Newborn Brain Injury due to Premature Delivery
Lawsuit Against George Washington University Hospital
On December 2, 2022, WVFK&N attorney Chris Norman filed a medical malpractice claim on behalf of twin newborns who suffered avoidable brain injuries.
The complaint alleges that on November 10, 2010, in the early morning, the children’s mother telephoned her physicians at 25 weeks and 2 days of gestation and reported complaints of “light vaginal bleeding, [contractions] [every] few min[utes] since yesterday.” She was told to report to the Labor and Delivery Unit at George Washington University Hospital for evaluation. The mother was a 27-year-old G3P1011 with a dichorionic diamniotic twin pregnancy at the time. At 10:05, she arrived at the George Washington University Hospital Labor and Delivery triage. At 10:23, she was admitted to her examination room. At 10:24, she was connected to an electronic fetal monitor. Although the fetal heart rate signal was lost shortly after placement, the initial fetal heart rate tracings for both twins appeared to be reassuring, demonstrating two neurologically intact fetuses. At 10:31, the EFM alarm went off due to signal loss for both fetuses’ heart rates. The alarm was silenced by a nurse. Throughout the course of the mother’s admission, the EFM alarm went off several times due to signal losses, however, each time the monitor was adjusted and reconnected, the EFM demonstrated reassuring fetal heart rate tracings, consistent with two neurologically intact fetuses. At 10:45, a third-year resident entered a Labor and Delivery History and Physical Note that the mother was experiencing contractions and spotting. He documented a vaginal exam of 3 cm. 80 eff, ↑ sta., soft. He noted that the twins were in breech-breech presentation on ultrasound. At 11:20, the resident placed an order to admit the mother to the Labor and Delivery Unit with a diagnosis of preterm labor. He also ordered the administration of magnesium 4g IV bolus then 2g IV every 1 hour thereafter, betamethasone intramuscularly now then again in 12 hours, ampicillin, azithromycin, and lactated ringers. He also ordered several laboratory studies, a NICU consultation, and an anesthesia consultation. At 11:30, the attending physician entered an attending note that stated “Concern for imminent vaginal delivery, BMZ now, Magnesium for neuro-prophylaxis, IVF, NPO status – 8 AM, Ampicillin for GBS prophylaxis, Cultures G/C, GBS done.” However, the attending physician, the resident, and the nurses all failed to recommend or administer appropriate tocolytic medications, which are administered to stop preterm contractions to prolong the pregnancy and administer steroids and other medications to develop the twins’ lungs and brains before delivery. At 11:54, betamethasone was administered almost two hours after arrival. At 12:13, a nurse started a magnesium sulfate 4-gram bolus at a rate of 200 cc/hour, more than two hours after the mother’s arrival. At 12:39, the nurse documented that the mother was 3-4 cm dilated and 80% effaced, exactly as she was at 10:45, when the resident performed an exam, and at 11:15, when the nurse documented the second exam. At 13:25, the nurse noted, “very difficult to monitor twins continuously despite adjusting FHR monitors frequently. Frequent movement of twins noted. PT getting more uncomfortable, and Dr. notified.” At 13:29, the nurse documented that the mother was 4 cm dilated and 80% effaced, almost exactly as she was at 10:45, when the resident performed an exam, at 11:15, when the first nurse documented the second exam, and at 12:39, when the second nurse documented the third exam. At 13:29, the attending physician ordered a cesarean section delivery, despite the fact that there were no clinical indications for an urgent delivery of very preterm twins at that time. At 14:23, the first twin was born via cesarean section delivery, without the benefit of a full course of antenatal corticosteroids, with Apgar scores of 1, 2, and 4, at 1, 5, and 10 minutes respectively. At 14:25, the second twin was born via cesarean section delivery, without the benefit of a full course of antenatal corticosteroids, with Apgar scores of 2 and 7 at 1 and 5 minutes respectively. The only listed indication for cesarean section delivery was that the mother had dilated 1 cm over the course of three hours since her arrival and had “increasing pain,” neither of which are recognized indications for cesarean section delivery. The twins have been diagnosed with and now suffer from cerebral palsy, neurodevelopmental delays, brain damage, and other injuries.
The lawsuit alleges that the injuries were a result of the negligence of George Washington University Hospital and its employees in failing to properly treat the mother’s preterm labor.
The action is pending in the Superior Court for the District of Columbia.