http://www.yourlawyer.com/topics/overview/birth_injuries Sat, 21 Nov 2009 03:46:18 -0800 pixel-app en http://www.yourlawyer.com/articles/read/15815 Thu, 08 Jan 2009 00:00:00 -0800 http://www.yourlawyer.com/articles/read/15815 birth injuries when delivered by early cesarean section.  According to a new study, over one-third of all American babies—those born via planned and repeat C-section prior to 39 weeks gestation—are at increased risk for birth-related problems, reports WebMD.

C-section births accounted for one in every five births ten years ago; that number has increased, said WebMD.  It seems that women who have undergone at least one C-section are likelier to proceed with a C-section and not a vaginal birth for subsequent pregnancies, WebMD explained, adding that, according to national figures 40 percent of the annual 1.3 million C-section births performed are repeat, with most being planned procedures.

The American College of Obstetrics and Gynecology (ACOG) suggests that unless medically necessary, such planned, elective procedures prior to the 39-week gestational mark should not be considered unless testing confirms the baby's lungs are mature enough for delivery, said WebMD.  US News and World Reports HealthDayNews added that delivering a baby just two weeks earlier doubles the risks that the baby will experience breathing problems requiring mechanical ventilator intervention; infection, such as the blood infection newborn sepsis; and low blood sugar.  At 38 weeks, the complication rate is 1.5 times increased.  WebMD reported that, according to the study, babies born between their 37th and 38th weeks experienced up to four times the risks.

HealthDayNews quoted Dr. Alan T.N. Tita, study lead and assistant professor of obstetrics and gynecology and an epidemiologist at the University of Alabama at Birmingham as saying that, "About 36 percent of women were delivered prior to 39 weeks, electively by Caesarean.  These early deliveries were associated with adverse outcomes.  There was a two-fold increase in morbidity in those delivered at 37 weeks compared to women delivered at 39 weeks." The study appears in the January 8 issue of the New England Journal of Medicine.

The new study looked at 13,258 women who underwent elective, repeat C-section deliveries at one of 19 U.S. academic medical centers affiliated with the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Maternal-Fetal Medicine Units Network, said HealthDayNews.  Dr. Peter Bernstein, a maternal-fetal medicine specialist at Montefiore Medical Center and Albert Einstein College of Medicine in New York City, said that while the increase in complications was not surprising, "The bigger surprise to me was that nearly 36 percent of elective procedures were done before the 39th week”, reported HealthDayNews.  "The institutions that participate in this network are big academic centers," Bernstein said. "In the academic world, these are among the top institutions, and that more than one-third apparently aren't following ACOG guidelines is a surprise," he added.

WebMD said that the study found that planned, repeat, early C-section procedures were being performed on women who were insured, older, and married.  Also, women who want to have their babies delivered by their own doctor are also more likely to schedule the birth, working around the doctors’ schedules rather than leave the performing physician up to chance and the baby’s timing.

]]> http://www.yourlawyer.com/articles/read/13494 Wed, 12 Dec 2007 00:00:00 -0800 http://www.yourlawyer.com/articles/read/13494 caesarean sections, or C-sections, may leave babies at risk for breathing problems.  Today, Danish researchers revealed findings from a study that indicates that babies delivered by non-emergency caesareans sections are up to four times more likely to experience breathing problems than those babies who were delivered by vaginal birth.  The finding strengthens evidence about the risk of birth injuries posed by elective caesareans, which are becoming increasingly popular around the world.  Anne Hansen of the Aarhus University Hospital in Denmark said the risks were greatest when a caesarean section procedure was performed early, urging women not to choose to undergo an elective C-section procedure prior to their 39th week of pregnancy.  Many elective C-section procedures are being done at the 37th- and 38th-week time frames currently.

The study did not cover or explain why babies borne via caesarean section procedure are at higher risk for breathing problems, but the prevailing theory is that the risk was likely due to the hormonal and physiological changes that occur in the mother and baby’s bodies during the labor experience.  The process of labor triggers the release of a variety of stress hormones in the mother; these hormones are then passed on to the fetus during the labor and birthing process.  These stress hormones are thought to be an important factor in maturing the baby's water-filled lungs and are not released when the mother gives birth via a C-section procedure.  Cases of breathing problems that are associated with caesarean section births are generally not considered serious; however, they do typically require placing the infant in an incubator and administering oxygen treatment.

Hansen and her colleagues based their research, which was published in the British Medical Journal, on a study of more than 34,000 births taking place in Denmark.  The study revealed a nearly four-fold increased risk of breathing difficulties in those babies delivered via caesarean section procedure at 37 weeks.  Babies delivered via caesarean section procedure at 38 weeks experienced a three-fold increase.  Babies delivered via a caesarean section procedure at 39 weeks experience a doubled risk.  As a result, 10 percent of babies delivered via caesarean section procedure experienced respiratory problems when delivered at 37 weeks, compared to 2.8 percent of infants intended for vaginal delivery.  By 39 weeks, the proportion was 2.1 percent compared to 1.1 percent.

Hansen stressed that C-sections procedures still offer many expectant mothers and their babies a wide variety of benefits, particularly in the case where babies are in a breech position and in cases where the mother and/or the baby was in danger or experiencing distress.

But many feel that the medical profession should do more to try and curb the rising demand for non-emergency caesareans section procedures saying that many women choose to undergo caesarean section procedures because their first delivery was a frightening experience and they fear a repeat of that experience with their future births.  Critics feel it is up to the medical professionals to work toward assuaging expectant mothers’ anxieties and fears and try and help to make the birthing process a more fulfilling, less frightening experience.

]]> http://www.yourlawyer.com/articles/read/13291 Fri, 02 Nov 2007 00:00:00 -0700 http://www.yourlawyer.com/articles/read/13291 drug side-effects.

When a woman goes into a pre-term labor, it is likely that her baby will be born without the ability to breath on its own.  Obviously, a physician would want to do everything possible to keep this from happening.  One common method of dealing with pre-term labor is to give the mother a combination of a tocolytic agent and a steroid.   The tocolytic agent, in this case indomethacin, slows down or stops labor, while the steroid speeds up the development of the unborn baby’s lungs.  After the steroids have been given a couple of days to work, the mother is taken off indomethacin and her baby is allowed to be born.

It has been known for some time that indomethacin affected blood flow to the fetus, but the ramifications of this drug side-effect have never been fully studied.  This new study, conducted by researchers at the University of Rochester Medical Center, is the first to take an in-depth look at the health consequences of indomethacin use in premature babies.  The study involved an analysis of a group of indomethacin studies called a metaanalysis.  

From the metaanalysis, the University of Rochester scientists were able to conclude that indomethacin treatment can have some very serious consequences for babies.  The study showed an association between indomethacin and necrotizing entercolitis, a condition in which intestinal tissue dies.  While this condition can be treated with antibiotics, it often requires surgery and can be fatal. Indomethacin was also associated with periventricular leukomalacia, a disorder that reduces blood flow to the white matter of the brain and often leads to cerebral palsy.  The researchers did not find any association between indomethacine and bleeding in the brain, congenital heart defects and respiratory distress syndrome.

Most obstetricians only use indomethacin when a baby is going to be born extremely early.  Although some doctors use it when a pregnancy is further along, believing that indomethacin has fewer side effects than other tocolytic agents.  The authors of the new indomethacin study told Science Daily that they hope their findings will discourage doctors from using indomethacin when it is not necessary.  Indomethacin should only be used when it is certain that a premature baby will be unable to breathe on its own, and not simply to give it more time in its mother’s womb.

]]> http://www.yourlawyer.com/articles/read/12810 Fri, 04 May 2007 00:00:00 -0700 http://www.yourlawyer.com/articles/read/12810
The report, presented at the annual meeting of the American Academy of Neurology in Boston, was the latest to document the potential dangers of valproate to the unborn.

Last summer, researchers reported that 1 in 5 women who took the drug, sold as Depakote by Abbott Laboratories, had pregnancies that resulted in fetal death or birth defects, including malformed hearts and genitals, cleft palates and artery deformities.

Dr. Jacqueline French, a professor of neurology at the University of Pennsylvania, who was not involved in the study, said the latest findings were of great concern and that women of childbearing age should be informed of the risks, which are not included on the drug's warning label.

"It is time to have a different kind of conversation with our patients," French said.

An estimated 2.7 million Americans have epilepsy, a disorder in which clusters of nerve cells in the brain signal abnormally, causing seizures. Valproate has long been the preferred drug for treating generalized epilepsy, which affects up to one-half of patients.

The drug is also used to treat migraine headaches and some psychiatric conditions, including bipolar disorder. Abbott reported Depakote sales of $1.2 billion last year in the United States.

The latest study, led by Dr. Kimford J. Meador of the University of Florida in Gainesville, compared the IQs of 185 2-year-olds whose mothers had taken one of four epilepsy drugs while pregnant.

In addition to valproate, the drugs were carbamazepine, sold as Tegretol, lamotrigine (Lamictal) and phenytoin (Dilantin).

IQs were determined using the Bayley Scale for infant and toddler development. Researchers said a score of 100 was average and below 70 was mentally impaired.

Children whose mothers had taken valproate had an average IQ of 81, compared to an average of 96 for children in the carbamazepine group, 94 for the lamotrigine group and 95 for the phenytoin group.

Twenty-four percent of children whose mothers took valproate had IQs below 70, compared to 13% for carbamazepine, 11% for lamotrigine and 12% for phenytoin.

In the general population, an average of 2% of children have IQs below 70.

Meador said the research, funded by the National Institutes of Health, did not support a conclusion that all four drugs might cause mental retardation because the study was small and lacked a control group.

"The big thing is the difference between valproate and the other drugs," he said.

Abbott said in a statement that all epilepsy drugs posed serious risks, and Depakote's label made clear that the drug should not be a first-choice treatment for women of childbearing age.

Abbott said it was important to follow the progress of children in the study to see if they displayed cognitive impairments at age 6, when the study was scheduled to end.

The Food and Drug Administration had no comment on the study.

Women who must rely on valproate because they don't respond to other drugs should take the lowest possible dose if they become pregnant, Meador said. He stressed that pregnant women should not stop their epilepsy medication because a seizure could be dangerous for them and their fetuses.

French called for a mandatory informed consent process in which women of childbearing age would have to sign a document saying they were informed of the dangers before receiving prescriptions for valproate.]]> http://www.yourlawyer.com/articles/read/11246 Tue, 31 Jan 2006 00:00:00 -0800 http://www.yourlawyer.com/articles/read/11246
Almost eight million children annually suffer from a birth defect, including 3.3 million who die and another 3.2 million who live with severe mental and physical disabilities that often condemn them to a life of poverty and suffering.

"This is a serious, vastly unappreciated and underfunded public health problem," said Jennifer Howse, president of the March of Dimes, which commissioned the report.

Birth defects principally involve deformities of the heart and spine, and blood disorders, but as many as 70 per cent of the conditions are preventable with simple public-health measures and basic medical technologies, Dr. Howse said.

While the vast majority of children being born with birth defects are in the developing world, the problem also exists in wealthy, developed countries.

The new report is the first to catalogue the extent of birth defects on a country-to-country basis, and shows that the prevalence ranges from a low of 39.7 per 1,000 live births in France to a high of 82 per 1,000 in Sudan.

Canada ranked 14th among 193 countries, with a prevalence of 45.5 birth defects per 1,000 live births.

Arnold Christianson of the University of Witwatersrand in Johannesburg, South Africa, said the research team identified a staggering 7,000 types of birth defects, though there were five of genetic (or partially genetic) origin that accounted for a large number of the total, including: congenital heart defects; neural-tube defects such as spina bifida; blood disorders such as thalassemia and sickle-cell anemia; Down syndrome and glucose-6 phosphate dehydrogenase deficiency (G6PD).

Dr. Christianson said there are social and environmental factors that also explain why a significant proportion of birth defects occur.

For example, most neural-tube defects are due to dietary deficiencies. Canada has virtually eliminated conditions like spina bifida by fortifying flour with folic acid. Similarly, adding iodine to salt can slash the rate of hyperthyroidism, a leading cause of mental retardation.

Dr. Christianson said consanguineous (blood-relative) marriages greatly increase the risk of birth defects. For example, in the malaria belt, a higher proportion of the population carries one copy of a gene that confers protection against malaria, but also increases the risk of sickle-cell, thalassemia and G6PD. That problem could be curbed with basic genetic counselling, he said.

The risk of having a child with Down syndrome increases with maternal age, and that can be addressed by improving access to birth control, Dr. Christianson said. Even basic vaccinations against conditions like rubella could eliminate grave conditions like congenital rubella syndrome.

The report notes that only about 50 per cent of birth defects are accurately diagnosed, even in wealthy countries.

The new data focus largely on genetic and dietary factors known to cause specific birth defects, because they are easiest to track. But Dr. Christianson noted that there are other social factors like smoking and alcohol use during pregnancy that are taking an enormous toll.]]> http://www.yourlawyer.com/articles/read/11064 Sun, 18 Dec 2005 00:00:00 -0800 http://www.yourlawyer.com/articles/read/11064
A medical malpractice suit filed on behalf of the girl alleged the in-house obstetrician, Dr. Jacques Hercule, was negligent for waiting 20 to 25 minutes to perform an emergency Caesarean section on the girl's mother, Selene Araujo, who suffered a seizure during labor in 1998.

'I started crying'

The girl, 7-year-old Evelyn Araujo, was born with severe developmental problems that will likely require a lifetime of medical treatment and therapy, according to a statement issued by Anastopoulo & Clore, the South Carolina-based law firm representing the Araujo family.

Selene Araujo said she was pleased with the jury's decision.

"I started crying when I heard," she said. "It's for my daughter, and she's going to be able to have a better life."

The hospital would not disclose whether any disciplinary action had been taken against Hercule.

"We sympathize with the family involved in this case. While a verdict has been rendered, the parties have agreed to a confidential settlement," said St. Anthony President and CEO Kathleen DeVine in a statement.]]> http://www.yourlawyer.com/articles/read/9645 Tue, 19 Apr 2005 00:00:00 -0700 http://www.yourlawyer.com/articles/read/9645
The award, one of the largest medical malpractice verdicts in state history, was reached Friday in a lawsuit brought by Tami Lafferty, formerly of Lynnwood and now of Hasbrouck Heights, N.J., against Stevens Hospital in Edmonds and two physicians.

Jurors found the hospital responsible for 80 percent of the damages, or $13.7 million, with Dr. Jae Sim responsible for 15 percent and Dr. Myra Horiuchi for 5 percent. Edmonds Family Medicine Clinic, also named as a defendant, was absolved of liability.

In a statement issued Sunday, hospital Chief Executive Dr. John T. Todd said the verdict would be appealed.

The case was the second large malpractice case involving a difficult birth and the hospital's radiology department in the late 1990s.

In 2002 the hospital agreed to pay $13 million a state record for an out-of-court settlement in a medical malpractice case to resolve a lawsuit over damage to a baby whose size was underestimated, resulting in an attempt at a vaginal delivery that had to be abandoned in favor of a Caesarean section on Oct. 19-20, 1997.

Lafferty's case centered on an ultrasound examination that was performed before she gave birth to her son, Benjamin.

Because of a rare medical condition called fetal maternal hemorrhage, the child lost 75 percent of his blood before birth, had to be resuscitated after an emergency delivery by Caesarean section and was left with serious brain damage, impaired vision and cerebral palsy.

Dr. Arthur A. Castagno, who joined Stevens in 2002 and became head of the radiology department this year, said in the hospital statement he had reviewed the records and believes Lafferty, doctors and the hospital staff did all they should have done.

Lafferty went to her doctor the day before Thanksgiving in 1998 and reported decreased movement by the fetus. The physician referred her to Stevens for an obstetric ultrasound which was interpreted as normal by the radiologist, Castagno said.

The day after Thanksgiving, Lafferty returned to her physician with the same concern and was sent again to the hospital, where a monitoring device showed the fetus' heart had stopped beating. At that point the fetus "was in extremely bad shape," Castagno said.

Lafferty claimed that she was given the wrong ultrasound test, that the first test showed her fetus was in trouble, that she was wrongly directed to undergo further tests and that the baby should have been delivered immediately after the first test.

In his statement, Todd expressed "the utmost sympathy for Tami Lafferty and her son" but said the boy's condition could not have been diagnosed or prevented.

"We believe the ultrasound conducted in 1998 had no effect on the patient outcome," he added.]]> http://www.yourlawyer.com/articles/read/9521 Sat, 19 Mar 2005 00:00:00 -0800 http://www.yourlawyer.com/articles/read/9521
The young girl, who suffers from Erb's palsy, was awarded $200,000 for past pain and suffering, $1 million for future use and $100,000 for future medical expenses, said the plaintiff's attorney.

The settlement will allow Carmine and Stacey Losurdo's only child "the opportunity to get the best medical and therapeutic care and protect her in the future, one of parent's attorney's told the Advocate.

The money will be available to the Losurdos' daughter for certain medical expenses, he explained, but otherwise she will not personally be able to use the funds until she turns 18.

The case, which lasted three weeks, was decided in state Supreme Court, St. George, with Justice Philip G. Minardo presiding.

The jury had deliberated since Wednesday. Throughout the case there had been no offers of settlement.

According to court documents, during a vacuum extraction delivery, Dr. Francis X. Martingano, of Women's Healthcare Specialist Medical Practice, Annadale, improperly delivered the Losurdos' daughter from an internal location higher than usual for a vaginal childbirth.

In the procedure, a vacuum extractor device is placed on the infant's head to help remove it from the uterus.

The infant's left shoulder was impacted, causing irreversible damage to the nerves controlling the muscles in her left arm and hand, a condition known as Erb's palsy, according to one of the family's attorneys.

"There is such promise with a birth, and to have it taken away from you is a hardship," said a family lawyer "We have always maintained that this [injury] could've been avoided, if there was reasonable and customary care."]]> http://www.yourlawyer.com/articles/read/8708 Fri, 22 Oct 2004 00:00:00 -0700 http://www.yourlawyer.com/articles/read/8708
The jury ruled yesterday that St. Francis Hospital in Blue Island and Doctor Mary Ann Dean-Onayemi were negligent in Tairay Sewell's injuries.

Tairay is confined to a wheelchair. He can't walk, speak or eat on his own. The family attorney says his injuries occurred because the medical staff didn't intervene when problems arose during his birth.

His mother, 27-year-old Misty Campbell, says the money will allow her to buy everything her son needs, including a wheelchair-accessible van, house and therapy.

Spokeswoman Debra Robbins says hospital officials are disappointed with the verdict. She says the medical staff acted appropriately. ]]> http://www.yourlawyer.com/articles/read/8793 Wed, 06 Oct 2004 00:00:00 -0700 http://www.yourlawyer.com/articles/read/8793
Patrick Lombardo, and his wife, Christine, filed the lawsuit on behalf of their son, Jonathan, in 1996.
Their son died in August 2000 at the age of 4.

According to the lawsuit, Mrs. Lombardo was in her 40th week of pregnancy and was induced labor at 3 a.m. on Jan. 16, 1996.

The fetus' heart rate dropped and Mrs. Lombardo told hospital employees that she wasn't sure if she felt the fetus move.

The lawsuit alleged hospital employees failed to summon a doctor to care to Mrs. Lombardo due to complications during labor.

The fetus' heart rate continued to drop when their son was delivered by vacuum assistance.
According to the lawsuit, their son's condition improved but sustained permanent lung and brain injuries due to cardiopulmonary resuscitation efforts.

The Lombardos filed the lawsuit in 1996,claiming the hospital was negligent by failing to treat Mrs. Lombardo in a timely manner, and failing to have doctors available to perform an emergency delivery.

Named as defendants were: Mercy Hospital in Wilkes-Barre, Mercy Medcare, Inc., Pediatric Clinic of Nanticoke, Mercy Anesthesia Consultants, P.C., and doctors H. Chung, Marie Grabowski, Hyung B. Kim and Dasa S. Satyam.

On Friday, Luzerne County Judge Hugh Mundy approved the $3 million settlement reached between the parties.]]> http://www.yourlawyer.com/articles/read/8561 Wed, 22 Sep 2004 00:00:00 -0700 http://www.yourlawyer.com/articles/read/8561
A settlement was reached last week in which representatives for Barbara Winters, the Monmouth Medical Center nurse midwife who cared for Alyson Shannon during the labor, delivery and birth of her daughter, Corialle, on Nov. 7, 1997, will establish a trust for Corialle Shannon's future care.

There was no admission of liability as part of the settlement, and all other parties of the suit, which included Monmouth Medical Center and three doctors, were dismissed, according to the Shannon family's attorney.

Alyson Shannon and her mother, Kim, filed suit in 1999 on behalf of Corialle, alleging negligence on the part of doctors and medical staff at Monmouth Medical Center in Long Branch during the labor and delivery.

Specifically, a 30-minute delay in the child's delivery caused a lapse in oxygen, which resulted in seizures, brain injury, and over time, mental delays and cerebral palsy, said the familys laywer. Cori Shannon now uses a wheelchair and attends a special school.

The baby had to be resuscitated when born, said the familys lawyer.

Of the settlement reached last week, Alyson Shannon said, "As long as the trust properly manages the money, then she might just have enough money to help her with all of her needs throughout her life expectancy.

"All a mother wants is for her daughter to have a fun, fulfilled life, which she can now do so."]]> http://www.yourlawyer.com/articles/read/8534 Tue, 07 Sep 2004 00:00:00 -0700 http://www.yourlawyer.com/articles/read/8534
The settlement amount will be put into a trust and will provide a lifetime payout of $13 million for the injured child, Jamion Cash of Person County.

The settlement came just as the case was about to go to trial in Durham County Superior Court. Officials had predicted the proceedings would last about five weeks.

The lawsuit alleged negligence on the part of Durham County Hospital Corp., which owns Durham Regional Hospital and contracts with Duke for its operation, and three physicians: Gregory Fisher, Stephanie Rand and Christine Hale, a pediatric resident at the time.

According to the lawsuit, Jamion was born prematurely Feb. 16, 2001, and soon was noted to be jaundiced. In other words, he had a yellowish tint to his skin.

The infant was discharged two days later with no treatment for the jaundice and no scheduled follow-up appointment, the suit said.

Four days after that, he was readmitted to the hospital for decreased feeding, fever and jaundice, the suit added.

The suit said that Jamion developed kernicterus, a preventable, lifelong neurologic syndrome caused by severe jaundice.

As a result, Jamion will suffer permanently from cerebral palsy, developmental disabilities and impaired vision, speech and hearing, according to the suit.

"Durham County Hospital Corp. Inc. is liable for its own negligence in training, selecting, controlling and supervising its residents as well [as] its own negligence in developing and promulgating newborn protocols, guidelines and procedures," the suit said. It said the corporation "had the right and non-delegable duty to supervise and control the manner and method of job performance by nurses, physicians, medical students and administrators on the pediatric floor." ]]> http://www.yourlawyer.com/articles/read/8110 Mon, 24 May 2004 00:00:00 -0700 http://www.yourlawyer.com/articles/read/8110
You may not know it, but most nail polishes contain a chemical to prevent chipping. It's commonly called DBP. And now at least two major cosmetics firms are eliminating DBP from their polish formulas because of links to birth defects in lab mice.

Dr. Jacqueline Moline, a specialist in occupational and environmental medicine at the Mount Sinai Medical Center, says the animals were subjected to very high doses.

"The studies gave them 100 mg per kilogram per day. There are of a magnitude much greater than anyone would have exposure to in the course of daily living using nail polish. They were also fed it," Moline said.

There are no studies on humans. So the potential threat to humans is unclear. Nonetheless, Procter & Gamble and Estee Lauder are phasing out the ingredient. Urban Decay did so several years ago.

Rebecca Owens says it was a topic she took seriously when she was pregnant.

"I became aware of it through a friend who always keeps me posted on this kind of stuff. I actually looked up on the Internet what brands," Owens said.

The companies are following the lead of the European markets, where the use of DBP is effectively banned from cosmetics. The Cosmetics Toiletry and Fragrance Association representing the U.S. industry says DBP presents no health risk, and that it's more a matter of politics than science.

Moline says consumers should know DBP belongs to a family of chemicals known as phthalates, which are widely used in cosmetics.

"So once you look at the cumulative exposure and all the products they use and they may want to see which ones they could possibly use that may not have as many chemicals," Moline said.

That is not a cause for alarm, she says, but a reason to be informed.]]> http://www.yourlawyer.com/articles/read/7780 Tue, 16 Mar 2004 00:00:00 -0800 http://www.yourlawyer.com/articles/read/7780
The Brooklyn jury, in a verdict returned Thursday, found that Dr. Paul Ennin, Dr. Paul Owusu Baah and Interfaith Medical Center were negligent in attending to the birth of Drita Manuka, who was delivered by emergency Cesarean section on Feb. 5, 1987.

An attorney who represented the family in the medical-malpractice lawsuit, charged that the doctors and the hospital wrongly treated the girl's mother Suzana Umerovska of Flatbush for a bladder infection before correctly diagnosing that the baby's umbilical cord was cutting off her oxygen supply.

"This extreme obstetrical emergency caused the infant's oxygen supply to be choked off for a prolonged period," the family's attorney said. As a result, he said, Drita Manuka was born with permanent brain damage, including severe cerebral palsy and other mental deficits that require daily medical and custodial care.

"Doctors and the hospital had several opportunities over a 24-hour period to rescue the infant from the mother's womb, but they failed repeatedly to correctly diagnose the mother's condition," the attorney said.

The mother and her husband, Ferik Manuka, a roofer, were not available for comment.

The verdict was returned in State Supreme Court in Brooklyn after a four-week trial before Justice Gerald Rosenberg. ]]> http://www.yourlawyer.com/articles/read/7660 Sat, 21 Feb 2004 00:00:00 -0800 http://www.yourlawyer.com/articles/read/7660
The lawsuit was filed against two practice groups, who employed the anesthesiologist and obstetrician, and Northwestern Memorial Hospital, which employed a resident.

They alleged a Caesarean section was not performed quickly enough on Evelyn Arkebauer in 1998.

As a result, Andrew was born with brain damage and can't talk or walk.

An attorney said the anesthesiologist didn't answer his pages promptly, and an off-duty nurse testified the anesthesiologist was with her in another room and was paged twice before responding to a third page.]]> http://www.yourlawyer.com/articles/read/6965 Sat, 08 Nov 2003 00:00:00 -0800 http://www.yourlawyer.com/articles/read/6965
A Circuit Court jury found pediatrician Stephen A. Liverman negligent in his treatment of the boy, who lawyers said was born blue and went without sufficient oxygen for 80 minutes after he was delivered prematurely.

The jury found him and the hospital, Anne Arundel Medical Center, liable for damages.

The boy's parents filed the lawsuit in late 2001 after a conscience-stricken nurse came to a family picnic nine years after the birth and revealed what she viewed as a series of missteps in the hospital's newborn nursery.

The parents, Thomas and Valerie Shea, brushed away tears yesterday as they described how the award would offer their mentally disabled son financial security for the around-the-clock care he will need for the rest of his life.

"Every day, we worried, what will happen to him when we're gone," Valerie Shea said in the hallway of the downtown Annapolis courthouse. "Now we don't have to worry."

The verdict ends what the Sheas described as a decade-long odyssey to discover the cause of brain injuries that left their son, Patrick T. Shea, with an IQ of 49, severe learning disabilities and no ability to care for himself.

The doctor and the Annapolis hospital denied the allegations in court papers and produced experts over the week-and-a-half trial who argued that other factors may have caused the boy's retardation.

Their lawyers declined to comment yesterday because a technical aspect of the case will not be resolved until the jury meets for the last time Monday. Asked to comment outside the courtroom, Liverman, who now works in the neonatal intensive care unit at the Greater Baltimore Medical Center, said, "No, thank you."

The jury awarded $1.4 million for Patrick's future medical expenses, $3.5 million for his lost earning capacity, and $1.5 million for pain and suffering. Patrick, a blond, bespectacled boy with an elfin smile, is a special-education pupil at Crofton Middle School.

According to the lawsuit, Valerie Shea went to her obstetrician for a routine prenatal checkup on Nov. 9, 1992, during which an ultrasound showed that Patrick's heart was racing at more than 200 beats per minute, a life-threatening condition known as fetal tachycardia. The obstetrician had her rushed to Anne Arundel Medical Center, where doctors performed an emergency Caesarean section at 12:24 p.m.

When he emerged, Patrick was blue, his heart was still racing, and he was having trouble breathing.

Liverman gave him an oxygen mask and tried to revive him by placing ice on his cheeks, but did not insert an oxygen tube down his breathing passage until 1:20 p.m., some 56 minutes after his birth, the boy's lawyers said. They said it was 1:38 p.m. when Liverman, at the suggestion of a nurse, administered a dose of a heart drug called adenosine. Within five minutes, the lawyers said, Patrick's heart rate returned to normal and his color to a healthy pink.

Shea's lawyers, Robert J. Weltchek and Christian Lodowski, argued that the oxygen deprivation in the 80 minutes after delivery led to severe and permanent brain damage.

The Sheas said they knew nothing of their son's ordeal until 2001. Just after Patrick's delivery, Valerie Shea was recovering from the C-section, and Thomas Shea was still en route from his job.

The Sheas said that they had sought Patrick's hospital records in 1994 but received no documents about the efforts to revive their son. At a family picnic in 2001, Valerie Shea approached Joannie Gammill, a nurse who is a distant relative, about what happened at the hospital that day.

The nurse hinted that there had been problems and called the next day with details, leading the parents to file the lawsuit on their son's behalf.

The jury will reconvene Monday in the courtroom of Judge Philip T. Caroom to decide whether Liverman's medical practice, Pediatric Consultants of Annapolis, should contribute to the $6.4 million award. ]]> http://www.yourlawyer.com/articles/read/6384 Wed, 06 Aug 2003 00:00:00 -0700 http://www.yourlawyer.com/articles/read/6384
The baby's mother was called to hospital on Aug. 4, 2001, after her doctor realized she was five days overdue. While in labour the next day, the woman's husband was contacted to give his permission for doctors to perform a caesarian birth.

The caesarean was never performed, however, and now the parents are claiming their son suffered a mechanical injury caused by traction to the head during birth.

They claim their son hasn't been able to properly move his left arm since being brought home -- requiring them to travel to the Toronto Hospital for Sick Children for a diagnosis last year.

UNDUE FORCE

The parents claim doctors at St. Boniface Hospital used undue force while using forceps to deliver their son and should have used the caesarean method they were initially considering.

They're seeking unspecified damages. ]]> http://www.yourlawyer.com/articles/read/6029 Thu, 29 May 2003 00:00:00 -0700 http://www.yourlawyer.com/articles/read/6029
The Alameda County jury found the hospital 60 percent responsible for the condition of Collin Page of Alameda, whose delivery by cesarean section on Jan.

20, 2001, came too late after his mother's uterus ruptured, said the family's attorney, Steven Brewer of Oakland.

Collin suffers from cerebral palsy, does not have control of his limbs and will need care for the rest of his life. The jury determined his life expectancy to be 32 years.

Nurses at the hospital and Dr. John Carper of Alameda failed to recognize the possibility of uterine rupture in women who attempt vaginal birth after a previous C-section, Brewer said.

Page, who suffered pain so severe she felt she was "dying," underwent a belated C-section that was performed by an on-call obstetrician. Collin would have been "happy and healthy" had he been delivered 15 minutes earlier, Brewer said.

Carper did not have surgical privileges to perform the procedure and failed to notice Collin's deteriorating heart rate, Brewer said. The jury found Carper 40 percent liable.

"Both the doctor and the hospital treated this delivery as routine, when it was very much a high-risk delivery," Brewer said. "They had no plan in place to deal with this, and they got the shock of their lives when her uterus ruptured."

The jury awarded the family $8.5 million for medical expenses, $6.1 million for wages Collin would have earned and $250,000 for emotional distress and suffering.

Attorneys representing the hospital and the doctor said they do not know whether they will appeal the jury award.

"I don't think there's anyone to blame for this outcome," George Clause, a San Jose attorney for the hospital, said. "I think the nursing staff appropriately managed this patient's labor and delivery."

An attorney for Carper, David Lucchese of Walnut Creek, said the child's injuries were "unpreventable."

"Bad things can happen to good people," he said. ]]> http://www.yourlawyer.com/articles/read/5189 Tue, 01 Apr 2003 00:00:00 -0800 http://www.yourlawyer.com/articles/read/5189
Laboratory experiments by geneticists at Case Western Reserve University in Ohio showed that bisphenol A disrupts the way that chromosomes align to produce the eggs of mice, leading to a condition that is the main cause of miscarriages and Down's syndrome in humans.

Scientists say the study is the first to show that exposure to a small amount of an environmental contaminant that mimics the hormone estrogen disrupts the growth of embryos, killing them or leading to genetically abnormal offspring.

Bisphenol A, known as BPA, is used in the manufacture of hard, clear plastics, including containers used to store and microwave food and sealants used on teeth to prevent cavities.

Toxicologists say the chemical leaches from plastic food and drink containers, including baby bottles and cookware, as they age, especially when they are microwaved or cleaned with harsh detergents. BPA also has been found at low levels in water supplies.

The new study showed that when a cell is exposed to BPA, "it looks like someone shot the chromosomes with a shotgun. They are totally disorganized. If you disorganize the chromosomes, it is a death sentence for an embryo," said Frederick vom Saal, a reproductive toxicologist at University of Missouri. "This is a stunning form of damage. It disrupts development of the cell that becomes your baby."

Plastic-industry representatives have said there are no safety issues related to low exposure, and they have disputed the results of past studies that showed other reproductive effects. Representatives of the Society of the Plastics Industry were unavailable for comment on Monday.

BPA ranks among one of industry's top chemicals, with 2 billion pounds used yearly.

Medical experts say the study is important because they have long tried to unravel the causes of chromosomal defects in humans, known as aneuploidy. An estimated 10 percent to 25 percent of fertilized human eggs are aneuploid, and almost all end in miscarriage in the first trimester, often before a woman knows she is pregnant. The rest result in children born with Down's syndrome.

"Our studies have obvious relevance to the genesis of aneuploidy in the human," the scientists wrote in the journal Current Biology. They reported that they found defects in the mice "at exposure levels close to or even below those considered safe" for human exposure.

"The effect is so striking in the mice and so unexpected," Patricia Hunt, a geneticist at the university who was the lead researcher in the study, said in an interview on Monday. "Of course we have no way of knowing that the effect of BPA is exactly the same in humans. But given the striking effects in mice, I'm not sure we can wait to know if mice and humans are exactly the same."

Because the risk of birth defects increases with a mother's age, scientists have long theorized that a mother's fluctuating hormones may be at the root of aneuploidy and birth defects. The new study confirms that there is a hormonal link. In this case, however, the defects were caused by an industrial chemical that mimics estrogen.

The scientists' discovery was accidental. In 1998, at three separate laboratories at the Cleveland-based Case Western, researchers noticed a sudden, large increase in chromosomal abnormalities in the eggs of mice they were using to study aneuploidy and Alzheimer's disease.

The researchers thought at first that the mice were mutants. But an investigation revealed that a worker had used an improper detergent to clean the plastic mouse cages and water bottles. The detergent was highly alkaline, and it caused large amounts of BPA to leach from the plastic, continuously exposing the mice.

The eggs of mice in these cages had eight times more aneuploidy and 20 times more errors in chromosomal alignment than the eggs of mice not exposed to BPA. The death rate of newborn mice also was higher. When the mice colony was moved to a new facility, the defect rates returned to normal.

The scientists then conducted repeat experiments, feeding mice water contaminated with BPA. The tests confirmed that the chemical altered chromosome alignment at exposures that were low and short in duration, Hunt said. Levels that caused the damaging effects are similar to those found in studies of human exposure in Europe.

The mouse is considered a reliable model for human genetic research. It is useful for studying birth defects in particular because meiosis, the process of cell division that creates an egg, is the same. ]]> http://www.yourlawyer.com/articles/read/5187 Mon, 31 Mar 2003 00:00:00 -0800 http://www.yourlawyer.com/articles/read/5187
In this purely coincidental scenario, the detergent apparently damaged the plastic cages, causing them to leach bisphenol A (BPA), a compound that has hormone-like properties. This in turn appears to have led to chromosomal abnormalities in the mice. Although this was an extreme circumstance, scientists have since shown that even normal wear-and-tear to common plastic items can cause the same problem.

While not discounting the results of the research, a spokesman for the plastics industry says the research is incomplete and the compound has been safe in people.

A few years ago, Patricia Hunt, a geneticist at Case Western Reserve University in Cleveland, was conducting an experiment to see if hormone changes in women during their last decade of reproductive life resulted in aneuploidy, or an abnormal number of chromosomes in the egg.

An estimated 10 percent to 25 percent of fertilized human eggs are aneuploid, or have an abnormal number of chromosomes. Aneuploidy is consequently the leading cause of mental retardation and birth defects in humans, including Down syndrome.

Hunt's study was going well and producing the results she wanted when, almost overnight, the rate of chromosomal abnormalities in the control mice jumped from under 2 percent to 40 percent.

Researchers conducting an unrelated experiment in a different lab in the same department reported the same thing at exactly the same time.

Hunt initially thought it was the animals themselves, or perhaps an environmental cue coming in through an air duct. Then she and her colleagues noticed the mouse cages were deteriorating. "They were going from clear plastic to hazy, then some stress cracks appeared, then they got bubbly and sticky and really nasty," she recalls. This happened over a period of many weeks, even after the cages were repeatedly washed with normal detergent.

A little detective work revealed that a temporary building worker had used the wrong detergent to wash the mouse cages. That detergent had apparently damaged the plastic, causing BPA to leach from the polycarbonate material used to make the cages and water bottles.

BPA is used widely by the plastics industry to make common plastic food and beverage containers as well as baby bottles. Although it is manmade, BPA has been shown to mimic the effects of estrogen. Its effect on reproduction is controversial, Hunt says.

Hunt decided to take another, methodical look at the problem and discovered that extremely low levels of BPA daily doses of 20 parts per billion over five to seven days interfered with the cell division in the eggs of female mice. This study, which is reported in the April 1 issue of Current Biology, is the first time scientists have shown that environmental exposure to BPA affects the eggs in such a way.

A looming, unanswered question, of course, is whether environmental exposure to BPA can cause the same problem in humans. "It's always hard to know how to extrapolate to humans," Hunt says. "We use the mouse under the assumption that the basic process of cell division is really well conserved between mammals and, for the most part, that's true. If it's true for something like this, we have no way of knowing."

While an extra-strong detergent caused the mouse cages to leach quickly and dramatically, normal wear and tear can have the same effect over time, Hunt says. "It just depends on what levels are sufficient to do bad things, and we don't really have any idea," she says. One concern is the levels that caused harm to mice are within the realm of what humans are normally exposed to.

"The more I read, the more I'm concerned that there are some significant reproductive effects of this and they have been dismissed," Hunt says. The effects being seen here are different than in the past. "Unlike previously reported effects that lead to alterations in the reproductive tract, the effect we are reporting would influence the next generation."

"Nobody really knows how to interpret these results," says Steven Hentges, executive director of the polycarbonate business unit of the American Plastics Council. "It's only an indicator that more research is needed to see if the technique is valuable. She also makes a point that the relevance to humans isn't known that ties into the technique she's using whether it really has predictive value, is it repeatable."

While Hunt and her colleagues looked at chromosomal abnormalities, they did not actually look at whether the mice had reproductive or birth defects, Hentges says.

A number of previous studies essentially absolved BPA of harmful effects in these areas. "If you look at that full weight of evidence, studies that actually look at health outcomes, reproductive success or congenital defects or any other kind of developmental issues, you don't actually find them," Hentges says.]]> http://www.yourlawyer.com/articles/read/5188 Mon, 31 Mar 2003 00:00:00 -0800 http://www.yourlawyer.com/articles/read/5188
Low-level exposure to Bisphenol A, used in food and beverage containers and baby bottles, interfered with cell division in female mouse eggs, researchers discovered. The interference resulted in the chromosomal abnormality known as aneuploidy, which can lead to mental retardation and birth defects in humans.

Patricia Hunt, genetics professor at Case Western Reserve University, said she was "happily" studying the effects of age on chromosome abnormalities in female mouse eggs when something unexpected happened.

"One day our control values went completely crazy," Hunt told United Press International. The rates of chromosome abnormalities increased dramatically.

Some sleuthing revealed a temporary worker had picked up the floor detergent to clean the mouse cages. A harsh cleanser, the detergent started to degrade the rodents' plastic enclosures. "Once the damage is done, the plastic degrades and continues to degrade," Hunt said. After a while, the almost transparent cages went white then bubbly, she said.

Knowing from previous research that Bisphenol A, a compound in the plastic cages, mimics estrogen and could contribute to early onset of girls' puberty, Hunt figured the damage to the cages might have contaminated the mice's water with BPA.

To confirm this suspicion, Hunt worked with collaborator Terry Hassold and a team of researchers to get to the bottom of the mystery. The evidence pointed to BPA, which in increasing doses raised the number of chromosomal abnormalities in the eggs of female mice.

"The chromosomes should line up and divide into two equal groups," Hunt said. "They weren't lining up right."

Although the results cannot be extended to humans, there has been research on human levels of BPA. Hunt said a German study had determined blood levels of the compound in pregnant women, their fetuses and placenta.

"The levels they reported are not far from the range we were at," Hunt noted, although the source of the BPA in the German research was not determined. Other studies, however, suggest resin coatings used to line food and beverage containers can leach the compound, she added.

The reason for the cell division interference is unclear. Hunt said BPA is not structurally similar to estrogen but can bind to the hormone's receptors. Because the attraction is weak, some scientists think BPA should not affect humans adversely, Hunt said. However, she added, the compound might act in an unsuspected way not related to its timid affinity to estrogen receptors.

Hunt said she would not suggest doing away with all plastics, which would be impossible, but noted some are more stable than others. Instead, she suggested that less stable polycarbonate plastics which are composed of BPA be switched with glass or other alternatives.

The new data are consistent with historical research on environmental estrogens and are a big deal, said John McLachlan, director of the Center for Bioenvironmental Research at Tulane and Xavier Universities, New Orleans.

"It's big because it gives a plausible explanation for why there is this high percentage of chromosomal abnormalities in human embryos," McLachlan told UPI. Although environmental estrogens might not explain for all of the cases, the possibility "adds another kind of biology to our thinking," he continued.

The implications of the results should mobilize manufacturers and regulators to act, said Frederick vom Saal, professor of reproductive biology at the University of Missouri in Columbia.

"The use of these products in Japan has already decreased dramatically," said vom Saal. A number of studies have shown BPA can affect behavior, decrease sperm count and cause changes in the urinary tract, he said.

Hunt's is the first to show BPA can have chromosomal effects. Vom Saal said the consequences of this phenomenon are dire. The new findings show the compound can damage fetuses and it can kill them, he said, and regulatory agencies will no longer be able to ignore the harmful effects.

"This is something that has to be of significant concern," vom Saal said. "These animals get (BPA) from drinking out of the equivalent of old baby bottles."

Although the study was done in mice, vom Saal said the process of oocyte, or egg, formation in mice is the same as that in humans.

"This is simply not a product that should be used to put food in," vom Saal told UPI. "Or people should be told to use it a few times then throw it away." ]]> http://www.yourlawyer.com/articles/read/5036 Fri, 21 Mar 2003 00:00:00 -0800 http://www.yourlawyer.com/articles/read/5036
However, researchers at Johns Hopkins Children's Center caution that these are preliminary findings and shouldn't dissuade couples from considering IVF. The study appears in the April issue of the Journal of Urology.

The Hopkins team collected information on 78 children with cloacal-bladder exstrophy-epispadias complex treated at the center from 1998 to 2001. They found these birth defects are seven times more common in children conceived through IVF.

The condition includes defects of the bladder, pelvic bones, urethra and genitals. It occurs in about four of every 100,000 live births.

"What we are seeing now is simply an association between this group of birth defects and IVF births," senior author Dr. John P. Gearhart says in a news release.

"Further research is needed to verify these findings and understand this association. These defects are extremely rare, and our preliminary findings should not alone discourage couples from undergoing IVF," he adds.]]> http://www.yourlawyer.com/articles/read/2794 Mon, 04 Nov 2002 00:00:00 -0800 http://www.yourlawyer.com/articles/read/2794
Over a three-year period from 1997 to 2000, about 3,750 serious injuries, birth defects and deaths in children under 2 were linked to medications and reported to the Food and Drug Administration, according to a study in the November issue of Pediatrics.

The study, conducted by researchers at George Washington University and the University of Maryland, comes two weeks after a federal court said the FDA does not have the power to require drug makers to test adult medicines in children.

The study found 769 deaths and 664 cases of birth defects or disabilities possibly linked to drugs used in children or to medications taken by their mothers during pregnancy, delivery or breast-feeding.

"These results underscore the need for additional drug testing in the youngest pediatric patients and for carefully weighing the risks versus benefits of medication," the researchers said.

Adult medications are commonly prescribed for children without clinical testing on youngsters because such studies can raise ethical and practical concerns.

"There is extremely limited testing of drugs, so it is very hard to know how to use them well" in children, said lead researcher Thomas J. Moore, a health policy analyst at George Washington University.

The researchers cautioned that when a report is filed about an apparent adverse drug effect, it does not necessarily mean the medicine was at fault.

Dr. Charles J. Cote, a pediatric anesthesiologist at Children's Memorial Hospital in Chicago who was not involved in the study, said it is often hard to determine whether a very sick child died from the drug or the illness.]]> http://www.yourlawyer.com/articles/read/737 Tue, 21 May 2002 00:00:00 -0700 http://www.yourlawyer.com/articles/read/737
The risk of mortality for a baby delivered vaginally after the mother had a previous caesarean is about one in 775, says the study of more than 22,000 births in Scotland. That is more than 11 times the risk of perinatal death when mothers chose a second caesarean, says a report appearing in tomorrow's issue of the Journal of the American Medical Association. In 9,000 such births, only one baby died.

But those numbers should not be decisive in making a choice, says Dr. Gordon C. S. Smith, professor of obstetrics and gynecology at the University of Cambridge and leader of the study. Other factors must also be considered, he adds.

One of those factors is "the downside of having another major surgical procedure for the mother," says Dr. Frederic Frigoletto, professor of obstetrics and gynecology at Harvard Medical School (news - web sites) and a past president of the American College of Obstetricians and Gynecologists (ACOG).

"This study obviously has provided some good information to put into the equation, but the equation has more than one variable," he says.

The other variables include not only the risk to the mother but also the facilities available in the hospital where the birth will take place, Frigoletto says.

About one in five deliveries in the United States is done by C-section. It was once a medical fact of life that a woman who had one baby by caesarean had all subsequent ones that way, but that is changing. Concerned over the rising rate of the procedure, doctors offered women the option of delivering a subsequent child vaginally. The rate of vaginal deliveries after a C-section was about 27 percent in 1997.

The great value of the new study is that it concentrates on pregnancies that went to full term, Smith says.

"Previous quantifications of risk have included a lot of premature births, and the risk I present is lower than those," he says. "The vast majority of women do get to the end of the pregnancy."

He and Frigoletto agree on one thing: It's the woman's decision to make.

"We must give her all the information and let her decide whether the risk is acceptable or unacceptable," Smith says.

"The principle is one of informed consent," Frigoletto says. "We try to provide the mother with as much information as possible and support her in any decision she makes. The exception is when we regard her decision as unjustifiable."

The new study is bound to be controversial, because every study on the subject is controversial, says Mona Lydon-Rochelle, a midwife who is a senior research fellow at the University of Washington Center for Women's Health Research.

"The field is very polarized," she says. "There are Web sites that are totally dedicated to one side or the other of the issue. We have these polarized reactions in the United States, but the issue doesn't seem to resonate in Europe."

One reason for strong emotions here is that some health maintenance organizations have promoted vaginal delivery after C-sections as a way to save money.

An accompanying article in JAMA, by Dr. W. Benson Harer, Jr., of the Riverside County Regional Medical Center in California, notes that one California medical center adopted a policy requiring vaginal deliveries on the grounds that it cost $2,300 less than a second caesarean. The policy was dropped after two years, but more than $24 million has been paid thus far to settle claims of adverse outcomes, Harer says.

ACOG has no one overall recommendation on the issue, Frigoletto says. What it does have, he adds, is "some very specific guidelines about what are the ideal patient characteristics for considering vaginal delivery after caesarean, and what resources, human and physical, should be considered in making the decision."

What To Do

Keep in mind that the risk presented in this study is relative. The overall risk of problems if you decide to deliver vaginally after having had a C-section is still low. ]]> http://www.yourlawyer.com/articles/read/219 Thu, 14 Mar 2002 00:00:00 -0800 http://www.yourlawyer.com/articles/read/219
After a seven-day trial, the jury took four hours to find that a Sand Lake Hospital physician's assistant, doctor and nursing staff were negligent in their care of Henalori "Hena" McGee, 44. McGee was hospitalized in April 1998 for abdominal pain that eventually ended in a brain injury that has left her incapacitated, her attorney said.

"She's basically locked in a body that does not work," said attorney Jesse Faerber. "She needs basically 24-hour care to assist her. She's really in the worst kind of situation she can be in."

Joe Brown, a spokesman for Orlando Regional Healthcare System Inc., which includes Sand Lake, said the hospital would appeal the verdict. He said the hospital staff treated McGee appropriately.

"Obviously our initial reaction is we were shocked with the amount of the award," he said.

Faerber said McGee, who once worked at Burdines in South Florida, was neglected from the minute she got to the hospital.

McGee, her husband and their grandson were in Orlando for her husband's insurance convention in 1998. While here, she developed severe abdominal pain and was taken by ambulance to Sand Lake just before 1 a.m. April 6, 1998. A physician's assistant saw her and decided she could have been having a gall bladder or appendix attack and gave her pain medicine about 2:15 a.m, Faerber said.

"They never picked up on the signs that she was bleeding" internally, Faerber said.

By about 3:45 a.m., her heart stopped and, for 13 minutes, McGee had no blood pressure, Faerber said. Doctors started her heart again and she was taken to Orlando Regional Medical Center, where tests determined she had a tumor the size of a grapefruit on her liver. Doctors removed it.

"Unfortunately at that point she had a brain injury," he said.

Faerber said McGee, expected to live well into her 70s, requires constant care. Among other things, she can't walk, speak, see or manage her own personal hygiene.

"She's going to live the rest of her life with other people having to take care of her," he said.]]> http://www.yourlawyer.com/articles/read/138 Tue, 26 Feb 2002 00:00:00 -0800 http://www.yourlawyer.com/articles/read/138
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Eyewitness News 25 reports that the family hopes their son's case will draw statewide attention to rules that prevent people from getting what they call fair compensation for medical malpractice.

The emptiness in 19-month-old Adam Susser's eyes warned his parents that he wasn't much like his fraternal twin, Brandon.

While Adam (pictured, above) can hear, and laugh at his dad like a normal child, there is a lot that he cannot do on his own.

"Adam is significantly brain injured," Adam's father, Gary, said. "Adam can't hold his head up. He can't crawl or talk. He's blind."

Susser said that it's unlikely Adam will ever be anything close to a normal person, because his brain did not receive enough oxygen during his mother's labor.

"This should never happen to anybody," mother Judy Susser said. "That's what I want to bring across. And I want those responsible, who harmed our son, held accountable, (they) must account for their actions or inactions."

The Sussers said there were signs of serious trouble four days before Judy gave birth to the twin boys.

Doctors said Adam's heart rate weakened to the point where a fetal heart monitor could not detect a pulse.

Gary Cohen, the Susser's attorney, said two high-risk pregnancy doctors at Coral Springs Medical Center discussed delivering the babies via a C-section, but refused to perform it.

"And by delaying as long as he did, (the physician) got a vaginal birth, but he got a vaginal birth of a severely asphyxiated infant," Cohen said.

When the Susser's decided to sue, they found out their hospital is part of the North Broward Hospital District, which means that the medical center's liability for malpractice is capped at $100,000, and the two doctors' liability is capped at $250,000 each. The most the Sussers could collect is $600,000, unless they get lawmakers to change the rules.

"All we're asking for this family is fairness and to have their rights not be abridged by legislators and governors who restrict the care this child will need," Cohen said.

As part of their lawsuit, the Sussers and their attorney will go to Florida's legislature to push for a new bill.

The bill would force the hospital district and its doctors to have insurance. At the same time, it would restrict insurance companies from raising malpractice rates.]]> http://www.yourlawyer.com/articles/read/107 Fri, 04 Jan 2002 00:00:00 -0800 http://www.yourlawyer.com/articles/read/107
FOR YEARS, doctors advised women who had Caesarean sections to deliver all their babies by C-section because of the scars left on their uterus. But more recently, women have been encouraged to attempt to deliver vaginally after a Caesarean and approximately 60 percent of them try labor.

From 1989 to 1996, the rate of vaginal births after a Caesarean increased 50 percent in the United States to 28 per 100 women. By 1999, it was down to 23 per 100 women.

The rate of Caesarean births has remained at about 22 percent during the same 10-year period.

Questions persist, however, about whether labor causes problems such as uterine rupture, an uncommon but serious complication. A tear in the uterus can result in a hysterectomy, blood transfusions or death for the mother and brain damage or death for the infant.

Researchers at the University of Washington in Seattle studied this issue by looking at 20,095 women who delivered their first baby by Caesarean section and then had a second child. There were 91 cases of uterine rupture, according to the findings reported in Thursday’s New England Journal of Medicine.

Compared to women in the group who had a repeat C-section without labor, the researchers said those who went into labor spontaneously were three times more likely to have a uterine rupture. Women whose labor was induced - but not with a class of drug known as prostaglandins - were nearly five times more likely to have a rupture and those induced with a prostaglandin, which is more potent, were 15 times more likely.

“By no means does our study suggest that no woman should have a vaginal birth after a Caesarean. What it says is there are risks of doing that that we didn’t fully appreciate,” said one of the researchers, Dr. Thomas R. Easterling.

He said some women may opt to try a vaginal delivery for the birth experience or because of the faster recovery. Those who try labor should do it in a hospital that can quickly perform a C-section should it become necessary, he said.

“Women need to talk to their provider about their own individual pregnancy and their health,” said Mona Lydon-Rochelle, another researcher. “They may have a very low chance of uterine rupture” and the benefits may outweigh the risks.

The data on the 20,095 women was culled from birth certificates and hospital discharge records in the state of Washington from 1987 to 1996. Home births were not included.

“It’s a huge study and it shows quite clearly that there is an increased risk associated with the use of prostaglandins,” said Dr. Michael F. Greene, who wrote an editorial accompanying the study and is director of maternal-fetal medicine at Massachusetts General Hospital in Boston.

He said doctors need to tell patients about the risk of uterine rupture so they can weigh the risks and the benefits of a vaginal birth.

“Strictly speaking, if the question you’re asking is, ‘What is safest for the fetus?’ There’s no doubt repeat Caesarean is safest,” Greene said.]]> http://www.yourlawyer.com/articles/read/6150 Tue, 01 Jan 2002 00:00:00 -0800 http://www.yourlawyer.com/articles/read/6150
The Santa Clara County Superior Court jury yesterday ruled against the San Jose Medical Group, Doctor Ilene Newman and Regional Medical Center of San Jose.

Brandon Nunez is now three years old and lives at home with his parents, Carmelo and Sonia Nunez.

Sonia Nunez was two weeks overdue when she went into labor on September 27th, 1999. Her labor didn't progress normally and experts testified that an immediate Caesarean section was called for.

A C-section was finally performed, but Fagel says that by that time the baby had already suffered brain damage.]]> http://www.yourlawyer.com/articles/read/70 Tue, 11 Jul 2000 00:00:00 -0700 http://www.yourlawyer.com/articles/read/70
Before consenting to the induction, Holly's midwife says, she asked one of the obstetricians in her group practice if Holly would be a good candidate to try a new induction drug. He approved the prescription.

Holly disputes her midwife's story, asserting that the midwife recommended induction against Holly's better judgment. "My body was made to have babies," she told me. With five vaginal births to her credit, Holly had confidence in her ability to labor.

Whatever the truth, both parties agree that over the next several hours the nurse-midwife gave Holly three 25-microgram doses of Cytotec. (Because of legal considerations, both parties requested anonymity.) What Holly didn't know and the midwife never told her was that it was an unapproved drug with potentially disastrous side effects.

One hour after the third dose, labor began, with contractions every two and a half minutes. According to Holly's 19-year-old daughter, Ann, who was present throughout labor, Holly handled herself very well.

Thirty hours later, her cervix not yet fully open, Holly stood up and walked around. Then her bag of water broke. A little later she heard a popping sound from her body. The midwife monitoring her labor noticed that the baby's heart rate had dived from a normal 130-140 beats to a frightening 40 beats per minute.

She exhorted Holly to push, and within five minutes, Holly's 8-pound, 13-ounce daughter was born, followed by a huge gush of blood. The baby was blue and didn't breathe on her own, so the resuscitation team intubated her.

Holly, meanwhile, continued to bleed. Frightened, she told her midwife that something was wrong. The midwife assured her that her blood loss was not enough to warrant a doctor's presence. Later, realizing that Holly was bleeding excessively, the midwife removed several huge clots from her vagina, gave her medication to stop the bleeding and left her in the care of nurses.

Ann and Darryl, Holly's husband, were far from reassured. By this time, Holly lay unconscious, white as a ghost. They helplessly watched her struggle for breath. Darryl begged the nurses to get a doctor and the midwife directed a nurse to call for a doctor on the intercom. The physician who entered the birth room two minutes later was shocked at Holly's condition. "This lady is dying," he shouted. "I'm taking her to the O.R.!"

Holly's heart stopped twice during the surgery. At one point, the doctor told Darryl that he did not expect her to survive. Her uterus had ruptured from the top down through the cervix. This kind of wound is characteristic of Cytotec-related ruptures, according to obstetricians I've since spoken to. (One doctor described them to me as "totally exploding.") Surgeons removed Holly's uterus along with one of her ovaries and a fallopian tube. Thirty-seven units of blood, plasma and platelets were required to replace the blood lost during her ordeal. Gone forever was her chance to have another baby.

Was Holly's labor a nightmare fated to happen, with or without intervention? Or did Cytotec cause her uterine rupture, thereby threatening her and her daughter's life? As with so many forms of obstetric intervention, even hindsight isn't 20/20. Every birth is unique, and the influences on labor are far more numerous than most studies can account for. And even with large, long-term, controlled studies, it is sometimes complicated to ferret out the facts about the efficacy or safety of a given medical procedure.

Cytotec, however, doesn't have the benefit of such scientific debate, because it is still essentially an experimental birth drug that is being tested ad hoc by trial and error. But most patients are never informed of this fact.

As a midwife of 30 years and one of the founders of the natural childbirth movement, I have overseen more than 2,000 births at my birthing center in Summertown, Tenn. Over the years I've listened to innumerable anecdotes about the dangers of medical intervention. But the stories I was hearing about Cytotec I found especially unsettling.

Over the past three years I have watched in increasing dismay as this once little-known ulcer medication has become a popular obstetric drug -- one with potentially horrifying side effects and a frightening lack of safety protocols. Buried in study after study, reports show that the drug has been connected to numerous cases of ruptured uteri and even a few maternal deaths, stillbirths and newborn deaths. Despite these reports, however, tales like Holly's -- in labors attended by practitioners who appear to have little understanding of the drug's potential dangers -- continued to reach me. In fact, the widespread use of Cytotec essentially amounts to a massive medical experiment carried out on thousands of unsuspecting women -- a situation, sadly, that is all too common in the world of modern obstetrics.

Most Cytotec-induced labors do not cause adverse effects like those in Holly's labor -- in fact, for a significant number of women Cytotec seems to work amazingly well. In a way, that's what scares me the most. Since it works so efficiently for a majority and can be prescribed obstetrically without Food and Drug Administration approval, there's less motivation for learning why for some women the drug has a catastrophic effect. Aside from the oft-cited though widely ignored warnings against giving it to women who have had Caesarean sections, we know very little about which women are at risk.

What we do know about Cytotec is that it is dirt cheap: A single 25-mcg dose costs roughly 13 cents; Pitocin, in contrast, necessitates hundreds of dollars in high-tech intervention. Since Cytotec is made in 100-mcg tablets to be taken orally, its quarter-tab dosages are necessarily inaccurate: Nurses or doctors have to literally cut up the pills with little knives. Furthermore, there is still no agreement as to the dosage size or interval or even most appropriate route of administration. The most common means of administration, by placing a quarter-tablet next to the cervix, is so easy that some doctors and midwives give the pills to women to take home and insert themselves. As a result, some women who experience emergency complications like Holly's do so without a hospital staff to care for them.

Unlike a Pitocin drip, which has a half-life in the body of about 10 minutes and can easily be turned off if the woman responds to it violently, once Cytotec is administered, you can't get it out and nobody knows its half-life. This gives Cytotec an unpredictable, stealthy quality. Sometimes even when it is doing serious damage to the uterus, the woman has no awareness that something's wrong; other times it creates immediate violent contractions. Moreover, the ruptures can occur many hours after a single dose in which the drug seemed to have caused no adverse effects. No one understands how this works, but it has been the subject of discussion both in the medical literature and in physician chat rooms.

Finally, in an era of managed-care obstetrics in which doctors are seeing patients in their offices at the same time that they monitor other women's labors across town in the hospital by telephone, Cytotec's great claim to fame -- prompt, timely labors -- is a phenomenal boon. In most cases an obstetrician must be present at the time the baby is born to be paid in full for a birth. So financial factors may influence some doctors to induce labor at a convenient time. Moreover, most cases of malpractice litigation involve situations in which doctors were not present and an adverse outcome occurred. Hence doctors have ulterior motives for using drugs like Cytotec, which help speed labor and thereby ensure that they won't miss the big event.

How many women are being given Cytotec? Marsden Wagner, a Washington, D.C., perinatal epidemiologist, estimates that every year at least 150,000 U.S. women (about 3 percent of all births) are given Cytotec to start labor. But based on my conversations with other doctors and nurses, I sense that the number may be much higher. Its usage is certainly growing rapidly. Wagner also notes that the Oregon State Health Department recently told him that Cytotec is now the state's most common method of induction.

How did Cytotec become so widely used and yet remain so underresearched? In 1992 and 1993 the first reports of the obstetric use of the small white tablet -- generically known as misoprostol -- indicated that it could be highly effective for starting labor in women, whether or not their cervixes were ripe. (In contrast Pitocin, the most common induction drug, often doesn't work unless the cervix is already primed and therefore affords doctors fewer choices.) Cytotec had already been used in combination with other drugs as a chemical abortive -- why not use it as an induction medicine? Lacking other information, many physicians began incorporating it into their practices.

A few years passed before the first published reports appeared detailing Cytotec's adverse effects on labor induction. By then, word of mouth in medical circles had made Cytotec the new darling of American obstetrics. Cost-effective, quick and easy to administer, Cytotec was fast becoming a popular alternative to Pitocin, which requires a full high-tech approach, including I.V., continual fetal monitoring and often (because of its reputation for triggering especially painful contractions) an epidural. Cytotec, in contrast, can be administered (though it shouldn't be) in virtually any setting.

Just how many women have been hurt by Cytotec? The question is nearly impossible to answer. No one has done large-scale studies of the drug, and the doctors and midwives who administer it do so with such vastly different protocols that mixing and matching results from various studies would not render reliable data. The most rigorous scientific authority in English on the effects of healthcare, the Cochrane Library, cautions that too few well-designed studies have been carried out to assess the risk factors associated with using Cytotec for labor induction. While conceding that Cytotec is more effective than conventional methods of cervical ripening and labor induction, it cautions that "the apparent increase in uterine hyperstimulation is of concern."

Unable to find large-scale, comprehensive reporting on obstetric use of the drug, I decided to do a little statistical sleuthing (however unscientific) on my own. My research, and my gut sense, based on years of experience as a midwife, indicate that there are significant risks associated with Cytotec, certainly higher risks than those associated with other forms of induction like Pitocin. Combining the results in 20 studies of Cytotec-induced labors published in peer-reviewed journals and papers presented at professional meetings -- a total of 1,958 births -- I discovered a total of two maternal deaths, 16 baby deaths, 19 uterine ruptures and two life-threatening hysterectomies.

To make sense of these figures, consider the normal incidence of uterine rupture, the most common serious side effect of Cytotec. Uterine rupture virtually never occurs in spontaneous (unaugmented) labor in women who've had no previous uterine surgery. Probably because of differing practices surrounding labor induction and augmentation, the rate of uterine rupture varies widely from hospital to hospital. Uterine rupture is less likely to happen in an out-of-hospital birth. Most midwives providing these services do not use drugs to augment labor. The complication has been reported as frequently as one in every 100 births and as rarely as one in every 11,000 births. In my own group practice at the Farm Midwifery Center in Summertown, Tenn., in approximately 2,100 births we have had no uterine ruptures.

By contrast, approximately one in 100 Cytotec-induced births in the 20 studies I looked at resulted in uterine rupture. About half occurred in women having vaginal birth after Caesarean, the others among women who had had no previous uterine surgery.

In fact, it is women who have had Caesareans who are at greatest risk from Cytotec. An article published in 1999 in the American Journal of Obstetrics and Gynecology reported that uterine rupture occurred in five of 89 women with previous Caesarean delivery whose labors were induced with Cytotec -- about one out of 16, a shockingly high figure, representing a more than 28-fold increase over those who did not have Cytotec induction for VBAC (vaginal birth after Caesarean). One of the five ruptures also caused a baby to die.

According to epidemiologist Wagner, "It can be reliably estimated that between 1990 and 1999, as a result of the widespread off-label use of Cytotec for vaginal birth after Caesarean section, well over 3,000 women in the United States suffered a ruptured uterus, resulting in at least 100 dead newborn babies."

Amniotic fluid embolism, or AFE, is perhaps the most frightening complication associated with powerful labor-inducing drugs like Cytotec and Pitocin. AFE, which occurs when the amniotic fluid enters the mother's bloodstream, is one of the most dangerous complications that can happen in birth. More than 60 percent of women and their babies die when it occurs, with survivors usually suffering neurological impairment.

The rate of occurrence of AFE, once thought to occur only once in 80,000 births, seems to be rising in the United States. Chicago writer Deanna Isaacs, whose daughter died from AFE in 1994, found that the incidence of AFE at the Phoenix, Ariz., hospital where her daughter died in labor was 1 in only 6,500 births. AFE is now one of the leading causes of maternal death in the United States. Two cases of fatal AFE are associated in the medical literature with the use of Cytotec; a midwife told me about a third.

Alarmingly high as these figures are, they almost certainly don't reflect all of the adverse outcomes associated with Cytotec. I also gathered information -- much of it hair-raising -- from Internet chat-room discussions involving physicians who signed their names to their comments, as well as from obstetricians and midwives. This is anecdotal evidence, yes. But we can't afford to ignore anecdotes because current medical studies are inadequate, the drug has not been subject to FDA approval and mothers' and infants' lives are at stake.

The enthusiastic discussion of Cytotec in medical chat rooms sheds light on why the drug has become so popular in the United States. "You can almost count on a delivery 12 hours after inserting the Cytotec tablet," said one doctor. Another doctor added a cautionary note: "I must say that I have heard some great things about Cytotec myself. I know some people who have used it and say that they have pretty good luck with it. It sounds like your ladies are pretty happy with its effects -- two-hour labors and such. Just be careful. I would have to say that the biggest danger is leaving the woman alone. The stuff turns the cervix to complete MUSHIE [emphasis in original] and opens it with a couple of contractions. So whatever you do, remember that you must not stay gone too long."

Over the past 30 years, I have watched as wave after wave of medical fads have washed over the institution of modern childbirth. But one thing, unfortunately, hasn't changed: The push to discover a panacea to cure the pain and inconvenience of childbirth drives doctors to experiment -- and the women are usually the last to know.

In this case, to be sure, the demands of the women themselves are part of the problem. The Cytotec controversy is inextricably tied up with the increasing rate of induced labor in the U.S. Until fairly recently, induced labors were fairly rare: Now, one birth in five is induced, with only a small percentage of these inductions being medically necessary. Harried doctors in the HMO age are driving some of this, but women, too, are demanding faster labors. (This is not surprising, considering that the United States has the shortest maternity leave in the industrialized world.) If this trend increases, we can expect to see an accompanying rise in the medical problems that result when the strongest muscle in the human body -- which is also paper thin -- is stimulated to contract violently.

How was it that Cytotec came to be used as an obstetric drug in the first place? Misoprostol was originally developed by G.D. Searle & Co. of Chicago to prevent gastric ulcers in people who take anti-inflammatory drugs such as aspirin for arthritis pain. In 1988, it was approved by the FDA solely for this use. Yet it is quite legal for physicians to prescribe drugs for indications other than those for which the drug has received FDA approval.

This common practice, known as "off-label" use, usually involves prescribing one drug for another purpose. (Incidentally, no such loopholes exist for the use of pharmaceutical drugs in most Western European countries.) With misoprostol the practice seems particularly egregious: taking a medication meant for oral ingestion and inserting it vaginally.

According to Claudia Kovitz, public affairs specialist for Searle, the company does not intend to apply for FDA approval of Cytotec's use in starting labor. Indeed, why should it? At 13 cents a dose, with women taking no more than three doses per birth, the drug is too cost-effective to waste a heap of money on research whose primary result might only be to make the drug illegal to prescribe.

So what protection do pregnant women have when it comes to drugs that are prescribed for another purpose? Very little, according to Laura Bradbard, spokeswoman for the FDA. "People think we have more authority than we have. We approve a product for a particular indication, based on the data we receive. A physician is free to use a drug for any use he or she feels will benefit a patient. There are no safe drugs. You need to do your homework, ask a lot of questions and speak with your physician about your case and the medications," Bradbard said.

And even when the FDA approves a drug, there are no guarantees. "Once a drug reaches the marketplace, that's when we find out all the adverse events, because we have only seen it in 3,000 to 6,000 people perhaps," said Bradbard. "Then it goes into the marketplace, where you have a million prescriptions. Then a reporter will say to me, 'You are approving things too fast. You didn't find it.' Well, we can't find it. It's mathematically impossible. We have to have it in the marketplace and then we have to make warnings."

But Holly and her husband, like most patients who receive Cytotec, never received any warning. "We didn't know it wasn't FDA approved," she said. "We would have never let them use me or my baby as guinea pigs." ]]> http://www.yourlawyer.com/topics/overview/birth_injuries Tue, 11 Jul 2000 00:00:00 -0700 http://www.yourlawyer.com/topics/overview/birth_injuries Birth Injuries Complications in the process of labor and delivery can result in a wide variety of problems for a newborn baby. These problems, known collectively as birth injuries, can be mild or severe.

One major cause is oxygen deprivation, which commonly occurs when the umbilical cord is compressed or twisted in the birth process. The other main cause is mechanical trauma, which may occur when the baby assumes an unusual position at the time of birth (buttocks rather than head first, for example) or when the baby is too large to pass through the birth canal easily.

Numerous birth injuries are caused by mistakes made by doctors or hospitals during delivery. Birth injuries can occur if excessive force is applied in the delivery of a child or there is a delay in performing a necessary C-section delivery. Birth injuries can also occur if the delivery team fails to properly anticipate the size of a child, causing a turbulent delivery.

Birth injuries are most often caused by operative deliveries, whether vaginal or abdominal than spontaneous deliveries. Birth injuries have been reported to occur in 27 of 1,000 live births.

Common Birth Injuries are: Cerebral Palsy, Temporary Paralysis, Brain Damage, Erb's Palsy, Fractured Collar Bone, Klumpke's Palsy and Brachial Plexus Palsy.

The most serious birth injuries are those that affect the brain. They are caused by oxygen deprivation or bleeding within the skull or brain. These injuries vary greatly in severity. They may lead to long-term seizure disorders or cause cerebral palsy or mental retardation.

Lastly prescription medicines can often cause birth injuries. The following prescription drugs can cause birth defects: Accutane, Crestor, Cytotec, Lexapro, Paxil, Soriatane, and Terbutaline.

If you or a loved had birth complications and your child suffers from birth injuries, please fill out the form at the right for a free case evaluation by a qualified malpractice attorney.]]>