A summary of how to evaluate a cerebral palsy medical malpractice case. Get a free case review of Philadelphia and Pennsylvania Cerebral Palsy Medical Malpractice Case with Steven Reilly.

Pennsylvania Cerebral Palsy Medical Malpractice Case Evaluations

EVALUATING A CEREBRAL PALSY MEDICAL MALPRACTICE CASE

Parents of children born with cerebral palsy face a lifetime full of physical and emotional strain as well as the financial uncertainty of determining who is going to pay for the care that the child requires and who will take care of the child if the parents are no longer around. Parents need to make themselves aware of the various resources available for children with cerebral palsy including United Cerebral Palsy, Easter Seals and Federal, State and County Associations dedicated to helping children with cerebral palsy. Additionally, many local agencies/organizations provide support groups for parents of children suffering from cerebral palsy. Treating physicians often will be able to provide names of organizations that provide support to babies and their parents. Another important step that parents should take is to consult an attorney who handles malpractice cases to determine whether the child’s cerebral palsy was avoidable and the result of medical malpractice (negligence). In this article I would like to share with you how I, Steven F. Reilly a Philadelphia and Pennsylvania medical malpractice attorney evaluate a potential claim involving a child born with cerebral palsy.

SHOULD I CONSULT AN ATTORNEY?

Very often, the last thing on the minds of parents who have been told that their child has brain damage or cerebral palsy is to call an attorney. Typically, the parents went through a very emotional and physically stressful delivery and the baby endured a long NICU admission. The immediate concern is which physicians does my child need to see and what is the diagnosis and will my baby get better? However, at some point it may be prudent for the parents to consult a medical malpractice attorney to evaluate whether the child’s brain injuries were avoidable and the result of medical negligence.

In determining which attorney to consult, parents should feel free to ask the attorney about his or her experience with cases involving delivery issues. Ask what the process is for determining if there is a case, how long will it typically take and what are the fees?

I have handled many cases involving delivery issues leading to brain damage both representing physicians and for the last 9 years representing the patients. The first thing that I do when consulted is to meet with the parents and discuss the delivery and care that the baby received after the delivery. At this point, the parents will sign a HIPAA Authorization that will allow me to obtain the records of the child as well as the mother. To evaluate the case, it is imperative that the entire records of the mother and baby, including the fetal monitor tracings be obtained. I would like to address some of the issues that I analyze to determine if a claim exists.

FETAL MONITOR STRIPS

Fetal monitor strips look similar to an EKG and they track the baby’s heart rate in conjunction with the mother’s contraction pattern. Fetal monitor strips are a critical piece of evidence because they track how the baby is tolerating the labor process as reflected by the heart rate and strength of the heartbeat. They are two types of monitoring that occurs, external and internal. With external monitoring a belt is placed around the mother’s abdomen and a sonar type device is attached and the baby’s heart rate and the mother’s contractions can be documented. Internal monitoring involves the placement of an electrode on the scalp of the baby to monitor heart rate and the placement of an Intra Uterine Pressure Catheter on the mother’s uterus to track contraction patterns. Internal monitoring is widely considered to be more accurate and more specific. The evaluation of the strips that I perform in conjunction with my experts is to determine whether the baby was showing signs that he/she was not tolerating the labor process appropriately such that the baby should have been delivered sooner.

The baby’s heart rate is the best way the baby can communicate prior to delivery. There are certain fetal monitor patterns that are ominous and non-reassuring regarding the baby’s well being. Late decelerations (decelerations that occur in the baby’s heart rate after the peak of a contraction), variable decelerations (sharp, quick decelerations that make a V like pattern on the monitor strip) and decreased beat to beat variability (how strong each heartbeat is as documented by internal monitoring) are all types of patterns that need to be evaluated.

Fetal monitor strips are certainly not reviewed in a vacuum. It is important to correlate any non-reassuring patterns with the medical records to determine whether the patterns were recognized and what was done to address the situation. Often times, a nurse in the face of non-reassuring patterns will reposition the mother, apply oxygen, turn pitocin (drug used to facilitate contractions) off and increase the IV fluids. Hospitals have deceleration policies and it is important to review those policies to determine if the nurses and or physician complied with the hospital’s policy regarding response to decelerations.

Additionally, it is important to evaluate the records to determine communication between the caregivers. Did the nurses call the physician when they should have and if so, did the physician timely respond or did they nurses fail to call the physician in a timely manner? If the physician did respond did he/she appreciate the need for urgent delivery by cesarean section and how long did it take? There are many other aspects of the labor process that need to be evaluated including how long was each of the three stages of labor, what was the status of the amniotic fluid (low amniotic fluid may increase the chance of umbilical cord compression) and what was the mother’s condition during the labor (blood pressure, heart rate etc.)? The evaluation of the labor process is too detailed to fully list in this article. Each and every aspect of the care must be analyzed in conjunction with an expert physician.

DELIVERY

The evaluation continues with a review of the records of the delivery and for the time period after the delivery. It is important to determine the position of the baby at delivery and whether any devices were used to facilitate the delivery including forceps and vacuum extractors. Devices used to facilitate delivery that are applied to the baby’s head can cause serious damage to the baby when done inappropriately. The condition of the baby at the time of delivery is very important. The baby at 1, 5 and 10 minutes after birth is assigned a score called an Apgar score. The Apgar score consists of five categories (breathing, heart rate, muscle tone, skin color and reflex irritability) each with a two point maximum 10 is the best and 0 is the worst. Also, at birth a sample of the baby’s cord blood will be taken and can be very useful in determining if the baby was without sufficient oxygen for a time prior to birth (fetal hypoxia). A low cord pH is indicative of fetal hypoxia. Physicians are very wary of cord pH results and there has been a concerted effort to diminish their importance in determining if fetal hypoxia existed. In evaluating the cord pH it is important to determine if the sample was from the vein or artery as venous blood often times will have a higher pH and be falsely normal and not reflective of the fetal hypoxia that occurred.

AFTER DELIVERY

In any case involving a brain damaged baby, physicians and hospitals will almost always blame the brain damage on a condition or event that occurred long before the delivery. Often times, physicians will claim that the baby had some unknown inborn error of metabolism or genetic condition. Fortunately, many hospitals in Pennsylvania are screening for metabolic disorders in newborns and these records certainly need to be reviewed to dispute any defense claim that the injury was not caused by the delivery process.

Records of the physicians that treated the baby after the delivery need to be reviewed. Treating physicians often times are reluctant to offer the opinion that the baby’s problems are from the delivery process so it is important for the parents to be vigilant in describing the delivery process. Often times imaging of the baby’s brain via CT Scan or MRI will demonstrate findings consistent with birth injury. The ultimate diagnosis of cerebral palsy may not be made for several months to several years after birth depending on the area of the brain that was injured and the developmental skill associated with that area of the brain.

CONCLUSION

As can be seen from this brief summary, the analysis and pursuit of a claim involving medical malpractice causing cerebral palsy is a very complex and detailed process. Parents should be sure to consult an attorney who handles these types of cases and who knows the medicine and the law.

In deciding whether to contact an attorney to evaluate a possible malpractice claim, parents should be mindful that the statute of limitations in Pennsylvania for a medical malpractice claim is two (2) years subject to certain limited exceptions. However, the statute of limitations for a minor is his or her 20th birthday. While a majority of the legally recoverable damages suffered in a cerebral palsy claim are those suffered by the baby, the parents may have a claim for expenses (medical bills etc.) as well as potentially a claim for negligent infliction of emotional distress. The parents’ claim is subject to the two (2) year Statute of Limitations.

FREE CASE REVIEW

If you or a friend or relative would like to discuss a potential malpractice claim please feel free to contact Steven Reilly at 610-272-7075 or sreilly@reillylawpc.com. The consultation and investigation are at no cost to the client and I only take a fee (a percentage of the recovery) if there is a recovery. Please feel free to call or contact me with any questions.



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Steven F. Reilly, PC
509 Swede Street
Norristown, PA 19401

Phone: (610) 272-7075
Fax: (610) 272-5729

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