Facts

Cristal Cazares Valenzuela became pregnant with FRV in early 2018 and received her prenatal care from Vista Community Clinic beginning on March 30, 20218. On October 16, 2021, an ultrasound was performed at Tri-City Medical Center (TMC) which indicated an estimated fetal weight of 8 lbs., 4 oz. On October 21, 2018, in the morning hours, Valenzuela's water broke while she was at home. She went to TMC and was admitted to the labor and delivery unit. Dr. Melissa Hawkins, M.D. was her doctor at the unit. Dr. Hawkins performed a physical exam and obtained Valenzuela's medical history. As part of the exam, Dr. Hawkins performed a manual external palpitation to evaluate FRV's size, which she estimated to be 8 lbs., 5 oz. Dr. Hawkins initially induced labor with Cytotec and then administered Pitocin approximately four hours later. FRVs heart tracings were recorded beginning at 8:17 a.m. The nurses and Dr. Hawkins continued to monitor FRV's heart tracings remotely at the nurses' station and at bedside. At 8:29 p.m., Valenzuela was 9.5 cm dilated and was exhausted from pushing but failed to deliver FRV. Dr. Hawkins obtained Valenzuela's consent for vacuum-assisted delivery and noted a fetal heart rate of 80 beats per minute, well below the 110-160 beats per minute norm. The vacuum brought FRV's head to crowning at 9:24 p.m. After applying the vacuum a second time, FRV's head was delivered but Dr. Hawkins noticed FRV's head was retracting backwards, which indicated shoulder dystocia. Three nurses and Valenzuela's husband applied suprapubic pressure to dislodge FRV. The should dystocia lasted between five and eight minutes. At 9:35 p.m., FRV was born. He weighed 10 lbs., 11 oz., and he was noted to be floppy, limp without spontaneous respirations, and blue in appearance. Resuscitation efforts were initiated and FRV was transported to the TCMC Neonatal Intensive Care Unit (NICU). FRV began to have seizure activity and was transferred to Rady Children's Hospital. FRV was diagnosed with respiratory failure, hypoglycemia, seizures, brachial plexus injury, hypoxic ischemic encephalopathy, and intracerebral hemorrhage. He also suffered injury to the right C7 and C8 nerve roots, with avulsion of the C8 nerve root, which required two surgeries. FRV, by and through his guardian ad litem, Valenzuela, and Sonia Valenzuela Perez, filed a complaint against the United Staes of America alleging one count of medical negligence under the Federal Tort Claims Act relating to the birth injuries of FRV.

PLAINTIFFS' CONTENTIONS: Plaintiffs contended that an employee of the United States, Melissa Hawkins, M.D., committed medical malpractice by mismanaging Ms. Valenzuela's labor and delivery of her son, thereby causing plaintiffs' injuries and damages, including medical expenses, loss of earnings, and emotional distress. In particular, plaintiffs argued that FRV was cognitively impaired to a degree that he will never work or live independently and will require attendant care for the rest of his life and that he suffered hypoxic ischemic encephalophay of both an acute-profound and partial-prolonged pattern, and brachial plexus injury caused by shoulder dystocia as a result of Dr. Hawkins' mismanagement. Plaintiffs maintained that this mismanagement included Dr. Hawkins' failure to: properly interpret fetal heart tracings, detect signs of fetal intolerance to labor, and timely intervene and deliver fetal heart tracings by Caesarean section in the face of persistent nonreassuring fetal heart tracings. Moreover, plaintiffs contended that Dr. Hawkins fell below the standard of care by failing to recommend urgent cesarean delivery by 11:30 am based on these nonreassuring fetal heart tracings and other clinical factors, including Ms. Valenzuela's advanced maternal age, gestational diabetes, estimated fetal weight by sizing ultrasound, and pre-eclampsia.

DEFENDANT'S CONTENTIONS: Defendant argued that FRV will be able to graduate high school, secondary school, and maintain gainful employment despite any injuries. Defendant acknowledged that FRV will have life-long limitations to his right arm and shoulder because of the brachial plexus injury, which likely occurred during the shoulder dystocia. However, defendant alleged that Dr. Hawkins with the assistance of her nursing team managed Ms. Valenzuela's labor and delivery with the requisite skill of a reasonably careful OBGYN, that she made appropriate evidence-based medical decisions throughout labor based on the information known to her at the time, including her interpretations of the fetal heart tracings, and that she properly expediated delivery when confronted with the medical emergency of should dystocia, ultimately saving FRV's life. Defendant argued that reading fetal heart tracings was subjective and not amenable to objective calculation and precision and that FRV's estimated fetal weight of 8 lbs., 14 oz. was within normal limits.

Result

The court entered judgment for defendant since Dr. Hawkins did not breach her duty of care in delivering FRV.