$2,200,000.00 VERDICT IN BRACHIAL PLEXUS CASE

BIRTH INJURY Medical Malpractice Lawsuit: Excessive Traction Results in Permanent Brachial Plexus Injury.

The mom presented for pre-natal care with a pre-pregnancy weight of 216 pounds and a strong family history of diabetes mellitus. The mother’s father, uncle and maternal grandfather all had diabetes. During the pregnancy the mother showed high numbers on her glucose tolerance testing. Despite an abnormal glucose screen by the 28-week testing, and a strong family history of diabetes, no further glucose testing, accu-check blood sugar monitoring, diet or diabetes counseling was provided. Further, no late ultrasound evaluations of the fetal estimated weight or health status were performed.

Once in the hospital in labor, the mom received pitocin augmentation of labor and epidural anesthesia. The second stage of labor lasted approximately one hour and twenty minutes before the doctor elected to shorten the labor by performing a vacuum assisted delivery from 3+ stations and the perineum. After using the vacuum to deliver the head, at times not documented in the record, the doctor applied downward traction on the fetal head and neck for approximately 15 second before he realized that shoulder dystocia was present. This was followed by no documented physician or nursing note which explain how the shoulder dystocia was relieved or how long the process took. No episiotomy was cut and a small perineal laceration occurred.
At delivery the baby’s and his left arm was flaccid. The infant sustained a permanent brachial plexus injury.

As a result of the doctor’s failure to perform the episiotomy, use appropriate of maneuvers to resolve the shoulder dystocia as well as apply excessive later traction, the infant sustained a permanent brachial plexus injury. Once a shoulder dystocia is encountered the physician has the responsibility to (a) engage in a series of procedures and maneuvers to resolve the dystocia without applying traction to the fetal head or neck; (b) document fully in the medical record chart both the diagnosis as well as the treatment procedures and maneuvers employed; and, (c) inform the patient and family of the diagnosis and treatment performed. Specific maneuvers to resolve shoulder dystocia include (1) episiotomy; (2) rotation of the anterior shoulder; (3) rotation of the posterior shoulder; and (4) suprapubic pressure in a tangential plan; and (3) flexion of maternal legs toward chest aka McRoberts’ maneuver; and (6) proctoepisiotomy. The mechanism for Ryann’s brachial plexus injury is stretching of the neck from excessive traction during delivery with concomitant injury to the brachial plexus roots or nerves as they transverse the neck from their origins in the spine.

In this case, the doctor failed to engage in an appropriate series of procedures and maneuvers to resolve the dystocia including an appropriate episiotomy and/or proctoepisiotomy and wrongly applied lateral pressure on the head while the shoulder was impacted causing the permanent brachial plexus injury.
Further, the mother was placed at an increased risk for shoulder dystocia based upon her marked obesity and short stature, family history of diabetes, her elevated one-hour glucola test revealing gestational diabetes mellitus which was untreated and uncontrolled, the use of pitocin induction, epidural anesthesia and the elective use of the vacuum to shortened the second stage of labor.

The doctor was negligent in exerting excessive force during her attempts to relieve Ryan’s shoulder dystocia by pulling down and/or laterally flexing the head resulting in an injury to the left brachial plexus.

The child suffered a permanent brachial plexus injury that has required two surgeries to date and continued physical therapy.
Following a ten-day trial the jury returned a verdict in the amount of Two Million Two Hundred Thousand ($2,200,000.00) Dollars.

Categories: Case Results.