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M.J., An Infant, By Her Parent and Natural Guardian, Casey Johnson v. United States of America

September 25, 2012


The opinion of the court was delivered by: Thomas J. McAVOY Senior United States District Judge


Plaintiff Casey Johnson, on behalf of her infant daughter, M.J., commenced the instant action seeking to recover damages for injuries sustained by M.J. during and in the course of her birth. Presently before the Court is Defendant Samaritan Medical Center's motion for summary judgment pursuant to Fed. R. Civ. P. 56 seeking dismissal of the Complaint in its entirety.


At 1:05 p.m. on September 21, 2006, Plaintiff Casey Johnson, who was pregnant, presented to Samaritan Medical Center ("SMC") with a spontaneous rupture of her membranes. Plaintiff was initially evaluated by Nurse Sheila Marie who contacted Midwife Kristin Lewis. Lewis performed an artificial rupture of Plaintiff's membranes, revealing clear fluid. At 1:40 p.m., Lewis admitted Plaintiff to the labor and delivery unit. Lewis's examination revealed that Plaintiff was 2 to 3 cm. dilated, 70% effaced, *fn1 and at -2 station *fn2 with an estimated fetal weight of 8.5 lbs. At 12:30 a.m., Plaintiff was administered Pitocin, a drug that augments contractions.

The next morning (September 22) at 7:20 a.m., Nurse Toni Bonville assumed the nursing care for Plaintiff. Plaintiff's progress was slowing and the fetal heart rate was reassuring in the 120 to 130 range with positive short term variability. *fn3 At around 8:06 a.m., Bonville discussed and encouraged Plaintiff to begin pushing because she was entering stage two of labor. The fetal strips continued to be reassuring and the attending physician, Dr. Silva, saw Plaintiff at around 9:30 a.m. Dr. Silva noted continued reassuring progress of labor and documented complete dilation and effacement with fetal position at station. Dr. Silva assessed the fetal heart and found it to be reassuring (in the 120 to 130 range) with mild variability when pushing. Plaintiff was noted to have been pushing for an hour. Vaginal examination revealed thin to moderate meconium. *fn4 The baby's head was found to be slightly angled toward the mother's left hip looking down diagonally at the floor, which is a normal position. *fn5 Dr. Silva's plan was to continue to have the patient push with Pitocin augmentation and to reassess regularly. Plaintiff's progress continued to be monitored by the nursing staff.

Dr. Silva again saw Plaintiff at approximately 10:30 a.m. He documented that Plaintiff continued to push with good effort and that the fetal heart rate tracings were reassuring in the 140s with occasional mild variables with pushing. *fn6 At around 10:51 a.m., Nurse Bonville noted that she could see the caput, *fn7 but that the baby's head was not presenting for delivery. *fn8 At approximately 11:30 a.m., Dr. Silva re-assessed Plaintiff. Upon examination, Dr. Silva noted that Plaintiff no longer had good fetal descent with pushing, that she had made little progress, and was only at station. Dr. Silva saw no findings indicative of fetal distress and was not concerned with the fetal heart rate. Due to a lack of progress, Dr. Silva determined that there was a lack of descent and called Dr. Lural for a second opinion. In light of the baby's estimated size, Dr. Silva wished to proceed with a c-section, rather than an operative-assisted vaginal delivery. Dr. Silva did not believe the arrest of descent to be an emergent situation, particularly in light of the lack of persistent or severe decelerations in the fetal heart rate and/or any clinical findings that were suspicious or indicative of fetal distress or compromised fetal well-being.

Shortly after 12:00 p.m., Dr. Lucal evaluated Plaintiff and agreed that there was an arrest of descent. Dr. Lucal also agreed that performing a c-section, rather than operative-assisted vaginal delivery, was reasonable. Dr. Lucal testified that there was no fetal distress present and that a c-section was warranted solely due to arrest of descent. The baseline heart rate was around 170 with diminished variability. *fn9 The decision to perform a c-section was made at 12:12 p.m. due to arrest of descent and fetal intolerance to labor.

At 12:15 p.m., Dr. Silva noted that some of the fetal heart tracings appeared to be that of the maternal heart rate and not that of the baby. Dr. Silva examined the fetal heart rate and found that the maternal tracings always reverted back to the tracings of the fetal heart rate, which were reassuring, with good beat-to-beat variability. Drs. Silva and Lucal were present during the times the maternal heart rate was inadvertently traced. Neither Drs. Silva nor Lucal saw any clinical evidence from their respective examinations or of the fetal strips that there was fetal distress at any time during the labor and delivery.

Dr. Silva communicated to Nurse Bonville his decision to perform a non-emergent c-section at around 12:10 p.m. The surgery was delayed for 20 - 30 minutes because the local anesthetics were not taking effect and, therefore, they had to wait for the anesthesiologist. The c-section began at 1:34 and the baby was delivered at 1:47 p.m.

At the time of delivery, the baby weighed 9 lbs and 10 oz and had Apgar scores *fn10 of 1, 7, and 7 and a large amount of meconium was observed in the uterus. The infant's clinical condition at birth was near death with no vital signs other than a slow heart rate of 60 beats per minute. The baby was limp, lethargic, lifeless, and had no spontaneous respirations. At this point, the neonatal team took over the care and treatment of the infant. An umbilical cord arterial blood was obtained, revealing a pH of 7.168, a pCO2 of 62.5, a pO2 of 16.6 and base excess of -7.8. At 9:30 a.m. on September 23, 2006, the infant was transferred to Crouse Hospital. A CT scan of the brain without contrast was obtained on September 27, 2006 and was interpreted as revealing no sign of brain injury or edema as only a lower left parietal/posterior left occipital cephalohematoma was noted. According to Plaintiff, the baby suffered from acute intra partum asphyxia, ischemic low-flow insult related to cord compression and head compression during second stage of labor.

As a result of the foregoing, Plaintiff commenced the instant action claiming that Defendant's negligence caused the injuries to the infant. Specifically, Plaintiff asserts that Nurse Bonville was negligent by:

- failing to properly monitor the fetal heart rate; - improperly placing the external fetal monitor device; - improperly monitoring the mother's heart rate instead of the fetus's beginning around 11:19 a.m. on September 21, 2006; - failing to properly monitor the maternal heart rate; - failing to determine an internal fetal monitor was necessary; - failing to monitor Plaintiff's vital signs; - failing to document Plaintiff's condition; - failing to appreciate signs of fetal distress; - failing to properly interpret fetal monitoring strips; - failing to maintain continuous fetal monitoring; - allowing Plaintiff to remain in protracted labor; - failing to recommend an alternative mode of delivery to the physician; - failing to advice the physician and/or charge nurse of the fetus's intolerance to labor; - failing to appreciate the significance of prolonged, protracted second state of labor in a first time mother; - failing to maintain technically adequate fetal monitor tracing every five minutes in the second stage of labor in violation of Defendant Samaritan Medical Center's policies and procedures; - failing to anticipate the potential need for a Cesarean delivery; - failing to appropriately monitor the fetus in the second stage of labor; - failing to monitor the fetus every five minutes while in the operating room; and - failing to retain fetal monitoring strips in the patient's medical record.

Presently before the Court is Defendant Samaritan Hospital's motion for summary judgment pursuant to Fed. R. Civ. P. 56 seeking ...

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