Articles Posted in Labor and Delivery Mistakes

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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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We frequently blog about labor and delivery complications, including precipitate delivery, gestational diabetes and preeclampsia, and placenta accrete. Each can lead to serious injury to a baby, such as cerebral palsy.

Some Syracuse labor and delivery complications can be avoided if a baby is delivered by cesarean section (c-section), rather than a vaginal delivery. A recent study on 230,000 deliveries in 19 hospitals around the country revealed that about 1/3 of the babies were born by c-section. Rates are expected to continue rising because most women experience repeat c-section, rather than a vaginal birth after cesarean section (VBAC).

According to Syracuse birth injury lawyers Bottar Leone, PLLC, the medical industry was quick to blame the rise in abdominal deliveries on obstetrical medical malpractice claims and doctors practicing “defensive medicine.” However, the study did not cite legal concerns as the basis for the statistical increase. Rather, it cited “chemically-induced” labors as the primary reason for c-sections. Indeed, women whose labor was induced were twice (2x) a likely to have a c-section. The chemical commonly used to induce labor is Pitocin or “pit.”

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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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A recent National Institutes of Health panel announced that VBACs are not as dangerous as once believed, and that OBGYNS should reduce the barriers to women who want to try vaginal birth after cesarean section (VBAC). According to Central New York uterine rupture lawyers Bottar Leone, PLLC, VBACs are still dangerous.

In 1980, the NIH released a similar report, in which it encouraged doctors to permit vaginal deliveries after a prior cesarean section incision has weakened a pregnant mother’s uterus, exposing her to increased risk for rupture and hemorrhaging. VBACs rose through the 1990s from 3% to 23%, but have decreased in frequency since 1996, to 8.5% in 2006. In 1999, the American College of Obstetricians and Gynecologists (ACOG) revised its guidelines to practitioners from “encouraging” VBACs to pregnant mothers, to “offering” VBACs as an “option.” Shortly thereafter, as many as 30% of hospitals prohibited VBAC deliveries.

While encouraging more VBACs, the NIH panel conceded there was “moderate evidence” of a “clear increased risk of uterine rupture in trial of labor compared to an elective repeat cesarean delivery” and noted that uterine rupture “can be catastrophic and remains the most dreaded short-term complication of a trial of labor.”

In terms of risks to an unborn baby, the NIH panel found “moderate evidence” of “increased perinatal mortality and low-grade evidence of increased fetal mortality.” It concluded that there was “insufficient data on the incidence of hypoxic ischemic encephalopathy in cases of VBAC versus repeat cesarean sections.” Hypoxia and ischemia can lead to cerebral palsy.
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Normal pregnancy lasts 40 weeks. A baby born before 37 weeks is considered a preterm delivery. A baby born before 32 weeks is considered very premature. According to Syracuse New York premature birth injury lawyers Bottar Leone, PLLC, preterm deliveries are on the rise for women who conceive through in-vitro fertilization (IVF) or intracytoplsmic sperm injection (ICSI).

Danish researchers recently published the results of a study of births from 1989 through 2006. Of the 730 babies born to women who underwent IVF or ICSI, 8% were born premature and 1.5% were born very premature, compared to 5% and 0.06%, respectively, for women who conceived “naturally.”

There are many health risks for premature babies. Some premies are born with respiratory distress syndrome (RDS) and need to be on a mechanical ventilator for the first few weeks of life. Other premature baby diagnoses include intraventricular hemorrhaging (bleeding in a baby’s brain following birth), periventricular leukolamacia (baby brain damage), cerebral palsy, bronchopulmonary dysplasia (when a baby needs oxygen after 36 weeks), or retinopathy of prematurity (due to abnormal blood vessels in the eyes). In addition to any of the above problems, premature babies are also predisposed to learning disabilities, problems with their hearing and vision, blindness, deafness, and mental retardation. More often than not, however, premature babies grow up with no problems whatsoever.
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Testing of a new therapy is underway at Nationwide Children’s Hospital in Columbus, Ohio, which may revolutionize the way that Syracuse babies diagnosed with cerebral palsy exercise to strengthen their muscles.

The system incorporates a harness into the use of a treadmill. The harness supports the child’s weight while he or she walks, which should make it easier for cerebral palsy patients to walk without the risk of falling. As children using the system learn how to walk and grow stronger, the amount of weight carried by the harness can be decreased — essentially returning the child’s body weight to their legs.

Previously, children with cerebral palsy received physical therapy only once a week. With the treadmill program, they can receive therapy several times a week. More therapy means more practice walking, and shorter periods of complete disability. More than 90% of recent participants showed improvement in walking over the course of eight weeks. Two children made remarkable advances, with one moving completely out of braces and the other moving to less supportive bracing.

Every day, at least one child in the United States is diagnosed with cerebral palsy. All too often, cerebral palsy is the result of a doctor’s mistake, such as when an OBGYN fails to perform a cesarean section despite fetal distress, when a medical resident ignores ominous fetal heart rate monitor tracings, or when a labor and delivery nurse negligently increases Pitocin despite pregnancy complications.
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According to the American College of Gynecologists (“ACOG”), with members including Binghamton New York obstetricians and Binghamton New York gynecologists, women should not deliver at home because a labor and delivery complication during a Central New York home birth could result in birth injury or death.

ACOG explains that labor and delivery complications can arise without warning, even in low-risk patients. Appropriate treatment for a complication, such as a shoulder dystocia or an umbilical cord wrapped around a baby’s neck, must come from an OBGYN or skilled birth center capable of determining whether a cesarean section is necessary to prevent Erb’s palsy, cerebral palsy or other birth injury. In high risk cases, such as vaginal birth after cesarean (“VBAC”) deliveries, a complication such as a uterine rupture could also lead to the death of a pregnant mother if hemorrhaging is not treated. ACOG reports that “the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex.”

ACOG also advocates against deliveries managed by midwives who are not certified by the American College of Nurse-Midwives or American Midwifery Certification Board.
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