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Young v US 11 Jul 2003 FINAL
Young v US 11 Jul 2003 FINAL (Decision) - _Young v United States.pdf (Documents)
- Comp-MAL-USRuleTreeDiagram.jpg (Pictures)
- ●the United States is liable to Kalen Young for medical malpractice.
- ○AND [1 of 4] : the United States, or an actor for whose conduct the United States is legally responsible, owed Kalen Young a legal duty of care.
- ●AND [2 of 4] : the failure to perform an episiotomy, to give an enema during labor, to administer pre-emptive antibiotics in repairing the breakdown of Mrs. Young's laceration, or to use chromic stitches did not conform to the applicable legal or medical standard of care.
- ○AND [1 of 3] : the United States or the actor engaged in the failure to perform an episiotomy, to give an enema during labor, to administer pre-emptive antibiotics in repairing the breakdown of Mrs. Young's laceration, or to use chromic stitches.
- ●AND [2 of 3] : For circumstances sufficiently similar to those in the particular case, there existed a legal or medical standard of care.
- ●In California, for circumstances sufficiently similar to those in the particular case, there existed a medical standard of care that reflected that degree of learning and skill ordinarily possessed by reputable members of their profession practicing in the same or similar locality and under similar circumstances [C: "Conclusions of Law," para 9, citing Polikoff v. US, 776 F.Supp. 1417, 1421 (S.D. Cal. 1991); Munro v. Regents, 215 Cal.App.3d 977 (1989)].
- ●"[T]he elimination of fecal material prior to delivery was standard operating procedure and was almost universal ... to avoid constipation during the postpartum period" [C: "Findings of Fact," para 32; S: opinion of Dr. Burke].
- ●REBUT [1 of 1] : "Plaintiffs have failed to establish the necessary standard of care or to show the reliability of their expert's opinion" [C: "Findings of Fact," para 35; S: finding of Court].
- ●MIN [1 of 2] : Dr. Burke's opinion concerning constipation was not reliable [C: "Findings of Fact," para 35; S: finding of Court].
- ●MIN [1 of 3] : Dr. Burke's "training and practice only encompassed communities in Georgia, Virginia, Alabama and Louisiana" [C: "Findings of Fact," para 34].
- ●MIN [2 of 3] : "Dr. Burke could point to no national standard of care grounded in peer review literature to support the reliability of his opinion on this matter" [C: "Findings of Fact," para 34].
- ●MIN [3 of 3] : Dr. Burke "was neither asked nor offered any testimony as to what the local community standard of care was in California where this case arose" [C: "Findings of Fact," para 34].
- ●MIN [2 of 2] : There was no other evidence in the record supporting Dr. Burke's opinion.
- ●MIN [1 of 2] : Dr. Taslimi, the expert for the United States United States, provided "the only testimony regarding what the California community standard of care would be regarding whether or not Mrs. Young's constipation was properly addressed during this labor and delivery based on the relevant standards of care" [C: "Findings of Fact," para 37; S: finding of Court]
- ●MIN [2 of 2] : Dr. Taslimi's opinion contradicted that of Dr. Burke: "[I]f a doctor gave an enema prior to C-section or to a laboring patient, he or she would be considered old-fashioned and unacquainted with contemporary medical literature and practice," and "administration of an enema in this situation is unnecessary" [C: "Findings of Fact," para 36; S: implicit finding of Court, opinion of Dr. Taslimi].
- ●AND [3 of 3] : the failure to perform an episiotomy, to give an enema during labor, to administer pre-emptive antibiotics in repairing the breakdown of Mrs. Young's laceration, or to use chromic stitches did not conform to the applicable legal or medical standard of care.
- ●At least one of the four instances of conduct identified by Kalen Young constituted negligent conduct, in that it did not conform to the applicable medical standard of care [S: allegation of plaintiffs].
- ●MAX [1 of 4] : The failure to perform an episiotomy was negligent [S: allegation of plaintiffs].
- ●REBUT [1 of 1] : "There was no negligence in not performing an episiotomy with this forceps delivery" [C: "Conclusions of Law," para 14; S: finding of Court].
- ●MIN [1 of 2] : "[W]hether an episiotomy should or should not have been performed is generally left to the treating physician's best judgment under the restrictive episiotomy approach, which is supported in the medical literature" [C: "Conclusions of Law," para 14].
- ●MIN [2 of 2] : "Dr. Burke, plaintiffs' expert, conceded that the practice of restrictive episiotomy, which is now the current thought, is appropriate" [C: "Findings of Fact," para 70].
- ●Very Plausible
- ●EVIDENCE FACTORS
- ●FACTOR [1 of 2] : "[S]tudies indicate that liberal episiotomies produce more tears than restrictive episiotomies" [C: "Findings of Fact," para 74].
- ●FACTOR [2 of 2] : "Dr. Taslimi criticized the Williams textbook, relied upon by Dr. Burke, which states that if an episiotomy is cut it produces a cleaner wound that can be repaired better, as an opinion unsupported by data" [C: "Findings of Fact," para 73].
- ●Very Plausible
- ●MAX [2 of 4] : The failure to give an enema during labor was negligent [S: allegation of plaintiffs].
- ●REBUT [1 of 1] : "Mrs. Young's constipation was appropriately addressed" [C: "Findings of Fact," para 30; S: finding of Court].
- ●MIN [1 of 2] : "[A]dministration of an enema in this situation is unnecessary" [C: "Findings of Fact," para 36; B: Dr. Taslimi's opinion].
- ●MIN [2 of 2] : "Dr. Taslimi provides the only testimony regarding what the California community standard of care would be regarding whether or not Mrs. Young's constipation was properly addressed during this labor and delivery based on the relevant standards of care" [C: "Findings of Fact," para 37; B: see supra, reasoning under California medical standard of care].
- ●MAX [3 of 4] : The failure to administer pre-emptive antibiotics in repairing the breakdown of Mrs. Young's laceration was negligent [S: allegation of plaintiffs].
- ●REBUT [1 of 1] : In this case, it was not a violation of the standard of care in California to give no antibiotics [C: "Findings of Fact," para 58-60, "Conclusions of Law," para 15; S: implicit finding of Court]
- ●MIN [1 of 2] : "[I]t is not a violation of the standard of care in California to give no antibiotics when there is no evidence of infection present" [C: "Findings of Fact," para 60; S: finding of Court].
- ●MIN [2 of 2] : There was no evidence of infection in the pre-operative report [C: "Findings of Fact," para 59; S: implicit finding of Court; B: pre-operative diagnosis dictated and signed by Dr. Stamilio, who did the actual repair].
- ●MAX [4 of 4] : The failure to use chromic stitches was negligent [S: allegation of plaintiffs].
- ●REBUT [1 of 1] : It was not negligent not to use chromic stitches [S: implicit finding].
- ●"[T]he treating physician has the choice of what specific types of sutures they will use when performing surgical repairs" [C: "Conclusions of Law," para 14].
- ●Very Plausible
- ●EVIDENCE FACTORS
- ●FACTOR [1 of 1] : "[T]he plaintiffs' testifying expert, Dr. Burke, had also used the identical type materials in his practice in the past before the newer synthetic sutures were available" [C: "Conclusions of Law," para 14].
- ●Very Plausible
- ●AND [3 of 4] : Kalen Young actually suffered the third degree perineum tear and its consequences.
- ●"Mrs. Young experienced a third-degree perineal tear during delivery, which involves either a partial or complete tear through the muscle that goes around the rectum" [C: "Findings of Fact," para 49; S: finding of Court]
- ●AND [4 of 4] : the failure to perform an episiotomy, to give an enema during labor, to administer pre-emptive antibiotics in repairing the breakdown of Mrs. Young's laceration, or to use chromic stitches was a legal cause of the third degree perineum tear and its consequences.
- ●AND [1 of 2] : the failure to perform an episiotomy, to give an enema during labor, to administer pre-emptive antibiotics in repairing the breakdown of Mrs. Young's laceration, or to use chromic stitches was a cause in fact of the third degree perineum tear and its consequences.
- ●Causation in fact has been proven "within a reasonable medical probability based upon competent expert testimony" [C: "Conclusions of Law, para 15, citing Jones v. Ortho Pharmaceutical Corp., 163 Cal. App. 3d 396, 403 (1985); Morgenroth v. Pacific Medical Center, Inc., 54 Cal. App. 3d 521, 533-34 (1976)].
- ●"[T]he failure to do an episiotomy in this case caused a much worse laceration" [C: "Findings of Fact," para 72; S: plaintiff's assertion].
- ○EVIDENCE FACTORS
- ○FACTOR [1 of 2] : [the opinion of Dr. Burke]
- ○FACTOR [2 of 2] : "[I]f an episiotomy is cut it produces a cleaner wound that can be repaired better" [C: "Findings of Fact," para 73; S: the Williams textbook].
- ●REBUT [1 of 1] : "[P]laintiffs have failed to prove ... that the failure to cut an episiotomy was a cause in fact of Mur. [sic] Young's subsequent injuries" [C: "Findings of Fact," para 79; S: finding of Court]
- ●"[T]he lack of an episiotomy did not make the tearing worse, but to the contrary, if it had been cut, there was a greater risk that the tear would have been worse, possibly extending beyond the third degree into the fourth degree" [C: "Findings of Fact," para 77; S: opinion of Dr. Taslimi].
- ●EVIDENCE FACTORS
- ●FACTOR [1 of 2] : "[I]t is simplistic to think that if the perineum is cut it will not tear" [C: "Findings of Fact," para 76; S: Dr. Taslimi's medical opinion].
- ●FACTOR [2 of 2] : "[L]iberal episiotomies produce more tears than restrictive episiotomies" [C: "Findings of Fact," para 74; S: the Cochrane Database Systematic Review article].
- ●Very Plausible
- ○AND [2 of 2] : The causal connection between the failure to perform an episiotomy, to give an enema during labor, to administer pre-emptive antibiotics in repairing the breakdown of Mrs. Young's laceration, or to use chromic stitches and the third degree perineum tear and its consequences is sufficiently "proximate," such that the United States should be held legally responsible for the third degree perineum tear and its consequences.
- ○UNLESS [1 of 1] : An affirmative defense or privilege is established.