Child Injury Laws - By Jonathan Rosenfeld

For many children with cerebral palsy, complications related to orthopedic deformities and muscle spasms can quickly turn some of the most basic tasks in the impossible.  While occupational and physical therapies can be useful in improving the level of functioning, the treatments may have limited effects in addressing the underlying complications. 

The most commonly type of CP, spastic cerebral palsy, impacts the brain in a manner that disrupt messages from the child's brain resulting in muscle spasms.  The muscle spasms, make simple movements incredibly difficult for the child because muscles commonly fire at the same time.  It is common for children with spastic cerebral palsy may have difficulty with basic movements and may suffer from extreme fatigue and develop contractures which progressively inhibit their movements.

Thankfully, the medical community has made tremendous progress towards providing more expansive treatment options for children with cerebral palsy over the past decade.  Depending on the type of deformity, physicians can now provide some relief with the use of newer surgeries to correct the the alignment of bones and joints that are out of place.

I was happy to hear about how some of these medical developments hold the promise of substantially improving the quality of life for a 12-year-old boy with a form of CP that has restricted his ability to walk without the assistance of braces and a walker.

Following a complex surgery at Twin Cities Hospital (Minnesota) to realign the boy's bones and joints, the boy is now able to walk in a more 'normal' upright-position which would theoretically allow him to walk without any assistive devices.

While the road to recovery for this boy will no doubt be difficult, my guess is that the promise of an improvded quality of life make's such desions a bit easier.

Related:

Life Changing Spinal Surgery Allows Young Boy With Cerebral Palsy to Walk

What are the different forms and symptoms of cerebral palsy?

What are the symptoms of CP?

Some of the most prolific medical malpractice cases involve injuries sustained by children during the labor and delivery process.  I can’t image a warm-blooded-person who isn’t moved by the very thought of a severely disabled child who faces a lifetime of developmental difficulties and endless hours of specialized medical attention.

Despite their poignant tales, these children—or perhaps more accurately, the people bringing lawsuits on their behalves, still have the burden of establishing that their child’s injury derived from the negligence of the attending physician or hospital. 

That’s right, before these children receive a penny for their injuries or care-related expenses, the law says that they have the burden of proving the following:

• The doctor and / or hospital has a duty to provide proper medical care for the child

The fact that a doctor-patient relationship exists is usually considered enough in most jurisdictions for a doctor to act in a professional manner and treat their patients with the skill that a reasonable doctor would provide.

• The duty to provide reasonable medical care was breached by the treating doctor or hospital staff

Frequently, this part of the case proves to be the most difficult as it involves establishing what the ‘standard of care’ is for each procedure or circumstance presenting itself to the doctor.  While it may be easy to second-guess a physician’s decision after the fact, establishing how a prudent physician would act or react to circumstances presenting themselves can be difficult in light of the fact that there may be different opinions about how to handle certain circumstances.

In order to establish what exactly the standard of care is in each case, parties to a lawsuit typically rely upon expert witnesses.  While the name ‘expert witness’ correctly implies that the person is an expert in their profession.  The medical expert’s real role is to educate the jury as to what the proper way to do a procedure or response to a set of circumstances.

Just as an injured party has a opportunity to retain an expert witness(s) to prove their case, a doctor being sued for negligence can similarly retain his or her own expert witness to support that the things that they did were in fact correct.

• The doctors breach of care resulted in injuries to the child

Similar to other types of personal injury cases, birth injury lawsuits place a burden on the person initiating the lawsuit in terms of establishing the injuries alleged are due to the act of the defendant doctor--- as opposed to the injuries occurring from another source.  Cases involving cerebral palsy and other types of birth injuries commonly involve allegations that the child’s condition resulted from a genetic abnormality or developmental complication as opposed to the conduct of a physician.

• The child sustained damages

Most birth injury cases involve significant physical and cognitive loss, which require significant amounts of past and future care.  The plaintiff's in a birth injury case may use the services of a life-care planner to chronicle what type of medical equipment and care the child will require during each phase of their life.

As opposed to arguing that the child’s damages are not present, defendant doctors may simply allege that damages should not be considered because the plaintiff failed to establish that there was a deviation in the standard of care.

Simple enough?  Not so fast....

While the above elements of a birth injury case may seem simple enough, when complex medical issues are involved--- and credible experts from both sides advocate contradictory positions, the waters can quickly become quite murky.  Particularly when the presenting issues represent a judgment call, equally qualified physicians may have differing ways of addressing the issue.

I was again reminded about the uncertainties involved in birth injury lawsuits when I heard about a recent trial in Florida involving a three-year-old boy with significant physical disabilities.  After a mere forty minutes of deliberations, the jury returned a verdict in favor of the defendant hospital and doctors.

The trial centered on the way that the hospital and physicians interpreted--- and responded to a situation involving fetal distress.  While there was no dispute that the child involved suffered profound injuries at birth due to an interruption of oxygen during the labor and delivery process that stemmed from a uterine rupture-- the alleged medical malpractice really came down to one word-- forseeability. 

The tipping point of the trial was how a reasonable physician would respond to the information gathered about the situation in light of the diagnostic testing and information provided by the mother.  Unlike most situations involving a uterine rupture—where a woman has a scar in her uterus from prior pregnancies or trauma--- the mother in this case, presented without any of the factors which could increase her chance of a uterine rupture.

While my heart goes out to this family and the struggles they certainly will face, situations such as this are telling of the uphill battle faced in most birth injury cases.  As a birth injury lawyer, one of the more difficult parts of my job is explaining to a family with a special needs child that they may not have a case because of the difficulty in establishing a breach of care or causation.

Therefore, I try bringing complicating issues to the families attention immediately if a consulting doctor identifies them during his or her case review.  While these are always difficult conversations to have, I think it’s important for families to understand the issues involved--- both positive --- and negative before we put the case in the hands of a jury.

Related:

Vero Beach jury finds hospital not liable in birth injuries that caused boy's disabilities TCPalm by Elliot Jones, January 24, 2012

Can a mother’s obstetric hemorrhage result in injury to the baby?

What is a uterine rupture and does it pose a danger to mother or baby?

Complications During Pregnancy, Such As Uterine Rupture, Put Mother At Risk

Hemorrhages (Uncontrolled Bleeding) During Delivery Must Be Carefully Monitored To Keep Mom & Baby Safe

Children with severe cerebral palsy usually require a lifetime of intensive medical care.

Treatment often involves major corrective surgeries to help properly re-align a child’s hips and spine. While it’s a widely known that the surgeries involve great risks, a big question still remains: Do these surgeries, when successful, actually improve child’s quality of life?

In a recent blog entry from Children’s Hospital Boston, Rachel DiFazio, a nurse with the hospital’s CP Program, said that after 21 years of working with CP children, she still wasn’t sure.

“I’ve always wondered what the outcomes were of surgeries,” said DiFazio. “We have a lot of X-ray data and range-of-motion data, but we don’t really know if it gets any easier to take care of these children; whether life gets a little bit easier after the surgery, and in what ways.”

To try and answer her own questions, DeFazio recently launched a research study based on surveys. The study takes a look at the “complete picture” of the physical, familial and financial impacts that surgeries have on children and their families.

“Before surgery, we ask the parents to tell us about their child’s quality of life, about their own lives as caregivers, and about the effects on the family as a whole - including siblings and on the family’s finances,” said DiFazio. “I’d like to see how the whole family is doing. These are questions that have never been addressed before in this population of severe CP patients, largely because we haven’t had the instruments to do so in a systematic way.”

According to a recent study from the Children’s Hospital at Johns Hopkins University, most children with severe CP will eventually require spinal surgery. Recovery from surgery usually takes about a week. Recent CDC data indicates that the total lifetime cost for treating a person with CP is approximately $900,000.

Related:

Reconstruction of Dislocated Hips in Children with Cerebral Palsy

Hopkins Children’s Study Finds Some Patients with Cerebral Palsy Have Asymmetric Pelvic Bones

Economic Costs Associated with Mental Retardation, Cerebral Palsy, Hearing Loss and Vision Impairment

Treatment Options for Patients with Cerebral Palsy Are Dependent On Proper Diagnosis From Medical Community

Given the state of our high-tech delivery rooms, it might seem contradictory that most major birth injuries occur as a result of simple human communication problems.

We like to assume ALL doctors know exactly what they’re doing, at all times. Especially during the high-stress experience of labor.

But study after study has proved that teamwork breakdowns are more threatening to a baby’s health than anything else - simply because there’s so much to keep track of, at such a risky time.  

In 2008, a group of 16 hospitals called “the Premier Alliance” tried to change that, by implementing what they called “care bundles.” Care bundles are a series of protocols that apply to a singular birth event, and work best when used a team, in tandem.

“What we were trying to do is to make care delivered in the birth process more effective,” said Susan DeVore, Premier’s chief operating officer. “Our goal is to get [the injury rate] to as close to zero as possible, with zero being the only acceptable number.”

Care bundles can apply to any number of birth situations, but they’re most often used for two events: The decision whether or not to use pitocin to induce labor, and the use of vacuum extractors in more difficult vaginal deliveries.

In the case of a vacuum extraction birth, a “care bundle” would consist of:

• An in-depth discussion of between the doctor and patient about the risks and benefits of the procedure
• A documentation of the conversation
• An exam to ensure that the baby’s properly positioned
• Plans for emergency staffers to be on call, should a C-section be required

According to a recent Wall Street Journal article, Premier Alliance experienced an eleven precent drop in birth injuries since it started its care bundle programs.  It also reduced the number of babies with insufficient oxygen by 31 percent.

Recently, the federal government awarded $3 million each to two groups working on improving obstetrical safety - St. Louis-based Ascension health, and Minneapolis-based Fairview Health Services.

“I have a mental checklist now of what to do,” said Dr. Paul Burstein, a doctor at an Ascension Health hospital in Milwaukee. “It’s given me more confidence. And I know other members of the team are on the same page.”

Related entries from Child Injury Laws blog:

Lights, Camera, Baby Delivery! Are Parents Entitled To Film The Birth Of Their Children?

Is the rush to induce labor, jepordizing the safety of mother and baby?

Are Cesarean Sections Helping Or Hindering The Health Of Mother & Infant?

Birth Asphyxia: A Doctor's Delay, A Lifetime Of Medical Complications

As medical malpractice lawyer, who has worked on cases involving cerebral palsy, I've noticed a good deal of confusion regarding all aspects of CP.  

Like many medical conditions, it seems like the more we study this troubling condition, the more questions we have.

I've tried to draw out some particularly useful information from trusted sources to address many of the issues I come across in cerebral palsy cases.

What is cerebral palsy?

Cerebral Palsy (CP) is a condition (CP is sometimes referred to as a group of symptoms) that can affect the brain and nervous system functions including movement, posture, learning, hearing, seeing, and thinking. 

It is caused by brain injury or abnormal development of the brain that occurs before, during, or shortly after birth (brain damage occurring after age 5 is not considered cerebral palsy). 

Most problems occur in the womb, but problems can happen anytime during the first two years of life as the child’s brain develops.  It is estimated that almost 800,000 children and adults in the United States are living with symptoms of cerebral palsy.  And, the CDC (U.S. Centers for Disease Control and Prevention) estimates that every year about 10,000 babies born in the United States will develop cerebral palsy.  

What are the types of cerebral palsy?

There are actually several different types of cerebral palsy:

• Spastic – muscle stiffness and movement difficulties (occurs in 70% of children with CP)
• Athetoid (or dyskinetic) – involuntary and uncontrolled movements (occurs in 20% of children with CP)
• Ataxic – disturbed sense of balance and depth perception (occurs in 5% of children with CP)
• Mixed - (usually spastic and athetoid types are combined and may also involve severe mental retardation)

Symptoms assciated with cerebral palsy

Signs and symptoms of cerebral palsy usually present themselves during infancy or preschool years.  Symptoms can vary significantly between people and range from minor clumsiness to severe spasticity (muscles are continuously contracted).  In addition, the disability symptoms associated with cerebral palsy can be limited to one limb or one side of the body, or they can affect the whole body. 

Symptoms of CP usually become evident before a child has reached the age of two, but they can begin as early as three months.  Brain damage does not worsen after the damage has occurred; however, the symptoms may change as the individual grows and matures.

Symptoms include:

• Spasticity (stiff muscles and exaggerated reflexes)
• Rigidity (stiff muscles with normal reflexes)
• Joint contracture (joints are tight and do not open up all the way)
• Too stiff or too floppy muscle tone
• Ataxia (lack of muscle coordination)
• Athetosis (slow, writhing movements)
• Difficulty walking (walking on toes, crouched gait, scissors-like gait, wide gait)
• Tremors
• Delays in reaching motor skills milestones (sitting up alone, crawling)
• Favoring one side of body (reaching with only one arm, dragging one leg while crawling)
• Excessive drooling or difficulty swallowing
• Delays in speech development or difficulty speaking
• Difficulty with precise motions

Oftentimes, the brain problems that lead to cerebral palsy conditions can also cause additional neurological problems such as:

• Difficulty with vision and hearing
• Intellectual disabilities or mental retardation
• Speech problems (dysarthria)
• Seizures
• Abnormal touch or pain perceptions
• Dental problems
• Urinary incontinence

Causes of cerebral palsy

Oftentimes, the exact cause of cerebral palsy is unknown because it usually stems from an abnormality or problem in brain development before the child is born.  Factors that can cause problems with brain development include:

    •    Oxygen deprivation (hypoxia)
    •    Fetal stroke
    •    Genetic defects
    •    Bleeding in the brain
    •    Infant infections (encephalitis, meningitis, herpes simplex infections)
    •    Maternal infections (ex. rubella)
    •    Traumatic head injury
    •    Severe jaundice

Risk Factors and Prevention of Cerebral Palsy

CP affects 2-4 of every 1,000 infants and premature babies are at a slightly increased risk of developing cerebral palsy (CP is 10 times more common in premature infants).  Moreover, CP is more common in low birth weight infants (less than 3.3 pounds). 

A study in the American Journal of Obstetrics and Gynecology that looked at the times of delivery of two million neonates in California over fourteen years suggests that night births are linked to an increased risk of brain disorders such as epilepsy, cerebral palsy, and encephalopathy. 

Babies born between 10 p.m. and 4 a.m. were 22% more likely to develop cerebral palsy and other brain conditions because of lack of oxygen during delivery.  The authors suggest that medical errors and poor staffing in hospitals overnight may account for the higher incidence of brain problems.    

In many cases, the exact cause of CP is unknown, which makes prevention difficult.  However, if you are having a baby, there are steps you can take to lower the risk of CP.  These efforts include:

• Maintaining a healthy diet
• Proper prenatal medical care
• Review medications with your doctor
• Controlling diabetes, anemia, hypertension, seizures, and nutritional deficiencies during pregnancy
• Vaccination against diseases
• Practice good child safety (prevent head injuries)

Treatment for cerebral palsy

There is no cure for cerebral palsy.  However, many children benefit from physical therapy and special education.  Treatment is based on the individual’s symptoms and the need to prevent complications.  Usually, the earlier the treatment begins, the better chance the child has of overcoming disabilities or learning new ways to accomplish tasks. 

Treatment plans should include a team of professionals (doctor, dentist, social worker, nurses, therapists (occupational, physical, and speech), and specialists for specific symptoms.  Treatment plans can include self and home care, special education and schooling, glasses, hearing aids, muscle/bone braces, walking aids, wheelchairs, surgery, and medications to address seizures, spasticity, drooling, and tremors. 

The good news is that most children with CP survive into adulthood.  Long-term care may be required depending on the severity of symptoms, but a comprehensive care plan can help the individual be as independent as possible and reach their highest potential.  

Research efforts are underway to improve the treatment and diagnosis of cerebral palsy, but ultimately, prevention is the key for curing CP.  Researchers at Duke University are looking into stem cell therapy to treat cerebral palsy patients.  They are hoping that the stem cells can help regenerate cells in the brain that never developed because of lack of oxygen during birth, which could alleviate symptoms.  

If your child is diagnosed with cerebral palsy, there are support groups and circles that can help you cope with CP and its effects.  The following organizations offer good resources:

• NINDS
• United Cerebral Palsy
• U.S. Centers for Disease Control and Prevention

In addition, your doctor should be a good source for local community groups.  Cerebral palsy requires long-term and loving care.  You should encourage your child’s independence and take an active role in advocating for your child.  If you do not think your child is receiving the best possible care, you should speak up on your child’s behalf.  Proper care for cerebral palsy requires that each and every professional treating your child work together to ensure the best outcome for your child.  

Resources:

Seer Press News: Cerebral palsy more likely to develop in babies born during night time, study says

Seer Press News: Stem cells for treatment of cerebral palsy

HealthCommunities.com: Cerebral Palsy Signs and Symptoms

Mayo Clinic: Cerebral Palsy

Merck: Cerebral Palsy

Cerebral Palsy Lawyers FAQ

NCBI: Cerebral Palsy

National Institute of Neurological Disorders and Stroke (NINDS): Cerebral Palsy Information Page

Kids Health: Cerebral Palsy

When many of us consider 'medical malpractice' we commonly associate cases involving: surgical errors, birth injuries or a series of medical mistakes made by a doctor or medical professional. 

Rarely do we considered the circumstance where medical care was simply not provided at all or when treatment was delayed so significantly that the patient suffered harm related to the delay.

Particularly when patients are taken to an emergency room, it is the responsibility of the hospital to do triage on each patient and assess their medical needs to determine if the patient has a true "emergency" that requires immediate medical attention or perhaps has a situation that is not quite as pressing.

We recently discussed a situation involving delayed emergency room care in California where a two-year-old girl was forced to wait more than five hours when her family brought her to the emergency room for treatment related to an infection.  By the time doctors finally got around to providing the girl with the care that she needed, the Streptoccus A infection has progressed throughout the girls body.  While the girl was able to survive the ordeal, the delayed medical care is responsible for the amputation of her hands and feet.

In response to this medical error, the girl's family filed a medical malpractice lawsuit against the hospital and physicians group who staffed the nursing home where she was originally brought for care.  Recognizing the significance of the delayed medical care-- and the possibility of saving the girl's limbs with a more timely intervention, the hospital and physicians group has agreed to settle this matter for an estimated $10 million.

Is delayed medical care, medical malpractice?

As a medical malpractice lawyer, who handles cases involving serious injury or death from delayed medical care in a hospital, nursing home and immediate care setting, I see two primary reasons for these type errors: insufficient patient assessments and inadequate staffing levels-- where medical facilities may simply not have proper staff to care for the patient needs. 

From a triage standpoint, nurses and doctors should be tuned in to the subjective complaints and testing results when determining the patient's immediate need for medical care.  Staff needs to appreciate that when a patient presents themselves with certain conditions, they need to be addressed immediately.  Similarly, while not every medical facility can be expected to be able to provide quality patient care in every situation, a proper triage should be able to determine the patients needs and a transfer to a more specialized medical facility when necessary.

Related:

Family of Sacramento girl who needed amputations after ER delay is awarded $10 million, October 28, 2011, The Sacramento Bee

Medical Malpractice Lawsuit Alleges That Delayed Treatment Resulted In Baby's Amputations

Diagnostic Accuracy of Stroke Referrals From Primary Care, Emergency Room Physicians, and Ambulance Staff Using the Face Arm Speech Test (pdf) Stroke 2003, 34:71-76

Interval between decision and delivery by caesarean section—are current standards achievable? Observational case series (pdf) BMJ VOLUME 322 2 JUNE 2001

Two years of litigation has achieved a $7.5 million settlement in a birth injury lawsuit initiated by the grandparents of a child born with cerebral palsy.  As reported in the Chicago Sun Times, the medical malpractice lawsuit was brought against Christ Medical Center and treating obstetricians for their respective roles in the way they responded to a situation involving signs of fetal distress of a baby born at the hospital in 2002.

As with many birth injury lawsuits, the allegations of medical malpractice centered around the delay of hospital staff and treating physicians had with respect to taking action upon learning of the potential dangers facing the baby. The delay in responding to signs of fetal distress was blamed for oxygen deprivation and ensuing complications including brain damage and cerebral palsy.

Now, 9-years-old, and with significant care-related needs, the funds from the settlement can be used to provide for the extensive skilled-care needs that this child will need for the remainder of her life.  In addition to the care, some of the funds will likely be used to modify the child's home to make it more accommodating for specialized physical needs such a wheelchair access.

Significant Settlements For Birth Injury Cases:

While settlements such as this are indeed eye-popping for their significance, it is important to remember that the funds from the settlement of birth injury lawsuit are intended to provide for the needs of these children for the remainder of their lives.  In the case of a child with cerebral palsy, many physicians will opine that these children will have a normal life expectancy --- similar other children their age.

Additionally, in situations involving funds awarded to children in cerebral palsy or other types of birth injury cases, the funds are customarily put into a trust or other type of restrictive account where a only a parent or guardian can access the funds for the direct needs of the child.  

Many times, a judge oversees the administration of the funds to further protect the child from improper acts of a third-party--- and to assure that the funds last protect the needs of the child in the future.  Usually, an annual accounting is ordered to be filed with the court where all expenditures and trust income is accounted for in order to detect any issues as quickly as feasible.

Further distinguishing funds set-aside for a child's birth injury, is how the funds are to be invested.  Unlike accounts used for investment and growth, accounts established for special needs children are intended to utilize extremely conservative--- and inherently safer--- types of investment vehicles to further assure the needs of the child can be provided for in the future regardless of the overall economic volatility.

Related:

A lack of oxygen, or Hypoxic Ischemic Encephalopathy, is the frequent cause of baby brain damage at birth

Parents Settle Medical Malpractice Lawsuit Where Child Suffers Brain Injury At Birth

Life Expectancy: Cerebral Palsy

Life expectancy in children with cerebral palsy, BMJ 1994; 309 doi: 10.1136/bmj.309.6952.431 (Published 13 August 1994)

Diagnosing Cerebral Palsy

A pending matter, my office is working on involves a boy who sustained a brain injury due to the doctors' delay in perfoming a c-section.  The condition referred to as; hypoxic Ischemic Encephalopathy (HIE), also known as perinatal encephalopathy, may result when the brain does not receive enough oxygen (hypoxia).  HIE can refer to any brain injury caused by oxygen deprivation, but it often refers to an injury common to newborns that can cause long-term disability and death.  

HIE in newborns is caused by injury or complication during birth where the fetus or newborn suffers oxygen deprivation.  Causes of HIE include:

• Birth injury
• Perinatal asphyxia
• Delivery complications with delayed delivery
• Umbilical cord wrapped around neck of infant
• Trauma to the brain during delivery process

In the United States, HIE occurs in one to eight of every 1000 births.  If HIE is severe, the mortality rate is around 20% with deaths occurring mostly in the first week of life, with 25% of survivors suffering permanent neurological defects.  For infants who survive severe HIE, up to 80% of them develop serious complications, 10-20% develop moderate disabilities, and up to 10% have no complications.  For infants with moderately severe HIE, 30-50% have serious complications, and 10-20% have minor neurological problems.  

The lack of oxygen occurs to the brain as a whole not just one part of the brain.  HIE results in brain injury as a result of oxygen deprivation (hypoxia) and reduced cerebral blood flow.  Brain cells require proper circulation to receive oxygen and remain viable.  If the brain does not receive proper circulation and oxygen, the cell membranes of brain cells become compromised and the neurons die.  Within five minutes of oxygen deprivation, a child may suffer from irreversible brain damage.  

The extent of damage depends on how long the brain is without oxygen.  Brief oxygen deprivation may cause only minor brain cell injury while longer deprivation can cause damage to more sensitive areas of the brain including the hippocampus (plays an important role in memory).  

The damage can cause long-term disability, mental retardation, epilepsy, seizures, learning disability, delayed development, and cerebral palsy.  (See Rosenfeld Injury Lawyers “Cerebral Palsy” and Child Injury Laws Blog “The Needs Of Children With Cerebral Palsy Need Special Consideration for Their Optimal Functioning”)  

Diagnosis of HIE usually includes a physical exam along with any of the following tests: CT scan, MRI scan, electrocardiogram (EKG, ECG), blood test, electroencephalogram (EEG), or ultrasound.  In cases of severe HIE, treatment involves resuscitation, mechanical ventilation (artificial respiration) to help with breathing, oxygen treatment, medicine to help control seizures, and treatments to help with circulation.

If your child suffered a preventable brain injury from hypoxic ischemic encephalopathy (HIE) because doctors were negligent in the delivery of your child, you may be entitled to compensation.  Please give us a call for free legal consultation today regarding your potential claim.  Our legal consultations are always free and confidential.  (888) 424-5757.

Thank you to Heather Kiel, J.D. for her work on this Child Injury Laws Blog entry.

Resources:

eMedicine: Hypoxic-Ischemic Encephalopathy

Children’s Memorial Hospital: Hypoxic Ischemic Encephalopathy

NYU Langone Medical Center: Hypoxic Ischemic Encephalopathy

Neuropathology: Cerebral Ischemia and Stroke

Pediatrics: Interventions for Perinatal Hypoxic-Ischemic Encephalopathy

Rosenfeld Injury Lawyers: Cerebral Palsy

Child Injury Laws Blog: The Needs Of Children With Cerebral Palsy Need Specia Consideration for Their Optimal Functioning

Perinatal Encephalopathy / Oxygen Deprivation At Birth

Every day in the United States, 2-3 women die from pregnancy-related complications. Obstetric hemorrhage (heavy or uncontrolled bleeding) is one of the common causes of maternal death, and it is the most preventable cause of maternal mortality.  

The average blood loss for a vaginal delivery is 500 cc of blood and a cesarean section is 1000 cc of blood.  Excessive blood loss (also known as postpartum hemorrhage) causes complications in roughly 4% of vaginal deliveries and 6-7% of cesarean sections.  97% of women who die from hemorrhaging were in a hospital, which emphasizes the need for improvements.  

Improved care for pregnant women at risk for hemorrhage and rapid access to blood products can help reduce the number of maternal deaths from obstetric hemorrhage.  An article on the management of obstetric hemorrhage cites a general reluctance to perform hysterectomies as a more likely cause of preventable obstetric deaths than poor surgical or medical skills.  

Common causes of obstetric hemorrhage include:

• Uterine atony
• Placenta previa
• Placenta accreta
• Uterine rupture

Uterine Atony

Uterine atony is the most common cause of postpartum hemorrhage.  It occurs when the uterus does not contract after delivery.  During delivery, the placenta detaches from the wall of the uterus, severing the blood vessels that supply the placenta.  This causes bleeding, which usually stops when the uterine muscles contract which compresses the severed blood vessels.  However, with uterine atony, the muscles do not contract, so bleeding continues, which can result in significant blood loss.  

Risk factors for uterine atony include:

• Prolonged labor
• General anesthesia
• Twins or multiples
• Use of oxytocin/Pitocin
• Delivery of large baby
• Abnormal labor
• Infection
• History of > 5 pregnancies

Uterine atony is diagnosed when there is a large, relaxed uterus and excessive bleeding.  The doctor will perform a physical examination to ensure that there are no tears in the cervix or vagina and that all placenta fragments have been removed.  Treatment options include massaging the uterus to help it contract and use of oxytocin after delivery.  

If these methods do not work, drugs (methylergonovine or prostaglandin) can be used to help control bleeding.  In severe cases, surgery is necessary to tie off blood vessels or perform a hysterectomy.  

Placenta Previa

Placenta previa is a pregnancy complication where the placenta grows in the lowest part of the uterus, covering all or part of the cervical opening (total, partial, or marginal placenta previa).  Then, when the cervix opens during labor, the placenta detaches, which can cause severe vaginal bleeding.  

Placenta previa occurs in one out of every 200 pregnancies and is more common in women with: large placenta (from carrying multiples), many previous pregnancies, abnormally shaped uterus, or scars in the uterine lining (endometrium).  The condition is easily diagnosed during an ultrasound in the second trimester.  The main symptom is painless, bright red vaginal bleeding.  Oftentimes, the condition corrects itself.  

Risk factors for placenta previa include: having already delivered one baby, placenta previa with previous pregnancy, previous c-section, age 35+, carrying multiples, smoker, or previous uterine surgery.  Complications include: bleeding, premature birth, and placenta accrete (placenta implants too deeply and does not spontaneously detach, which often requires a hysterectomy).  

Treatment for placenta previa depends on the amount of bleeding, the mother’s health, the fetus’ age, the baby’s health, and the position of the baby and the placenta.  If there is only light bleeding, you may be prescribed bed rest.  If there is heavy bleeding, you may be on bed rest in a hospital.  A C-section should be scheduled in order to ensure safe delivery.  

In extreme cases, where bleeding will not stop or the baby’s health is in danger, an emergency C-section is best.  Because placenta previa is often diagnosed before any problems or complications occur, careful monitoring of the mother and baby can help prevent any dangerous complications.  The most common cause of infant deaths related to placenta previa is prematurity (fetus is less than 36 weeks).  .  

Obstetric Hemorrhage

Risk factors of obstetric hemorrhage include major blood loss, shock, and death.  Hypovolemic shock is a condition where blood and fluid loss causes the heart to be unable to pump enough blood to the body, which can cause multiple organ failure.  Symptoms of shock include: anxiety, confusion, weakness, rapid breathing, cool/clammy skin, pale skin color, sweating, and unconsciousness.  Treatment includes replacing blood and fluids via an IV line. Medications can also be given to help increase blood pressure.  Complications include: brain damage, heart attack, kidney damage, and gangrene.  

When a woman suffers from obstetric hemorrhage, the doctors have to monitor both the mother’s health and the baby’s health.  If the doctors cannot get the bleeding under control or if the baby is in distress, doctors might have to perform an emergency C-section.  Then, if they still cannot get the bleeding under control, a hysterectomy might be required in order to save the mother.  

If you or your child suffered injury because of your doctor’s negligence in not monitoring or delay in delivery, please give us a call for free legal consultation today regarding your potential claim.  Our legal consultations are always free and confidential.  (888) 424-5757.

Resources:

ObFocus: Obstetric Hemorrhage
Medical Dictionary: Placenta Previa
NCBI: Placenta Previa
Mayo Clinic: Placenta Previa
Medline Plus: Placenta Previa
PubMed Health: Hypovolemic Shock
Medline Plus: Hypovolemic Shock
PubMed; Uterine Atony
American Pregnancy Association: Placenta Accreta

The Bayonne Medical Center (New Jersey) settled a medical malpractice case with the family of a severely brain-damaged son for $8.5 million.  

The mother, Emily Ordonez, was 32 years old when she went into labor on August 14, 2005.  Ms. Ordonez went to the hospital at 1:30 am, when she first experienced labor pains.  The prenatal tests indicated a healthy baby and pregnancy.  However, at 9:32 am, the heart monitor indicated that the baby’s heart rate dropped from 140 beats/minute to only 60 beats/minute.  

The delivery room nurses waited half an hour before calling the attending obstetrician, who arrived 22 minutes later.  Then, the doctor waited until 10:55 am to start the emergency cesarean section, despite the baby’s low heart rate.  The reason for the low heart rate was that the umbilical cord was compressed, which resulted in the baby not receiving adequate oxygen.  (See Child Injury Laws - “The Needs of Children with Cerebral Palsy Need Special Consideration for Their Optimal Functioning”)

As a result of the delayed actions by the nursing staff and the doctor, the baby suffered permanent brain damage.  The child, José Ordonez, is now five years old and requires full-time care because of his brain injury.  José cannot see, walk, hold his head up on his own, and is prone to seizures.  While the settlement will not do anything to reverse the injury that the boy and his family suffered, it will provide $6 million for future medical care and needs and $2.5 million for the family’s emotional pain and suffering.  

José’s parents provide him with 24-hour care and also take him to Concordia Learning Center at St. Joseph’s School for the Blind.  The school has helped the boy improve his cognition and recognition capabilities.  In cases of cerebral palsy, early diagnosis and treatment of the condition can help improve the child’s capabilities.  

If your child suffered a birth injury because the doctor or nursing staff committed medical malpractice, you may be entitled to compensation.  (See Child Injury Laws “Birth Injuries”) Medical negligence cases such as these, involving severe and permanent brain injury, can cause a serious emotional and financial burden.  If you want to discuss your case, please give us a call for free legal consultation at (888) 424-5757.

Thanks to Heather Keil, J.D. for her work on this Child Injury Laws entry.

Resources:

New Jersey Local News: Bayonne family accepts $8.5 million to settle medical malpractice suit over boy’s brain damage during birth

Child Injury Laws: The Needs of Children with Cerebral Palsy Need Special Consideration for Their Optimal Functioning

Child Injury Laws: Birth Injuries

Medicine Net: Childbirth Complications

Cerebral Palsy Lawyers FAQ: Medical Malpractice Lawsuits

Diagnosing Cerebral Palsy

After the frustration, depression and anger goes away, many parents of children with birth injuries find themselves facing a never ending question:

How will I ever pay for the care my child requires?

The expenses related to the care of any child today can be daunting.  However, when it comes to the expenses related to the care of a child with a disability, such as cerebral palsy, the expenses for care are downright alarming.  In addition to regular doctor visits, many children with CP face a lifetime of future expenses related to:

• Specialized medical equipment
• Altered vans to accommodate wheelchairs
• Doctors visits
• Medication
• Specially designed homes
• Trained caregivers
• Specialized physical therapy

In the circumstances where a child's cerebral palsy can be traced to a medical error during the birthing process, the family may be entitled to recover the above expenses as part of the damages in a medical malpractice lawsuit.  In most medical malpractice lawsuits involving birth injuries, lawyers representing the child will retain experts in the fields of long-term medical needs and economics to help a jury in understanding what the needs may be.

A prime example of the future medical expenses for a disabled child

Speaking of significant expenses related to future care, a Connecticut jury recently awarded a boy suffering from cerebral palsy and his family $58 million in damages in a lawsuit against a doctor and hospital who were slow to perform a critical cesarean section procedure that resulted in extended oxygen deprivation.  Eight years later, the boy suffers from the episodes of seizures and impaired brain development.

While this record setting verdict is impressive for its shear magnitude, it is important to remember that much of the proceeds will be held in a trust for the boy to provide the necessary care for him over the course of his life. 

As a medical malpractice lawyer, I frequently use expert witnesses such as a life-care planner and economist to help a jury get an accurate grasp of the types of needs my clients are likely to require for the rest of their lives. 

The life-care planners that I use are board-certified doctors who have received specialized medical training regarding the vaious needs of disabled and injured people.  Life care planners  can calculate the future needs of my clients for all aspects of their lives including: medical needs, recreation, specialized medical equipment and the physical accommodations that may be necessary for their homes or vehicles.

Once a care-plan has been created, an economist can use the report to calculate both the lifetime costs associated with the care plan as well as the present cash value of the expenses.  When calculating the present cash value, economists will look at the historical rates of return on conservative investments (such as Treasury Bonds), to determine the amount needed to invest today to provide for the needs of the individual over the course of his or her life.

Certianly, given the important role experts play in the litigation process, I think it is always a good idea to get experts involved in the early stages of the case so they can become familiar with both the individual as well as the opinions of treating doctors.

Related:

Breakdown In Communications To Blame For Birth Delivery Complications In Mom And Baby

Delay In Performing C-Section Results In Baby's Brain Damage & Costs Doctor $3 Million

Lifetime Financial Benefits for Cerebral Palsy

The Needs Of Children With Cerebral Palsy Need Special Consideration For Their Optimal Functioning

Financial and Time Costs to Parents of Severely Disabled Children (PDF) By BARBARA LEONARD, RN, PhD;

JANNY DWYER BRUST, MPH; JAMES J. SAPIENZA, MA, MHA, MBA

Jury Awards $58 Million In Malpractice Suit, NBC Connecticut

Cerebral Palsy Support Groups

Promising new research is now being conducted at European Universities that may help the medical communities gain better appreciation for the real cognitive abilities of children with neurological impairments such as cerebral palsy.

In the past, researchers have had a difficult time assessing children with CP due to the fact that many of the traditional testing methods were impractical for due to restricted speech and movement.

Now, specialized computer software combined with electroencephalography (EEG) headsets, is being utilized to more accurately measure the skill-sets of those suffering from mental or physical disability.  In addition to the new cognitive skills measuring technique, researchers are hopeful that the technology may similarly be used to help disabled children communicate.

Certainly, research such as this is incredibly valuable and may ultimately improve the quality of life for all children and adolescents afflicted with neurological conditions.

Related Child Injury Law Blog Entries:

The Needs Of Children With Cerebral Palsy Need Special Consideration For Their Optimal Functioning

Medical Facilities Concentrating On Assisting Children With Cerebral Palsy

Cerebral Palsy Treatment

A truly horrific pattern of emergency room care is being alleged in a medical malpractice lawsuit filed against a California hospital and various doctors who assisted in the care of a young girl.  

The lawsuit alleges that staff at the Methodist Hospital in Sacramento, CA were negligent in responding to the medical needs of the young girl who's parents took her to the emergency room with complaints related to progressive: fever, skin discoloration and overall weakness.

After waiting in the emergency room for more than five hours, the girls condition progressed to the point where she began to lose consciousness.  Turns out, the girl had streptococcus A, a bacterial infection that quickly took over the girls entire body.

The family blames the delay in providing medical treatment at the emergency room resulted in the amputation of the girls hands and feet.

I wish this girl the best as she faces an obviously long road of recovery and physical therapy.  Nonetheless, I anticipate that this lawsuit will still be vigorously defended as the hospital will surely argue the the delay in treatment was not the proximate cause of this girl's injuries--- that the delay was not the cause of her current condition.

We will certainly keep our Child Injury Laws Blog readers updated as this medical negligence lawsuit proceeds. 

When you become aware of an injury to your child, you should obviously get medical attention as soon as feasible.  After your child's condition has stabilized, it is important to get into ‘fact collection mode’.

In fact collection mode, you are beginning to collect information about the incident, and they type of injuries your child sustained.. Doing some preliminary work early on, will help ensure valuable evidence is protected to maximize the chances of a successful recovery on your child's behalf.

While you may suggest that your child's situation is so vivid that you will never forget-- don’t assume you will remember all the facts. As time goes on, your memory will begin to fade. The following steps will help you organize your thoughts during a stressful time and to give an attorney the information he needs to work best on your behalf.

Despite the urge to block out the unpleasant facts and circumstances leading to an injury, much of the information listed below should be obtained as soon after an incident as feasible. The following information will prove to be valuable in both assessing the facilities responsibility and potentially as evidence to be used at trial.

1) Take Photographs

Take pictures of the physical injuries themselves, the area where the incident took place and if possible, the people or instrumentalities involved. In cases involving particularly gruesome medical conditions no medical record can do justice to what your child experienced. Use a real camera as opposed to a camera-phone as the photos will be better quality.

Similarly, is is a good idea to take photos of the equipment / defective condition where your child was injured as many defective machines / conditions are repairs soon after an incident.

2) Take Some Notes

You don't need to write a novel or minute-by-minute diary, but write down as much information about the incident or events as you can remember. Write some more. Details can be particularly helpful in the course of litigation as your child may not be able to appreciate many of the specifics. Concentrate on: names, locations, times, conditions, doctors names, and medications.

3) Keep a copy of the incident report / police report

An incident report completed following an incident may be offered to you following an event where a child was injured. If it is offered to you, keep a copy as many reports may not be available in the future without order of a court.  Frequently, incident reports are particularly important because they will include details and statements made soon after an incident.

4) Request a copy of your child's medical chart

The medical chart from doctor and / or hospital is crucial to determining what a facility may have done or failed to do that resulted in injury or death to your child. If your child sustained an injury that resulted in subsequent medical care at a hospital, these records will be important as well.

5) Put together a chronology

This does not need to be one’s life story. However, if a condition developed over time or there were multiple treaters, it is important get the correct names and general dates of admission at health care facilities. The names of doctors who provided medical can be helpful as well.

6) Save the physical evidence of your child's injury

Of course, no one wants the physical reminders of a horrific event-- a bike accident, dog bite or other similarly graphic incident.  Nonetheless, all things related to the incident-- your child's clothes, shoes, bills...bike, are indeed important evidence that may prove to be very important at a later date.

7) Get medical attention

Don't just take your child to a doctor or clinic because your neighbor says so. However, if your child is injured in an incident it is absolutely crucial-- both for their own physical well-being as well as well as from a legal perspective to seek timely medical care.  Seek out specialist when needed as they are frequently in a better position to diagnose-- and treat medical conditions.

Don't get discouraged.  While the above steps can be important towards preserving important materials related to your child's personal injury case, they may not be feasible in all circumstances.

An experienced child injury lawyer will be able to sort through the materials and determine what information is relevant to your case. Further, a law office that regularly handles personal injury and medical malpractice cases involving children should be able to access much of the above information with the use of properly executed medical authorizations. Meeting with an attorney soon after an incident will provide the best opportunity to secure information relevant to your child's case.

I receicve many inquiries from parents of injured children who are concerned both about the long-term impact of injuries on their children--- and how to go about seeking legal recourse from the party that may have caused the injured.  While the medical implications of an injury are indeed best suited for a physician to address, to potential legal redress may be evaluated by an attorney experienced in personal injury law.

Few relationships have such an alignment of interests as an attorney / client relationship in a personal injury context.  Under a contingency fee payment plan, the financial interest of client and lawyer and completely aligned. Simply put, a contingency payment is a payment based on a recovery for the injured person. In a contingency fee arrangement, the attorney receives no payment until the lawsuit is tried to verdict or settled. After all the work has been done, the attorney receives a percentage of the recovery.

The percentage of the recovery a lawyer charges is dependent on the type of case and the complexity of the matter. Nonetheless, the exact percentage should be agreed upon in writing soon after the retention of the lawyer.

In all cases there is a chance there will be no recovery--the case may not have merit or the defendant goes bankrupt, ect.. Under a contingency fee contract, if the lawyer does not win the case then the client will not be required to pay a fee. The client is not responsible for paying the lawyer for any of the time he spent on the case.

The ability to collect a percentage of the settlement or judgment provides a solid incentive for a lawyer to best serve a client. After all, the potential financial reward of getting the highest settlement benefits the attorney and the client equally. So, the attorney will not perform at anything less than his or her best because there is a huge incentive for successfully litigating the case.

Rosenfeld Injury Lawyers, consistently handled personal injury matters on behalf of injured individuals-- never corporations.  Our experience handling cases on behalf of children and other particularly vulnerable people has earned us a reputation in the medical and legal communities as the type of lawyers who will go the distance for their clients.

A recently filed birth injury lawsuit alleges that an Illinois hospital and attending doctor are to blame for the brain injury to a child during the delivery process.  

In the medical malpractice lawsuit, the child's parents allege that their daughter was born with hypoxic brain injury due to the negligence of physician and hospital staff during the delivery process.

Specifically, the medical malpractice lawsuit accuses the hospital and doctor of rupturing membranes in the child's head during the delivery process and further inadequate care by failing to timely perform a C-section when the vital signs indicated that the infant was in distress.

As a result of the birth injury, the girl faces a lifetime of pain, deminished earning capacity, medical expenses and educational needs.  The lawsuit is pending in St. Clair County Circuit Court.

Hypoxic Brain Injuries In Babies

Oxygen deprivation or hypoxia, typically occurs as a complication of birth. For example, if the umbilical cord becomes trapped between a baby's head and the wall of the uterus, pressure on the cord may cut off the baby's oxygen supply. Hypoxia may also result from blood loss, perhaps when the placenta tears free of the uterine wall or the uterus ruptures. Blood loss or hypoxia at birth may lead to hypoxic ischemic encephalopathy (HIE), a condition experienced by 1 in every 1,000 newborns.

When an infant has received inadequate supply of oxygen during labor or delivery, it may cause brain injury, confirmed by less electrical activity in the brain or brain wave analysis. A lack of oxygen at birth can result from a ruptured uterus, placenta which receives oxygen, nutrients, antibodies and hormones from the mother's blood and passes out the waste.

Another cause of HIE is when the umbilical cord wraps around the infant's neck and cut of the supply of oxygen or suffer hypoxic damage. Infants that survive can have long lasting disabling complications, such as cerebral palsy where a child has trouble controlling the muscles of the body, and may not be able to walk, talk, eat, or play. Hearing and speech problems may require the child to receive treatment by a speech therapist.

As scientists look for continually look for new treatment or therapy options, currently there is little medical treatment available to reverse this damage or prevent this damage from occurring, except only to place the infant on a respirator and give medicine to support blood pressure and other functions.

Related:

The Needs Of Children With Cerebral Palsy Need Special Consideration For Their Optimal Functioning

What are the signs of brain injury in newborns?

Parents sue doctor over child's brain injury suffered at birth, The St. Clair Record January 18, 2011

Birth Asphyxia: A Doctor's Delay, A Lifetime Of Medical Complications

Medical Malpractice Lawsuits

Delay In Performing C-Section Results In Baby's Brain Damage & Costs Doctor $3 Million

A really heart-breaking story involving a teenager who died during a routine medical procedure at UCLA Children's Hospital caught my eye as it appeared in the LA Times.  The article discusses how 17-year-old Olivia Cull went to UCLA for an outpatient heart procedure that required a catheterization.

The procedure went wrong and the young woman wound up going without oxygen for approximately 40 seconds which resulted in a brain injury.  Eight days after the incident, the girls parents elected to withdraw the life-extending medical care, allowing the girl's body to shut down on its own. 

An autopsy performed by the hospital concluded that the girl's brain damage resulted from a heart attack that was precipitated by a congenital heart defect.

Suspicious of how an outwardly healthy girl could suffer such a drastic injury during a routine medical procedure the family sought information on the details surrounding the procedure itself and the role treating doctors may have had in the outcome. 

The family soon found that despite the suspicious circumstances surrounding the incident, most medical malpractice lawyers were not interested in investigating the case due to the fact that medical malpractice caps in California severely limit an injured parties right to recover as well as the fees attorneys can earn on such cases.

With the assistance of a pro bono attorney and a fierce sense of determination, the family was able to determine that the post-doctoral fellow who treated their daughter removed the girl's catheter without doctor's supervision and another fellow who provided treatment was not cleared by the hospital to treat patients.

After the obvious lapses in patient care were brought to light, the hospital did agree to make changes in their policy to avoid similar errors including:

• Adding disclaimers to patient consent forms to clearly distinguish that patients were to be treated by physicians in training
• Changes in the way doctors remove patients catheters
• Clearly document patient heart rates during procedures

Though I truly admire Mr. & Mrs. Cull's dedication to uncovering the truth, I imagine there are many, many similar cases that go un-prosecuted because the caps on medical malpractice cases make prosecution of negligent events impracticable. Moreover, with the limited threats of a judgment against medical facilities and physicians, I fear that children thrust into similar situations as Olivia Hull will continue to face ongoing dangers related to negligent medical care.

Related:

Parents assail malpractice caps after daughter's death at UCLA hospital By MOLLY HENNESSY-FISKE

Let's Stick To The Facts About Healthcare Reform & Medical Malpractice

As Congress Debates Health Reform Measures, Some Still Want To Strip Injured People Of Their Legal Rights

As if going to the hospital for a surgical procedure wasn't stressful enough, a recent study on surgical errors confirms that doctors and hospital staff are responsible for as many as 40 surgical errors on patients every week.  Many the surgical errors involve: 

• Operating on the wrong body part
• Doing the wrong procedure
• Operating on the wrong side of the body
• Operating on the wrong patient.

Collectively known as wrong-site surgeries, the conclusions were reached after an analysis completed by the Joint Commission Center for Transforming Healthcare, an agency that accredits more than 19,000 health care facilities across the country.

The underlying reasons for the surgical errors blame doctor and staff errors such as:

• Inaccurate documentation 
• Scheduling errors
• Distractions during hospital admission and surgery
• Failure of staff to adhere to risk reduction procedures

Complacency with patient safety protocols is a significant factor in the prevalence of these surgical errors according to the Joint Commission president Dr. Mark Chassin.  

They're so uncommon that an individual surgeon or individual hospital ...may not have experienced one of these in the recent past.  As a result, they may not recognize the importance of following standardized safety procedures correctly and consistently with every patient.

Acknowledging the severity of wrong-site surgical errors, some medical facilities have implemented safeguards such as: reviewing patient identity, lab work and surgical markings by multiple staff members before a surgery is initiated.

As a medical malpractice lawyer, I am always shocked at how the failure to follow many of the most basic safeguards are responsible for patient injury.  If such drastic surgical errors are made with respect to basic patient care, I cringe to think of the problems that may arise when patients require more complex medical procedures.

Read more about this patient safety study here.

Forceps are a tool available to doctors to assist with the delivery of babies in circumstances where the anatomy of the mother or positioning of the child requires assistance for a vaginal delivery.  In most situations where forceps are used, the doctor encountered some difficultly during the delivery process to necessitate utilization of this tool. 

While there indeed may be a sense of urgency to extract the baby, doctors need to be mindful of the dangers that can ensue when forceps aren’t used carefully and with a sure hand. 

Though uncommon, the aggressive use if forceps by doctors during delivery can result in serious injury to the baby.  The added leverage and force put upon the child with forceps may result in injury to the neck or spinal cord.

A birth injury lawsuit was recently resolved in which a boy’s spinal cord was catastrophically injured by a doctor delivering him who used forceps to extract the boy during pregnancy.  Paralyzed from the neck down, the boy requires a ventilator and other types of assistance. 

Now 10-years-old and with profound physical disabilities, the lawsuit alleged that the doctors aggressive use of forceps were to blame for the spinal cord injury.

Much of the undisclosed birth injury settlement will be used to pay for the significant medical expenses that the boy has required since birth and will require for the rest of his life.  Unlike most birth injury settlements, where settlements are made in a lump sum fashion, the terms of the settlement state that the hospital will make yearly payments to ensure that there is adequate funds to pay for the  medical care for the remainder of the child’s life.

Resources:

Damages for by paralysed due to forceps delivery BBC News, June 16, 2011

Kielland's forceps- association with neonatal morbidity and mortality (pdf) British Medical Journal, 1979, 1, 7-9

What does cephalohematoma indicate in a newborn baby?

Healthpages.org: Birth Injury & Trauma

Can the rough handling of forceps during delivery lead to neurological injury?

Learning about childbirth and talking to the doctor can help address any anxieties or concerns that parents may have.  

In most cases, labor progresses normally, but problems and complications can occur.  Umbilical cord compression is one possible complication that can lead to serious injuries.  

During labor, the umbilical cord can become stretched and compressed, which can result in a decrease in blood flow.  This can cause periodic changes in fetal heart rate (variable decelerations).  

Fetal heart rate monitors can usually detect these abnormalities, so doctors can monitor the fetus for any serious problems.  (See Child Injury Laws – “The needs of children with cerebral palsy need special consideration for their optimal functioning”)

Cord compressions are actually pretty common, occurring in about one in ten deliveries. Most times the umbilical cord straightens out and the fetus does not go through any real distress.  However, if the fetus shows signs of distress such as decrease of fetal blood pH or heart rate worsens, an emergency cesarean section might have to be performed.  

In one unfortunate case, a Florida couple’s son died when he was three years old after a brain seizure.  The boy suffered serious and permanent brain injury during delivery when his umbilical cord wrapped around his neck, cutting off his blood supply.  

The couple filed a medical malpractice claim in 2005 where they were awarded $60.5 million to provide medical care for the child over his lifetime.  Their child could not sit, speak, or eat and required constant care including a feeding tube.  The baby’s injuries could probably have been prevented if doctors were monitoring the fetal heart rate to look for signs of distress.  (See Child Injury Laws “Delay in performing c-section results in baby’s brain damage & costs doctor $3 million”)  

If your child suffered an injury during delivery, we would honor the opportunity to speak with you for a free case evaluation.  

Thank you to Heather Keil, J.D. for her assistance with this Child Injury Laws Blog entry.

Sources:

Medicine Net: Childbirth Complications

Chicago Birth Injury Lawyer Blog: Couple Awarded $10.2 Million for Wrongful Death Lawsuit

Pub Med: Umbilical cord compression associated with amniotomy – laboratory observations

Pub Med: Regional cerebral blood flow changes during severe fetal asphyxia produced by slow partial umbilical cord compression

Why is umbilical cord compression a concern for the fetus?

Pub Med: Amnioinfusion for umbilical cord compression in labor

Child Injury Laws: Delay in performing c-section results in baby’s brain damage & costs doctor $3 million

While prescription drugs may be an invaluable tools in the practice of medicine-- and can be used to treat numerous illnesses and diseases-- prescription errors can cause serious injury and death.  About 1.5 million preventable adverse drug events occur every year in the U.S.

Pharmaceutical malpractice may occur in the following circumstances: 1) when a doctor prescribes the wrong medication or incorrect dose or 2) when a pharmacist fills the wrong medication or dosage. The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) defines a medication error as:

A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use.

Pharmaceutical errors can result in serious health complications including:

• Allergic reactions
• Organ damage caused by an overdose
• Infection
• Stroke
• Heart failure
• Death. 

Knowing the serious nature of even the most modest pharmaceutical errors, doctors and pharmacists must follow strict regulations in order to prevent mistakes. In Illinois, the Pharmacy Practice Act (225 ILCS 85) regulates the practice of pharmacy in Illinois-- and importantly sets for practice guidelines to protect the public.

Though there are many different types of pharmaceutical errors, common problems include:

• Incorrect labelling
• Adverse drug side effects
• Incorrectly filling a prescription
• Filling medication with wrong medicine
• Failing to screen for incorrect drug reactions
• Improper instructions regarding usage

Some prescription medications have serious side effects that should be considered before taking them-- particularly in situations involving children. The doctor prescribing your medication should consider the pros and cons of prescribing the medication as opposed to leaving the condition untreated or prescribing a different medication. Further, the physician should take all factors into consideration including the child's height, age, and body weight.

When prescribing a drug with serious side effects, the doctor should consider the child's full medical history and information to determine whether the child can handle the side effects. Also, when filling a prescription order, pharmacists have a duty to advise you about any side effects that might accompany the use of the prescription medication as the side-effects may vary drastically by age.

Incorrect Prescription

Pharmacy errors  / medication errors can result when there is a miscommunication of drug orders during the time the medication is prescribed and when it is ingested by the individual. While the reasons why the incorrect medication was given, can vary drastically, common problems may be traced to: poor handwriting, pharmacist confusion between drugs with similar names, misuse of zeroes and decimal points, confusion of metric and other dosing units, wrong dosage for the age of the patient and inappropriate abbreviations. 

In order to prevent medication errors / pharmaceutical errors, doctors (and their staff) must take reasonable care in correctly and accurately writing prescriptions. One way to reduce the chance of prescription errors is to use electronic prescriptions, removing the risk of errors associated with poor handwriting. However, mistakes can still occur when a doctor types in the wrong prescription order. Therefore, doctors should take extra care when prescribing medications to ensure that no transcribing errors have occurred.

Medication errors can also occur when doctors take incomplete patient information. For example, the doctor might not know about the patient’s allergies, any other medications the patient is taking, previous diagnoses, and lab results. Doctors perform best when fully informed about the patient’s history and information. Doctors should ensure that they have a patient’s complete and up to date information before prescribing medication, in order to cut down on medication errors.

Incorrect Labeling Of Drug

Pharmacists must ensure that medications have correct labels before selling them to patients. Prescription medication labels should include:

• Name of the drug
• Dosage 
• Time of day to take the medication
• Warnings while taking the drug. 

Catastophic problems may arise when prescription medications are labeled incorrectly, you may end up taking the wrong drug, the wrong dose, the wrong time, or be unaware of warnings about what foods, beverages, or activities to avoid while taking the drug.

Particularly with children, even minor variances when taking medication may result in serious complications including liver or kidney damage or death or not receiving the full benefit of the drug’s intended purpose.

Even when pharmacists include the correct information on the label, they should go over the recommended dosage, procedures, and warnings to ensure that you understand how to safely and correctly take the medication. This is especially important with younger children who may process the drug substantially diffferent than an adult. 

Incorrect Dosage of Phamaceutical Drugs

Prescription medications  usually have more serious dangers associated with them than over the counter (OTC) drugs. Therefore, it is important that pharmacists issue the correct drug (the one the doctor prescribed) at the correct dose.

Errors in filling prescriptions can result from similar-looking pills, difficult to read physician handwriting, and rushed work at pharmacies. Pharmacists must exercise reasonable care when filling each and every prescription order to ensure that you receive the highest standard of care and avoid patient injury and death due to incorrect dosages of the medication

In Illinois, registered pharmacy technicians may, under the supervision of a pharmacist, assist in the dispensing process, offer counseling, and receive new verbal prescription orders (225 ILCS 85/9 – Registration as pharmacy technician). Depending on the pace of business at the pharmacy, these pharmacy technicians might not receive proper supervision to ensure the highest standard of care-- particularly when filling medication for children or infants.

Even slight errors related to improper dosage can also cause serious medical complications in children, either because you take too much or too little of a drug or even taking the wrong drug. 

Adverse Drug Interactions

Sick children may be required to take multiple prescription medications, which are commonly prescribed my multiple doctors. However, problems can occur because the doctors prescribing these medications might not know about the other drugs your child is taking.

This can lead to serious complications stemming from drug interactions. Drug-drug interactions are not the only type of potentially dangerous drug interactions; there can also be drug interactions with foods, beverages, individual allergies and dietary supplements.

Three main types of adverse drug interactions include:

• Drugs with food and beverages
• Drugs with dietary supplements
• Drugs with other drugs

Drug interactions can reduce the effectiveness of drugs, cause unexpected side effects, or increase the action of a particular drug. Drug interactions with food and beverages might result in delayed, decreased, or enhanced absorption of a medication. Dietary supplements can also cause a variety of drug interactions.

The rate of adverse drug reactions increases significantly when a patient is on four or more medications. This is especially worrisome because almost 40% of Americans receive prescriptions for four or more medications.

Pharmacists filling prescriptions issued by multiple doctors are in the best position to detect and prevent adverse drug reactions.  In order to avoid problems with drug interactions with your children it is usually suggested to use one pharmacy for all of your medications and keep a record of all prescription drugs, over the counter (OTC) drugs, and dietary supplements that you take.

Physician & Pharmacists Duty To Use Reasonable Care To Protect Children

Pharmacists and doctors have a duty to exercise reasonable care in prescribing and filling prescription drugs. When this duty is breached, serious injuries and even death can occur.

Children are particularly susceptible to injuries stemming from pharmaceutical medication errors because many older adults take multiple medications. Furthermore, many already ill children may see multiple doctors for specialized care to treat specific injuries or illnesses.

The increased number of prescription drugs and multiple drug providers can increase the likelihood for a pharmaceutical error. Children are also less able to prevent pharmaceutical errors because they may be unable to read or comprehend  the labels and warnings on warning labels and they take medication at school or camp--- away from parental supervision.

If your child has suffered injury because of a pharmaceutical error, you may be entitled to bring a pharmaceutical malpractice medical malpractice claim against the pharmacist, pharmacy or doctor involved.  Lawyers experienced in handling pharmacy error matters can help determine who the proper parties may be.

Poor communication probably accounts for a fair number of arguments amongst my wife and myself. However, at the end of the day, our miscommunication usually accounts for nothing more than the wrong brand of bread retrieved from the the grocery store or perhaps a delayed dinner.

However, in the medical field basic miscommunication can have disastrous consequences for young and old patients alike.  In perhaps a medical communication breakdown for the record books, an English couple is blaming a communication meltdown between hospital staff for a significant delay in the delivery of a baby that resulted in serious injury to both the moth and infant.

Like many late-term mothers, Jennifer Kennedy arranged to go to her local hospital for a scheduled delivery where doctors would delivery the baby via cesarean section.  Forty weeks pregnant, Ms. Kennedy arrived at the hospital as was told the doctors would perform the procedure within two hours.

Soon after Ms. Kennedy's arrival, there was a shift change for her attending nurses and physicians.  Apparently, the game plan was not communicated to the fresh staff.  

Things turned drastically wrong after the the staff failed to timely perform the scheduled c-section.  More than twelve hours after the c-section was intended on being performed, Ms. Kennedy's babies heart stopped and her uterus had ruptured.

A crash cesarean was performed to save both mother and baby.  However, the delay in performing the c-section is believed to account for depriving the baby of oxygen for an extended period and for causing severe bleeding in mother.  After delivering the baby, doctors had to resuscitate the baby in order to get its heart beating.

The failure to timely perform the c-section is believe to have caused the oxygen deprivation in the baby and resulting brain damage.  According to Ms. Kennedy,

The worst thing about all this is that he was a perfect little baby until that day in the hospital.  Now he has brain damage and will need constant care.  He doesn't deserve that.  We did all that was asked of us and we were let down by the people you're meant to trust.  It's hard to deal with.

While the above may have occurred overseas, the scary fact remains that similar delivery horror stories still happen in the United States.  Therefore, as a lawyer who represents families in matters relating to birth injuries, I feel strongly about taking the depositions of all medical personnel associated with the event.  In many circumstances we learn that simple communication breakdown is at the heart of the problem.

Just last month, the FDA issued some fairly impressive warnings regarding women's use of Topamax during pregnancy.  In fact, the FDA re-categorized the drug from a Category C- Pregnancy Drug to Category D-- an important reclassification due to the scientific evidence linking Topamax usage with birth defects.

Like other drugs categorized as a Class D, the FDA has conclusively established the use of Topamax with "human fetal risk based on adverse reaction data from investigations or marketing experience or studies in humans."  However the FDA's Class D warning goes on to say that even with the known risks, the use of the drug may be acceptable if the pregnant woman has a medical condition that threatens her life.

In particular, Topamax has been associated with birth defects such as:

• Cleft lip
• Cleft palate
• Heart defects
• Facial deformities
• Deformed limbs

While some of these Topamax birth defects, appear to have been known by the medical community years before the stern warnings, I find it particularly troubling that an added side-effect of Topamax usage is the ineffectiveness of oral contraceptives taken by woman to avoid becoming pregnant.  

A study published in 1996, the same year the FDA approved Topamax for treatment for partial onset seizures, indicates that seizure medications-- such as Topamax may substantially increase the likelihood of a woman becoming pregnant while she is on birth control.

The net result of this important information is that many woman were likely taking Topamax before they knew they were pregnant in the first place.  Given the nature of fetal development, it is likely that many of the facial malformations and cleft palates are due to the mother taking Topamax during the vital first trimester when many of these features form.

As we begin the process of learning just how much Ortho-McNeil and other generic manufacturer had about this drug, I believe the drug's impact on the effectiveness of women's birth control medication will prove to be important as women begin to disclose the fact that they may never have intended to give birth to a child with birth defects.

Rosenfeld Injury Lawyers is in the process of evaluating Topamax (and generic equivalents) cases.  Please use our contact form or call us and we will return you call promptly. 

Related:

Effect of Topiramate on the Pharmacokinetics of an Oral Contraceptive Containing Norethindrone and Ethinyl Estradiol in Patients with Epilepsy.pdf By William E. Rosenfeld, Dennis R. Doose, Sally A. Walker, and R. K. Nay Epilepsia, 38(3):3 17-323, 1997

New FDA Warnings Suggest Correlation Between Topomax And Birth Defects Including: Cleft Lip & Cleft Palate

A recent study completed by researchers at University of California, San Francisco determined that black infants have higher rates of cerebral palsy than other nationalities. The study is one of the first large-scale evaluations of infants born with low-birth weights and diagnosis of cerebral palsy.  

Head researcher Dr. Yvonne Wu, lead a team that evaluated medical records from 6.2 million children born in California between 1991 and 2001.  After analyzing the data based upon children with cerebral palsy severe enough to qualify for state services, the study compiled the following:

• 8,400 of the 6.2 million children evaluated in the study were diagnosed with cerebral palsy
• Of the 8,400 babies born with cerebral palsy: 758 were black,  2,878 were white, 3,963 were Hispanic and 656 were of Asian descent
• Black infants were about 30% more likely than white infants to have cerebral palsy
• Low birth weights drastically increased the likelihood of a child with cerebral palsy

Though the study didn't necessary reach any physiological conclusions for the racial disparities, researchers suggest that the frequency of pre-natal care and educational levels of the parents may be at least partially to blame for the increased cerebral palsy rates.

Clearly, more medical research is needed in this important area that effects children of all races and nationalities.  If your child has been diagnosed with cerebral palsy or is just developing 'slowly', we would honor the opportunity to speak with you for a free case evaluation.  Many cases involving cerebral palsy or 'slow development' are traceable to physician or hospital negligence.

Related:

Prenatal Events and the Risk of Cerebral Palsy in Very Low Birth Weight Infants — Am J Epidemiology (PDF)

Medical Facilities Concentrating On Assisting Children With Cerebral Palsy

Blacks' higher cerebral palsy risk, birth weight tied, Neurology February 22, 2011

The Needs Of Children With Cerebral Palsy Need Special Consideration For Their Optimal Functioning

Years ago, the treatment options for children with cerebral palsy were incredibly limited. Today, there is an increased understanding of the condition and the specific treatment needed to provide the most significant impact for children with CP. 

The Center for Independence through Collective Education is part of a new generation of treatment facilities specifically geared towards helping children with cerebral palsy.  Children at the center receive various types of therapies to help them live as normal a life as possible.

Currently, the Northern Illinois facility serves 12 children living the the Chicagoland area with hopes of growing to accommodate a significant void for children with similar disabilities who don't currently have access to specialized treatment.  

Utilizing conductive education, a program developed by Hungarian researchers in the 1940's, the program focuses on using techniques to re-train the brains of children. The Center utilizes the expertise of: physical therapists, occupational therapists in conjunction with other therapeutic modalities.

Not surprisingly, the costs for these treatments can be significant. In an effort to offset the expense and expand the service to a larger group of children, the Center for Independence through Education is holding its 5th annual fundraiser on March 4th.  For more information call (847) 401-2995.

Cerebral Palsy In Children

Unlike many medical conditions afflicting children that may be due to genetic defects, cerebral palsy is a condition that may be traced to an injury to the brain.  Many scientists now believe the brain injury is due to a lack of oxygen immediately prior to and during the birthing process.  A diagnosis of Cerebral Palsy is usually made during the formative years.  

Though the extent of disability associated with Cerebral Palsy varies significantly from child-to-child, most children require a good deal of intervention to assist in learning basic developmental skills such as eating, dressing and using the toilet.

Rosenfeld Injury Lawyers represents families in cerebral palsy due to trauma at birth.  If your child has been diagnosed with cerebral palsy, call us today and talk candidly about your concerns.  All legal consultations are free and completely confidential.  Why not begin the process today and secure your child's future? 888-424-5757

The father of a 2-year-old boy who suffered a brain injury during a recent heart surgery is seeking answers about how his son could have suffered the injuries he did.  The father believes the boy was injured during the cardiac catheterization process, when his artery was ruptured.

Currently, the boy requires round-the-clock care and remains in the hospital for care.  In an effort to find out more information about what may have gone wrong, the boy's father is seeking assistance from the state's Department of Health as well as information from the hospital's own investigation into the matter.

My heart goes out to this little boy and his family.  As a lawyer who has works on medical malpractice cases involving children, I hope the family gets the answers they are looking for.  However, I remain somewhat skeptical that the family will receive unbiased and accurate information from the medical facility itself.  

As we find with many medical malpractice cases, the real reasons why an incident may have occurred will always remain somewhat of a mystery.  However, independent physicians can really help provide answers that the family is desperately seeking and can similarly advise if the case is such that a medical malpractice lawsuit is warranted.

If indeed the reviewing physician believe there to be a deviation from the acceptable medical protocols, the family may be able to pursue a medical malpractice lawsuit against the responsible physicians and hospital. 

While medical malpractice cases can be difficult for both the family and lawyers involved, pursuing responsible parties can help a family cope from with the mental anguish and future medical expenses related to their child's care.

Related:

Children's hospital defends risky procedure that left boy damaged The Seattle Times, October 7, 2010

Cerebral palsy is a group of neurological disorders usually caused by brain abnormalities early in development.  The disorders affect muscle coordination and body movement.  Most children are born with cerebral palsy, but symptoms may not be detected until months or years later.

There are three types of cerebral palsy:

• Spastic cerebral palsy – stiff muscles with jerky movement
• Athetoid cerebral palsy– uncontrolled movements, writhing
• Ataxic cerebral palsy – poor balance and coordination
• Also, a mixed type of cerebral palsy can occur, which is a mix of the different types of cerebral palsy.

Causes of Cerebral Palsy

Cerebral palsy is usually caused by non-progressive brain abnormalities in the part of the brain that control muscle function (“non-progressive” means that the brain abnormality does not cause ongoing brain degeneration).  Brain damage can occur during pregnancy (problems with the brain’s blood supply or genetic conditions) or after the brain has developed (later in the pregnancy, during delivery, or in the child’s first years of life. 

These post-natal causes include:

• Brain damage
• Strokes
• Brain infections (bacterial meningitis, viral encephalitis)
• Head injury  

Many cerebral palsy cases do not have a defined cause.   Research is underway to identify pregnancies most at risk, so that strategies to prevent cerebral palsy can be developed.

Cerebral Palsy Risk factors include:

• Premature birth (less than 37 weeks)
• Low birth weight (less than 5.5 pounds)
• Multiple babies
• Breech birth (feet-first)Toxic substances
• Severe jaundice (hyperbilirubinemia)

The Centers for Disease Control and Prevention (CDC) tracked the number of school-age children with cerebral palsy through the Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP).  In 1996 and determined that 1 in 278 children age 8 had cerebral palsy.  In 2000, the number of 8-year-olds with cerebral palsy was estimated at 1 in 323. 

Common Symptoms Of Cerebral Palsy 

Cerebral palsy can cause a variety of symptoms and disabilities depending on what part of the brain was damaged.  The most common symptoms are lack of muscle coordination during voluntary movements (ataxia), stiff muscles, exaggerated reflexes, asymmetrical walking gait, tremors, and difficulty with precise motions. 

Children who suffer from cerebral palsy usually have trouble with movement and posture.  The disorder can also result in contractures (muscles pull so tightly on the bones that the limbs curl), malnutrition (caused by problems swallowing or feeding).  Other associated problems include: difficulty with vision, hearing, and speech, dental problems, seizures, urinary incontinence, and dental problems. 

Treatment For Children With Cerebral Palsy

There is no cure for cerebral palsy, but treatment and therapy can make a difference.  Although there is no cure, some causes of cerebral palsy are preventable.  Head injuries can be prevented with proper seat belt use and bike helmets, and of course preventing child abuse.  Therapies such as physical therapy, occupational therapy, and speech therapy can improve some of the symptoms and disabilities.  Medications such as muscle relaxants and Botox can help relax contracted muscles.  Many people suffering from cerebral palsy require long-term services and care, depending on the severity of symptoms. 

Children suffering from cerebral palsy can benefit from early diagnosis and treatment of the condition.  Although there is no cure, therapy (physical therapy, speech therapy, medicine) can help improve their capabilities and life.  Children are resourceful and resilient, and when helped by therapy, they can learn new ways to accomplish tasks. 

Medical-Legal Issues Involved In Cerebral Palsy Cases

The debilitating nature of cerebral palsy for both child and family can be imposing from both an emotional and financial standpoint.  Consequently, all cerebral palsy cases should be evaluated from a medical-legal standpoint to determine if a physicians or hospitals negligence is responsible.  

In cases where negligence can be established, the family of the child may be entitled to substantial damages for past and future medical care as well as other elements of damages designated in the jurisdiction.  In order to determine the feasibility of a recovery, families dealing with a CP child should seek legal guidance as soon as feasible from a lawyer that handles birth injury matters.

Thanks to Heather Keil, J.D. for her assistance with this Child Injury Laws entry.

Resources:

eMedicineHealth: Cerebral Palsy

National Institute of Neurological Disorders and Stroke: Cerebral Palsy Information Page

Medline Plus: Cerebral Palsy

Cerebral Palsy Resource Center

Science Alert: Mere Cerebral Palsy Risks Found

Kids Health: Cerebral Palsy

CDC: Cerebral Palsy

Medicine Net: Cerebral palsy

Mayo Clinic: Cerebral palsy