Articles Posted in Birth Trauma

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Originally created by Dr. Lawrence Weed in the 1960s as a part of his recommendation for a problem-oriented medical record, a problem list, distilled to its basic form, is a document that states the most important health problems facing a patient, such as illnesses or diseases, injuries suffered, and anything else that has previously affected, or is currently affecting the patient. According to the Journal of American Health Information Management Association (AHIMA), among other things, the problem list was designed to help practitioners identify the most important health factors for each patient, allowing for customized care. However, a recent article entitled, “Problem Lists Can Threaten Safety, Pose Liability Risks,” published by Healthcare Risk Management, illustrates the ongoing problems with problem lists.

A team of researchers led by Adam Wright, PhD, a scientist at Brigham and Women’s Hospital in Boston, studied 10 healthcare organizations that use different electronic health records in the United States, United Kingdom, and Argentina. The study, which was published in the October 2015 issue of the International Journal of Medical Informatics, was designed to see how complete problem lists were at each facility. The investigation revealed staggering levels of completeness varying from 60% to 99%, with an average of 78%.

Larkin v. Johnston, a recent malpractice case out of Massachusetts, illustrates what can happen when a problem list is incomplete. Andrea Larkin, a 28-year-old woman, former school teacher, who ran the Boston Marathon in 2004, suffered a stroke that left her partially paralyzed after childbirth and now requires 24-hour care. The case began with Larkin’s visit to a clinic after running the Boston Marathon and experiencing dizzy spells. Dr. Jehane Johnston ordered an MRI and CT scan which revealed brain abnormalities. Dedham Medical Associates had a specific policy requiring doctors to make note of such abnormal findings in a “problem list,” on the inside cover of Larkin’s medical record. This policy was intended to improve patient safety by bringing the conditions to the attention of any clinician’s review of the chart in the future. Unfortunately, Larkin’s abnormal brain findings were never entered in the problem list, so, when Larkin became pregnant nearly four years later, Larkin’s obstetrician was not aware of her brain issues.  Larkin, who would have been given a C-section had her OB-GYN been aware of her brain abnormalities, was allowed to have a vaginal birth which resulted in a massive stroke just hours after giving birth to her daughter.  Larkin was awarded $35.4 million – over $41 million with interest.

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According to the Centers for Disease Control and Prevention, the number of women dying because of pregnancy and childbirth is going up. More than 25 years ago (1987), there were 7.2 deaths of mothers per 100,000 live births; in 2011, that number more than doubled to 17.8 deaths per 100,000 births.

According to experts reporting on this subject, there is not any one factor to explain the increase, but a number of issues, including obesity related complications, record-keeping changes, age and delayed childbearing, health disparities, and an increase in the number of cesarean section births. One of the causes not mentioned, however, is medical malpractice.

Recently, a family of a 32-year-old woman who died from complications during pregnancy while being treated at the Cooley Dickinson Hospital, filed a lawsuit against the hospital for negligence. According to the complaint, the hospital staff missed signs of pre-eclampsia – a potentially fatal complication of pregnancy – and then failed to timely treat it. The complaint further alleges that after the woman was unresponsive for over 10 hours and had given birth by cesarean section, staff realized she had suffered a massive cerebral hemorrhage and would not recover.

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According to a recent lawsuit filed in the U.S. District Court of Tennessee, defendant health care providers failed to properly handle the delivery of the minor plaintiff, resulting in extended fetal oxygen deprivation and brain injury at birth. Specifically, the complaint alleges that during the mother’s labor and delivery, medical personnel failed recognize and respond to clear signs of declining fetal response, indicating the need for an emergency C-section.

The mother plaintiff gave birth to her first child via Cesarean section, and shortly thereafter she became pregnant again. According to the lawsuit, despite her risk factors, including short stature; previously unsuccessful attempt at vaginal birth; and a brief time between the two pregnancies; the mother plaintiff was advised that she was a good candidate for a vaginal birth after C-section (VBAC).

The mother plaintiff went into labor early, and within the first half hour the EFM strip indicated minimal variability and loss of accelerations (two signs of fetal compromise). According to the lawsuit, rather than being admitted to the Labor & Delivery ward, the fetal monitoring was stopped and the mother plaintiff was advised to walk around the hospital for an hour or so. About two hours later, she was admitted whereupon labor progression was slow and the fetal monitoring continued to show repetitive late decelerations. After several hours, a C-section delivery was ordered.

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World Cerebral Palsy Day is a global innovation project created to improve quality of life for people living with cerebral families, and their families. The project is led by a group of non-profit cerebral palsy charities, and supported by organizations in over 45 countries.

Cerebral palsy is a neurological disorder caused by abnormalities in parts of the brain that control muscle movements, hearing, vision and cognition. It is the most common physical disability in childhood. The majority of children with cerebral palsy were born with it, although the diagnosis may not be made until a child reaches three years of age. According to en.worldcpday.org, at least two thirds of children with cerebral palsy will have movement difficulties affecting one or both arms, 1 in 4 children with cerebral palsy cannot talk, 1 in 3 cannot walk, 1 in 2 have an intellectual disability, and 1 in 4 have epilepsy. In the most severe cases, children born with cerebral palsy will live their lives dependent upon others for every aspect of daily living.

Causes of cerebral palsy include hypoxia or ischemia during childbirth, genetic disorders, stroke, infection and trauma. Where cerebral palsy is caused by a preventable medical error during labor and delivery, the child and his or her family may have a claim for medical malpractice.
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Syracuse medical malpractice lawyer Anthony S. Bottar, managing partner of Bottar Leone, PLLC, one of Upstate New York’s oldest law firms with a practice limited to medical malpractice, wrongful death, birth injuries, work injuries, brain injuries, and product/premises liability, was elected president of the New York State Academy of Trial Lawyers, an organization dedicated to protecting, preserving and enhancing the civil justice system.

The New York State Academy of Trial Lawyers boasts a membership of more than 1400 judges, law clerks, law firms, lawyers, paralegals and law students, including: Syracuse medical malpractice lawyers handling cases concerning stroke misdiagnosis, failure to diagnose cancer and failure to prevent a heart attack; Syracuse work injury lawyers handling cases concerning construction site accidents, scaffolding accidents and injuries caused by a fall from a height; Syracuse birth injury lawyers handling cases concerning fetal hypoxia and ischemia, cerebral palsy and Erb’s palsy; Utica brain injury lawyers handling cases concerning concussions, post-concussion symdrome and TBI; Watertown medical malpractice lawyers handling cases concerning Samaritan Medical Center negligence and Fort Drum physician mistakes; and Watertown injury lawyers handling New York State Thruway accidents.

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Every time a baby is born in an upstate New York hospital, such as Samaritan Medical Center in Watertown, New York, Faxton-St. Luke’s Healthcare in Utica, New York, Crouse Hospital in Syracuse, New York, St. Joseph’s Hospital Health Center in Syracuse, New York, Oswego Hospital in Oswego, New York, or Auburn Hospital in Auburn, New York, the baby’s birth weight is recorded. That data is made available to researchers who study trends in newborn birth weights.

A recent Harvard study reports that newborn birth weights are down in the United States by about 1.8 ounces. Average birth weights now hover around 7 pounds 6 ounces. The decline in baby weight is a positive development as larger babies are at greater risk for birth injuries and birth trauma, such as a shoulder dystocia because a baby’s body is too big for the birth canal or where a baby sustains brain damage from a lack of oxygen that leads to cerebral palsy. Macrosomic babies, including large babies because of a failure to diagnose gestational diabetes, are also at greater risk for diabetes and obesity later in life.
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The Irish High Court ruled that a mother was rendered incontinent due to ob/gyn medical malpractice arising out of the birth of her child. According to reports, the woman sustained internal and external sphincter muscle tears due to forcep use and vacuum use during labor. While double instrumentation was employed to facilitate the delivery, significantly increasing the risk of injury to the mother and baby, the internal sphincter muscle injury went undiagnosed. In turn, the woman was left with incontinent.
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Preeclampsia is a pregnancy complication affecting 10% of women. It is marked by high blood pressure and proteinuria (protein in the urine). Symptoms usually emerge in the 20th week of pregnancy, and include: headaches, hand and foot swelling (edema), excessive weight gain and, in extreme cases, blindness.

Preeclampsia must be timely diagnosed, because if left undiagnosed it can develop into eclampsia. Eclampsia can cause seizures, brain damage and death (for mother and child). Worldwide, preeclampsia is responsible for 500,000 infant deaths and 76,000 maternal deaths every year.

According to a recent study conducted by scientists at the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institute of Health, there may be a connection between maternal plasma concentrations and the risk for developing preeclampsia. The relationship between maternal plasma and preeclampsia should lead to a decrease in medical malpractice due to the late diagnosis of preeclampsia, as doctors will be able to screen for a patient’s predisposition to develop the dangerous condition.
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