Shoulder Dystocia Suffered by Baby in North Carolina

pregnant womanIn a recent North Carolina appellate case, the plaintiffs appealed from a judgment in favor of a women’s center and two health care providers. According to their complaint, one of the plaintiffs had come under the medical care of the defendants to manage her pregnancy. In March 2007, she was admitted for the medical induction of labor after her pregnancy progressed a week past her expected delivery date. Seven days after admission, there was a notation that a Pitocin induction was planned and would continue with increasing dosage throughout the day.

A couple of days later, the defendant doctor assumed responsibility for her obstetrical care during labor, while the defendant midwife assumed responsibility for midwifery care during that time. The midwife made a record in the woman’s chart that Pitocin would be administered again to the woman. An hour and a half later, she’d ordered that the dosage should stay at six mu/min. About an hour later, the midwife conducted a vaginal exam and found that the woman’s cervix was six cm dilated and consulted with the defendant doctor.

Almost an hour later, the defendant doctor performed a vaginal exam and found she was fully dilated at 10 cm. They stopped the Pitocin administration, and the midwife was paged. The woman started pushing, but a little over an hour later, she was only making slow progress.

A while later, the baby’s head was delivered, but the delivery was complicated by shoulder dystocia. For two minutes, the doctor and midwife tried unsuccessfully to deliver the whole baby, and finally the doctor was able to do so. A note on the chart stated there was bruising and no movement noted in the left arm. Later, the baby was seen by a different doctor and diagnosed with brachial plexus palsy and Horner’s syndrome. The doctor believed he’d need nerve graft surgery, and this was performed a few months later.

The plaintiffs sued the women’s center as well as the doctor and midwife for medical negligence. The entities were voluntarily dismissed without prejudice. The plaintiffs asked the court to bifurcate the trial, and it granted the motion. After the liability phase, the jury found for the defendants. The plaintiffs appealed, arguing that the court had erred in excluding causation opinions, excluding evidence about prior lawsuits and claims against the midwife, and using North Carolina’s Civil Pattern Jury Instruction 809.00.

The appellate court explained that medical experts are used to show medical causation. In this case, a doctor was accepted as an expert in biomechanical engineering and the assessment of forces used in managing shoulder dystocia. The doctor testified during voir dire that he had a Ph.D. in engineering, but he hadn’t ever delivered a baby. He was not a medical doctor and wasn’t qualified to offer medical opinions or standard of care opinions. The trial court had concluded that it was a medical malpractice case, and the expert presented by the plaintiff could give only mechanical evidence, which wouldn’t help the jury. The lower court found that he couldn’t render an opinion on medical causation.

The appellate court reasoned that under common law, an expert witness on a medical subject need not be someone licensed to practice medicine. However, in an earlier case involving a non-licensed expert, the expert was a nurse with clinical experience. In this case, the expert wasn’t a health care provider and had no clinical experience. Therefore, the lower court hadn’t abused its discretion by excluding his causation testimony.

The appellate court also disagreed with the plaintiff that the lower court should have permitted evidence about prior claims against the midwife. It reasoned that under the rules of evidence, evidence of past wrongs wasn’t admissible to prove the character of a person in order to show he acted that way in the case before the court. This evidence could be admitted for other purposes, but even if relevant, it could be excluded if its prejudicial value outweighed its probative value.

In this case, the midwife had managed two shoulder dystocia episodes that resulted in babies with the same pattern of severe brachial plexus nerve injury. The appellate court explained that evidence of prior lawsuits against a medical malpractice defendant was not relevant to whether a doctor was negligent in a current case. Therefore, it wasn’t relevant to whether the midwife was negligent. It also determined there was no error in the jury instruction.

If you or your child suffered injuries due to the wrongful conduct or negligence of another party, the experienced North Carolina personal injury attorneys at Maurer Law may be able to help you recover compensation. Contact us at 919-229-8359 or via our online form.

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