Articles Posted in Labor and Delivery Negligence

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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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November is National Diabetes Awareness Month, so a recent report published in JAMA Pediatrics, revealing that pregnant woman with elevated blood sugar levels are more likely to have babies with congenital cardiovascular defects, even if their blood sugar is below the cut off for diabetes, could not come at a more appropriate time.

The study was conducted over four years out of the Stanford University Medical Center, where researchers examined blood samples taken from 277 California women during their second-trimester of pregnancy. Out of the 277 women, 180 were carrying infants without congenital heart disease, and the others had infants affected by one of two serious heart defects. Specifically, 55 had tetralogy of fallot, where a baby is getting too little oxygen, and 42 had dextrotransposition of the great arteries, where the position of the two main arteries leading form the hart are swamped, preventing oxygenated blood from the lungs to circulate throughout the body.

The women’s levels of glucose and insulin were measured and used to test the association between those levels and the odds of having a baby with a heart defect. The results revealed that women who had fetuses with tetralogy of fallot had higher average blood glucose levels, but there was no significant finding in the relationship between dextrotranspostition of the great arteries and glucose levels.

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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, 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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Preeclampsia, also known as toxemia, is a condition that complicates as many as 10% of pregnancies. Typical symptoms during pregnancy and the immediate post-partum period include high blood pressure, protein in the urine (i.e., proteinuria), foot, leg and hand swelling (i.e., edema), nausea, severe headaches and abdominal pain.

A dangerous variant of preeclampsia is known as H.E.L.L.P. syndrome. A woman with H.E.L.L.P. syndrome may have a low platelet count and elevated liver enzymes. Women who suffer from H.E.L.L.P. syndrome may not exhibit the primary indicators for preeclampsia, such as high blood pressure and proteinuria. Because a pregnant woman with H.E.L.L.P. may not have symptoms that doctors typically look for, a woman suffering from preeclampsia may be misdiagnosed with the flu and treatment may be delayed.

Preeclampsia affects pregnant women everywhere, including in central New York. According to, in the weeks before she gave birth by cesarean section on August 1, 2011, Cato resident Kristie Rubino experienced several preeclampsia symptoms. She presented to St. Joseph’s Hospital Health Center on July 28, 2011, but was discharged. Days later, she underwent an abdominal delivery performed under general anesthesia. Shortly thereafter, her blood pressure escalated and she passed away.

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“Bottar Law, PLLC is presently handling several New York birth injury cases involving permanent disabilities caused by new york obstetrical malpractice and labor and delivery nurses errors made during a nighttime labor and delivery,” said Syracuse birth injury attorney Michael A. Bottar, Esq. “Certainly, the outcome of a birth is linked to the time of day a baby is born.”

An article published in the Journal of Obstetrics and Gynecology entitled “The Night—A Dangerous Time To Be Born?,” reported that babies were twice as likely to sustain a birth injury if born during the night (between 7:00 p.m. and 6:59 a.m.), as compared to a daytime birth (between 7:00 a.m. and 6:59 p.m.). A Queensland study
entitled “The Impact of Time of Delivery On Perinatal Outcomes,” reported additional troubling statistics. That is, that fetal death rates were highest between 1:00 a.m. and 2:59 a.m. Of note, was that the rate of fetal death was lowest between 11:00 a.m. and 12:59 p.m., and the rate of neonatal death was lowest between 5:00 p.m. and 6:59 p.m.

A German study reported in 2003 linked nighttime delivery dangers to the delivery of substandard medical care, also known as obstetrical medical malpractice and labor and delivery mistakes.According to The March of Dimes, low birth weight babies are at high risk for respiratory distress syndrome (i.e., RSD), intraventricular hemorrhaging (i.e., bleeding in the brain), patent ductus arteriosus (i.e., PDA), necrotizing enterocolitis (i.e., NEC), and retinopathy of prematurity (i.e., ROP).
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Jaundice, which is the clinical manifestation of hyperbilirubinemia (too much bilirubin in the blood), occurs in about one-half of term newborns as well as most premature babies (85%). Elevated bilirubin levels are also associated with low birth weight babies, sepsis, delivery requiring instrumentation, and history of maternal diabetes.

Hyperbilirubinemia is also associated with epidural anesthesia and Oxtyocin,” said Syracuse birth injury lawyer Michael A. Bottar, Esq., of Bottar Law, PLLC. “Epidural anesthesia is the most popular mode of pain relief during labor and, while it is widely believed that regional anesthetics present little if any risk to an unborn baby, this is not true in all cases.” Epidural anesthesia is associated with fetal respiratory depression, decreased fetal heart rate, fetal malpresentation, and difficulty breastfeeding after birth. Likewise, Oxytocin (i.e., Pitocin) may also cause hyperbilirubinemia.

Where a pregnant mother receives an epidural, or where labor is augmented by Oxytocin to stimulate contractions, the obstetrician and labor and delivery nurses should be on alert for newborn hyperbilirubinemia Neonatologists and pediatricians should also conduct appropriate surveillance by testing serum bilirubin levels.

While too much bilirubin in a baby’s blood is easily treated by phototherapy (or an exchange transfusion in severe cases), it can lead to permanent brain damage if the diagnosis is not made early. Baby brain damage caused by exposure to too much bilirubin is known as kernicterus. Kernicterus can cause cerebral palsy and other permanent disabilities such as long-term hearing loss, behavioral problems, and bilirubin induced neurological dysfunction (BIND).
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