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Doctors can be held negligent, despite using their “best judgment”

CASE: Pringle v. Rapaport REFERENCE: D.O. 980 A.2d 159(Pa. Super. 2009) (en banc) CASE LOCATION: Allegheny Co., PA.

On July 31, 2002, Dr. Rapaport was ready to deliver Mrs. Pringle’s second child, Austin, but Austin’s birth was complicated because during the delivery, Austin’s shoulder got stuck behind his mother’s pubic bone, a condition known as shoulder dystocia.

When Austin’s shoulder did not deliver, Dr. Rapaport engaged maneuvers to try to remedy the situation. One of the things the doctor is not supposed to do is apply excessive traction to baby’s head, as it may injure the nerves in the neck of the baby.

Dr. Rapaport engaged several maneuvers, which allowed Austin to be delivered, but upon delivery, Austin’s right arm was limp. It was subsequently determined that during delivery, multiple nerves in Austin’s neck were torn, causing an injury to the brachial plexus, which is the web of tissue and nerves located in that area.

Brachial plexus injuries involve the stretching or tearing to some or all of the five nerves located in the neck, which are referred to as C–5, C–6, C–7, C–8 and T–1. In Austin’s case, all five nerves were injured; most drastically, C–5 was ruptured, or torn apart, and C–6, C–7, and C–8 had been ripped from his spine, or avulsed. Although T–1 was not ruptured or avulsed, it was injured. This brachial plexus injury caused the paralysis of Austin’s right arm. Brachial plexus injuries are uncommon occurrences and an injury as severe as Austin’s is extremely rare.

In the lawsuit, it was alleged that Dr. Rapaport was negligent by using excessive force on Austin’s head during delivery and that the excessive force caused the brachial plexus injury and resultant paralysis.

There was expert testimony presented by both sides agreed that shoulder dystocia is an emergency situation, and that maneuvers must be used to resolve the shoulder dystocia but there was disagreement as to whether Dr. Rapaport applied excessive force to Austin’s head when delivering him.

When the trial court instructed the jury on the law, it added that

If a physician has used his best judgment and he has exercised reasonable care and he has the requisite knowledge or ability, even though complications resulted, then the physician is not responsible, or not negligent. The rule requiring a physician to use his best judgment does not make a physician liable for a mere error in judgment provided he does what he thinks best after careful examination.

Physicians who exercise the skill, knowledge and care customarily exercised in their profession are not liable for a mere mistake of judgment. Under the law, physicians are permitted a broad range of judgment in their professional duties, and they are not liable for errors of judgments unless it is proven that an error of judgment was the result of negligence

The jury found Dr. Rapaport not negligent, and we appealed since the law was incorrect.

The Superior Court heard argument in the case, and held argument en banc (that is before seven judges of the Superior Court), and then held that the law was incorrect.

The Superior Court held that doctors are subject to the same standard of law as everyone else and that they are *not allowed to be excused for their negligence if they make an “error in judgment”.