Due to the estimated fetal weight and age of the mother a plan was made for induction. Upon being admitted for induction at 8:20 the mother was examined by the defendant doctor who noted contractions at 2-3 minutes. Also, that the mother was uncomfortable with the contractions. The defendant ordered an epidural for pain control. The fetal heart rate tracing was noted to be reassuring at that time.
At 10:00 the resident evaluated Ms. Rivera’s progress and noted in the medical record that she seemed comfortable with the epidural. At 11:20 the resident reviewed the fetal heart rate tracing and noted a category II tracing. The resident also ordered Pitocin to start at that time.
The mother progressed to complete although the medical record does not indicate when she was fully dilated and began to push in the second stage of labor. At 12:22 the baby was delivered by the defendant. The delivery note states there was diagnosed shoulder dystocia at delivery lasting 1.5 minutes. The defendant documents that she put the mother in the McRoberts position and had someone apply suprapubic pressure. The delivery note states that as the defendant was attempting to deliver the posterior arm, the anterior shoulder released from the symphysis pubis allowing delivery of the baby.
The APGAR scores at delivery were noted to be 8 and 9. The birth weight of the baby was 8 pounds 11 ounces.
The medical records for the baby indicate that at delivery there was marked facial bruising and marked erbs palsy on the left arm indicating an injury to the brachial plexus. The baby’s medical records also note that at delivery the left arm was limp and flaccid.
At trial, the Plaintiffs established that, upon diagnosis of shoulder dystocia by the birth attendant, the standard of care calls for cessation of maternal pushing, examination of the posterior pelvis, and avoidance of any traction after diagnosis of shoulder dystocia and until the shoulder dystocia is relieved by properly applied maneuvers. Also, that inappropriate traction that separates head away from shoulder, or traction that involves forceful twisting and pulling of the baby’s head is below the standard of care and is a known and well-accepted cause of this child’s permanent brachial plexus injury. The Plaintiffs eliminated by careful examination of all of the relevant medical records any and all other possible and medically accepted reasons to account for the severity of this child’s injury.
At trial, the Plaintiffs established that the defendant inappropriately relieved shoulder dystocia in her attempts to deliver the shoulders applying inappropriate traction/lateral bending on the neck to deliver the baby.
The child underwent multiple surgeries in an effort to improve function and use of the affected arm. The child underwent brachial plexus nerve reconstruction surgery during which time the surgeon found an avulsion of the C-7 nerve and extensive neuroma at C-5 and C-6 indicative of rupture of the brachial plexus roots at those levels.
Another nerve graft/transfer surgery was performed which also indicated injury to C-5, C-6 and C-& nerve roots as well as involvement of the C-8 and T-1 nerve roots as well. The brachial plexus nerve injury suffered by the child involved a global injury to the brachial plexus resulting from “excessive” traction during delivery applied by the defendant. The brachial plexus injury was so severe that the child also suffers from Horner’s Syndrome which involves a drooping of the right eye.
At trial the defendants presented testimony from Michelle Grimm concerning the cause of the child’s brachial plexus injury. Grimm’s nonsense was rejected and discounted resulting in a verdict for the Plaintiffs in the amount of Four Million Dollars.