Washington DC Metro Medical Malpractice Lawyer Blog

Life can turn in an instant. For some, as we have discussed in our recent blogs, this upheaval happens in the form of a birth injury. There are other instances, though, where these conditions are overcome and patients are able to lead relatively normal, productive lives. It is all the more grievous when later in life, a medical practitioner's negligence becomes the stumbling block for these individuals.

One such case we handled involved a boy with spina bifida and hydrocephalus. These conditions are usually caused by defects during intrauterine development. Spina bifida involves a condition when the spine does not fully close around the spinal cord, resulting in the formation of a myelomeningocele or sac containing the protruding spinal cord and overlying membrane. Ninety percent of patients with myelomeningocele also develop hydrocephalus, or "water on the brain." Hydrocephalus occurs when excessive cerebrospinal fluid (CSF) builds up in the ventricles, or cavities, of the brain. If untreated, this causes intracranial pressure to increase, potentially enlarging the skull and causing brain damage, mental disability, or death.

The boy had successful surgery as an infant to repair his spine and place a shunt that would control the pressure in the ventricles of his brain by removing excess CSF. Despite having executive dysfunction, ADHD, and several other medical conditions associated with his hydrocephalus, he either functioned or showed promise of functioning at normal levels in all areas. He was mainstreamed in school, managed to cope with his difficulties, and was expected to graduate with his peers.

At the age of 16, he began to experience periodic severe headaches. After examination, it was found that his shunt, though still functioning, needed revision. Surgery was initially successful, but indications of infection prompted removal of the entire shunt system, requiring placement of a new one at a later date. His surgeon suggested that he could perform an additional and unnecessary procedure, making a 4-5mm hole in the third ventricle for CSF to drain. He did not inform the boy or his parents of all the possible risks, nor did he mention simpler alternatives that were available. During surgery, this doctor also felt he could see well enough to carry out the delicate operation without the assistance of a visualization device. During surgery it became apparent that the attempted repair was a complete failure, and had caused the boy to suffer serious brain injury.

Our law firm's investigation showed that the surgery had been executed in a negligent manner, cutting too deep and in the wrong location, severing the connections between various parts of the brain. Whereas the boy had successfully overcome congenital hydrocephalus and was college-bound, he is no longer fully independent and depends on assistance from others to perform many vital functions. We filed suit on his behalf promptly and recruited top national experts in neurosurgery and neuroradiology to support the case. Fortunately, we were able to achieve a very substantial settlement for this young man and his family, providing help that they desperately need to deal with the problems caused by an unnecessary and cavalier surgical misadventure.

Part two

In this part of our birth injuries blog series, we will look at a condition known as HIE or Hypoxic Ischemic Encephalopathy. HIE is a lack of oxygen to the brain as a whole, and can cause serious permanent brain damage or death. While the term HIE can be used to describe any brain injury caused by low oxygen, it most commonly refers to those sustained by newborns.

It only takes five minutes of oxygen deprivation to begin brain cell death. Any injury or disease affecting oxygen supply to the brain can potentially cause HIE, including blocked or ruptured blood vessels, strangulation, drowning, cardiac arrest, choking, overdose, high altitudes, smoke inhalation, carbon monoxide poisoning, and respiratory failure, as well as complications from general anesthesia, paralysis of respiratory muscles or organs, and injury or complications during birth.

Symptoms depend on the extent of oxygen deprivation, and whether any brain damage has occurred. In milder cases, this may involve extreme lethargy and poor coordination with mental state changes including possible euphoria, poor judgment and trouble concentrating. In severe cases, seizures or coma are likely; if the brain stem has been damaged, breathing and other vital functions can be affected as well.

Treatment is determined based on symptoms and diagnostic tests to evaluate the brain and heart, and may include medications to maintain the circulatory system or control seizures, cooling blankets, hyperbaric oxygen treatment, and mechanical ventilation or other life-sustaining measures. If not treated promptly, or if too much deterioration has taken place, HIE can cause long-term damage including seizures, delayed development, intellectual disability, and cerebral palsy.

We have successfully tried and settled medical malpractice cases involving this and other birth injury conditions. If you or someone you love has suffered a birth injury like HIE as a result of a medical provider's negligence, please contact Laurie A. Amell at (202) 661-0934 for a free consultation. You may also contact any of our other experienced civil litigation lawyers at Stein, Mitchell & Muse, LLP by calling our toll-free number (877) 783-4664 or by filling out and submitting our online "Contact Us" form today.

See part one here.

Part One

Medical malpractice is especially devastating when it affects the lives of newborns and their families. The long-anticipated and normally joyous birth of a child is overshadowed by the shock of serious birth injuries. Too often these result from errors and negligence, even taking place within a few hours of birth. In a previous blog, we discussed one such case which we tried successfully. Through this blog series, we will take a more in-depth look at some of the conditions that can be caused by birth injuries.

Cerebral palsy is an incurable life-long disorder that affects brain and nervous system functions including vision, hearing, cognition and learning, and movement. It develops as a result of brain abnormalities or injury including brain bleeding or infection (or infection of the mother during pregnancy), head injury, or severe jaundice, and can occur anytime during gestation up until a child is 2 years old. Treatment is aimed at improving quality of life and allowing patients to be as independent as possible.

Signs and symptoms can include pain, tremors, twisting or writhing of the extremities while awake, unsteady gait, floppy muscles, loss of coordination, speech problems, seizures, hearing or vision problems, decreased intelligence, learning disabilities, slower than normal growth, problems swallowing and chewing, increased drooling, vomiting or constipation, incontinence, and irregular breathing. These vary in severity from person to person and further depend on the form of cerebral palsy, which can be spastic, dyskinetic, ataxic, hypotonic, or mixed. The most prevalent form is spastic cerebral palsy, which can also cause severe muscle tension, tight joints, and muscle weakness or paralysis.

Parents should be aware of delays in developmental milestones like sitting, reaching, rolling, crawling, or walking as these can be early indicators of the condition. When cerebral palsy is suspected, a full neurological exam is vital. Other tests that may be performed are vision and hearing screening, MRI and/or CT scans of the head, EEG (electroencephalogram), and blood tests.

While not all cases of cerebral palsy are preventable, receiving proper prenatal and delivery care can greatly reduce the risk. We have successfully tried and settled cases involving cerebral palsy and other birth injuries caused by breaches in the standard of care during those crucial times.

When a baby is born and during the first year of life, it is difficult to diagnose serious brain and neurological injuries and illnesses. Parents have to be very alert and not shy away from investigating any suspicion or observation they have made. If the baby is doing well it is still necessary to take the child to a pediatrician for a thorough physical examination and periodic evaluations.

Not even these physical examinations are always enough as some conditions are not detected in regular medical encounters. What should you do? First, make sure that your child has had the screening required by law for detection of inborn errors of metabolism and genetic disorders. The first condition refers to a child's inability to process certain foods metabolically. In the District of Columbia, Maryland, and Virginia, screening for 21 inborn errors of metabolism is mandatory by law.

Next, it is the parents' duty to assess the child's development in terms of developmental milestones. These are the stages of growth and development of the baby. The list of milestones includes: 1) first smile (4 to 6 weeks), 2) following objects with one's eyes (3 to 6 weeks), 3) rolling over (16 weeks), and 4) sitting assisted (5 months) and unassisted (8 months), and many others. Many books list the milestones you should be alert about. If there is any concern, go to your doctor/pediatrician. Check if the inborn errors were screened for or not. If in doubt, take the records of the baby to an appropriate medical practitioner.

If you think that your child was not screened according to the standard of care, you may need to get legal counsel involved to protect your child's interests and wellbeing. An example: A baby was not smiling at 9 weeks. The child was also listless and had a strange cry in a shrill voice. The baby was not willing to feed well, pushing his mother's attempts away. The parents took the baby to a pediatrician after 10 weeks but nothing was initiated by the pediatrician by way of evaluation or diagnosis. Finally, at 9 months, the baby was hospitalized due to a diagnosis of "Failure to Thrive." Blood work showed that the baby had very low levels of thyroid hormones compatible with a diagnosis of congenital hypothyroidism.

The thyroid hormone is essential during our entire life-span. However, during early life it is truly essential. Without this hormone the baby fails to grow and becomes lethargic with lack of energy. The disease which evolves is known as Cretinism. Symptoms include arrested development and decline of brain functions. Restoration of thyroxin blood levels can be achieved through synthetic thyroid administered in pill form by mouth. However, some dysfunction remains in many children as a chronic condition.

Our lawyers were able to demonstrate the long-term effects of insufficient synthesis of thyroid hormones. The Healthcare Providers were shown to be negligent and the case settled just before trial.

Gerard Mitchell
Dr. Michael Cohen

Recently, we handled a medical malpractice case in Maryland involving a baby with a preventable brain injury leading to cerebral palsy.

There are many causes of brain injuries in children. Some are preventable; some are not. A condition known as Kernicterus is a preventable form of severe brain injury in children.

It is advisable to assess all brain injuries in children in order to determine whether these injuries are genetic, or whether they are related to preventable or nonpreventable causes.

Parents of a baby of 8 months came to our law firm to ask us to review the records of their daughter who had cerebral palsy on the basis of early jaundice after delivery. They were able to tell us that their daughter was yellow after birth and that when she was admitted to the hospital in their hometown the little girl needed a replacement transfusion of her blood. The records indicated that the baby was discharged on day 4 of life after a normal vaginal delivery. She was yellow at the time and her bilirubin levels were somewhat high. On her first wellness visit to the pediatrician she was yellow and lethargic, and she was not sucking her mother's breast effectively to obtain nourishment. The couple was told to come back one week later and to continue and feed the baby the best they could. Four days later the mother noticed her daughter to be listless, sleeping constantly, and not crying at all. The mother decided to take the baby to the emergency room of the local community hospital. On arrival in the ER the baby's blood was found to contain high levels of bilirubin and an MRI of the skull and brain detected that the child's bilirubin had attached itself to certain areas in her brain known as cerebral nuclei. These areas are known as "kerns" in German, which combined with "icterus" (meaning yellow) explains the origin of the name "Kernicterus."
Kernicterus is a serious and potentially devastating neurological illness in children.

Our review of the records documented that the child had high levels of bilirubin and should have been treated rather than discharged from the hospital after birth. Early treatment is simple and highly effective: the baby is placed under a lamp emitting ultra-violet light which breaks down bilirubin very effectively. Even at the first wellness evaluation the baby's condition could still have been treated effectively with blood transfusions and ultraviolet light. Our medical experts told us that the delay in diagnosis and treatment was negligent and amounted to a serious failure of the healthcare providers to follow the standards of care for monitoring young babies with early jaundice. Following a year of litigation we were able to obtain a significant settlement to fund the child's lifelong needs including medical, rehabilitation and remediation services.

Gerard Mitchell
Dr. Michael Cohen