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I. N., a minor v Sutter Delta Medical Center and Sutter Delta Medical Group

Dr. Fagel obtained a settlement of $4,000,000 on behalf of a young girl who now suffers severe cerebral palsy and developmental delays after hospital staff failed to treat a uterine rupture in a timely fashion. The mother previously had two C-section deliveries and, due to her increased risk for uterine rupture, was scheduled for another C-section one week before her expected delivery date. However, she was admitted to the defendant hospital 16 days early with a sudden onset of abdominal pain, weakness and dizziness. Nurses immediately noticed her to be hypotensive, cold and clammy, and fetal heart rate was noted to be decreased. The obstetrician was notified of the mother’s arrival and her current condition, but he did not come to evaluate her until a third phone call was placed over 1½ hours later- despite the fact that his office was located just four minutes away. During this 1 ½ hour period, the mother’s condition was managed by the hospital nursing staff. Nurses ran IV fluids in both her arms to increase blood pressure, but made no diagnosis as to the underlying cause of the mother’s condition and never notified the obstetrician of possible fetal distress. The mother’s blood pressure became more normal after her IV rate was increased and a second call was placed to the OB, but, once again, he chose not to come evaluate the patient. Shortly after, there was a short drop in fetal heart rate and a crash Cesarean section was ordered. A uterine rupture along a previous incision line was discovered and the infant plaintiff was delivered 33 minutes later. She had critically low Apgar scores and did not have a heart rate until 20 minutes of life. The baby was then transferred to Oakland Children’s Hospital, where she was diagnosed with cerebral palsy as a result of severe hypoxic brain damage sustained during the uterine rupture.

The defense contended that all care was within standard, as the need for a C-section was not evident until the sudden drop in fetal heart rate. However, Dr. Fagel argued that hospital staff could and should have prevented the minor plaintiff’s injuries by delivering her by Cesarean section at a much earlier time. First, the nurses were negligent for failing to notify the obstetrician of the mother and fetus’ non-reassuring vital signs. Although the nursing staff called the OB three times, they never notified him of the seriousness of the situation and did not demand him to visit the patient immediately because they felt it was not necessary. The defendant obstetrician was also negligent for failing to evaluate the patient until the complications became serious and developed into fetal bradycardia. Although nurses may not have warned him of the extent of the mother’s condition, he had the ability to look at the fetal heart pattern and blood pressure from his office computer. In addition, he was available to visit the mother at any time and his office was only four minutes away. As such, the 33 minutes that passed between the start of the bradycardia and the time of delivery were clearly unjustified.