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Rafael Correra, a minor v Methodist Hospital Sacramento

Dr. Fagel obtained a verdict of $13,000,000 on the behalf of a child who suffers serious brain damage as a result of hypoxic injuries sustained during a uterine rupture. The mother was first admitted to the hospital for a VBAC (Vaginal Birth after Cesarean Section) trial of labor after being found to have irregular contractions. The fetal heart tracing was reactive and reassuring, and remained so until the final hour before delivery. The obstetrician, Dr. Knoll, arrived at 7:10 a.m. and ruptured the mother’s membranes in an attempt to facilitate labor. Over the course of the next 5 ½ hours, there was minimal progress in labor and Dr. Knoll offered the patient a repeat C-section. The discussion was not documented, but evidently the patient wished to proceed with an attempt at vaginal delivery. The doctor then left and returned at 6:10 p.m., and found that there had still been no progress in labor. According to his deposition, at this time he recommended a Cesarean delivery once again but the patient declined. However, this discussion was also not documented. The doctor then left and the night-shift nurse, nurse Blanco, assumed management of the patient at 7:00 p.m.

Shortly after midnight, nurse Blanco found that there was still minimal progress in labor and notified Dr. Knoll, who was at his home 17 miles away. At this point, the mother began requesting a Cesarean section, but was told by the nurse that she would have to wait until the morning. At 2:58 a.m., the fetal tracing began to show a consistent pattern of decelerations. At 3:26 a.m., the fetal heart rate began a prolonged deceleration for over five minutes. Dr. Knoll was notified at home, and he ordered terbutaline and then went back to sleep. The fetal heart rate continued to drop and Dr. Knoll was notified to come in while the patient was being prepped for an emergency C-section. He arrived at 3:48 a.m., and surgery began at 4:01. A uterine rupture and placental abruption were discovered, and the baby was found free-floating in the abdominal cavity. The baby was severely asphyxiated and had dangerously low Apgar scores. He was resuscitated and transferred to the intensive care unit, where he was diagnosed with profound neurologic impairments caused by prolonged oxygen deprivation.

Dr. Fagel argued and proved that the plaintiff’s injuries would have been avoided had a Cesarean section been performed earlier. A uterine rupture and consequent injury to the fetus is a recognized complication of vaginal birth after previous Cesarean delivery, so Dr. Knoll and the nursing staff should have performed a C-section as soon as progression of labor began to stall. The baby’s injury would not have occurred had the uterus not ruptured, and Dr. Knoll had ample time to perform a Cesarean delivery earlier. Dr. Knoll’s recommendation to perform a C-section was at first declined by the patient because he failed to clearly communicate this recommendation to the patient. Furthermore, Dr. Knoll was negligent for failing to communicate this recommendation to nurse Blanco. As a result, she did not inform him when the patient requested a repeat C-section shortly after midnight. Dr. Knoll was additionally negligent for not coming to the hospital immediately after being notified of the prolonged fetal heart deceleration at 3:26 a.m. Had he come to the hospital at first notification, rather than prescribing terbutaline and returning to sleep, the delivery would have been accomplished earlier, thereby preventing or at least reducing the extent of the injury. Finally, guidelines regarding VBACs require that the obstetrician be “readily available” to respond to complications in the labor process- being 17 miles away and asleep is clearly inconsistent with being readily available. All in all, Dr. Fagel proved that Dr. Knoll made decisions that delayed delivery, thereby causing or worsening the fetal asphyxia that caused the baby’s profound brain injuries.