Shoulder Dystocia Birth Injury Malpractice Case: In a Missouri birth injury medical malpractice case in which the plaintiff alleged that her baby suffered a permanent brachial plexus injury during delivery after the baby experienced shoulder dystocia during delivery and the delivering OB used excessive force to release the stuck shoulder to deliver the baby, and the defense argued through its biomechanical engineer expert that the baby’s injuries were due to ordinary maternal forces during delivery, the Missouri Court of Appeals Eastern District Division Three (“Missouri Appellate Court”) held in its July 18, 2023 opinion: “The circuit court did not err in admitting Dr. Grimm’s testimony that, as a matter of general causation, maternal forces are capable of causing a brachial plexus injury of the type suffered by J.H. [but] Dr. Grimm’s testimony regarding the specific cause of J.H.’s injury, on the other hand, should have been excluded. Dr. Grimm opined that J.H. was within the portion of infants susceptible to permanent brachial plexus injury and that his injury was caused primarily by maternal forces with some contribution from the gentle axial traction applied by Dr. Branson. Dr. Grimm was not qualified to give this opinion and did not reliably apply her computer modeling to the specific facts of this case.”
“Dr. Grimm’s biomechanical engineering education, training, and self-taught knowledge about the brachial plexus did not include identifying which infants have the type of tissue variations that make them more susceptible to brachial plexus injury. Regardless of whether it constitutes a diagnosis of a pathological condition, Dr. Grimm was not qualified to opine that J.H. fell into that portion of the population that is more susceptible to brachial plexus injury. Particularly where the only basis for her opinion appears to be that J.H. must have been more susceptible to injury because he sustained an injury.”
“Similarly, Dr. Grimm was not sufficiently qualified to testify regarding the “standard traction” used during deliveries. Dr. Grimm testified that her familiarity with axial traction and understanding that it is the typical type of traction used during deliveries was based on discussions with the obstetrician she collaborated with in her research who was “having us model typical scenarios in deliveries.” She testified to no other knowledge, skill, experience, training, or education that would qualify her to give what amounts to an opinion that Dr. Branson’s conduct was within the standard of care. Being told by a colleague that an obstetrics maneuver is typical did not give Dr. Grimm the requisite degree of expertise needed to qualify her to give this opinion. As a result, Dr. Grimm’s specific causation testimony does not meet the requirements of §490.065.2(1) that the witness be “qualified as an expert by knowledge, skill, experience, training, or education.””
“Dr. Grimm’s specific causation opinion was also inadmissible because it was not based on sufficient facts and data about this particular delivery and because she did not reliably apply her computer program to the particular facts of this case as required by § 490.065 … Dr. Grimm did not know the size or shape of Huett’s pelvis or the amount of maternal forces involved in this delivery. In fact, she testified that it is not possible to measure the maternal forces that were exerted during J.H.’s delivery at this point. Although she guessed that there were probably fifty pounds of maternal forces involved here, that testimony was not based on any measurement or input from J.H. or Huett, and Dr. Grimm admitted there was no way for her to know if Huett’s contractions and pushing were producing “normal amounts” of pressure during this delivery. A guess about the amount of the forces involved here does not provide a sufficient basis for opining that those forces caused the injury.”
“Although Dr. Grimm’s computer program appears to be a reliable method on which to base her general causation opinion about the stretch that occurred to the brachial plexus, that opinion cannot reliably be applied beyond the scenario of that program: a ninetieth percentile model baby delivered by a model mother with an average-sized, gynecoid-shaped pelvis, during a delivery involving “normal amounts” of maternal forces and “normal amounts” of clinician-applied force. Without any facts about this mother and this baby and this delivery, Dr. Grimm could only
speculate that the situation here was comparable to the one in her computer simulation. Dr. Grimm herself acknowledged that she does not apply the computer model on a case-by-case basis because “there would still be too many things we would have to guess at.” Therefore, her computer simulation program was not a reliable method for analyzing this specific case and was not reliably applied to the facts of this case as required by § 490.065.2(1)(c)-(d).”
“Although two other defense experts discussed the general theory that maternal forces can lead to a brachial plexus injury, neither of them testified that maternal forces were the specific cause of J.H.’s injury. Therefore, the error in permitting her [Dr. Grimm] to give specific causation testimony materially affected the outcome of this case. As such, that error was prejudicial and warrants reversal.”
Source Huett v. Branson, No. ED110991.
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