NEWBORN BRAIN INJURY DUE TO MISPLACED CATHETER – LAWSUIT AGAINST ASCENSION SAINT AGNES HOSPITAL
On August 10, 2023, WVFK&N attorneys Christopher Norman and Kieran Murphy filed a medical malpractice claim on behalf of a newborn who suffered an avoidable brain injury.
The complaint alleges that the child was born via cesarean section on November 2, 2010, at 32 weeks gestation following the administration of a full course of antenatal corticosteroids. At approximately 10:00 a.m. on the day of delivery, a doctor placed umbilical artery (UAC) and umbilical venous catheters (UVC). The indication for placing these lines was not noted, and there is no indication that the providers were unable to use a peripheral IV line. An x-ray was performed at approximately 10:45 a.m. to confirm placement, which showed the tip of the UAC overlying the T9-T10 intervertebral disc space and the tip of the UVC laying adjacent to the right lateral aspect of the T10 vertebral body. Several days later, another portable x-ray was performed at 8:00 a.m. on November 5th, and it was again reported that the “umbilical lines appear unchanged.” An untimed progress note stated that the child was found to have a full abdomen with loops and scant bowel sounds. The child was still noted to have normal tone and reflexes, and a repeat blood gas was again reported as normal. At 05:30 a.m. on November 6th a nurse noted the presence of green secretions from the orogastric tube. A doctor noted that bilious aspirates continued, but were minimal, and that the UAC had been removed on November 5th. An untimed progress note was entered on November 7th in which the doctor again noted a full appearing abdomen with scan bowel sounds. Bilious aspirates continued. At 18:00 a nurse documented drainage from the orogastric tube, with bilious aspirates and air aspirated from the stomach. Doctors authored another attending progress note on November 9th which again documented that the abdomen appeared full, and the ongoing presence of bilious aspirates. They also noted mild facial edema, which was a new finding. On November 10th an untimed attending progress note again documented the presence of a full appearing abdomen, bilious aspirates, and facial edema. The child began to have increasing episodes of bradycardia which required stimulation for resolution. Overnight and into the morning of November 11th, the child’s apnea and bradycardia events continued. At 03:00 on November 11th a nurse documented the presence of 5 ccs of green bile emesis from the right nare. An additional 3cc’s of green bile were aspirated, and the doctor was notified. Labs were returned at 04:15 which showed abnormal kidney and liver function. The apnea and bradycardia events continued, which were accompanied by dusky color change and required stimulation for resolution. By 06:00 the child’s skin was noted to be pale, mottled, and green tinged, and she was noted to be lethargic (the first abnormal neurologic/mental status exam since her birth). Blood gases were drawn at 06:55 and the child was found to have profound metabolic acidosis with a pH of 6.92 and BE of -20. She was emergently intubated at 07:30 after going from HFNC to SiPAP to a ventilator. A portable chest x-ray was read to show that “a venous line is noted, the same as prior study”, and also noted gaseous distention of the stomach and bowel loops. Repeat blood gas following intubation revealed a pH of 7.01 and a BE of -25. The UVC was finally pulled at 11:00. A surgeon was consulted regarding the abdominal distention, acidosis, and regarding the possible free air that was seen on the recent x-ray. He performed a bedside mini-laparotomy, during which he found a large amount of blood stained, milky, low viscosity fluid under pressure in the child’s abdomen, which he documented was likely intraabdominal TPN. The surgeon drained the fluid and placed a peritoneal penrose drain. During the procedure, the surgeon visualized the child’s bowel and found the visualized loops to be “entirely normal” without distention and without evidence of necrotizing enterocolitis (NEC). A doctor acknowledged that the intraabdominal fluid drained by the surgeon was suspected leakage from the child’s UVC into her peritoneal cavity. Following the removal of the UVC, the drainage of the intraabdominal fluid, and intubation, the child’s blood gases returned to normal. On November 12th, the child was noted to have developed acute renal failure, and her status was “extremely critical.” The child was ultimately found to have developed periventricular leukomalacia (PVL) and diffuse volume loss of her brain. The child was subsequently diagnosed with cerebral palsy, seizure disorder, and severe developmental delays, and required a kidney transplant.
The lawsuit alleges that the injuries were a result of the negligence of Ascension Saint Agnes Hospital and its employees in failing to timely respond to clinical signs and failing to properly place the catheter.
The action is pending in the Circuit Court for Baltimore City, Maryland.