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A.B., a minor v Anonymous Medical Center

Dr. Fagel achieved a settlement of $3,650,000 on behalf of a child who suffers cerebral palsy after hospital staff failed to diagnose an arrest of labor and perform and immediate C-section. The mother was admitted to the defendant medical center one day after her due date for induction of labor. She was under the care of a certified nurse midwife, who discussed the plan for labor management with an obstetrician. At 3 a.m., the midwife started Pitocin, and by 8 a.m. determined that there was an arrest of dilation due to inadequate forces of labor. The on-call OB had another discussion about the plaintiff and then went to her office, but remained available if needed. At 9 a.m., another midwife assumed responsibility for the mother’s labor. Over the next three hours, there was little progress in labor and the Pitcoin was turned off twice due to fetal heart decelerations, but overall the fetal monitor strip remained reassuring. At noon, the midwife ordered an amnioinfusion and the OB returned to the hospital to see another patient. At 12:25 p.m., there was a sudden drop in fetal heart rate without recovery. The midwife paged the OB and the mother was moved to the operating room for an emergency C-section. The baby was delivered at 12:49 p.m., with critically low vital signs and hypoxic brain injuries.

The defense contended that all care was within standard and that there was no indication for an earlier delivery before 12:25 p.m., when there was an unexpected drop in fetal heart rate. On the other hand, Dr. Fagel claimed that the midwives were negligent for failing to diagnose arrest of labor and fetal distress, which required involvement by the OB to deliver the baby by C-section before the terminal bradycardia. Had nurses properly diagnosed the complications, the plaintiff’s injuries could have been avoided.