Cerebral Palsy Medical Malpractice Cases Involved Birth Asphyxia and HIE

A 2019 study of Chinese cerebral palsy medical malpractice cases found that over 60 percent of them involved birth asphyxia and hypoxic-ischemic encephalopathy. These results quantity CP-associated medical errors and conditions. Narrowing them down helps healthcare providers better understand the necessary steps to prevent it.

What does this tell us about cerebral palsy malpractice cases in the United States? Good question. Well, not much for the compensation awarded for a cerebral palsy case. But the nature of the claims does provide a lens into malpractice cases here, perhaps with less fluff because so many papers on cerebral palsy malpractice cases are really just arguments against the civil justice system we have had in this country since before we were a country.

Birth asphyxia

Birth asphyxia arises when the baby’s brain experiences blood flow and oxygen deprivation during or after the delivery. Brain cells will not function properly without enough oxygen. This will result in brain damage. Birth asphyxia causes include prolonged delivery, placental abruption, and preeclampsia.

The condition’s severity depends on the oxygen deprivation duration, oxygen levels, and time it took to administer appropriate treatments. If treated fast enough, babies with mild to moderate asphyxia can fully recover. However, prolonged asphyxia will cause permanent injuries, including cerebral palsy. Therapeutic hypothermia, also known as brain cooling, can yield positive outcomes for full-term babies. However, this treatment is not for babies born before 32 weeks. Death and organ failure can occur in the most severe birth asphyxia cases.

Hypoxic-ischemic encephalopathy

Hypoxic-ischemic encephalopathy (HIE) is a specific form of asphyxia. It occurs when the brain experiences oxygen deprivation. This can lead to CP. Risk factors include a nuchal cord, a prolapsed umbilical cord, preeclampsia, a prolonged pregnancy, and fetal macrosomia.

Medical errors associated with cerebral palsy

The following are a few medical errors associated with cerebral palsy:

Negligent fetal monitoring: Electronic fetal monitoring devices help hospital staff accurately track the baby’s heart rate. However, it is not foolproof. Their effectiveness depends on careful monitoring. Failure to do this results in severe errors. Hospital staff may incorrectly monitor the mother’s heart rate instead of the child’s. They may also fail to timely address fetal distress. These errors prolong fetal distress, which increases the cerebral palsy risk.
Prolonged C-section: Failure to timely perform a C-section can lead to cerebral palsy. A prolonged delivery causes severe oxygen deprivation. Emergency c-sections can be performed within 10 to 15 minutes. This means that this procedure can prevent permanent injuries in hypoxic babies. However, it is extremely time-sensitive. Physicians and nurses can ignore fetal distress for hours. This dramatically increases the cerebral palsy risk.
Negligent forceps use: Sometimes the baby’s struggles to make it through the birth canal. The OB sometimes uses forceps to give the child a boost through the canal. Forceps are a tong-like contraption. Its curved cup ends grip the baby’s head. Forceps are fine in the right hands. Excessive force or pressure causes fetal head trauma. This can cause severe brain damage that leads to cerebral palsy.

2019 study on medical malpractice cases involving cerebral palsy

In a 2019 Journal of Forensic and Legal Medicine-published study, Chinese researchers reviewed 400 medical malpractice cases involving cerebral palsy. Their data came from China Judgements Online.

The researchers sought to find a causal relationship between medical errors and cerebral palsy. The researchers found that the most common associated conditions were hypoxic-ischemic encephalopathy and perinatal asphyxia. They found that 63.3 percent of cerebral palsy cases involved HIE, while 63.5 percent of cases involved perinatal asphyxia. The other observed risk factors and medical errors include:

Neonatal infections: 52.3 percent
Brain hemorrhages: 36 percent
Delivery delays: 30.2 percent
Failure to timely identify fetal distress, adequately monitor the fetal heart rate, or properly address birth complications: 28.8 percent
Poor management and communication within the medical records: 25.3 percent.

The researchers also found that plaintiffs received compensation in 91.4 percent of cases. Defendants were found liable for medical errors in 89.1 percent of cases. The mean compensation was over $73,000, while the mean actual total loss for families was over $128,000. They found no difference in medical error frequency between premature and full-term births.

Cerebral palsy birth injury verdicts and settlements

Below are sample cerebral palsy settlements in the United States.

YEAR / STATE

CASE / INJURY SUMMARY

RESULT

2020 – Michigan

A 29-year-old expectant mother experienced reduced fetal movement at 39 weeks. She had a low biophysical profile score and a non-reactive non-stress test. The woman was admitted for labor induction. The fetal heart tracings showed little variations. Despite this, the hospital staff administered Pitocin. This caused excessive uterine activity and bradycardia. The hospital staff then performed an emergency C-section. The baby was born pale, limp, and not breathing. They underwent pulse pressure variation and chest compressions. After eight minutes, the baby’s heart rate exceeded 100. They were subsequently admitted to the NICU. The baby underwent brain cooling for hypoxic-ischemic encephalopathy. Despite the treatments, they developed spastic quadriplegic cerebral palsy. The baby’s mother alleged that the hospital staff’s negligence caused their permanent injuries. She claimed they failed to recognize fetal distress signs and negligently administered Pitocin. This case settled for $8,000,000.

$8,000,000 – Settlement

2020 – Mississippi

An expectant mother at 20 weeks underwent a routine sonogram. She was informed that her child suffered from fetal growth restriction. The treating obstetrician failed to perform additional monitoring. The woman’s son suffered an intracranial hemorrhage four days after his birth. He developed cerebral palsy. The boy could not talk, walk, or use the bathroom on his own. His mother alleged that the obstetrician’s improper management of the pregnancy caused his permanent injuries. She argued that he should have made a maternal-fetal medicine specialist referral and performed follow-up ultrasounds to monitor fetal growth. The woman and her son received a $2,600,000 jury verdict.

$2,600,000 – Verdict

2020 – Tennessee

A newborn boy was delivered via emergency C-section at a federal hospital. The hospital staff attempted a vaginal delivery. They discovered fetal distress. This prompted an emergency C-section. The boy sustained perinatal asphyxia and hypoxic-ischemic encephalopathy. He developed spastic quadriplegic cerebral palsy. The boy was left with motor function impairments, delayed cognition, and seizures. He required lifelong assistance and care. The boy’s parents alleged that the federal hospital staff’s negligence caused his permanent injuries. They claimed they failed to offer a C-section, timely address the fetal heart rate, and consider the vaginal birth after cesarean risks. The federal government denied liability. It argued that that the boy’s injuries were unrelated to his treatments. The federal judge awarded the family $15,153,488.

$15,153,488 – Verdict

2020 – Missouri

An expectant mother underwent vaginal delivery. She previously underwent two C-sections. During the delivery, the hospital staff encountered a uterine rupture. This prompted an emergency C-section. The hospital staff encountered severe abdominal bleeding. The baby girl was born not breathing and limp. She developed spastic quadriplegic cerebral palsy. The now 8-year-old girl could not speak, walk, stand, sit up, or use her arms. Her mother alleged that the hospital staff’s negligence caused her permanent injuries. She claimed they failed to warn of vaginal birth after cesarean risk. This case settled for $7,750,000.

$7,750,000 – Settlement

2020 – Michigan

A baby sustained hypoxic-ischemic encephalopathy at birth. They developed cerebral palsy. The child was left with developmental delays. Their mother alleged that the hospital staff’s negligence caused their permanent injuries. She claimed they failed to recognize placental abruption signs, address fetal distress, timely consult the attending OB/GYN, and timely deliver her child. The woman argued that a timely consultation would have prompted the OB/GYN to immediately report to the hospital for a C-section. This case settled for $4,500,000.

$4,500,000 – Settlement