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still evident three days later. The C.T. scan documented evidence
of swelling of the child's brain over the first three days of
life.
Following delivery, the child's care was transferred to
defendant family practitioner, who had responsibility for the
newborn pediatric care. He failed to recognize an abnormal condition
known as polycythemia and failed to initiate treatment to decrease
the risk of neurologic injury. Polycythemia is an abnormally high
number of red blood cells which has the effect of thickening or
"sludging" the blood, increasing the risk of clotting due to this
hyperviscosity. The pediatrician failed to diagnose the polycythemia
despite laboratory evidence documenting its presence. The standing
order at the hospital required that nurses determine the hematocrit
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level by heel stick within six hours
of birth, and that they contact the physician if the value is greater
than 60 or less than 40. The hematocrit would then be rechecked
from a central venous source. If polycythemia is confirmed, a partial
exchange transfusion may be performed to dilute and reduce the hyperviscosity
of the blood.
The pediatrician was notified that the first heel
stick hematocrit was 72.9, but he simply decided to disregard the
whole issue because in his experience the central venous hematocrit
was always lower than the heel stick. He was not thinking in terms
of polycythemia and he did not alert the nursing staff to be on
the lookout for clinical signs and symptoms of polycythemia, which
can be subtle. The combination of the bleeding and |
swelling from the trauma, and the hyperviscosity from the polycythemia,
combined to produce the neurologic injury.
The majority of the
fault in the case was on the obstetrician, who had previously
declared bankruptcy and who claimed to have $800,000 in insurance
coverage (see Insurance Aticle, page 6). The pediatrician had
a $1,000,000 policy, and no significant personal assets. The case
was settled shortly before trial for $1,600,000, including the
full $1,000,000 paid on behalf of the obstetrician.
Due to the
brain injury, our client suffered left-sided hemiparesis, borderline
mental retardation, some moderate speech deficits, and has an
ongoing seizure disorder. The settlement is being used to fund
an intensive physical and occupational therapy program.
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