Sacramento Personal Injury Lawyer Blog

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the proceedings.)

3) Dr. X. testified that it took only 2 minutes to provide a surgical level of analgesia with a spinal anesthesia (between 11:08 am and 11:10 am). Plaintiff’s expert anesthesiologist will testify that despite the circumstances here of some elevated blood pressure, some indication of PIH, fetal distress, and an ASA of 2-3:
a) It was below the standard of care for Dr. X. not to provide a rapid sequence general anesthesia (which would have taken 2-3 minutes), and
b) It is impossible that the spinal took only 2 minutes. Instead, such anesthesia would have required at least 7-10 minutes to conduct. If the spinal took longer to take effect than Dr. X. has been willing to admit, the difference in the time it took to complete it, compared with general anesthesia, was a significant factor in this child's catastrophic birth injury outcome.

DAMAGES:
The reports of plaintiff’s expert pediatric physiatrist, Amy Morris, MD, and the expert pediatric neurologist, Dr. William Samuels, have been provided. Further, the Life Care Plan of Karen Collins, RN, and the economic report of Peter Steiners, Ph..D. have also been provided. Based on the medical condition of Martha Cruz and the level of care required for proper care at home, including a gastrostomy feeding tube and the high probability that she will require a tracheostomy, Plaintiff’s experts have testified that she will require 24-hour LVN care, plus other medical expenses. There is no off-set for Medi-Cal payments now or in the future, under current case law. Based on a markedly reduced, but probable, life expectancy of 30 additional years, the present cash value of her life care plan is $11.5 million per plaintiff’s economist, or $9.2 million per the defendant’s economist. Additionally, there are future loss of earnings in the range of a present cash value of $750,000 to $1,000,000.

Continue reading " Surgeons' Mistakes At Sacramento-area Hospital Result In Brain Damaged Child, Part 11 of 11 " »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the proceedings.)

Dr. Stuart X.
1) Although Dr. X. testified that he didn't recall ever seeing Ms. Cruz in L&D on October 5, the L&D nursing notes clearly place him there at 10:32 am. The notes also clearly demonstrate that he was needed in the OR for Ms. Cruz. The notes do not indicate what Dr. X. was told regarding patient status, but assuming he was aware that the patient was in distress, he had an obligation to do whatever was reasonable to insure that the Cesarean section was done as quickly as possible. Dr. X. testified that he did nothing until being instructed by Dr. U.. Given that Dr. X. had been called for Ms. Cruz in L&D and was at her bedside under circumstances in which a CRASH Cesarean section had been called, he had an absolute responsibility to assist in getting a surgeon to operate sooner than Dr. U. became available - which did not occur at least until 10:52 am and probably later. This was particularly so if Dr. X. was the physician identified by Amanda Cruz who claimed to know about surgery ongoing in the main OR and yet refused to have the patient transferred or pursue alternative options to get Ms.Cruz delivered. According to the deposition of Dr. Z., he likely had remained in the main OR until at least 10:40 am (following surgery that ended at 10:25 am).

2) L&D nursing had documented on the fetal monitor tracing at 10:52 am, that Dr. U. had requested general anesthesia but that Dr. X. insisted on a spinal. This tracing never was transferred with the patient to the main OR.

Continue reading " Delayed Anesthesia At West Sacramento Medical Facility Results In Birth Injury, Part 10 of 11 " »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the proceedings.)

6) Substandard care to have given Terbutaline at 10:20 am, whether ordered by Dr. U. or not, given the likelihood that the placenta was abrupting (based on irritable uterus, abdominal pain and frequent, small decelerations occurring every minute), as this medication causes a vaso-dilation which aggravated perfusion to the fetus, contributing to ischemia of the fetus. From this point until delivery, the fetus was under increasing fetal distress and hypoxia from decreased placental perfusion.

7) L&D nursing notes indicate that the anesthesiologist was at the patient's bedside at 10:32 am. At deposition, Dr. X. denied having seen the patient in L&D. Yet, spinal analgesia was not administered until 11:08 am, 36 minutes after the note suggests that the anesthesiologist was at bedside. L&D nursing personnel had an absolute duty to discuss the case with Dr. X., to obtain a surgeon and run the CRASH Cesarean section given circumstances in which they obligated Dr. U. to deliver the breech patient without having informed Dr. D. of his commitments, and having failed to contact other available OB/GYNs to avoid any further delay in the delivery of Ms. Cruz.

8) Failure to properly interpret the fetal monitor tracing at 10:52 am, leading to a reticence on the part of L&D nursing personnel to pursue the Cesarean delivery of Ms. Cruz on a CRASH or STAT basis. In fact, the external monitor demonstrated a doubling of the FHR (as it was known to do when the FHR became exceedingly low) while L&D personnel assumed that the FHR was once again within normal limits. While L&D personnel acted as if the fetus had recovered, the fetus was likely becoming further de-compensated with a baseline of 65-75 bpm at that time, culminating in an absent FHR at 11:07. If, at 10:52 am, L&D nurses informed Dr. X. that the FHR had stabilized with variability in the range of 130-155 bpm” causing him to defer anesthesia or to assume he had the time to administer spinal analgesia, then they fell below the standard of care in the community. Further, there was a failure to actively monitor the fetus following transfer from L&D. Between 10:52 am and 11:10 am, a period of 18 minutes, no fetal monitoring was conducted. During this period, there is a total absence of the mother's pulse documented in the chart, suggesting that L&D nursing personnel never considered that the apparent change in the fetal heart rate was in fact evidence of the mother's heart rate instead..

Continue reading " Sacramento-area Physicians' Negligence Causes Birth Injury, Part 9 of 11 " »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the proceedings.)

LIABILITY:
Regional Medical Center: Hospital nursing personnel fell below the standard of care in the following areas:

1) Regardless whether Ms. Cruz or the breech patient arrived at the hospital first, once the second of the two arrived, hospital nursing personnel had a duty to obtain a third OR crew, which would, at a minimum, have necessitated phone calls to obtain a third anesthesiologist STAT. Assuming that the second OR crew was called for Ms. Cruz, as was suggested by the timing of Dr. U.'s call to house supervisor Nurse F., an OR crew had not been called for the breech patient which, under the circumstances was below the standard of care. The hospital made no provision for two simultaneous Cesarean deliveries under circumstances in which a scheduled surgery had also been planned. There were three operating rooms in the main OR, but the hospital only had 2 OR crews. No calls were ever made to obtain a third anesthesiologist, who was then available.

2) Failure to transfer Ms. Cruz directly to the main OR with fetal monitor and L&D nursing personnel at 9:20 am, and to monitor the patient at that location until surgery could begin, thereby avoiding the delay of delivery which occurred between 10:52 am and 11:15 am.

Further, at 9:34 am, the FHR baseline was noticeably smoother than it was at 9:10 am, which failed to get the attention of L&D nursing personnel or to form an additional basis on which to prompt immediate transfer to the main OR. There is nothing in the chart indicating that Dr. U. was ever made aware of these changes of the FHR.

Continue reading " Roseville Child Born With Catastrophic Brain Injury, Part 8 of 11 " »

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Nursing notes picked up again in the OR. The first reference after 10:52 am was at 11:05, with Ms. Cruz in the OR. The anesthesia record of Dr. X. referred to fetal distress. Thus far, no one has testified to what occurred between 10:52 and 11:05 am. Dr. U. testified that he was present when Ms. Cruz arrived in the OR and that he left the breech patient to Dr. V. to sew up the initial skin incision. The surgery schedule indicated that the surgery stop time for the breech case was not until 11:15 am. The anesthesia record and Dr. X. testified that his spinal anesthesia began at 11:08 am. At 11:09 a.m., the fetal heart rate could not detected on Ms. Cruz' baby. The spinal was said to have taken effect by 11:10 am - the time of the start of surgery for Ms. Cruz. At 11:10 am, a nursing progress note indicated that the spinal was completed and that the FHR (by hand-held doppler) on Martha was absent. In his operative report, Dr. U. reported that the surgery was rushed with a single shot of spinal analgesia, that there was massive intra-uterine bleeding” (estimated at 1800 cc), that a nuchal cord was present and 1200 cc of clots were found. Martha was delivered at 11:15 am.; she was born clinically dead with no signs of life. Dr. W. testified that he believed that the child probably had been dead for at least 8 minutes, from the time that nursing noted the absence of a heart rate at 11:10 am, until 3 minutes following the birth, when the first signs of life appeared. The placenta was sent to pathology and found to be normal.

Continue reading " Surgical Confusion Leads To Malpractice At West Sacramento Hospital, Part 7 of 11 " »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the proceedings.)

After her second call to the main OR, charge Nurse E. went to the main OR herself to see what could be done to expedite the delivery for Ms. Cruz, who was still upstairs in L&D. Nurse E. reported again to Dr. U. and to the main OR nurse the emergency circumstances involving Ms. Cruz. No one volunteered any information as to how best to resolve the situation. There was no discussion about the use of other OBs, or about informing the OR crew that was on the unit, though still in surgery in OR #1.

At 10:10 am,, anesthesia began on the breech patient. At 10:15 am, the FHR baseline on Ms. Cruz dropped to 100 bpm. At 10:20 am, L&D nursing documented absent variability with bradycardia.” The L&D nursing staff communicated this information to Dr. U. while he was operating on the breech patient. In turn, Dr. U. testified that he called for a crash Cesarean section on Ms. Cruz but he gave no further instructions as to how this order would be carried out. After 10:20, Dr. U. testified that he was not further advised of Ms. Cruz' status.

At 10:25 am, Drs. Z. and C. completed the scheduled abdominal hysterectomy in OR #1. The surgery had begun before Ms. Cruz had even arrived at the hospital. Based on their deposition testimony, neither could recall anyone having advised them during that surgery that an emergency was unfolding either with the breech patient or with Ms. Cruz. Even after the procedure was completed, neither could recall anyone having advised them to stay or to assist with either patient and Dr. U. testified that no one advised him that other OB/GYNs were in the main OR area during this time.

The anesthesia stop time for the hysterectomy patient was 10:30 am. At that approximate time, Dr. X. has testified and provided a declaration under penalty of perjury, that he was the primary anesthesiologist in the OR that morning and that he was to stay in the hospital, but claimed to have been given no further instructions. Ms. Cruz remained upstairs in the L&D unit. Dr. .X. was in fact available at 10:30 a.m. to start anesthesia for Ms .Cruz. Shortly thereafter, pediatrician Dr. W. arrived and waited with Dr. X. for further instructions. At 10:32 am however, nursing notes on the fetal monitoring tracing of Ms. Cruz documented that Dr. X. was at her bedside in L&D.

Continue reading " Roseville Family Suffers With Brain Damaged Newborn, Part 6 of 11 " »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the proceedings.)

According to the deposition testimony of nurses E. and F., the breech patient arrived after Ms. Cruz in L&D. Nurse E. did a physical examination and found the patient to be a term footling breech with bulging membranes and completely dilated. She considered her to be in need of an emergency Cesarean section, due to the threat of cord prolapse if her membranes ruptured spontaneously. She assigned the breech patient to L&D nurse, Nancy G.. At approximately 9:30 am, nurse G. called Dr. D. to advise him of his need to come in for his patient due to the breech emergency. Dr. D. informed nurse G. that he was out of town, two hours away, and asked whether there was another physician in-house who could deliver his patient. Nurse G. told him that Dr. U. was either coming in or already was in. She did not mention that he had an emergency patient of his own. There was no further contact with Dr. D.. According to charge nurse E., Dr. U. was made aware of the breech patient upon his arrival and that he agreed to deliver that patient. At 9:30 am, house supervisor Nurse F. called the members of the second-call OR crew as requested by Dr. U., and within 5 minutes, all team members had been contacted. Nurse F. then called L&D to confirm that the crew was on their way in. Sometime between 9:30 am and 10:00 am, the breech patient was taken down to the main OR on the orders of Dr. U., though the OR crew, called by Nurse F., had actually been initially requested for Ms. Cruz.

At 9:30 am, the systolic pressure on Ms. Cruz reached 150. Magnesium sulfate was started at 9:42 am. At 9:46 am, the FHR dipped to 110 beats per minute (bpm). At approximately 10:00 am, Dr. U. went to the basement to see about the status of the OR crew. At that time, Ms. Cruz's systolic pressure rose to 164. There were no orders for anti-hypertensive medications. There is no documentation in the patient's chart to indicate that Dr. U. was told about the rising systolic pressures.

Continue reading " Botched Emergency C-Section Causes Catastrophic Birth Injury At Sacramento-area Facility, Part 5 of 11 " »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the proceedings.)

On arrival at Regional Medical Center, the systolic pressure on Ms. Cruz was 138. Her blood sugar was relatively low. Nursing personnel were aware of a history of pregnancy-induced hypertension (PIH) but it had not been treated earlier by anyone. A fetal monitor was placed at 9:00 am. L&D nursing wrote that variability is non-reassuring and referred to the contraction pattern as very irritable.” The fetal heart baseline was holding just at 120 beats per minute (bpm). By 9:10 am, Ms. Cruz was placed on oxygen by mask and changes in position were made in order to better oxygenate the fetus. In anticipation of Cesarean delivery, nursing personnel had Ms. Cruz sign a consent for Cesarean section at 9:10 am. At 9:15 am, nursing personnel called Dr. U. and reported their concerns. Dr. U. ordered an emergency Cesarean section (per L&D nurses) and a STAT Cesarean section (per his own notes) over the telephone and indicated he was en-route. He asked for a PIH panel (blood test) and requested that the patient be placed on magnesium sulfate to avoid seizing. L&D charge nurse, Gabrielle E., RN, testified that she spoke with personnel in the main OR at 9:15 am and gave them a heads-up for an anticipated Cesarean section, but never mentioned the name of the patient. At the time, the hospital had two OR teams available on-call. One was already attending to the hysterectomy which began during the 8 o'clock hour. The other would need to be called in not by the OR, but by the relief house supervisor, Olivia F., RN.

L&D nursing personnel never documented when Dr. U. arrived at bedside. Dr. U. wrote a progress note, timed at 9:20 am, in which he indicated that he had reviewed the tracing. He testified in deposition that he expected that Ms. Cruz would be delivered within 30 minutes; his orders relative to the urgency of the situation had not changed.

Continue reading " Operating Room Mismanagement Results in Roseville Child's Birth Injury, Part 4 of 11 " »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the proceedings.)

FACTS:
Due to absence of comprehensive nursing notes on Ms. Cruz while she was in L&D, exceedingly poor memories of the witnesses whose depositions have been taken to date, and a lack of access to the chart on the breech patient, the facts relating to both Ms. Cruz and the breech patient while each were in L&D and the OR remain somewhat uncertain.

Ms. Cruz was a 42-year-old mother of six when she first began receiving prenatal care from Dr. U. at Universal Health Clinic on April 18, 2002. An OB sonogram revealed a due date of October 23. Ms. Cruz had no complaints until August, 2002. During the month of August, Ms. Cruz developed headaches, weakness and sweats. Later that month, a 3-hour glucose tolerance test (GTT) found excess sugar so she was referred to a high-risk OB to manage those problems. During the months of August and September her systolic blood pressure rose to 140. Late in September, Ms. Cruz was seen by a high-risk OB and ante-partum testing was begun on October 1. On October 1, a non-stress test (NST) revealed a healthy, reactive fetus. The systolic pressure on Ms. Cruz remained borderline at 140. No physician thought it necessary to place Ms. Cruz on anti-hypertensive medication or on magnesium sulfate based on these borderline values. Her pressures never increased from that level for any significant period of time.

Continue reading " OB/GYNs At West Sacramento Hospital Cause Birth Injury, Part 3 of 11 " »

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At 10:20 am, Dr. U. was informed by L&D personnel (while operating on the breech patient) that the FHR on Ms. Cruz had fallen further. As a result, Dr. U. called for a crash Cesarean section on Ms. Cruz. Dr. U. gave no instructions as to who would deliver Ms. Cruz or how. If there was no one to deliver Ms. Cruz sooner than he, Dr. U. expected that he would leave the breech patient to her assistant surgeon, Dr. V., toward the end of surgery in order to attend to Ms. Cruz.

At 10:25 am, OB/GYN's, Ralph Z., MD and Erica C., MD, had completed the scheduled hysterectomy in OR #1. However, no one informed them that there was another patient, Ms. Cruz, awaiting an emergency c-section, and thus they left the hospital at that time. The anesthesiologist from the hysterectomy, Stuart X., MD, became available at 10:30 am, and he remained in the hospital. At 10:30 a.m., surgery for the breech case began in OR #2.. At 10:32 a.m., Dr. X. was noted to be at the bedside with Ms. Cruz. For the next 35 minutes, until 11:05 am, Dr. X. and Dr. W. waited until Ms. Cruz arrived in OR #3 and Dr. U. became available for the surgery. They had been given no specific instructions by the nurses or hospital supervisor. It was not until close to 11:05 am that Dr. U. emerged from the surgery with the breech patient and attended to Ms. Cruz again. At 10:40 a.m., the breech case delivered without complication. Also at 10:30 a.m., no more could be heard of the fetal heart rate on Ms. Cruz's baby.The breech patient's OB/GYN, Maria D., MD, was never informed that Dr. U. had an emergency case of his own and, even after the crash Cesarean for Ms. Cruz was called by Dr. U., Dr. D. was not contacted again to assist in any way. Dr. Z. and Dr. C. were never asked by anyone to operate on Ms. Cruz, or assist in any way. The OB/GYN physician scheduled by the hospital to be on-call in the ER for emergencies that morning, was never contacted.

Continue reading " Roseville Family Files Action For Medical Malpractice, Part 2 of 11 " »

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Plaintiff's Settlement Conference Brief

BRIEF SUMMARY OF THE CASE:

This action for malpractice involves severe birth-related brain injuries to Martha Cruz, born XX/XX/2002, at Regional Medical Center in West Sacramento. Briefly, Martha’s mother, Patricia Cruz, was seen for prenatal care by OB/GYN, Gregory U., MD. The pregnancy was uneventful except for gestational diabetes and some elevated blood pressures, neither of which caused or contributed to the infant's injuries in this case.

Ms. Cruz arrived in Labor & Delivery (L&D) at Regional Medical Center at 8:57 am on Saturday, October 5, 2002, complaining of abdominal pain. A fetal monitor was placed immediately. Nursing documented a non-reassuring fetal heart rate (FHR) and a uterine contraction pattern described as very irritable . At 9:10 am, Ms. Cruz signed a consent for Cesarean delivery. At 9:15 am, nursing first contacted Dr. U. by telephone. At that time, he advised that the patient be admitted for an emergency Cesarean section . As October 5 was a Saturday, an on-call operating room (OR) crew, including anesthesiologist, Sandy Y., MD, assistant surgeon, Michael V., MD, scrub nurse, Robert A., circulating nurse, Elaine B., RN, and pediatrician, Susan W., MD, were contacted for Ms. Cruz' delivery. At the time of Dr. U.’s arrival in L&D, she confirmed the need for an emergency Cesarean section. At the time, there was a scheduled surgery on another patient for removal of a hysterectomy occurring in OR #1.

At Regional Medical Center, all Cesarean sections were conducted in the main hospital OR, one floor below L&D in the
basement. Dr. U. testified that she expected the surgery to occur within 30 minutes of her order. At approximately 10:00 am, Dr. U. left L&D and went downstairs to the main OR to determine whether the OR crew had arrived yet.
Either before she went to the OR or immediately after her arrival in the OR, Dr. U. was informed that there was a breech
patient at high risk that required an emergency Cesarean section, though the patient was not Dr. U.'s patient.

Continue reading " Sacramento-area Medical Facility Sued For Birth Injury, Part 1 of 11 " »