8 hours into the induction process, and Ms. Coller was given Pitocin for augmentation.
At some point prior to delivery, a nurse sent everyone out of Ms. Coller’s room so that she could get some rest. A peanut ball was placed between her legs, and she was turned onto her side. At approximately 9:34 p.m. on March 1, 2017, one of the nurses responsible for Ms. Coller’s care and treatment determined that she had precipitously delivered the baby into the bed when the nurse lifted the sheet that was covering Ms. Coller and discovered a baby in the bed. Ms. Coller testified that the nurse stated, “Oh my God. He’s here.”
Fetal heart monitoring is used to track a baby’s heartbeat during labor and monitor the health of the baby. The fetal heart rate monitor displays a tracing that shows the speed and pattern of the baby’s heartbeat.
The delivery of Brent Coller was unwitnessed and the documentation surrounding the event was sparse. While a nurse documented sometime after the delivery that the baby was found in the bed at 9:34 p.m., according to the fetal heart tracing, the fetal heart rate seemingly disappears from the tracing at or around 9:18 p.m. demonstrating that the baby was born prior to the stated delivery time. A nurse testified that she coincidentally witnessed the baby being born at the exact same time she removed the peanut ball from between Ms. Coller’s legs. However, her testimony was inconsistent with the records, other testimony, and common sense.
The fetal heart tracing shows that a fetal heart rate was not picked up by the fetal heart monitor starting at or around 9:18 p.m., and the baby was not discovered until 9:34 p.m. This means that approximately 16 minutes passed without the fetal heart monitor picking up a fetal heart rate and without anybody assessing Ms. Coller to determine the reason for the loss of capture.
After the nurse discovered the baby in the bed, the emergency cord was pulled by a nurse and the OB team and NICU were emergently notified to assist in treatment. Resuscitative measures were initiated, and chest compressions were performed. The baby was intubated and quickly taken to the NICU where neonatal care was resumed. The baby was born with APGAR scores of 1, 3, and 6 at 1, 5, and 10 minutes respectively indicating that the baby was in poor condition. The baby’s birth weight was 2 lbs. 5 oz.
On March 3, 2017, an ultrasound of the head found that Brent had a Grade 2 bilateral IVH (Intraventricular Hemorrhage). On March 8, 2017, a repeat ultrasound reported Brent having a Grade 3 IVH on the right and Grade 4 IVH on the left. Brent remained at the Hospital NICU until his discharge to home on May 12, 2017, approximately 2 ½ months later.
At the time of trial, Brent was 6 years old and attending kindergarten. Since his birth, he had received extensive speech and occupational therapy. His I.E.P. (Individual Educational Plan) through the school district indicated that Brent received Life Skills Support under the category of “intellectual disability” along with speech/language support and occupational therapy. The I.E.P. indicated that intellectual disability meant significantly subaverage general intellectual functioning, existing concurrently with deficits in adaptive behavior and manifested during the developmental period, that adversely affects a child’s educational performance.
Brent’s significant deficits were a result of the asphyxia he suffered at birth due to the amount of time he was in bed without being discovered.
Lawsuit
Birth injury cases often taken years to reach a resolution, and this case was no different. There are a number of reasons why these cases take as long as they do, but it is often difficult to fully realize a child’s damages until later in life when the child’s deficits are more pronounced. For children who suffer brain injuries around the time of birth, it is most often the case that the child’s deficits will become more apparent as the child’s peers continue to grow and mature while a brain injured child continues to fall further behind. Therefore, while it can often seem daunting to wait years before reaching a resolution, it is important to understand how a child’s brain injury materializes over time.
This case went to trial when the child was 6 years old. Birth injury cases involve complex medical testimony from multiple different specialties, including but not limited to neuropsychology, neonatology, obstetrics, nursing, neuroradiology, economics, and life-care planning. In this case, we had 8 expert witnesses testify on the child’s behalf in addition to a treating physician, the family, and teachers and staff from Brent’s school who interacted with Brent on a daily basis. The testimony from these witnesses was powerful in describing the struggles that Brent has faced and will continue to endure throughout his life.
The Defendant Hospital also had a host of expert witnesses in each of the specialties listed above. In this case, the Defendant Hospital intended to call a genetics expert who testified that the child’s injuries and deficits were not a result of the Grade 3 and 4 brain bleeds suffered as a result of the birth, but rather his severe cognitive deficits were the result of a genetic abnormality. The Defense went as far as obtaining a Court Order to require the child to get genetic testing completed in an attempt to support the Defense’s baseless theory. Importantly, there was no treating physician of the child that ever indicated the need or benefit of genetic testing. However, per the Court Order, the genetic testing was completed. The testing was returned as NEGATIVE and described that there were no genetic abnormalities identified that could explain the symptoms Brent exhibited. Despite these NEGATIVE genetic testing results, the Defense still intended to present a defense that the child’s deficits were the result of a genetic abnormality; a genetic abnormality that cannot be identified on any genetic testing that currently existed.
In addition to the absurd genetic defense, the Defendant Hospital also intended to offer testimony that the child’s deficits were a result of prematurity, and the Grade 3 and 4 brain bleeds had entirely resolved shortly after they were diagnosed. The Defendant also intended to offer testimony that the child’s deficits were a result of autism unrelated to his severe brain injury. The Defendant essentially took the approach of “let’s throw everything at the wall and see what sticks.” At trial, our experts precisely described in detail why the defense was unfounded and how Brent’s damages were directly caused by the circumstances surrounding his birth.
After one week of trial, and after we presented the majority of our case in chief, the parties agreed on a multi-million-dollar settlement.
The entire recovery from this settlement was placed in a Special Needs Trust, which is a financial instrument that enables children like Brent Coller to have his recovery safely invested and preserved for Brent to utilize over the course of his lifetime. The banking fees for these Special Needs Trusts are restricted by law. Special Needs Trusts also serve the purpose of preserving certain governmental benefits that might otherwise be lost without this type of Trust.