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A. A., a minor v Pomona Valley Hospital

Case Report - $6.975 million cash settlement - birth injury, amniotic fluid embolus.

Case ID: Confidential Los Angeles County

Plaintiff Attorney: Bruce Fagel, Law Office of Bruce Fagel, Beverly Hills Defense Attorneys: Steve Fraser, Fonda & Fraser, Glendale for Doe Hospital David O'Keefe, Bonne, Bridges, Mueller & O'Keefe, Los Angeles for Doe Doctor Sheila Alexander, Schmid & Voiles, Los Angeles, for Roe Neonatologist.

Facts: Plaintiff's mother, age 30, entered defendant hospital on Oct. 14, 2010 for delivery of her first baby, at term, under the care of defendant family practice doctor. After admission she was given Cervidil and later Cytotec to induce labor. By 6:50 am on Oct. 16, 2010, she had progressed to 9.5/95%/-1. The fetal monitor strip showed no abnormalities. At around 8:00 am the FMS showed some late decelerations. At 8:08 am, the L&D nurse called the defendant family practice doctor who indicated he was in the parking lot and would be bedside shortly. He arrived at 8:15 am and Pitocin was started, the vaginal exam showed 10/100%/0.

The family practice doctor then requested that the nurse call the in-house OB, and then proceeded to attempt a vacuum delivery. At 8:26 am the mother suddenly became unresponsive and a crash c-section was called at 8:30 am. The mother was moved to the OR and the baby was delivered at 8:48 am with Apgar scores of 3/3/4. The cord arterial blood gas showed a pH of 6.6 and a BE - 29.2. The baby was resuscitated and taken to the NICU. The mother developed massive bleeding thought to be due to DIC from an amniotic fluid embolus, but she survived and had no residual injury. The baby remained in the NICU until discharge.

Injuries: Baby has severe CP, developmental delay, g-tube feeding.

Special Damages: Past medical expense - $128,123 MediCal lien, Future medical expenses $7 million - $10 million based on a 40 year life expectancy. Defense claimed future medical expenses at $2 million to $3 million based on a 15-20 year life expectancy. Future loss of earnings - $800,000 - $1.2 million per plaintiff and $400,000-$800,000 per defendant.

Plaintiff Contentions: Hospital nurse was negligent for not calling in-house OB earlier since she knew that family practice doctor could not perform c-section. The c-section delivery should have been performed earlier and the neonatologist was negligent for not transferring the baby for brain cooling.

Defense Contentions: Plaintiff's mother suffered an acute unexpected amniotic fluid embolus which carries a very high risk of maternal mortality and neonatal morbidity. OB hospitalist saved mother's life. The fetal monitor strip did not show any need for c-section before 8:26 AM and the mother was moved promptly to the OR. There was some delay in starting the c-section because the mother's airway made placement of an ETT difficult so it was decided to re-bolus the epidural. The neonatologist was an independent contractor and studies have shown only a 17% - 28% improvement in outcome from brain cooling.

Settlement discussions: CCP Sec. 998 demand $6 million to Hospital, $1 million to Doctor (policy). and $2 million to Neonatologist (policy). At mediation before Jay Horton, at Judicate West, Neonatologist offered $2 million and Doctor offered $975,000 which was accepted. Hospital offered $1 million, then sent CCP 998 offer for $3 million, and then later agreed to offer $4 million which was accepted.