Obstetrics - Delivery - Severe Brain Injury - Doctor, Hospital Sued - Largest Reported N.C. Medmal Settlement - $10.75 Million

May 01, 2000

Medical Malpractice

Obstetrics - Delivery - Severe Brain Injury - Doctor, Hospital Sued - Largest Reported N.C. Medmal Settlement - $10.75 Million

Brief Statement of Claim: The plaintiff, a three-year old girl with cerebral palsy, was delivered by forceps and vacuum extraction in September 1996. She was in a severely depressed condition at birth. A lawsuit was filed in 1998 alleging negligence on the part of an obstetrician and the hospital.

The obstetrician allegedly failed to properly monitor the mother and was responsible for a delay in delivery. The hospital allegedly failed to notify the doctor of signs and symptoms of fetal distress, resulting in a delay in delivery.

Principal Injuries (in order of severity): Severe hypoxic-ischemic brain injury, resulting in cerebral palsy

Special Damages: n/a

Tried or settled: Settled

County where tried or settled: Gaston

Case Name and number: Carlisle A. Snell et al v. Gaston Memorial Hospital et al (98 CvS 4491)

Date Concluded: March 31, 2000

Name of Judge: n/a

Amount: $10.75 million: $4.75 million on behalf of doctor; $6 million on behalf of hospital

Insurance Carrier: n/a

Expert Witnesses and areas of expertise: The plaintiff utilized obstetricians, labor and delivery nurses, pediatric neurologists, a neuroradiologist, a life care planner and an economist.

Attorneys for plaintiffs: C. Mark Holt of Kirby & Holt, L.L.P., Raleigh; Wade E. Byrd of the Law Offices of Wade E. Byrd, Fayetteville

Other Useful Info: Carlisle A. Snell was born on September 9, 1996 at Gaston Memorial Hospital, Inc. Her father, John Snell, was an anesthesiologist in private practice in Gastonia who worked at the hospital. Her mother, Theresa Snell, was a nurse who worked in a medical practice in Gastonia.

According to the plaintiff's counsel, Mrs. Snell was admitted to the hospital on Sept. 9, 1996. A Pitocin drip was begun. From 11 a.m. until about 4 p.m., the labor progressed normally. The fetal heart rate as electronically monitored displayed a reassuring pattern.

At about 4:10 p.m., when the doctor performed a vaginal exam, there was a prolonged drop of the fetal heart rate, down from its baseline range in the 120s to as low as 95 beats per minute for about three minutes.

Around 5 p.m., Mrs. Snell complained to the nurse of an increased pain that did not subside between contractions and a sensation she said felt like feeling the baby's foot outside the uterus. The nurse reassured Mrs. Snell and did not tell the doctor about the reported pain.

At about 5:04, while the doctor was not present, the nurse attending to Mrs. Snell noted another deceleration in the fetal heart rate to 90 to 100 beats per minute with a decrease in the variability. The nurse turned Mrs. Snell on her left side, applied oxygen, turned the Pitocin off and called the doctor.

At 5:07, the doctor came into the room. While he was there, the fetal heart rate had another deceleration, lasting about a minute. The doctor ordered the Pitocin back on at a reduced rate of 10 milliunits per minute and left the room. With the first contraction after the Pitocin was back on, a pattern of late decelerations in the baby's heart rate began.

The nurse taking care of Mrs. Snell noted the decelerations and turned down the Pitocin from 10 to 8 milliunits per minute. The late decelerations continued but improved. At 5:46, the pattern of late decelerations returned.

At no time between 5:10 and 5:55 did the nurse contact the doctor. When he returned to the room at 5:56, the nurse did not tell him there had been late decelerations since he left the room. The doctor observed Mrs. Snell to be fully dilated and believed the fetal heart rate monitor showed an acceleration, a positive sign. He instructed Mrs. Snell to begin pushing and left the room at about 6:00 to go to a doctor's meeting in the hospital cafeteria.

As soon as Mrs. Snell began pushing, the fetal heart rate decelerations worsened. At about 6:06, the fetal heart rate fell below 100 beats per minute down to a bradycardic range. The nurse attempted various maneuvers to try to correct the heart rate but it did not return to a normal range.

At 6:12, the nurse called the doctor. At 6:13 she turned the Pitocin off. At 6:15, the doctor arrived back in the room. He performed a vaginal exam and decided to attempt a vaginal delivery, first trying to deliver the baby by vacuum extractor and then by forceps. Carli was delivered at 6:38 p.m., after about 30 minutes of bradycardia.

At the time of her birth, Carli was limp, with a low heart rate and no respirations. She weighed 10 pounds, 7 ounces. When it appeared she needed to be intubated, the doctor asked Carli's father, Dr. Snell, if he would like to intubate the baby. Dr. Snell, did so.

Carli's initial cord blood gas had a pH of 6.67, indicating severe metabolic acidosis. She later had seizure activity.

Mrs. Snell continued to complain of pain. Almost two hours after the delivery, the doctor decided to take Mrs. Snell to the operating room where he performed exploratory surgery and it was determined that Mrs. Snell had suffered both a uterine rupture and lacerated bladder during labor and delivery.

Carli lives at home with her mother and father. The Snells moved from Gastonia to Maryland in 1998. Carli suffers from quadriplegic cerebral palsy. She cannot sit, roll, crawl or talk. Her brain injury is permanent.

The obstetrician blamed the situation on the nurse, and said she failed to notify him of the late decelerations. The hospital blamed the doctor for failing to adequately monitor his patient, and said he was in and out of the room and looked at the monitoring strip.

[Editor's note: The recovery in Snell is the largest North Carolina medmal settlement ever reported to Lawyers Weekly.]

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