In 2013, Dawn M. Morgan-Baker was admitted to the labor and delivery unit of a hospital operated by Alegent Creighton Health Creighton University Medical Center, LLC, in Omaha, Nebraska, for her anticipated delivery of her son, J.R.M.B. (J.R.). She was at 36 weeks gestation. She had suffered a fall the day before, causing a “spontaneous rupture of membranes” before her admission. The rupture of membranes increased the risk of infection if J.R. was not delivered within a reasonable period of time. At the hospital, Morgan-Baker attempted to deliver J.R. without the assistance of Pitocin, but she did not go into labor. Pitocin is a synthetic oxytocin that can be used to cause uterine contractions or to strengthen them during labor.
Peggy H. Jones, M.D., F.A.C.O.G., an obstetrician and gynecologist employed by Alegent Creighton Clinic and affiliated with the hospital, ordered the hospital’s nursing staff to administer Pitocin. Jones also instructed the nursing staff to increase Morgan-Baker’s dose of Pitocin every 30 minutes, depending on their assessment of her contraction pattern. Staff employed continuous fetal monitoring and an intrauterine pressure catheter to measure contractions.
Morgan-Baker’s contractions became more frequent as the dose of Pitocin increased. Due to the staff’s observations of Morgan-Baker’s having more than 5 contractions within a 10-minute period averaged over 30 minutes, considered “tachysystole,” along with Morgan-Baker’s complaints of pain and a spike in Morgan-Baker’s blood pressure, Jones directed the staff to decrease the dose of Pitocin by half and to stop the Pitocin if decreasing the dose did not eliminate the tachysystole. Staff decreased the Pitocin. Later, Jones ordered that staff increase the dose of Pitocin in accordance with protocol and alert her to any concerns. The nursing staff increased the dose of Pitocin.
When Morgan-Baker progressed enough in her labor, she began pushing and delivered J.R.’s head, but his body did not follow. Jones recognized that J.R.’s right anterior shoulder was impacted behind Morgan-Baker’s pubic bone, a condition known as shoulder dystocia. At no point during the labor was J.R.’s heart rate abnormal, and there was no indication that he was not getting enough oxygen. However, if not resolved quickly enough, shoulder dystocia can cause hypoxia, because the umbilical cord becomes pinched against the pelvis.
Jones and the nursing staff implemented the “McRoberts maneuver” to resolve the shoulder dystocia. The maneuver opens the pelvic outlet by pulling a mother’s legs up toward her chest. The McRoberts maneuver was successful, and Jones delivered J.R.
J.R. was later diagnosed with a permanent brachial plexus injury due to damaged nerves in his left posterior shoulder and neck, limiting the use of his left arm. J.R., by and through Morgan-Baker, brought a Nebraska medical malpractice lawsuit against the hospital, the clinic, and Jones (collectively Alegent).
J.R. alleged that Jones and, vicariously, the clinic were negligent because Jones used more than gentle traction when delivering him and failed to communicate to the nursing staff the appropriate administration of Pitocin. J.R. alleged that the hospital was negligent because its nursing staff failed to communicate to Jones the signs of tachysystole, administer Pitocin appropriately, and interpret the intrauterine pressure catheter.
The jury ultimately found that J.R. had not met his burden of proof and rendered a general verdict in favor of Alegent.
In its decision dated June 27, 2025, the Supreme Court of Nebraska stated: “It is plainly evident from the record that instruction No. 10 was erroneous and, further, that the jury was confused in a material way on a vital issue by the erroneous mandate that it “shall not determine the standard of care (also referred to as the required skill and knowledge to be exercised) from the testimony of the expert witnesses who testified in this case.” (Emphasis supplied.) Because the correct standard of care is vital to a medical malpractice case, and the record demonstrates the jury was misled as to the correct way to determine the standard of care, we hold that erroneous instruction No. 10 prejudicially affected a substantial right of J.R. and is of such a nature that to leave it uncorrected would cause a miscarriage of justice or result in damage to the integrity, reputation, and fairness of the judicial process. … Although not objected to at trial, we agree with J.R. that it was plain error for the court to give the erroneous instruction to the jury that it could not consider expert testimony when determining the standard of care for malpractice or professional negligence. We reverse, and remand for a new trial on that ground.”
Source J.R.M.B. v. Alegent Creighton Health Creighton University Medical Center, LLC, No. S-24-205.
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