Confidential
Settlement – $3,250,000Court
Sacramento Superior
Attorneys
Plaintiff
Bruce G. Fagel
(Law Offices of Bruce G. Fagel & Associates)
Defendant
Facts
Plaintiffs' mother, age 34, was followed by defendant obstetrician during the pregnancy for her first child. There were no problems noted until 37 weeks gestation when her blood pressure was recorded at 150/94 with 3+ protein in urine. The obstetrician admitted her into the defendant hospital on June 21, 1996, with a diagnosis of pregnancy induced hypertension (PIH). After admission to the hospital, blood tests showed an elevation in liver enzymes and decreased platelets, which indicated HEELP syndrome, a potentially severe form of PIH. The obstetrician decided to induce prior labor with Pitocin. Because he anticipated that the mother would have significant pain, he asked the defendant anesthesiologist to place an epidural, even though the patient was in very early labor. The anesthesiologist was aware of the laboratory tests showing low platelets and a blood pressure of 171/112, but he decided it was safe to place the epidural. The patient was not told about any special risks or problems. The obstetrician and the anesthesiologist did not discuss specific plans for fluid management, which were in conflict between fluid restriction for PIH and extra fluids for the epidural anesthesia. The anesthesiologist remained in the hospital as required by written policy, but the obstetrician went home after determining that the patient had made little progress in labor. Before leaving the hospital, he ordered Magnesium sulfate for a blood pressure of 172/94. At midnight, the blood pressure was 182/103. Her vaginal examination at this time showed four centimeter dilation, and a platelet count showed 30,000 (markedly low). At 1:05 a.m., the blood pressure was 191/103. The anesthesiologist gave a bolus to the epidural and then went to his on-call room in the hospital. At 4:25 a.m., the mother's blood pressure was noted to be 129/75. At 4:39 a.m., the blood pressure had dropped to 78/47, and a few minutes later, the fetal monitor tracing showed decelerations down to 65 beats per minute. The nurses then stopped the Pitocin and called both the anesthesiologist in the hospital and the obstetrician who was at home. At 4:45 a.m., the anesthesiologist responded and gave two doses of Ephedrine to raise thd blood pressure. The nurse anticipated that the obstetrician would want a caesarian section, and she moved the patient into the delivery room. When the obstetrician arrived at 5:05 a.m., he determined that the patient was completely dilated and decided to proceed with a vacuum delivery. When he was unable to deliver by vacuum, the obstetrician restarted the Pitocin. At 6 a.m., the obstetrician attempted both vacuum and forceps to deliver the baby. When he was unable to effect a vaginal delivery, he decided to perform a caesarian section at 6:19 and the baby was delivered at 6:24 a.m. with Apgar scores of 1, 5, 6. The cord blood gas showed a pH of 7.15. After resuscitation, the baby was transferred to the NICU at another hospital.
Settlement Discussions
The plaintiff made C.C.P. º998 (policy limit) settlement demands for $1 million from defendant anesthesiologist; $1 million from defendant hospital and $1.5 million from defendant hospital. The defendants made an offer of $3.25 million in cash, with part used to purchase a life annuity and the remainder in up-front cash. $1 million paid by obstetrician; $800,000 paid by anesthesiologist and $1.45 million paid by hospital.
Specials in Evidence
in dispute $1.5 million and $2.5 million (in dispute)
Injuries
The minor plaintiff sustained cerebral palsy and development delay. The child is able to be fed by mouth and can stand and walk at age 2+ years.
Other Information
The settlement was reached approximately one year and four months after the case was filed. A mediation/VSC was held on Nov. 30, 1998, which did not resolve the case. The settlement was reached thereafter and then approve by the court on Jan. 20, 1999.
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