Facts

Plaintiff, Ayani Elizondo, was 4 and a half years old at the time of trial, and her mother, Janeka Elizondo, was her assigned guardian ad litem. During her pregnancy with Ayani, Janeka was considered to be a high risk patient, due to her advanced maternal age, diabetes, obesity, and history of three prior C-sections. Her prenatal care was managed by her primary obstetrician, defendant Dr. Carstens, and she was also seen weekly at the office of defendant Dr. Brar, her perinatologist. Leading up to the delivery, Janeka presented twice to Riverside Community Hospital with labor related complaints, but was discharged both times. She followed up with her perinatology appointment on Oct. 30, 2015, and had a normal fetal non-stress test and biophysical profile. Janeka then presented to Dr. Carstens' office the following week on Nov. 5, 2015, where she was found to have no abnormalities by Dr. Carstens' nurse practitioner. The next afternoon, on Nov. 6, 2015 around 4:25 pm, Janeka presented to Dr. Brar's office for her scheduled weekly non-stress test and biophysical profile.

At Dr. Brar's office on Nov. 6, Dr. Brar's nurse observed that the non-stress test was non-reactive, and the fetal tracings were tachycardic (with a baseline between 170 to 180) with minimal variability. A biophysical profile was then performed, which was scored at 8/8. Dr. Brar was paged and ordered that Janeka go to Riverside Community Hospital for ongoing monitoring. Dr. Brar's nurse alerted her primary obstetrician's office and the hospital about the planned hospitalization, and Dr. Brar's nurse verbally reported to the hospital the 8/8 biophysical profile result.

Janeka presented to Riverside Community Hospital at 4:50 on Nov. 6, and brought her records from Dr. Brar's office, which showed the findings of the non-stress test from earlier that day, but did not include any results of a biophysical profile. At the hospital she was placed on a fetal heart monitor and the fetal heart tracing remained tachycardic and non-reactive, with mostly minimal variability. About 1.5 hours after her arrival at the hospital, the nurses called Dr. Moola, the on-call physician covering for Dr. Carstens, who was out of town. The nurses reported the tachycardia and non-reactivity, along with the findings from Dr. Brar's records, but did not report the prior biophysical profile score. Dr. Moola then made telephone orders for continual fetal monitoring, a biophysical profile, and a sterile vaginal examination. Fetal monitoring continued, showing no significant changes, while the biophysical profile (completed 3.5 hours later) no longer showed any fetal breathing, resulting in a score of 6/8. The nurses called Dr. Moola again with the results of the biophysical profile, and Dr. Moola made her way into the hospital where she talked to Janeka about her options to deliver then or wait to see whether the tachycardia resolved overnight. The decision was made to move forward with the delivery via C-section around 10:45, and the baby was delivered by 11:46. Cord gases were within normal limits, but APGAR scores were 2, 6, and 8. Shortly after delivery, Ayani was intubated and sent to the NICU at Riverside Community Hospital.

Ayani was subsequently transferred to the NICU at Loma Linda University Hospital, where she was diagnosed with severe hypoxic ischemic encephalopathy. She was ultimately discharged home with a feeding tube, and remains in the family home. Ayani has since been diagnosed with HIE and spastic cerebral palsy, which has resulted in a severe case of kyphoscoliosis and chronic lung disease. She still cannot swallow, so she requires regular suctioning and g-tube feeding, along with 24 hour care for all activities of daily living.

PLAINTIFF'S CONTENTIONS: Plaintiff claimed that each of the defendants were negligent in their care and treatment of Janeka during her pregnancy, labor and delivery of Ayani.

As to Dr. Carstens, plaintiff claimed his office negligently failed to provide the hospital with the complete and up to date prenatal chart for Janeka (including the last several normal visits to his office prior to delivery).

As to Dr. Brar, plaintiff alleged his office was negligent in failing to inform the hospital that a biophysical profile was done on November 6th, resulting in the unnecessary order for a second biophysical profile when Janeka presented to the hospital shortly after she left Dr. Brar's office.

As to the hospital, plaintiffs alleged negligence from various delays. Specifically, delays in getting the patient into a room and placed on a monitor, delaying over an hour after the patient's arrival before calling her physician, delaying 3.5 hours to complete the biophysical profile, and further delays in getting the patient into the operating room once the decision was made to deliver.

As to Dr. Moola, plaintiff claimed she was negligent for failing to come directly to the hospital to assess the patient and deliver her immediately. Plaintiff further claimed that Dr. Moola should have done more to press the biophysical profile along when it took more than 1.5 hours to complete, and should have delivered her immediately after those results.

Plaintiff's experts testified that the injury in this case was the result of a rare umbilical vein clot, which compromised the blood flow to the baby for 20 minutes prior to delivery (while the patient was in the operating room and not on the monitor). They claimed that every minute counted and that if the baby had been delivered minutes earlier, she would have lived a perfectly normal and healthy life.

DEFENDANTS' CONTENTIONS: Defendants each denied liability, and contended that at all times defendants complied with the standard of care. All defendants also maintained that the injury in this case occurred prior to the patient's presentation to Dr. Brar's office on November 6th, as seen by the fetal tachycardia and non-reactivity, along with the normal blood gases at delivery. Each defendant contended that there was no reason to perform an emergency delivery on November 6th, as the fetal monitoring strips never showed any decelerations or deterioration.

Defendants also maintained that the injury in this case occurred up to five days prior to delivery, and was likely the result of an unpreventable and undetectable cord accident (supported by findings in the placental pathology).

The defense pathologist agreed that a clot was present within the umbilical vein, but theorized that this clot did not significantly impact the blood flow to the baby while the damage to the placenta dating back five days showed extensive interruption of blood flow.

Settlement Discussions

Prior to trial, plaintiff made a global demand of $10 million, with an individual demand to the hospital for $7 million. Prior to jury selection the hospital offered $250,000. Following jury selection, plaintiff was offered in excess of $4 million (with $3 million from the hospital, $1 million from Dr. Moola, and $125,000 from Dr. Brar). During trial, a $5 million demand was made to the hospital only.

Damages

Plaintiff asked for approximately $15 million in damages for future medical care and lost earnings (present value). Plaintiff asked for approximately $3.2 million in non-economic damages.

Injuries

Plaintiff suffered catastrophic spastic cerebral palsy, kyphoscoliosis, severe cognitive limitations, g-tube dependency, dependent on a manual suction machine to manage secretions, and chronic lung disease, among other things. Ayani has had a number of lengthy hospitalizations over her life to treat infections and related lung issues, and is expected to have a severely limited life expectancy. Defense experts testified that Ayani would not survive beyond age 10, while plaintiff's expert testified that she is expected to survive to between the ages of 25 to 30 years old. Defendants projected plaintiff's future care needs to be up to $10 million, while plaintiff's projections were greater than $15 million (present value).

Result

The jury rendered a defense verdict in finding no negligence on any of defendants' part.

Deliberation

3.5 days

Poll

After the verdict the jury was polled revealing the following figures on the question of negligence: 9-3 in favor of Defendants Riverside Community Hospital and Dr. Brar, 11-1 in favor of Defendant Dr. Carstens, and 12-0 in favor of defendant Dr. Moola.

Length

53 days