Delayed Delivery by Nurse Midwife Causing H.I.E. - Jordich
The Jordich Case
BRIEF SUMMARY
This was a nurse midwife delivery that presented a clear picture of a mother coming to the hospital with a perfectly healthy baby who ended up giving birth to a baby born with a brain injury from insufficient oxygen. The nurse midwife in charge of the labor blatantly ignored an extremely ominous fetal heart rate pattern (showing insufficient oxygenation to the baby) for hours and hours, ignored tachysystole (too many contractions that causes insufficient oxygenation to the baby), neglected to turn Pitocin off (a drug that strengthens contractions), and neglected to get an obstetrician (medical doctor) involved as was her responsibility. Once delivered, the baby showed classic signs of a brain injury from insufficient oxygen - even according to the strictest guidelines of the American College of Obstetricians and Gynecologists (ACOG) which are written solely to defend lawsuits. Brain damage was later confirmed by MRI.
NARRATIVE
Johanna Jordich (“Mom”) was 27-years old and pregnant with her first child. Her husband was an electrician who was laid off so their insurance coverage was very limited. Johanna was given two options: (1) treat with a nurse midwife (the same one throughout her pregnancy with whom she would establish a relationship with and whom would get a medical doctor involved immediately if needed); or (2) treat with a residents’ clinic and have an evolving door of residents act as her doctor. Since Johanna really wanted to establish a relationship with her provider, she chose the midwife.
Throughout the prenatal course, Johanna’s pregnancy was unremarkable.
Two days before her due date, on October 6th, Mom went to the Hospital with complaints of contractions. At that time, the fetal heart rate was 130 beats per minute baseline (normal is 110- 160) with positive accelerations (a good thing), no decelerations (a good thing) and moderate variability (a good thing). The non-stress was determined to be reactive, i.e. signs of a healthy baby. Her vaginal exam was 2/25/-2. Johanna was discharged to home approximately two hours after arrival.
The following day, on October 7, at approximately 4:00 a.m., Mom returned to the Hospital with complaints of contractions every 5-10 minutes. She was evaluated by a Midwife; and a non-stress test was again determined to be reactive with a baseline of 130 beats per minute, positive accelerations, no decelerations and moderate variability, i.e. again signs of a healthy baby. The impression was “prodromal labor contractions” for 24 hours now. The Midwife documented that contractions had not changed from exam 12 hours earlier, that the vaginal exam was 2/50/-2, cephalic, bag intact. Johanna was given 10 cc’s of paregoric and discharged home within an hour of arrival.
That same day, on October 7, 2008 around 3:38 p.m., Mom again returned to the Hospital with complaints of contractions and a positive bloody show. At that time, she was admitted to Labor & Delivery where she was placed on a fetal heart monitor. She received an epidural around 7:23 p.m. and throughout the evening was monitored by a different Midwife.
On the morning of October 8th, Mom’s water broke at 1:17 a.m. Over the next three hours, the Midwife noted no change in the cervix. Therefore, Pitocin, a High Alert medication to strengthen contractions was started at 4:27 a.m.
At 7:05 a.m., a new Midwife assumed care of this labor and documented Mom’s blood pressure to be hypotensive at 80/32. Despite the fact that the nurses’ notes began to document variable and early decelerations between 8:30 and 9:00 a.m., Pitocin was continually increased. Additionally, Mom’s blood pressure remained hypotensive at 94/53 with nursing documenting variable decelerations, a baseline of 145, and minimal to moderate variability.
Between 9:00 – 9:00 a.m., the Midwife was called and “notified of late decelerations” (late decelerations are ominous and sigh of insufficient oxygenation to the baby). Pitocin was discontinued as per protocol with decelerations.
At 9:54 a.m., the nurse documented late decelerations with a baseline of 160 and minimal long- term variability.
At 10:17 a.m., Pitocin was restarted and again gradually increased. Over the next five hours (from 10:00 a.m. until the time of delivery at 3:14 p.m.), the fetal monitor strip continued to show persistent late decelerations, which got worse and more pronounced up to the delivery.
Incredibly, in her deposition, the Midwife herself identified 58 decelerations in the last 3 hours of Johanna’s labor as being either “late” or “variable with a later component” (and there were a lot more decelerations than that). Despite the ominous pattern and excessive uterine activity, the Pitocin was never turned off contrary to the standard of care and hospital policy.
At approximately 3:14 p.m., Julia Jordich was born vaginally with APGARS of 3 at one minute and 6 at five minutes. The Midwife noted that Julia was born flaccid with mild respiratory effort and was sent to Neonatal Intensive Care Unit (“NICU”) within minutes. Julia displayed classic signs of a brain injury caused by insufficient oxygen at birth. She was diagnosed with hypoxic ischemic encephalopathy (brain damage from insufficient oxygen) almost immediately in the NICU. The arterial cord blood gases also confirmed acute acidosis from insufficient oxygen.
Julia remained in the NICU until her discharge to home after two weeks. During her hospitalization, she was diagnosed with an occipital hematoma, seizures, and neonatal encephalopathy. Due to an onset of seizures at 2 days of life, Julia was given an EEG, which was abnormal, showing non-specific findings of multifocal sharp waves. A brain MRI performed on day two of life was also abnormal, demonstrating bilateral watershed infarcts in the anterior area, as well as in the posterior left, i.e. classic signs of brain damage from insufficient oxygen.
The ominous signs on the fetal monitor strips were continuously ignored even though they required a C-section hours earlier to avoid exactly what happened in this case.
The following facts were indisputably clear from the Hospital’s records and the depositions of the doctors and nurses involved:
The labor was managed solely by a Nurse Midwife rather than an obstetrician for hours and hours after a C-section was needed; The fetal monitor strip upon arrival to the Hospital was excellent, Category I, evidencing a very healthy baby; Then, the fetal heart monitor strips showed persistent decelerations for hours and hours getting continually worse and more pronounced up to the delivery; In her deposition, the Midwife herself identified 58 decelerations in the last 3 hours which she either classified as “late” or “variable with a late component”; Pitocin administration continued despite the presence of persistent late decelerations for hours – a clear contraindication even by Hospital policies; Some other concerned caregivers were aware of the ominous situation and tried to get a medical doctor involved before the delivery; however, the hospital’s attending obstetrician was busy with another delivery. Eventually another obstetrician arrived too late and witnessed the delivery. Julia was 10-years at the time trial was scheduled. She was receiving special education in her public school for deficits in activities of daily living functioning, gross motor abilities, visual perceptual abilities and functional visual skills. She was receiving occupational therapy, speech therapy and learning support services for Reading/English Language Arts and Math. On a social level, due to Julia’s maturity level, she had limited friends and showed no interest in the subjects that girls her age have interest in, which made it extremely hard for her to fit in. It was clear that Julia would never gain any type of meaningful independent employment and would need ongoing medical and support services throughout her life. Shortly before trial, it was suggested that Julia see a neuro-urologist due to bed-wetting and inability to hold her bladder at night.
So how did the Hospital defend such a clear case?
First, to claim no one did anything wrong, they hired an “expert” obstetrician who is well known throughout the country for defending the indefensible. This hired “expert” has and will say anything to defend doctors and nurses in clear birth injury cases and has made millions of dollars doing so. In his expert report, which is required to be filed before trial, he simply claimed, with no support, that hospital polices were followed and that the care was appropriate. He ignored hospital polices, the deposition testimony, and how the Midwife identified 58 decelerations on the fetal heart monitor strip at her deposition. He claimed the Midwife was too hard on herself and just got it wrong.
Next, to defend “causation” – how the delayed delivery clearly caused the brain injury – the defense hired two “experts”. The first was a pediatric neurologist who ignored the obvious, claimed the treating doctors were wrong, and claimed the brain injury was caused by mild chorioamnionitis (a common infection found in the placenta). The second was a placenta pathologist to support this outrageous defense. Notably, we have some of the country’s most leading authorities in pediatric neurology, neonatology, pediatric neuro-psychology, pediatric neuro-radiology, and placental pathology who could not believe what the defense “experts” were claiming. These leading experts authored expert reports in the case and were scheduled to testify at trial.
Last, the defense was trying to claim that Julia “wasn’t hurt that bad” and would go on to lead a normal life, etc. One incredibly offensive argument the defense made was that Julia’s mom and dad were “just high school graduates” who went on to become “just a hair stylist and electrician” and so Julia was never going to go on to be “more than that anyhow.” Next, the Hospital had their “expert” pediatric neurologist perform an “exam” of Julia. This “exam” was a complete sham, lasted less than an hour, and included some very basic testing for children well younger than Julia. The “expert” then claimed that all of Julia’s treating doctors were wrong, that Julia’s teachers have all been wrong, that our experts were all wrong, and that Julia did not have any deficits.
Notably, following this “exam” and this “expert’s” outrageous claims, we deposed several of Julia’s grade school teachers, her special education teacher, and occupational therapist from her school. They each explained Julia’s deficits in extensive detail (some while taking breaks due to crying).
One week prior to trial, we were able to resolve the case for multi-million dollars. The money was placed into a Special Needs Trust. The money can only be used for Julia’s benefit and is supervised by the Court.
The Jordichs are a beautiful family and we’re blessed to say we have remained extremely close with the whole family and continue to be involved in Julia’s life.