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CM v US 9 Nov 2006 FINAL
CM v US 9 Nov 2006 FINAL (Decision) - CM v US 9 Nov 2006.pdf (Documents)
- Comp-MAL-USRuleTreeDiagram.jpg (Pictures)
- ●the United States is liable to C.M. for medical malpractice.
- ●AND [1 of 4] : the United States, or an actor for whose conduct the United States is legally responsible, owed C.M. a legal duty of care.
- ●AND [2 of 4] : acts and omissions during labor and delivery did not conform to the applicable legal or medical standard of care.
- ●AND [1 of 3] : the United States or the actor engaged in acts and omissions during labor and delivery.
- ●Dr. Reed delayed in arriving at the hospital to deliver C.M. and failed to deliver C.M. by caesarean section.
- ●MIN [1 of 2] : "Dr. Reed must have arrived in the delivery room, at the hospital, sometime between 11:30 and 11:50 a.m." on February 1, 2003, at least 27 hours after Jasmine Lucius (C.M.'s mother) was admitted, and at least 43 minutes before "C.M. was delivered at 12:33 p.m." [C: *4 - *10; S: findings of the court]
- ●MIN [1 of 7] : Jasmine "was admitted Friday, January 31, 2003 at 8:30 a.m. in an attempt to induce labor as she was approximately one week behind schedule." [C: *3-*4; S: hospital notes]
- ●MIN [2 of 7] : Jasmine's "labor was somewhat prolonged"; "[i]t was not until 17 1/2 hours after admission, on February 1st at 2:00 a.m., [Jasmine's] cervix was 4 cm. dilated." [C: *19-*20; S: medical records]
- ●MIN [3 of 7] : "At 4:30 a.m. [on February 1], the FHR [fetal heart rate] had changed from the earlier 100 to 130 to 152 to 170"; and "Dr. Reed was notified by telephone at that point of [Jasmine's] progress" by 4:40 a.m. [C: *20; S: medical records; Fn 2: "A normal heart rate for a fetus is 120-150. Generally, a monitor reading in excess of 150 is high."]
- ●MIN [4 of 7] : "At 7:00 a.m., Dr. Reed was notified by telephone that C.M.'s FHR was 170." [C: *20; S: medical records]
- ●MIN [5 of 7] : "[A]t 10:35 a.m., [Jasmine's] temperature reached 39.2 Celsius which is 102.5 Fahrenheit"; the nurse "also reported to Dr. Reed that [Jasmine] was dilated to eight centimeters as of 8:00 a.m. and remained in that position at 10:30 a.m."; "[f]ollowing his 10:35 a.m. conversation with Nurse Holifield, Dr. Reed stated that he would be coming to the hospital to attend [Jasmine] and perform the delivery." [C: *9; S: findings of the court; B: nurse's notes]
- ●MIN [6 of 7] : "Dr. Reed must have arrived in the delivery room, at the hospital, sometime between 11:30 and 11:50 a.m." [C: *10, *20; S: finding of the court]
- ●MIN [1 of 2] : "Dr. Brock Meyer, a resident on call stated that at 11:30 a.m., Dr. Reed was not in the labor and delivery area." [C: *10; S: hospital records]
- ●MIN [2 of 2] : Dr. Reed had probably arrived by 11:50 a.m. [C: *10; S: finding of the court]
- ●MIN [1 of 2] : "The fetal heart monitor ... showed signs that [Jasmine] began pushing ... at 11:50 a.m." [C: * 10]
- ●MIN [2 of 2] : "[T]he first thing [Dr. Reed] did when he came to the hospital was to examine [Jasmine], following which he directed that she attempt to 'push.'" [C: *10; S: testimony of both Nurse Holifield and Dr. Reed]
- ●MIN [7 of 7] : "C.M. was delivered at 12:33 p.m." [C: *11; S: finding of the court]
- ●MIN [2 of 2] : Dr. Reed failed to deliver C.M. by caesarean section.
- ●MIN [1 of 5] : Jasmine "was fully dilated at approximately 11:48 a.m. following which Dr. Reed advised C.M. to push." [C: *10; S: hospital notes]
- ●MIN [2 of 5] : "[W]hen a normal delivery was apparently not working, Dr. Reed elected to effect delivery with the use of a vacuum extractor." [C: *10; S: hospital notes]
- ●MIN [3 of 5] : "The Mity-vac electrical pump did not operate appropriately and Dr. Reed elected to use another pump which was hand-operated." [C: *11; S: finding of the court]
- ●MIN [4 of 5] : "The vacuum was attached to the head of C.M. but during the usage, the vacuum on the pump popped off"; "[a]t that point, [Dr. Reed] elected to use a third vacuum extractor which was another hand-held pump." [C: *11; S: finding of the court]
- ●MIN [5 of 5] : "C.M. was delivered at 12:33 p.m. with the use of the third vacuum extractor." [C: *11; S: finding of the court]
- ●AND [2 of 3] : For circumstances sufficiently similar to those in the particular case, there existed a legal or medical standard of care.
- ●For circumstances similar to Jasmine's, there existed medical standards of care for when to arrive at the delivery room and for use of caesarean section.
- ●MIN [1 of 2] : Ordinarily, under same or similar circumstances, physicians with Dr.Reed's expertise would have arrived at the hospital at least between 10:35 and 11:00 a.m. [C: implicit finding of the court; B: NOTE: there is no explicit statement of an expert opinion as to the standard of care for time of arrival at a hospital for labor and delivery]
- ●MIN [2 of 2] : "[I]t was not uncommon to cause delivery by the use of forceps or by the use of vacuum extractors or by a C-section"; "[w]hile the attending physician has the option of selecting the method that will properly accommodate the mother and the fetus, all of the factors that were present at the time must be examined to determine if the doctor in charge exercised the proper standard of care in making the selection and effecting the delivery." [C: *18; S: finding of the court; B: "[a]s to the methodology of delivery, all physicians who testified in that area suggested" this assertion]
- ●AND [3 of 3] : acts and omissions during labor and delivery did not conform to the applicable legal or medical standard of care.
- ●the United States, or an actor for whose conduct the United States is legally responsible, "failed to use that degree of skill and learning ordinarily used under the same or similar circumstances by members of his profession." (See Washington by Washington v. Barnes Hospital, 897 S.W.2d 611, 615 (Mo. 1995)) [C: *18-*19]
- ●"[T]he acts and omissions of Dr. Reed in the care of [Jasmine] during her labor and in the delivery of C.M. did not meet the standard of care required." [C: *19; S: finding of the court]
- ●MAX [1 of 2] : "Dr. Reed should have been present earlier to monitor personally plaintiff's labor." [C: *19; S: finding of the court]
- ●MIN [1 of 2] : Dr. Reed repeatedly had notice that Jasmine's "labor was prolonged" (notice at 4:40 a.m., 7:00 a.m., 10:35 a.m.), that "[t]he FHR demonstrated moderate variability and accelerations" (notice at 4:40 a.m. and 7:00 a.m.) and that Jasmine's "temperature reached 102.5 Fahrenheit" (notice at 10:35 a.m.), yet "Dr. Reed did not arrive at the hospital until sometime between 11:30 and 11:50 a.m. which was at least an hour after Nurse Holifield reported [Jasmine's] symptoms by phone at 10:35 a.m." [C: *19-*20; S: reasoning of the court]
- ●MIN [2 of 2] : Ordinarily, under same or similar circumstances, physicians in Dr.Reed's situation would have arrived at the hospital at least between 10:35 and 11:00 a.m. [C/S: implicit reasoning of the court; B: there is no explicit statement of an expert opinion stating this, and taking into account the circumstances of this particular case]
- ●MAX [2 of 2] : "[I]t fell below the proper standard of care when Dr. Reed failed to order a caesarean delivery after the initial vacuum extractor did not operate properly." [C: *22; S: finding of the court]
- ●MIN [1 of 3] : "Dr. Reed failed to order a caesarean delivery after the initial vacuum extractor did not operate properly." [C: *22; S: finding of the court]
- ●MIN [2 of 3] : "Given the exigencies of the moment, Dr. Reed could have quite easily shifted to a caesarean procedure at that time." [C: *22; S: finding of the court]
- ●MIN [3 of 3] : Ordinarily, under same or similar circumstances, physicians in Dr. Reed's situation would have performed a caesarean section after the initial extractor did not operate properly. [C/S: implicit reasoning of the court; B: there is no explicit statement of an expert opinion stating this, and taking into account the circumstances of this particular case]
- ●AND [3 of 4] : C.M. actually suffered the subgaleal hematoma, hypoxic ischemic encephalopathy and related injuries.
- ●"[A]t the time of delivery, C.M. was limp and blue but was resuscitated"; "[e]ight hours later, twitching was noted and five hours thereafter there was a generalized seizure activity"; "a CT exam revealed a subgaleal hematoma"; "[t]he MRI revealed diffuse ischemic injury"; "C.M.'s diagnosis at Children's Hospital was that she had hypoxic ischemic encephalopathy with neo-natal seizures" ("[a]cute brain injury due to asphyxia (insufficient intake of oxygen)"). [C: *11-*12; S: medical notes, apparently uncontested]
- ●AND [4 of 4] : acts and omissions during labor and delivery was a legal cause of the subgaleal hematoma, hypoxic ischemic encephalopathy and related injuries.
- ●AND [1 of 2] : acts and omissions during labor and delivery was a cause in fact of the subgaleal hematoma, hypoxic ischemic encephalopathy and related injuries.
- ●Dr. Reed's "negligent act or omission in fact caused [C.M.'s] injury" -- that is, the alleged injury would not have occurred "but for" Dr. Reed's conduct. (See Washington by Washington v. Barnes Hospital, 897 S.W.2d 611, 615 (Mo. 1995); Callahan v. Cardinal Glennon Hospital, 863 S.W.2d 852 (Mo. 1993)) [C: *18-*19, *22-*23]
- ●Dr. Reed's "negligent acts and omissions caused C.M.'s injuries." [C: *19; S: finding of the court]
- ●MIN [1 of 2] : "[H]ad C.M. been delivered at 10:35 a.m. ... , C.M. would not have been damaged"; "had Dr. Reed been at the hospital no later than 11:00 a.m., much if not all of the damage could have been avoided"; "it could have been avoided had a caesarean section been performed by 11:00 a.m." [C: *21; S: findings of the court; M: "obviously" as to the last assertion; B: "all agreed that that [the caesarean section] would have taken 10 minutes time"]
- ●MIN [2 of 2] : After the initial vacuum extractor did not operate properly, "Dr. Reed could have quite easily shifted to a caesarean procedure at that time, and avoided the subgaleal hemorrhage and possibly the ischemic injury." [C: 22; S: finding of the court]
- ●EVIDENCE FACTORS
- ●FACTOR [1 of 2] : "45 minutes elapsed between the time [Jasmine] began pushing and C.M. was delivered." [C: *21; S: finding of the court]
- ●FACTOR [2 of 2] : At approximately 11:48 a.m., "there was a late deceleration in the FHR pattern, followed by a fetal Bardycardia" [sic] [Fn 6: bradycardia = low heart beat]; "[t]he FHR monitor shows a drop in the baseline FHR from 190 to 90"; "[t]he rate stayed at 90 until noon and increased to 200 at 12:15 p.m. and to 210 at 12:20 p.m. which indicated severe tachycardia" [high heart beat]. [C: *10-*11; S: medical notes]
- ●Very Plausible
- ●AND [2 of 2] : The causal connection between acts and omissions during labor and delivery and the subgaleal hematoma, hypoxic ischemic encephalopathy and related injuries is sufficiently "proximate," such that the United States should be held legally responsible for the subgaleal hematoma, hypoxic ischemic encephalopathy and related injuries.
- ○UNLESS [1 of 1] : An affirmative defense or privilege is established.