July 10, 2013

162017_132140396847214_292624_nOn July 3, 2013, the Court of Special Appeals of Maryland (“Court of Special Appeals”), Maryland’s second highest appellate court, vacated a Baltimore medical malpractice jury verdict in the amount of $28,301,825 (the Maryland medical malpractice jury originally awarded the plaintiffs $55 million in damages, including $26 million for noneconomic damages, $25 million for future medical expenses, and $4 million for lost wages, but the trial judge subsequently reduced the lost wages awarded from $4 million to $2,621,825 and reduced the noneconomic damages awarded from $26 million to $680,000, pursuant to Maryland’s cap on noneconomic damages at the time of the medical malpractice incident).

The Underlying Facts

On March 25, 2010, a pregnant woman went into labor with her first child. She had planned to have a natural child birth at home with the assistance of a registered midwife and a labor coach. She was 10 days overdue and was in labor for 14.5 hours during the first stage of labor and at least five hours more in the second stage of labor. The baby’s presentation was atypical (occiput posterior fetal position), with his head down and facing forward instead of inward, toward his mother’s spine, which often leads to the baby not being able to progress through the birth canal because the position of the baby’s head prevents him from tucking his chin in and results in the baby’s head being wider in comparison to his mother’s pelvic bones than it would otherwise be.

At 12:30 a.m., the midwife attempted to expedite delivery while at the woman’s home by first applying fundal pressure two or three times and by injecting the woman multiple times with Pitocin to increase the strength and frequency of contractions. The midwife then performed an episiotomy, misjudging the state of the woman’s labor. The midwife then directed the woman to cleanse herself with a probiotic treatment as an alternative to taking antibiotics, in order to prevent the potentially fatal transmission of Group B streptococcus bacteria to the baby during delivery, for which the woman had tested positive.

After the midwife’s efforts proved futile, the midwife decided to send the woman to the hospital after suturing the episiotomy; the midwife called an ambulance.

The woman arrived at the hospital (The Johns Hopkins Hospital) at 3:30 a.m. on March 26, 2010 and was evaluated by the hospital’s labor and delivery team, which applied a fetal heart rate monitor. The medical records indicate that the descent level of the baby was assessed as +1 station when the woman arrived at the hospital and remained at +1 after the woman was provided the chance to push a few times.

At 3:45 a.m., the treating physician and the attending senior resident physician determined that the woman would be unable to deliver vaginally and therefore concluded that an “urgent” Cesarean section delivery was required. The hospital physicians determined that an “emergency” Cesarean section delivery was not required because the fetal heart rate monitor indicated that the fetus was being adequately oxygenated.

The hospital physicians ordered certain blood tests, the results of some of which were returned at 4:52 a.m. Based on the blood tests results, the hospital physicians determined that it would be safe to use spinal/epidural anesthesia for the Caesarean section delivery. Anesthesia was administered and the woman was prepared for Cesarean section surgery. At 4:57 a.m., the woman was transported to the operating room and the baby was delivered at 5:40 a.m. The baby’s condition at birth was poor and he now suffers from cerebral palsy, retardation, and other disorders.

The Maryland Medical Malpractice Lawsuit

The baby’s parents subsequently filed a medical malpractice lawsuit in which they alleged that the hospital negligently failed to perform a timely Cesarean section and that if it had been performed by 4:15 a.m., as required by the standard of care, the baby would not have suffered any injury. The Maryland medical malpractice lawsuit further alleged that the hospital negligently failed to recognize ominous signs of fetal distress and should have converted to an emergency Cesarean section based on the status of the baby’s fetal heart rate monitor.

The defendant hospital alleged that the midwife was solely responsible for the baby’s injuries that occurred hours before the delivery and prior to the woman’s arrival at the hospital. The hospital further argued that the timing of the Cesarean section was not negligent.

The Trial Court’s Order Precluding Testimony Regarding The Midwife’s Standard Of Care

Before the medical malpractice case was tried before a jury, the plaintiffs moved to preclude any testimony regarding the midwife’s standard of care and the defendant hospital opposed the plaintiffs’ motion. The trial court granted the plaintiffs’ motion, stating, in part, “The issue here is the standard of care, whether or not, [the hospital] breached the standard of care and whether that conduct caused [the injuries] … Not somebody else’s breach of a standard of care. Not somebody else’s negligence. [The Hospital’s] conduct [is what is relevant], because if [the midwife] breached the standard of care [but] caused no damage, then it’s totally irrelevant … [or it could be that] she didn’t breach the standard of care, [but] caused the damage … if you have testimony as far as causation. You have testimony that fundal pressure was applied at home, before she came to Hopkins, and if you have causation testimony … t]hen why do you have to tell the jury that — and that is a breach of standard of care, that’s negligence to do that … I just — I’m concerned about the potential prejudice from the jury feeling there is a third-party here, who is not a party to the action.”

The trial court concluded that as to the midwife’s conduct, only evidence regarding causation was relevant. The trial court, therefore, limited the defendant hospital to presenting evidence of: (1) the physical actions and conduct of the midwife; and (2) the reactions of the defendant hospital personnel when learning of this conduct.

The Appeal

The Court of Special Appeals held “that the trial court erred by excluding evidence of the midwife standard of care, and [the midwife’s] breach of that standard of care while treating [the woman]” because “the evidence of the midwife standard of care, and [the midwife’s] breach of that standard of care material to causing [the baby’s] injury, is relevant to the Hospital’s defense that it was not negligent and not a cause of injury,” thereby denying the defendant hospital a fair trial.

The Court of Special Appeals explained that “the relevant inquiry on appeal is whether evidence of a non-party’s negligence is relevant to a defendant’s complete denial of liability,” holding that “evidence of both negligence and causation attributable to a non-party is relevant where a defendant asserts a complete denial of liability.”

The Court of Special Appeals reasoned that “the Hospital was entitled to try to convince the jury that not only was it not negligent and not the the cause of [the baby’s] injuries, but that [the midwife] was negligent and did cause the injuries. There was a void of evidence that left a logical hiatus in the story because the jury was not allowed to hear what role [the midwife’s] conduct played. This void was amplified by the fact that this was a medical malpractice case involving obstetrical medicine and treatment decisions. The Hospital’s defense was contingent upon showing that [the midwife’s] use of intra-muscular Pitocin injections, fundal pressure, and/or attempting home delivery after 41 gestational weeks solely caused [the baby’s] injuries. Surely it was far from self-evident to the lay jury whether this treatment caused injury. Accordingly, because the Hospital was precluded from presenting any evidence that [the midwife] breached the standard of care and was therefore negligent, it follows that the jury was left to wonder whether anyone other than the Hospital — the sole defendant — could have caused [the baby’s] injuries.”

Source Enzo Martinez, a minor, by and through his Parents and Next Friends, Rebecca Fielding and Enso Martinez, et al. v. The Johns Hopkins Hospital, No. 1394.

If you or someone you know suffered serious injuries or other substantial harms as a result of possible medical malpractice in Maryland, you should promptly seek the legal advice of a Maryland medical malpractice attorney who may be willing to investigate your Maryland medical malpractice claim for you and represent you in a Maryland medical malpractice case, if appropriate.

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