Sacramento Personal Injury Lawyer Blog

The following blog entry is written from a defendant’s position as trial approaches. Reviewing this kind of briefing should help potential plaintiffs and clients better understand how parties in personal injury cases present such issues to the court.

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury case and its proceedings.)

It is also worth noting that situations similar to those described in this medical malpractice case could just as easily occur at any of the healthcare facilities in the area, such as Kaiser Permanente, U.C. Davis Medical Center, Mercy, or Sutter.

Under the discovery rule, the statute of limitations began to run when plaintiffs suspected their injury was caused by wrongdoing. Plaintiffs, therefore, cannot take advantage of the provisions of Code of Civil Procedure §474 and relate back the Amendment of Complaint, adding Dr. Brown as a DOE defendant, back to the date of the filing of their original Complaint. For more information you are welcome to contact Sacramento personal injury lawyer, Moseley Collins.

The medical records establish that plaintiffs had knowledge of Dr. Brown as well as his extensive participation in the delivery of their baby on February 21, 2001. Further, both Ms. Smith and Mr. Smith, Sr., testified that they were aware that Dr. Brown was the primary treating obstetrician who delivered their son on February 21, 2001. During her deposition, Ms. Smith testified as follows:

Q. Now, do you recall meeting a doctor by the name of Dr. Brown?
A. Yes.
Q. When is the first time you met him?
A. While I was in the delivery room.
Q. Now, when you first saw Dr. Brown, you understood that he was part of the XYZ group?
A. Yes.
Q. You understood that he was the doctor in charge at that point?
A. Yes; he told me he was.

Continue reading "Sacramento Doctors Sued By Family For Son's Birth Injuries, Part 7 of 7" »

The following blog entry is written from a defendant’s position as trial approaches. Reviewing this kind of briefing should help potential plaintiffs and clients better understand how parties in personal injury cases present such issues to the court.

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury case and its proceedings.)

It is also worth noting that situations similar to those described in this medical malpractice case could just as easily occur at any of the healthcare facilities in the area, such as Kaiser Permanente, U.C. Davis Medical Center, Mercy, or Sutter.

The California Supreme Court declared that:

Under the discovery rule, the statute of limitations begins to run when the plaintiff suspects or should suspect that her injury was caused by wrongdoing, that someone has done something wrong to her...[T]he limitations period begins once the plaintiff has notice or information of circumstances to put a reasonable person on inquiry ... So long as a suspicion exists, it is clear that the plaintiff must go find the facts; she cannot wait for the facts to find her. (emphasis added) Jolly v. Eli Lilly & Co., supra, 44 Cal.3d 1103, 1110, 245 Cal.Rptr. 658, 751 P.2d 923 (1988).

"It is the occurrence of some such cognizable event rather than knowledge of its legal significance that starts the running of statute of limitations." Graham v. Hansen, (1982) 128 Cal.App.3d 965, 180 Cal.Rptr. 604. For more information you are welcome to contact Sacramento personal injury lawyer, Moseley Collins.

PLAINTIFFS FAILED TO MEET THE REQUIREMENTS OF CODE OF CIVIL PROCEDURE §474 AND, THEREFORE, THIS ACTION IS BARRED BY CCP 340.5.

Continue reading "Medical Malpractice Lawsuit Filed By Sacramento Family, Part 6 of 7" »

The following blog entry is written from a defendant’s position as trial approaches. Reviewing this kind of briefing should help potential plaintiffs and clients better understand how parties in personal injury cases present such issues to the court.

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury case and its proceedings.)

It is also worth noting that situations similar to those described in this medical malpractice case could just as easily occur at any of the healthcare facilities in the area, such as Kaiser Permanente, U.C. Davis Medical Center, Mercy, or Sutter.

PURSUANT TO CODE OF CIVIL PROCEDURE, SECTION 340.5, PLAINTIFF'S ACTION IS BARRED BY THE STATUTE OF LIMITATIONS.

Code of Civil Procedure, Section 340.5 provides in pertinent part:
In an action for injury...against a health care provider based upon such person's alleged professional negligence, the time for the commencement of action shall be three years after the date of injury or one year after the plaintiff discovers, or through the use of reasonable diligence should have discovered the injury, whichever occurs first. For more information you are welcome to contact Sacramento personal injury lawyer, Moseley Collins.

Code of Civil Procedure, Section 340 provides in pertinent part:
Within one year: (3) An action for ... battery.

In Gutierrez v. Mofid, (1985) 39 Cal.3d 892, 898, 218 Cal.Rptr. 313, 705 P.2d 886, the plaintiff alleged that she gave consent only to an exploratory operation to remove a tumor on her appendix.

Continue reading "Boy From Sacramento Suffers Catastrophic Birth Injuries, Part 5 of 7" »

The following blog entry is written from a defendant’s position as trial approaches. Reviewing this kind of briefing should help potential plaintiffs and clients better understand how parties in personal injury cases present such issues to the court.

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury case and its proceedings.)

It is also worth noting that situations similar to those described in this medical malpractice case could just as easily occur at any of the healthcare facilities in the area, such as Kaiser Permanente, U.C. Davis Medical Center, Mercy, or Sutter.

SUMMARY JUDGMENT IS PROPER WHERE THERE IS NO TRIABLE ISSUE OF FACT

The law governing summary judgment is set out in California Code of Civil Procedure section 437c. This Court must determine whether plaintiffs have presented any facts which give rise to a triable issue. California Code of Civil Procedure § 437c provides in pertinent part:
(a) Any party may move for summary judgment in any action or proceeding if it is contended that the action has no merit or that there is no defense to the action or proceeding.

(c) The motion for summary judgment shall be granted if all the papers submitted show that there is no triable issue as to any material fact and that the moving party is entitled to a judgment as a matter of law. For more information you are welcome to contact Sacramento personal injury lawyer, Moseley Collins.

See also Vesely v. Sager (1971) 5 Cal.3d 153, 95 Cal.Rptr. 623. See also Hills v. Aronsohn (1984) 152 Cal.App.3d 753, 759, 199 Cal.Rptr. 816, 819.

Continue reading "Sacramento Family Suffers After Child Deals With Birth Injuries, Part 4 of 7" »

The following blog entry is written from a defendant’s position as trial approaches. Reviewing this kind of briefing should help potential plaintiffs and clients better understand how parties in personal injury cases present such issues to the court.

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury case and its proceedings.)

It is also worth noting that situations similar to those described in this medical malpractice case could just as easily occur at any of the healthcare facilities in the area, such as Kaiser Permanente, U.C. Davis Medical Center, Mercy, or Sutter.

STATEMENT OF FACTS

Abbey Smith initially presented to Universal Hospital on February 19, 2001, at or about 6:30 p.m., and was shortly thereafter admitted for induction. The records clearly indicate that Dr.Lee was the physician on duty at the time of admission. While on duty, Dr.Lee was responsible for treating the patients from the XYZ Obstetrics and Gynecology group that were admitted to Universal Hospital. The hospital records further note that Dr. Brown relieved Dr.Lee at approximately noon on February 20, 2001. The hospital records, as well as the deposition testimony of Ms. Smith and Mr. Smith, clearly establish that Dr. Brown was Ms. Smith's obstetrician throughout the remainder of her labor. Such records and testimony further establish that Dr. Brown delivered Mark Smith, Jr., the following day, February 21, 2001.

During the course of her labor, Ms. Smith received several amnioinfusions, the first of which was initiated sometime around 1:15 p.m. on February 20, 2001. An epidural was administered around 3:20 p.m.; a second amnioinfusion was started around 4:30 p.m. and completed around 5:00 p.m. At approximately 6:00 p.m., it was documented that Ms. Smith was complaining of pain secondary to the epidural, vomiting of yellow sputum-like fluid and that the fetal heart rate was reactive with mild variable decelerations. For more information you are welcome to contact Sacramento personal injury lawyer, Moseley Collins.

Continue reading "Mother And Father File Suit Against Hospital For Birth Injuries, Part 3 of 7" »

The following blog entry is written from a defendant’s position as trial approaches. Reviewing this kind of briefing should help potential plaintiffs and clients better understand how parties in personal injury cases present such issues to the court.

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury case and its proceedings.)

It is also worth noting that situations similar to those described in this medical malpractice case could just as easily occur at any of the healthcare facilities in the area, such as Kaiser Permanente, U.C. Davis Medical Center, Mercy, or Sutter.

INTRODUCTION cont.

On January 19, 2001, plaintiff commenced a medical malpractice action against the following defendants: Xavier Greene, M.D., XYZ Perinatal Group, and Universal Hospital. The Complaint contains the following causes of action:

(1) The First Cause of Action, on behalf of Mark Smith, Jr., alleges negligence as against various health care provider defendants. For more information you are welcome to contact Sacramento personal injury lawyer, Moseley Collins.

(2) The Second Cause of Action, on behalf of Abbey Smith, alleges negligence as against various health care provider defendants.

(3) The Third Cause of Action, on behalf of Abbey Smith, alleges a claim for negligent infliction of emotional distress, as against various health care provider defendants.

Continue reading "Sacramento Physicians Cause Birth Injuries At Local Hospital, Part 2 of 7" »

The following blog entry is written from a defendant’s position as trial approaches. Reviewing this kind of briefing should help potential plaintiffs and clients better understand how parties in personal injury cases present such issues to the court.

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury case and its proceedings.)

It is also worth noting that situations similar to those described in this medical malpractice case could just as easily occur at any of the healthcare facilities in the area, such as Kaiser Permanente, U.C. Davis Medical Center, Mercy, or Sutter.

PLEASE TAKE NOTICE that defendant, David Brown M.D., will move this Court for summary judgment in his favor, and against plaintiffs, Abbey Smith and Mark Smith, Sr., in the above-captioned action, in Sacramento County Superior Court. For more information you are welcome to contact Sacramento personal injury lawyer, Moseley Collins.

Defendant David Brown, M.D.’s, Notice of Motion and Motion for Summary Judgment, and Memorandum of Points and Authorities.

This motion for summary judgment is brought on the following grounds:

(1) This action is barred by the Statute of Limitations, pursuant to Code of Civil Procedure §§ 340.5 and 474;

(2) There is no triable issue of material fact as to the summary judgment sought, and therefore the moving party is entitled to such summary judgment as a matter of law, pursuant to Code of Civil Procedure § 437c.

Continue reading "Parents Sue Sacramento Physicians For Son's Birth Injuries, Part 1 of 7" »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury/personal injury case and its proceedings.)

The Evidence Demonstrates Triable Issues Of Whether Defendant Dr. Lee Breached the Standard of Care And Whether She Caused George Jackson's Brain Damage

Even if the defendant could overcome the several evidentiary defects of her motion, she has still failed to demonstrate as a matter of law that she met the standard of care or that she did not cause George's brain damage. The defendant's expert evidence focuses on the events of 17:22, when defendant Lee finally went up to see her patient. At that point., she contends, she reacted quickly and her supervisor endorsed her actions. The defendant necessarily disregards her prior lapses that created the emergency in the first place. In other words, while she boasts that she acted quickly to "put out the fire," she ignores her own negligence that started the fire in the first place. For more information about this topic, please visit http://www.sacramentopersonalinjurylawyerblog.com/.

The expert testimony of Dr. Jason White, board-certified in Obstetrics and Gynecology, and a Clinical Professor of medicine at the University of California, explains defendant Dr. Lee's multiple breaches of the standard of care and how they caused George's brain damage. The defendant failed to ask for the objective data concerning the fetus's status. She relied on vague and generalized interpretations from a nurse, rather than soliciting facts that she could use to make a determination.

If she had asked those questions, she would have fully appreciated the growing danger to George. The baby's baseline heart rate had become 170 beats per minute when not in deceleration, which was not only an increase but abnormally high as well. The baby was already tachycardic at 17:00, but the defendant failed to ask about that. She also would have ordered the Pitocin to be turned off, because that was contributing to the fetal distress.

Continue reading "Sacramento Baby Suffers Brain Damage During Botched Delivery, Part 13 of 13" »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury/personal injury case and its proceedings.)

The Ross declaration is equally week on the issue of causation. The defense expert asserts that the few minutes of delay in attempting a vacuum extraction did not cause George's brain damage. The declaration fails to address the manifest question, though: If that did not cause the brain damage, then what did? Further, the defense expert fails to address the delay from 17:00 to 17:22. If this did not cause brain damage either, then what explanation does the defense expert offer? The defense expert's declaration is silent about all of these questions. For more information about this topic, please visit http://www.sacramentopersonalinjurylawyerblog.com/.

As Kelley held, without illuminating explanation, [an expert's declaration is] insufficient to carry [the defendant's] burden in moving for summary judgment. Moreover, because the defendant's supporting declaration is inadmissible to support summary judgment, the defendant failed to meet her threshold burden of persuasion. The burden of production thus never shifted to George, so the defendant's motion for summary judgment should be denied even without considering the opposing evidence. C.C.P. § 437c(o)(2); FSR Brokerage, 35 Cal.App.4th at 73 n.4, 41 Cal.Rptr.2d at 407 n.4 (1995) (plaintiff has no burden to show a triable issue if the defendant failed to meet its initial burden of showing by admissible evidence the absence of a triable issue of material fact).

The defendant may attempt to cure these deficiencies by having her expert submit a new or supplemental declaration. Again, however, any such declaration should be rejected as untimely.

Continue reading "Delays By Sacramento Physicians Result In Child's Birth Injuries, Part 12 of 13" »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury/personal injury case and its proceedings.)

The Richard Green Declaration is Insufficient To Support Summary Judgment

If the defendant relies upon expert testimony to meet its burden of persuasion, that testimony must meet the standards of admissibility. An expert's bare conclusion is insufficient to support summary judgment, just as it would be insufficient at trial. In Kelley v. Trunk, 66 Cal.App.4th 519, 78 Cal.Rptr.2d 122 (1998), the appellate court held that an expert declaration was insufficient to support summary judgment. That declaration was remarkably similar to the Willis Declaration in the present action. For more information about this topic, please visit http://www.sacramentopersonalinjurylawyerblog.com/.

Kelley held that the declaration of the expert was deficient to support summary judgment. As the appellate court stated, to be admissible the expert had to explain the connection between the recitation of facts gleaned from the medical records and the ultimate opinion:
[A]n expert opinion is worth no more than the reasons upon which it rests. Here, the crucial issues were: What was the nature of the disease or condition that required Kelley's surgery? Was it brought on by the laceration? What symptoms of this condition reasonably might have been observable at the time Kelley complained to Dr. Trunk of continuing intense pain unmediated by medication? Should a reasonable doctor at this point in time have recognized the possibility of severe complications? If so, why? If not, why not? Would complications of the kind Kelley eventually suffered have become evident any earlier than three or four days after the laceration? Would earlier intervention have mitigated Kelley's injury? Herndon's declaration addressed none of these issues. Without illuminating explanation, it was insufficient to carry Dr. Trunks' burden in moving for summary judgment. 66 Cal.App.4th at 524, 78 Cal.Rptr.2d at 124.

In the case at bar, the Ross declaration has the same deficiencies, because there are no explanations or answers to the analogous questions that would be relevant in this case. Why didn't defendant Lee recognize the complications earlier? In view of Ms. Jackson's higher risk, and thus greater dangers to the baby, why was it within the standard of care to wait an additional 22 minutes to check on the labor, after the defendant was plainly aware of the risk of hypoxia (as indicated by the order for 8 liters of oxygen by mask)?

Continue reading "Sacramento OB/GYNs Caused Birth Injuries, Part 11 of 13" »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury/personal injury case and its proceedings.)

The Defendant's Separate Statement Fails to Include Citations to Evidence that Support the Assertions

Another flaw of the defendant's Separate Statement is the failure to include citations to evidence that support the assertions of fact. Material Fact 2 asserts that the defendant Lee initiated care of Ms. Jackson only once, at 5:22 p.m. As support, the defendant cites several lines on pages 63 through 65 of co-defendant Stein's deposition.

Defendant Lee's testimony, however, does not state the supposed Material Fact. That testimony merely states that it was her custom to tell the attending physician (co-defendant Stein) that if there was a call from a nurse about Ms. Jackson, it would have been her practice to notify the attending physician that she was going to see the patient and, later, to tell him what was happening with the patient. The cited testimony does not state or even insinuate that defendant Lee initiated care of Ms. Jackson only once at 5:22 p.m. In fact, defendant Lee admitted that she does not even remember getting a call from a nurse before 5:22 p.m.

The defendant also relies on her Exhibit E to prove that she entered Ms. Jackson's room at 5:22 p.m., but that document has significant evidentiary flaws. There is no testimony regarding who wrote the notes or when they were written. For more information about this topic, please visit http://www.sacramentopersonalinjurylawyerblog.com/.

The defendant includes as part of her counsel's declaration several other documents, but the defendant's Separate Statement cites none of them in support of the motion or the alleged material facts. In particular, the defendant includes pages 21, 24, 25, 34, 35, 43, 44, 52, 70-72 and 77 from the deposition of co-defendant Stein.

Continue reading "Sacramento Child Suffers Brain Injury During Birth, Part 10 of 13" »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury/personal injury case and its proceedings.)

The appellate courts have emphasized that a defendant's failure to provide a foundation for the documents on which it is relying will require denial of a motion for summary judgment. In Sanchez v. Hillerich & Bradsby Co. (2002) 104 Cal.App.4th 703, 719-710, 128 Cal.Rptr.2d 529, 541-542, an attorney for a defendant offered a declaration in support of a motion for summary judgment. That declaration attested to the purported authenticity of exhibits in support of motion for summary judgment. The declaration failed to show that attorney was custodian of records, that the documents were prepared in the regular course of business, that he prepared documents or circumstances under which the documents were created. The trial court ruled that the documents were inadmissible due to lack of foundation, and the appellate court affirmed that ruling.

The defendant's Separate Statement of Material Facts must cite to admissible evidence. A violation of this rule is sufficient in itself to deny the motion for summary judgment. C.C.P. § 437c(b). Because the defendant's Material Facts 3 and 4 are unsupported by admissible evidence, the motion for summary judgment can be denied on that basis alone. For more information about this topic, please visit http://www.sacramentopersonalinjurylawyerblog.com/.

The defendant may attempt to add additional evidence to cure this defect in her reply brief. If she does so, that effort should be rejected. New evidence can be offered in a reply only in exceptional circumstances. Plenger v. Alza Corp. (1992) 11 Cal.App.4th 349, 362 n.8, 11 Cal.Rptr.2d 811, 819 n.8.

Continue reading "Mother Of Brain Damaged Sacramento Child Sues Doctors For Birth Injuries, Part 9 of 13" »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury/personal injury case and its proceedings.)

The Defendant Failed to Meet Her Threshold Burden of Proving that She is Entitled to Summary Judgment

The Evidence Upon Which the Defendant Relies Has No Foundation

The defendant relies upon one piece of evidence to try to prove that she acted within the standard of care: Defense Exhibit E, a photocopy of a portion of a fetal monitor strip. The defendant's lawyer also attached a document identified as Exhibit D, which she asserts is a portion of a fetal monitor strip. This document has all of the same evidentiary infirmities as Exhibit E, plus it is not relevant to any issue because it is not cited anywhere in the defendant's Separate Statement.

The defendant's Separate Statement shows that she relies solely on this document as proof that of her assertion that she acted quickly and timely, and within the standard of care. The document, however, has no foundation and is unauthenticated. For more information about this topic, please visit http://www.sacramentopersonalinjurylawyerblog.com/.

Two of the material facts in defendant Lee's motion rely upon this unauthenticated document that her lawyer attempts to interpret and introduce into evidence. Material Facts 3, 4 and 5 rely upon alleged medical records that have no foundation. There is no declaration from a custodian of records showing that this document concerns Ms. Jackson or her baby. There is nothing on the document that is self-authenticating. There is handwriting on the document, but there is no identification of the author of the handwriting. There is no declaration or deposition testimony from anyone who purports to be the author. Further, the writings themselves are plainly handwritten, often illegible, and using a plethora of uncommon abbreviations.

Continue reading "Sacramento Doctors Breached Standard Of Care During Delivery, Part 8 of 13" »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury/personal injury case and its proceedings.)

The plaintiff has no burden to show a triable issue if the defendant failed to meet its initial burden of showing by admissible evidence the absence of a triable issue of material fact. FSR Brokerage, Inc. v. Superior Court, 35 Cal.App.4th 69, 73 n.4, 41 Cal.Rptr.2d 404, 407 n.4 (1995) (citations omitted). Even if the defendant makes its initial showing in support of summary judgment, it is not necessarily entitled to summary judgment. The showing merely shifts the burden to the plaintiff to show a triable issue about one of the elements of the action or of those affirmative defenses. C.C.P. § 437c(o)(2). For more information about this topic, please visit http://www.sacramentopersonalinjurylawyerblog.com/.

A court must liberally construe the evidence offered in opposition to a motion for summary judgment, and strictly construe the evidence offered in support of the motion, when it is determining the existence of a triable issue of fact. Speaker v. Adamson Cos., 30 Cal.3d 358, 373, 178 Cal.Rptr. 783, 791 (1981). A court must consider the direct as well as the circumstantial evidence on each issue, and the reasonable inferences that can be drawn from the evidence. Mann v. Cracchiolo, 38 Cal.3d 18, 210 Cal.Rptr. 762, 771 (1985).

In ruling on the motion [for summary judgment], the court must consider all of the evidence and all of the inferences reasonably drawn therefrom ... and must view such evidence ... and such inferences ... in the light most favorable to the opposing party. Aguilar, 25 Cal.4th at 843, 107 Cal.Rptr.2d at 856 (citations and internal quotations omitted).

Continue reading "Physician Malpractice Results In Sacramento Child's Brain Damage, Part 7 of 13" »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury/personal injury case and its proceedings.)

The Defendant's Multiple Breaches of the Standard of Care Caused or Contributed to George Jackson's Brain Damage

The defendant's delay in obtaining the necessary information to make a determination about the fetus's status, and the consequent delay in having the baby delivered, was a substantial factor in causing or contributing to his birth injuries. By failing to attend to Ms. Jackson immediately upon receiving the 17:00 telephone call, defendant Lee delayed the delivery of George Jackson by more than 20 minutes. For more information about this topic, please visit http://www.sacramentopersonalinjurylawyerblog.com/.

Even if defendant Dr. Lee and Dr. Stein first tried a failed vacuum extraction at 17:01 or 17:02, they would have moved to perform a Cesarean-section by 17:05, with the baby delivered within about 10 minutes. (Defendant Lee in her deposition stated that a Cesarean-section could be performed at this hospital within 10 minutes.) This would mean that the baby would be delivered at about 17:15 to 17:20, thus avoiding an additional 22 minutes of fetal distress and avoiding the deprivation of oxygen to George's brain. Indeed, the defense expert acknowledges that the bradycardia did not develop until 17:20, so that event would have been avoided entirely or would have been sustained for only a minute or two. The defense expert concedes that a minute or two of fetal bradycardia would have been harmless.

The Defendant's Burden To Prove that She is Entitled to Judgment as a Matter of Law

The burden of persuasion on a defendant's motion for summary judgment in California is clear: It is on the defendant.

Continue reading "Sacramento Baby Suffers Brain Damage During Birth, Part 6 of 13" »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury/personal injury case and its proceedings.)

The Expert Evidence About the Defendant's Multiple Breaches of the Standard of Care

Defendant Dr. Lee breached the standard of care in three significant ways. First, she failed to obtain complete information from the nurse concerning the status of the labor and delivery at 17:00. The standard of care for a physician, whether resident or attending, required the physician to learn from the nurse the data that is necessary for the physician's own diagnosis and assessment of the fetal status. She cannot rely only upon the nurse's interpretation of the data. Also, the standard of care required a physician to monitor Ms. Jackson closely, because of her pre-eclampsia and gestational diabetes. By failing to ask for specific information, the defendant failed to fulfill that duty.

Second, if the defendant had asked for and obtained accurate data about the status of the labor, then the standard of care required her to understand that the fetus was having severe variable decelerations, diminished variability, fetal tachycardia and that the fetus was at risk for hypoxia. The standard of care would have required the physician to order the Pitocin to be turned off, and to assess the fetus's status immediately and personally. Instead, the defendant waited another 22 or 23 minutes before examining Ms. Jackson. For more information about this topic, please visit http://www.sacramentopersonalinjurylawyerblog.com/.

Third, the standard of care required the defendant to deliver the baby immediately - as rapidly as she could get to Ms. Jackson's room after the 17:00 telephone call, which the defendant physician testified took only a couple of minutes.

Continue reading "Mother's Pregnancy Mishandled By Sacramento Doctors, Part 5 of 13" »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury/personal injury case and its proceedings.)

If defendant Lee had asked, she would have learned that the variable decelerations were worsening (lower heart rate and longer duration) and the baseline was increasing and the variability was diminishing. A baseline increasing means that the fetus's heart rate was getting faster when not in deceleration (fetal tachycardia). Here, the fetus's heart rate had increased as high as 170 beats per minute from a previous normal baseline of approximately 150 beats per minute. This increase is indicative of fetal hypoxia (oxygen deprivation). Also, defendant Lee would have learned crucial information that the variability was diminishing as well, which is also indicative of hypoxia. For more information about this topic, please visit http://www.sacramentopersonalinjurylawyerblog.com/.

At this point (17:00), Ms. Jackson's condition required that the Pitocin be discontinued. Continuing the Pitocin in light of Ms. Jackson's fetal monitoring changes is contraindicated, because uterine contractions decrease blood flow to the fetus. Pitocin has the effect of increasing the strength of the contractions. Pitocin should be discontinued if there is fetal distress. Lee did not order the Pitocin to be discontinued at 17:00. In fact, a nurse turned the Pitocin off, but waited about another 20 minutes before doing so.

At 17:18, a nurse telephoned defendant Dr. Lee once more and reported that there were variable decelerations that were deeper with a slower return to baseline. Most probably, to a reasonable degree of medical probability, these variable decelerations were the result of prolonged administration of Pitocin, or umbilical cord compression, or a combination of both. Defendant Lee, after five hours since her last visit with Ms. Jackson, at last went to examine her at 17:22 or 17:23. Three minutes earlier, however, the baby developed fetal bradycardia (a slow heart rate in the fetus). A normal fetal heart rate is 120 to 160 beats per minute. George's heart rate had slowed to 80 to 90 beats per minute.

Continue reading "Birth Injuries Caused By Sacramento Physicians, Part 4 of 13" »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury/personal injury case and its proceedings.)

The nurse's reference to "variables" means the variable decelerations of the fetus's heart rate. There are many different types of decelerations of fetal heart rate. "Early decelerations" are decreases in the fetus's heart rate that start at the beginning of a contraction and stop at the end of the contraction. "Late decelerations" are transient decreases in fetal heart rate that begin at the peak of the uterine contraction and do not return to baseline (the fetal heart rate over a period of time) until well after the contraction has ended. Late decelerations are indicative of utero placental dysfunction (insufficiency of the placenta to perform its function).

"Variables" (variable decelerations) are decelerations that are unrelated to the uterine contractions. They appear on a monitor strip as drops from the baseline heart rate and promptly return to baseline. Typically, this fetal heart pattern is the result of umbilical cord compression (the cord is compressed, which impairs the flow of blood and oxygen to the fetus) or maternal hypertension (which is part of pre-eclampsia). Variables that are persistent and continue to drop to very low heart rate levels, and that lengthen in duration, can indicate fetal distress. For more information about this topic, please visit http://www.sacramentopersonalinjurylawyerblog.com/.

According to the hospital's Physician Order records, defendant Dr. Lee ordered 8 liters of oxygen by mask and ordered the nurse to turn off the epidural (but not the Pitocin). This is a substantial amount of oxygen delivered in a manner intended to oxygenate the blood immediately. By using a mask (as opposed to a nasal cannula, which blows oxygen into the nostrils), the patient gets oxygen regardless of whether she breathes through her nose or her mouth. The amount of oxygen and the manner in which defendant Lee ordered it delivered indicates a concern about the variable decelerations. The reason for ordering 8 liters of oxygen by mask is to try to increase immediately the oxygen in the mother's blood, which in turn oxygenates the fetus's blood.

Continue reading "Sacramento OB/GYN's Negligence Causes Birth Injuries, Part 3 of 13" »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury/personal injury case and its proceedings.)

When she arrived at the hospital at 0615, Ms. Jackson was in early labor. She also had a blood pressure of 171/108, which is quite elevated (above normal). Her previous blood pressures were approximately 100/60, so Ms. Jackson's blood pressure was dangerously high. She also had 3+ protein in her urine, which is also elevated. (Normal is 0.) She also had pedal edema (swollen feet).

Ms. Jackson thus had a condition known as pre-eclampsia; in fact, it was severe.
Severe pre-eclampsia increases the risks to the mother and the child. Those risks include: heart failure, stroke, seizure, and placental abruption. These can cause severe brain injury or death to the baby. This condition indicated that Ms. Jackson's labor must be closely monitored. A woman with severe pre-eclampsia should be delivered as expeditiously as possible in order to avoid these serious consequences. For more information about this topic, please visit http://www.sacramentopersonalinjurylawyerblog.com/.

At 12:30, Ms. Jackson was placed on Pitocin. Pitocin is a drug that is used to induce labor or augment labor. For Ms. Jackson, it was being used to augment labor because she was having inadequate contractions. If a patient in Ms. Jackson's condition is on Pitocin, then the baby is at greater risk for hypoxia. This is because Pitocin increases the contractual forces of the uterus, reducing placental blood flow and its ability to transfer oxygen and carbon dioxide to and from the fetus. The standard of care in 1998 required a physician, whether attending or a resident, to be aware of these greater risks to the baby associated with the use of Pitocin in women with Ms. Jackson's condition.

Continue reading "Sacramento Baby Born With Severe Birth Injuries, Part 2 of 13" »

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury/personal injury case and its proceedings.)

Plaintiffs’ Opposition to Defendant Ana Lee's Motion for Summary Judgment; Memorandum of Points & Authorities

Summary of Argument

The defendant's motion rests on evidence for which there is virtually no foundation and no authentication. Because the defendant bears the burden of proof, its reliance upon inadmissible evidence requires denial of the motion (regardless of whether the plaintiff offers countervailing evidence. Further, even if the defendant could overcome the deficiencies of her evidence, the testimony of the Dr. Jason White (a board certified obstetrician and Clinical Professor of Obstetrics and Gynecology) establishes that Dr. Lee breached the standard of care. The testimony of Dr. White also establishes that defendant Lee's substandard care was a substantial factor in causing or contributing to George Jackson’s catastrophic injuries. For more information you are welcome to contactSacramento personal injury lawyer, Moseley Collins.

Statement of Facts

Ms. Jackson's Labor and Delivery Of Son George Jackson

Ms. Jackson was a pre-natal patient of the NorCal Perinatal Medical Group on January 26, 1998, the date she arrived at Universal Hospital. Ms. Jackson's expected due date was February 2, 1998, so she was considered at full term for this delivery.

Ms. Jackson developed gestational diabetes during her pregnancy with George. Because Ms. Jackson had gestational diabetes, she was at greater risk for perinatal (near delivery) complications.

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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.

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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.

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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..

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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.

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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.

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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.

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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" »

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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.

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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.

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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.

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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.

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