I know I have a good case, but why

[LvgonaDream]

What is the name of your state (only U.S. law)? MI

I don't understand why I can't get a malpractice/wrongful death attorney to pick this case up.

There are multiple failures to diagnose and failures to treat by the OB/GYN for placental separation, IUGR and heart defects of the baby. Frank breech presentation, resulting in trauma and oxygen deprivation to the baby. An emergency c-section. Baby was born very small and purple, but did survive for 6 short weeks. Because of the placental separation and c-section, the mother has permanent damage to her reproductive system, a chance of having another IUGR baby and has a poor prognosis of taking future babies to term. This OB also failed to evaluate for lack of amiotic fluid following a "false labor" that was actually "preterm labor" 2 weeks prior by not doing an ultrasound following that preterm labor.

Further in the morning on the day the baby was born, instead of keeping the mother at the hospital the OB nurse sent her home (45 min away) even tho the mother kept insisting that her water had already broke 2 weeks previously. "Not possible and DO NOT come back until your water breaks". It never did. Also this L&D does not have a bedside ultrasound or if it does, it was not used at the preterm labor, the morning the baby was born nor later that day. They used an x-ray machine to determine that the baby was in frank breech presentation.

Following birth the baby was air lifted to a higher level hospital. There they found in the mother's prior blood work that the placenta had separated/abrupted 2 weeks previous resulting in the IUGR. Further the baby had multiple heart defects. They stabilized the baby and sent her by ambulance to a pediatric cardiologist.

After 4 weeks in the hospital, mother and baby were finally sent home. Interestingly, the diagnosis of IUGR - which is a serious condition and an IUGR baby needs a different type of treatment at home and many followup tests was never discussed with the mother or grandmother (me) at any time by either the cardiologist or pediatrician assigned in the hospital, nor was IUGR evaluated or treated. Nor were the mother or grandmother given classes in infant CPR.

After arrival back home, an appointment with our pediatrician of choice was made. While in the waiting room, I had my first opportunity to read the discharge papers from the hospital. Discharge DX - of course her heart defects and "IUGR" I had no idea what it was, so asked the doctor "that just means she's small."

2 weeks later, after drinking a bottle, the baby left us. Attempts were made at CPR, but I wasn't sure I was performing it correctly having never been taught. She was born in the 3rd percentile and at the time she passed was only in the 9th percentile.

Had the OB diagnosed and treated prenatally the heart defects, they most likely would not have been as serious as they were. Had the OB diagnosed and treated prenatally the IUGR the baby would have been bigger and healthier than she was. Had an at home monitor been prescribed we would have been aware that she was having problems sooner than we discovered them. Had IUGR been addressed, the baby would not have been handled as much as she was the day prior to her demise (IUGR babies tire very easily). Had I been taught infant CPR (the mother is a minor) we might still have our precious gift from God, she did open her eyes when I started CPR and they did get her heart beat back 2x in the ambulance to no avail.

I know this is long - but I felt all of the information needed to be presented so someone can tell me how I am presenting this wrong. I have been told by 3 attorneys so far that we have an excellent case, but they still decline to take it on.

Finally I have to add, in attempting to get the medical records from the OB, we received very few pages. When we asked again we were told "all of your records have been destroyed. It is our practice to dispose of records once a patient has been discharged." this OB KNOWS he messed up!

Now WHY can't I get an attorney to pick up this case!

[ecmst12]

What have the lawyers you talked to told you when they declined your case?

Who do you intend to blame for the fact that you were not trained in infant CPR? Also, a google search for IUGR turned up tons of well written, easy to understand pages. You could have done your own research prior to baby being discharged, so you would have been more prepared. But it is unlikely that your handling of the baby caused her death, you should not blame yourself.

It sounds like you had a very sick baby whose chances of survival were slim even with the best of care. That makes for a very poor malpractice case, generally speaking, because you must be able to prove that the acts of malpractice ALONE caused the unfavorable outcome, and not the underlying health conditions being treated. I looked up IUGR and it DOES mean that the baby is small. Was mom smoking or drinking during pregnancy? That is one of the possible causes, though I did read that more commonly, it's something beyond mom's control. Also that the chance of a second pregnancy with IUGR is rare unless the mom has some illness which caused the IUGR the first time, and it remains untreated or uncontrolled. Was the cause ever determined? The placental problem could have done it, but there were at least a dozen 'associated factors' that I saw.

Mom is very young and her chances of complete physical recovery and successful future pregnancies are very good. I am sure her emotional pain is intense (as is yours) and I encourage you both to seek grief counseling.

Are you sure it would have been possible to both detect and treat the heart defects prenatally? They can't always be detected on ultrasound and even if they could have been, fetal surgery is very risky to mom and baby.

I don't see any clear cut negligence that directly led to the death or that the death would definitively NOT have occurred if not for the negligence, just because the baby had so many problems. You don't say whether mom was given a nonstress test in the OB's office 2 weeks before the birth, that certainly would have been the standard of care (not necessarily an ultrasound), but even if it was NOT done, there is no guaranty that the outcome would have been different.

[lealea1005]

I am sorry for your loss.

Malpratice cases are very expensive and time intensive. The lawyers you spoke with must not think your case is as "excellent" as they led you to believe.

Perhaps they feel it will be difficult to prove anything other than the baby aspirated formula during her last feeding. Maybe the heart defects were genetic and not caused by IUGR. How premature was the baby?

Regarding the OB's medical records: Medical records must be kept on file for 7 years after the end of treatment for an adult, and 7 years past the 21st birthday of a minor.

[LvgonaDream]

The baby had asymmetric (brain sparing IUGR) - meaning that her head was normal size, but the rest of her was not.

There is prenatal treatment for both IUGR and for the heart defects, corticosteroids would have helped a lot with both. The baby would have been born a lot healthier.

The baby was full term. IUGR babies should be delivered via c-section early at a hospital that specializes in these conditions.

This is an excellent article by Pediatrics online about asymmetric IUGR and how it is different than SGA (small for gestational age). [url=http://www.pediatriccareonline.org/pco/ub/view/AAP-Textbook-of-Pediatric-Care/394097/2/chapter_97:_abnormalities_of_fetal_growth]Pediatric Care Online : Chapter 97: Abnormalities of Fetal Growth[/url]

"Growth-restricted infants have a higher incidence of sudden infant death syndrome. Compared with appropriate for gestational age infants who are the same ages, the perinatal mortality rate for SGA infants with relatively severe IUGR is 5 to 20 times higher."

So therefore an at home monitor should have been prescribed. The home monitor should have also been prescribed by the followup treating cardiologist. At her office visit with him she had a supraventricular tachycardia of 176. Also when born the baby had an acute life threating event and should have been prescribed an at home monitor. So you have 3 conditions now for what that should have been prescribed.

It is HIGHLY recommended that an IUGR baby NOT be excessively handled, which she was the day before she left us.

"However, newborns with severe IUGR may be floppy because they become easily exhausted when they are handled."

As far as doing my own research on IUGR, etc., are we to do our own research and not ever trust a doctor? Plus, I had only found out about IUGR 1 week before the baby left us, had been away from home with a husband and 3 other children for a LONG time and was too overwhelmed catching things up to do the research.

CPR? It is from the hospital's very own website! No child who has had cardiac surgery will be discharged without all persons who will be assiting in the child's care have been taught infant or pediatric CPR, whichever applies.

My daughter, altho misguided when she decided to have unprotected sex and became pregnant, is a good girl. Almost straight A's in school and does not drink or smoke. The IUGR was caused by the placenta separation and the oligohydramnios.

Further because of all of the above - placental detachment, previous IUGR and heart defects, the chances that my daughter will carry a HEALTHY baby to term is about 30-70. The chances that she will ever be able to experience the wonders of normal delivery as opposed to a c-section is 0%.

Further evidence that all treating doc's of the baby completely ignored IUGR is that fact that it is extremely important that the baby have an eye test for retinopathy which if not detected by the age of 6 weeks can result in total blindness. This test was never performed by either the treating Hospital or the pediatrican after her release from the hospital.

[lya]

I suspect no attorney will take the case because it can't be proven that any act of negligence caused the baby's heart problems or the IUGR or the death of the infant.

The fetus did not develop normally, possibly because the mother was not yet fully grown.

The heart defects were most likely genetic or due to the mother's age (lack of being an adult).

It was a very long original post and unless I missed it, there was no mention of an autopsy; therefore, only speculation exist as an answer to why all of this happened.

No act of negligence can be identified as the only possible cause of the infant's death.

You are in the step of the grief process where one seeks to blame someone or to blame God. Allow yourself to move beyond this.

I understand your grief. The sorrow never really goes completely away but in time you will be able to look at the events from a different and more realistic prospective.

My heart goes out to you and your family, especially your daughter, and to the infant's father and the other set of grandparents.

Best wishes,

[ecmst12]

It does not sound like a monitor would have made any difference. The baby didn't pass in her crib when no one was in the room, she was being cared for by an adult and no time was lost when someone did not know something was wrong. I also don't know how you can 'excessively handle' a newborn. Everything I have learned about babies says that leaving them alone in their crib for long periods of time is bad, and human interaction encourages brain development as well as healthy emotional attachments. None of the sites I read this morning had a thing to say about the need to not handle the baby. If the baby was tired out and then slept, and the death happened the next day after she had slept and woken up again, then it does not sound like any over-handling that may have been done affected the outcome.

Also was cardiac surgery performed? You mentioned she was treated by a cardiologist but I didn't see you mention surgery.

It is almost 100% assured that your daughter would have needed a c-section due to the breech presentation and the detached placenta, so that outcome is not affected by any possible mistakes in her treatment. I wouldn't necessarily give her a 0% chance of being able to have a vaginal birth in the future (unless she needed a vertical incision or there was some problem with her healing), but in general it is difficult and uncommon to be able to have a VBAC. That is the medical truth for anyone who has a c-section though, and the fact that she had to have one can't solely be linked to negligence, so she can't claim that as damage.

It is unclear whether failure to provide the steriod treatment prior to birth was below the standard of care for this condition. An expert in the field who has reviewed the records in full would be able to tell you that. It is also uncertain whether that treatment would have been successfull or if it would have changed the outcome. You would need an expert to state definitively that not only was choosing not to treat with steroids negligent, but that negligence alone led to the baby's death, and that she would have been healthy enough to survive if it had been given. I do not think you will be able to find such an expert. It is not as black and white as you would like to believe.

[LvgonaDream]

See I knew better than to post here. But I was hoping for an answer on how better to present the case to an attorney. I received the same type of naysayer responses as I did when I was fighting Mortgage Servicing Fraud - which I ended up being the lead plaintiff in a class action. I then opted out and fought them in pro per and won with an over $100,000 settlement after I was advised on this board that we didn't have a case. I'll be unscribing after this post. My intelligence has never been so insulted in my life.

I just got off the phone with a very well known law firm here in Michigan. Again, we have an excellent case, but it is very complex because of the "numerous incidents of malpractice". After about an 1 on the phone, they declined the case "because I decided I was not the best champion for this cause and your granddaughter deserves justice."

We are now in the hands of not 1 but 2 power medmal-wrongful death law firms here in Michigan.

And my daughter can not ever have a VBAC because of the risk of uterine rupture.

Here's some food for thought - pay attention to "failure to correctly interpret ultrasound"
[url=http://www.goldrich.com/Main/recentcases.htm]Recent Cases of a law firm dedicated to medical malpractice, federal torts claims and other significant personal injury litigation.[/url] They sometimes refer to it as "failure to ... sonogram"

Also
$950,000 settlement awarded to the family of an infant. ******* & ******* obtained a settlement against a pediatrician. The physician should have ordered a home apnea monitor at time of discharge of a female infant, who had an admitting history of ALTE (apparent life threatening event involving apnea and color change). As a result, the baby died at age 3 months.

My granddaughter had apnea and color change several times throughout her short 6 weeks of life.

The heart defects are congenital and not genetic. Testing proved that.
[url=http://pediatrics.aappublications.org/cgi/content/full/119/4/e976]Association Between Congenital Heart Defects and Small for Gestational Age -- Malik et al. 119 (4): e976 -- Pediatrics[/url] This is an article on how congenital heart defects are connected to SGA

The baby was sleeping and in her crib when she passed. The mother was also sleeping. I was the one who found the pale, lifeless baby.

The "very large VSD" is obvious on the 13-week gestational age ultrasound.

I really am not crazy.

[wyett717]

You are more than welcome to pursue a case, no one has told you otherwise. I think the respondants were only explaining why they think an attorney won't pick up your case, which is what you were wondering in the first place. No one is trying to insult you or your family, they are simply pointing out the facts. Malpractice suits are extremely expensive and time consuming; the advice you've been given is to help ensure that you have a strong case in your favor. Based on what you posted here, it doesn't sound like the doctors were irresponsible and/or negligent in the care of the baby before or after delivery. Sometimes tragedies like this just happen, and we can't control them. I wish you luck as you resolve this and send my sympathies to your family.

[Zigner]

Originally Posted by LvgonaDream

See I knew better than to post here. But I was hoping for an answer on how better to present the case to an attorney. I received the same type of naysayer responses as I did when I was fighting Mortgage Servicing Fraud - which I ended up being the lead plaintiff in a class action. I then opted out and fought them in pro per and won with an over $100,000 settlement after I was advised on this board that we didn't have a case. I'll be unscribing after this post. My intelligence has never been so insulted in my life.

And the funny thing is that I can't even find any post you made asking about mortgage servicing fraud.

[lealea1005]

I do not see anywhere in any answer given to you that ANYONE said you were "crazy", nor were we insulting your intelligence.

If you already knew you would not get the answers you were looking for, then why waste your time and ours?

You initially stated the baby died after drinking a bottle, not while sleeping in her crib. That is why I suggested aspiration as a possibility. Lya has alread asked, and I will again. Was there an autopsy performed? If so, what was listed as the cause of death?

Why even bring up the fact that you were involved in previous litigation netting you $100,000. That has/had nothing to do with this situation.

[Silverplum]

Originally Posted by Zigner

And the funny thing is that I can't even find any post you made asking about mortgage servicing fraud.

The sad thing is that I thought every advisor was most kind and pleasant to her. They don't deserve the OP's unpleasantness in return.

[Zigner]

Originally Posted by Silverplum

The sad thing is that I thought every advisor was most kind and pleasant to her. They don't deserve the OP's unpleasantness in return.

That is very true...

[ecmst12]

OP is upset and in mourning and I will cut her some slack.

OP, you did not say that the baby died in her crib until the last post. Originally you said she died after drinking a bottle, which I took to mean IMMEDIATELY after, in the caretaker's arms. When you post vague or unclear information, you should expect misinterpretation and inaccurate responses. Given that she was alone in her crib when it happened, a monitor might in fact have made a difference and it strengthens your case significantly. A monitor might not have definitely saved the baby, but if the standard of care dictates that it should have been prescribed and it was not, that is negligence. You may still have trouble definitively linking the negligence to the death, simply because the baby was so sick and had so many things against her, but it does sound like your chances are better then it seemed from your initial posts.

A risk of uterine rupture is present in any VBAC attempt. I don't know if your daughter's risk would be especially high, and neither would anyone else at this time. I would encourage her, in 5 or 10 years or whenever she is ready to have another baby, to be evaluated for the possibility of attempting a VBAC. She will be well healed by then and may be able to find a doctor willing to attempt it. I still don't see the potential to tie the need for the c sec to any act of negligence though. It would have been needed no matter what. You posted yourself that babies with IUGR SHOULD be delivered by C section always (which is not what I read but your research is certainly more thorough then mine) so there was no way she was going to be able to have a vaginal birth this time around. Any case that exists for the baby, is not going to include mom's c sec as a damage, unless there is yet more information that you didn't post.

I am glad you found a lawyer to accept your case, but you should know that a lawyer is NEVER going to tell you that they are declining your case because you don't have a good case. They will always give you a flowery sounding reason. But the fact is, if they don't take your case, it's because that particular lawyer or firm does not believe the case will be profitable for them, end of story. Malpractice cases take a lot of years and cost a lot of money and if there is not a very strong case with potential for significant return, it's just not worth it to them. Now sometimes, if you keep looking, you will find a firm willing to take the risk for whatever reason. And sometimes, NO lawyer will take the case - that usually means there is no case to take. I think it's good that you found someone to take the case. Know that it will take 5-10 years before mom sees any money. And know that no amount of money will represent justice, or do anything to make your loss easier to deal with. Don't kid yourselves - lawsuits are never about justice or principal, they are ALWAYS, ONLY about money. Money is nice to have, but it doesn't heal wounds or right wrongs.

[TheGeekess]

Originally Posted by LvgonaDream

My granddaughter had apnea and color change several times throughout her short 6 weeks of life.

The heart defects are congenital and not genetic. Testing proved that.
[url=http://pediatrics.aappublications.org/cgi/content/full/119/4/e976]Association Between Congenital Heart Defects and Small for Gestational Age -- Malik et al. 119 (4): e976 -- Pediatrics[/url] This is an article on how congenital heart defects are connected to SGA

The baby was sleeping and in her crib when she passed. The mother was also sleeping. I was the one who found the pale, lifeless baby.

The "very large VSD" is obvious on the 13-week gestational age ultrasound.

I really am not crazy.

Objective: To determine whether first and second births among teenagers are associated with increased risk of adverse perinatal outcomes after confounding variables have been taken into account.
Design: Population based retrospective cohort study using routine discharge data for 1992-8.
Setting: Scotland.
Main outcome measures: Stillbirth, preterm delivery, emergency caesarean section, and small for gestational age baby among non-smoking mothers aged 15-19 and 20-29.
Results: The 110 233 eligible deliveries were stratified into first and second births. Among first births, the only significant difference in adverse outcomes by age group was for emergency caesarean section, which was less likely among younger mothers (odds ratio 0.5, 95% confidence interval 0.5 to 0.6). Second births in women aged 15-19 were associated with an increased risk of moderate (1.6, 1.2 to 2.1) and extreme prematurity (2.5, 1.5 to 4.3) and stillbirth (2.6, 1.3 to 5.3) but a reduced risk of emergency caesarean section (0.7, 0.5 to 1.0).
Conclusions: First teenage births are not independently associated with an increased risk of adverse pregnancy outcome and are at decreased risk of delivery by emergency caesarean section. However, second teenage births are associated with an almost threefold risk of preterm delivery and stillbirth.

[url=http://www.bmj.com/cgi/content/full/323/7311/476]Teenage pregnancy and risk of adverse perinatal outcomes associated with first and second births: population based retrospective cohort study -- Smith and Pell 323 (7311): 476 -- BMJ[/url]

A retrospective study was performed in 613 singleton pregnancies born to mothers aged <=19 years over a 4-year period to determine the relationship between maternal height and preterm delivery (<37 weeks). The pregnancies were grouped according to maternal height quartiles for comparison of maternal and infant characteristics, obstetric complications and pregnancy outcome. The incidences of preterm delivery and labour decreased from 17.5% and 15.6% respectively in the lowest quartile, to 8.5% and 7.1% respectively in the highest quartile, without any difference in the risk factors or major complications. In the pregnancies without major complications, which included 73.3% of the cases of preterm labour, the rate of preterm labour was significantly and inversely correlated with the height quartiles. In the newborns, gestational age, birthweight and crown–heel length increased with the higher quartiles, but the ratio between infant crown–heel length and maternal height (height ratio) decreased with the higher quartiles. Unlike birthweight and crown–heel length, the height ratio was not correlated with gestational age. Our findings suggested that the inherent risk of preterm delivery in teenagers was related to their immature physical development at the time of pregnancy, as reflected by the maternal height.

[url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=48130]Teenage pregnancy and risk of adverse perinatal outcomes associated with first and second births: population based retrospective cohort study[/url]

Abstract

Background: Whether the association between teenage pregnancy and adverse birth outcomes could be explained by deleterious social environment, inadequate prenatal care, or biological immaturity remains controversial. The objective of this study was to determine whether teenage pregnancy is associated with increased adverse birth outcomes independent of known confounding factors.
Methods: We carried out a retrospective cohort study of 3 886 364 nulliparous pregnant women <25 years of age with a live singleton birth during 1995 and 2000 in the United States.
Results: All teenage groups were associated with increased risks for pre-term delivery, low birth weight and neonatal mortality. Infants born to teenage mothers aged 17 or younger had a higher risk for low Apgar score at 5 min. Further adjustment for weight gain during pregnancy did not change the observed association. Restricting the analysis to white married mothers with age-appropriate education level, adequate prenatal care, without smoking and alcohol use during pregnancy yielded similar results.
Conclusions: Teenage pregnancy increases the risk of adverse birth outcomes that is independent of important known confounders. This finding challenges the accepted opinion that adverse birth outcome associated with teenage pregnancy is attributable to low socioeconomic status, inadequate prenatal care and inadequate weight gain during pregnancy.

[url=http://www.medscape.com/viewarticle/559712]Log In Problems[/url]

[wyett717]

Further in the morning on the day the baby was born, instead of keeping the mother at the hospital the OB nurse sent her home (45 min away) even tho the mother kept insisting that her water had already broke 2 weeks previously.

Looking at this again, this part is really odd. Did the mother go to the hospital when her water supposedly broke?

Also, was an autopsy ever completed? It would be really hard to link any type of medical negligence if the cause of death wasn't officially known.