Nationwide Birth Injury & Medical Malpractice Firm
Call Today for a Free Consultation Baltimore  410.567.0800 Chicago  312.993.5750
Click for live chat!

Newborn Brain Injury Due to Negligent Intubation

Lawsuit Against Johns Hopkins Hospital | June 4, 2021

On June 4, 2021, WVFO attorneys Christopher Norman and Brian Cathell filed a medical malpractice claim on behalf of a newborn who suffered an avoidable brain injury.

The complaint alleges that:

  • In or around June 2018, Ms. Brittany Bryant became pregnant with a baby girl. Ms. Bryant’s pregnancy was relatively normal, with the exception of a prenatally diagnosed fetal omphalocele. As a result of this diagnosis, a pre-delivery consultation was performed by Dr. William Christopher Golden, a neonatologist at Johns Hopkins Hospital. At the time of the consult, Ms. Bryant was noted to be a G2P0010 at 29w6d with an EDD of 3/29/19.
  • Dr. Golden’s note explains that the most recent fetal sonography (1/4/19) showed that the fetus was in the less than 4th percentile for age (but with appropriate interval growth over the prior month) and revealed a 5.3 cm x 5.0 cm x 4.4 cm omphalocele with the fetal liver and bowel included. The stomach and bladder were noted to be in the correct position in abdomen. Dr. Golden also points out that the fetal echocardiogram completed on 12/21/19 evidenced normal anatomy and function. Testing revealed no evidence of trisomies. Dr. Golden documents that he discussed the likely NICU course for the baby with Ms. Bryant, noting that sometimes infants with omphaloceles require mechanical ventilation post-surgery due to increased displacement of the diaphragm.
  • According to the records, Ms. Bryant’s membranes ruptured spontaneously on March 16, 2019, with clear fluid. Kaydance was ultimately delivered at approximately 9:00 p.m. on March 17 following a failed induction. At the time of birth, she was 38w2d gestation and weighed approximately 3,000 grams (an appropriate size for her gestational age). Her APGARS were good at 8 and 9 at 1 and 5 minutes respectively. A head ultrasound was completed on March 18 and was read as normal.
  • Kaydance dealt with the expected complications of omphalocele during her newborn course, but appears to have remained neurologically intact without evidence of brain injury during the time period preceding her April 9th arrest. Kaydance was intubated on April 7 for respiratory distress following IV extravasion from her PICC line. At that time, she was noted to be neurologically normal. Throughout the early morning hours of April 9, the nurses suctioned a moderate amount of thick white secretions from Kaydance’s ETT. At 11:51, Maide Ozen, MD – a neonatologist who appears to have been Kaydance’s attending physician on April 9 – completed her daily NICU note. At the time, she noted no neurological abnormalities. She also noted that the respiratory plan was for continued SIMV adjustments, and aggressive ventilatory weaning as tolerated. At this time, Dr. Ozen also documented that genetics had been consulted, and had concluded that the maternal cfDNA was normal, as was the cord blood testing for single nucleotide polymorphisms (SNP).
  • According to the records, Kaydance was extubated at 14:44 by Crystal Sinclair, RRT and Kelly Dougherty, RT. At 14:45, Kaydance was noted to have a pulse of 156, a respiratory rate of 23, and an Spo2 of 99%. From the records, it does not appear as though Kaydance was assessed between 14:46 and 15:10. At 15:10, Lauren Frank, RN noted that Kaydance was experiencing increased work of breathing, and that “RT and NNP Weng at bedside”. Kaydance’s HR at the time was 176, her respiratory rate was 46, and her Spo2 had dropped to 77%.
  • Racemic epinephrine (“epi”) was administered at 15:38 and 15:39 by RRT Sinclair. Frank, RN administered a third dose of racemic epi at 15:45. By 15:50, Kaydance was on non-invasive positive pressure ventilator (“PPV”) support via a RAM cannula at 6 liters at 100% Fio2. Atropine was given for rapid sequence induction (“RSI”) at 15:54, and a fourth dose of racemic epi was also given at that time.
  • According to her own note, Dr. Ozen was called at approximately 15:58 by the NICU NNP to come to the bedside to assess Kaydance, and she arrived immediately. On exam, Dr. Ozen observed increased work of breathing, retractions, and nasal flaring. The decision was made to intubate, and RSI medications were ordered and administered as noted above. Dr. Ozen noted that PPV was initiated with a self-inflating bag with an inline ETCO2 reader. Poor to no chest rise was noted despite increasing BMV pressures with a good seal.
  • According to the nursing notes, and consistent with Dr. Ozen’s documentation, the first intubation attempt was made by Dr. Ozen at 15:58. At the time of this first attempt, Dr. Ozen documented that, upon direct laryngoscopy, the vocal cords were readily visualized. However, the vocal cords were closed, and did not open in response to toe flicking. Given the closed cords, Dr. Ozen documents that she did not attempt to push the ETT and instead pulled out the blade.
  • Following this initial unsuccessful intubation attempt, PPV was reinitiated at 15:59. A second intubation attempt was completed by Dr. Ozen at 16:02. According to Dr. Ozen’s note, she asked for a 2.5 ETT for this second attempt, due to airway edema. The cords were again readily visualized, and clear secretions were suctioned. Dr. Ozen notes that the vocal cords were temporarily open, but were closing shut. She documents that she did not make an attempt to pass the ETT, and again pulled the blade. Dr. Ozen documents that, at that time, she asked for back up and required Dr. Chavez-Valdez (who appears to be another neonatologist) to be called to the bedside for intubation. PPV was resumed at 16:03.
  • Dr. Ozen made a third intubate attempt at 16:06. Regarding this attempt, Dr. Ozen documents “[t]hird attempt by myself given respiratory failure. Visualized the airway with direct laryngoscopy. Vocal cords closed. Scant blood in surrounding edematous tissue. Did not attempt to pass ETT through the closed cords and pulled back the blade.”
  • PPV was continued at 16:07. Chest compressions were started at 16:10, at which time epinephrine was given and the code bell was pressed. A normal saline bolus was given at 16:11, and a second dose of epinephrine was administered at 16:13.
  • The Difficult Airway Response Team (DART) was not called until 16:14 – 16 minutes after the first unsuccessful intubation attempt by Dr. Ozen. By this time, Kaydance’s heart rate had dropped to 28, and her Spo2 had dropped to 55%.
  • Multiple rounds of epinephrine and saline boluses were given from 16:16 through 16:35. At 16:21, Kaydance’s heart rate was noted to be 0 – her heart rate was not restored until 22 minutes later at 16:43. By 16:30, in addition to having no detectible heart rate, Kaydance’s Spo2 had decreased to 2%, and remained dangerously low.
  • According to the records, the DART team did not respond until 16:37 – 23 minutes after they had allegedly been called by Dr. Ozen.
  • Dr. Anushree Doshi’s (anesthesiology fellow) procedure note from the intubation explains that they were called to respond to the code. Upon arrival, Dr. Doshi noted that Kaydance was blue, and was being bag mask ventilated with notable bleeding in her mouth. Regarding the intubation attempts, Dr. Doshi documented the following: “1st attempt made by Doshi (fellow). G1 view with miller 1 blade. Placed 3.0 ETT with no Co2. 2nd attempt made by Jim Flacker (attending) 3.5 ETT secured with G1 view with miller 1 blade. Third attempt made by ENT – ultimately 3.0 ETT secured (uncuffed). All placements were complicated by pulmonary hemorrhage and were attempted during CPR. Prior to this, NICU had attempted airway multiple times.” A diagnosis of pulmonary hemorrhage was made.
  • The DART note, written by Ioan Lina, MD (an OHNS Resident), explains that “multiple failed intubation attempts were made by NICU team. Patient developed worsening airway bleeding and subsequently began to code. On arrival there was a tube that was placed by anesthesia that was thought to be in the airway [presumably, the ETT placed by Dr. Fackler]. Unclear who had placed this tube from our perspective. CPR was initiated and code was started. The AIRWAY cart was brought up from the OR. A 0 parsons scope was used with a G1 view to intubate with a 3.0 uncuffed ETT by Dr. Janine Amos. It was noted that the previous tube was not in the airway. The code team continued to bag and gave several doses of epi and calcium gluconate. Around 4:40 pt had rosc.” “Copious” bloody secretions were suctioned from the ETT at 16:39. PPV was administered through the ETT, with a slow return of heart rate and increase in oxygen saturation.
  • The ECMO team apparently arrived at the bedside at 16:45. According to Dr. Fackler’s ECMO team note, he had been asked by the NICU attending to evaluate the child for ECMO in the setting of unexpected cardiac arrest. He explains that he responded to a call of CPR in progress in the NICU in the setting of a difficult airway call. When he arrived, CPR was ongoing, and the anesthesia team was at the head of the bed and were hand bagging Kaydance through her ETT. Dr. Fackler notes that “substantial blood was coming from the mouth, the ETT, and was in the bag and tubing.” He goes on to explain that the previously placed ETT was not in the airway, and that he had to intubate Kaydance again, after which he suctioned even more blood. He also writes, however, that “ENT was also at bedside and they reintubated with a 3.0 uncuffed tube.” On exam, Dr. Fackler noted Kaydance to be asystolic, with an absent pulse and mottled skin.
  • Multiple units of blood were given, as was fresh frozen plasma. Chest compressions and bagging continued until approximately 17:00, when Kaydance’s heart rate, respiratory rate, and oxygen saturation finally stabilized.
  • Following the code, Kaydance was transferred to the PICU. Regarding the intubation attempts, the PICU history and physical documented at 17:43 by Dr. Xiao Peng explains that “NICU attempted intubation 3 times, PICU/anesthesia attempted 3 times, then peds ENT successfully intubated.” Upon arrival in the PICU, Kaydance’s pupils were noted to be large, with only slight reaction. A chest xray was completed which appears to show aspirated blood in her right lower lobe as a result of the pulmonary hemorrhage.
  • Kaydance’s post-code labs were consistent with hypoxia and ischemia, and she developed post-arrest seizures (initially manifested by left eye deviation and oxygen desaturation events, confirmed via EEG). She was started on Keppra. Given the severity of Kaydance’s condition following the code, the hospital Chaplain was called for parental support and prayer.
  • A series of brain imaging studies were performed following the code, which revealed significant brain damage that the interpreting radiologist concluded were the result of hypoxic ischemic injury s/p cardiac arrest.
  • Kaydance was discharged from the NICU on July 8, 2019. The discharge summary explains that, as a result of Kaydance’s hypoxic ischemic injury, “...she will certainly have motor involvement and her exam and imaging place her at very high risk for CP…likely to have significant cognitive effects as well as cerebral vision involvement….”
  • Kaydance was transferred to the Mount Washington Pediatric Hospital for subacute rehab, back to the Johns Hopkins PICU, and then to the Children’s Hospital of Philadelphia. Kaydance remains and will permanently remain severely disabled, with cerebral palsy, an active seizure disorder, and a g-tube, among other disabilities that render her permanently dependent on others for her care.

The lawsuit alleges that the injuries were a result of the negligence of Baptist Memorial Hospital and its employees in failing to timely respond to concerning clinical signs and failing to timely deliver the baby.

The action is pending in the Circuit Court for Baltimore City, Maryland.

Areas of Focus

Correcting Medical Wrongdoing

“We were in the midst of a major storm, and we needed some calm. This law firm provided that for us.”

-
Contact Us
  • Please enter your first name.
  • Please enter your last name.
  • This isn't a valid email address.
    Please enter your email address.
  • This isn't a valid phone number.
    Please enter your phone number.
    You entered an invalid number.
  • Please select an option.
  • Please enter a message.