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Universally, the medical literature on neonatal resuscitation
requires that a severely depressed infant with thick meconium
must be immediately intubated and the lower airway suctioned of
meconium. Removal of the thick meconium allows for oxygenation
of the infant and reduces the risks of meconium aspiration. Although
physician #2 was negligent for just four minutes, it was a critical
period, because Kaitlyn arrived in the world asphyxiated from
the poor oxygenation during labor. At birth, Kaitlyn's cord blood
pH (the measure of acidosis) was 7.02. The medical literature
suggests that babies born with a pH of 7.0 or greater have not
suffered injury as a result of asphyxia during labor, though the
severe asphyxia would make the child easily vulnerable to irreversible
injury if not corrected. As a result of the four minute delay
in resuscitation, the pH dropped to 6.85, an ominous finding for
permanent, irreversible brain injury.
Amazingly, following the disastrous labor, delivery and resuscitation,
none of the healthcare providers involved did anything whatsoever
to determine what had gone wrong or how this type of event could
be prevented in the future. Instead all three healthcare providers,
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physicians #1 and #2 and the labor nurse, made separate written
statements about the disastrous events of the day, which they
then kept hidden and out of the medical record. The separate notes
only came to light through discovery in the case.
An interesting procedural development was that after identification
of plaintiffsÕ experts, but before their depositions, settlements
were reached with physician #1, the labor nurse (who had a separate
insurance policy apart from the hospital coverage) and the hospital.
Plaintiffs immediately withdrew the identified experts who were
criticizing the settling defendants, putting the burden on the
remaining defendant, physician #2, to obtain expert testimony
against the settling
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defendants for purposes of comparative fault.
The various theories of liability against physician #1 were that
after rupture of motherÕs membrane and discovery of thick meconium,
a non-reassuring monitor strip and a prior cesarean section for
failure to progress, it was incumbent upon her to closely monitor
the labor and, after the amniofusion, to evaluate fetal well-being.
If there was no improvement in fetal well-being, physician #1
was required to order a c-section, no later than 1030. The labor
nurse simply did not have the knowledge to appreciate the significance
of the non-reassuring fetal heart rate monitor strip, failed to
communicate the non-reassuring state of the strip to physician
#1 and failed to request the presence of the physician to evaluate
fetal well-being. The hospital failed to have adequate policies
on: (1) the resuscitation of a severely depressed infant in the
presence of thick meconium and (2) the presence of appropriate
personnel and equipment in attendance to resuscitate a severely
depressed infant. Physician #2 failed to appropriately resuscitate
the infant in the presence of thick meconium.
As a consequence of the negligence during labor,
Kaitlyn was born asphyxiated
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