Dr. Fagel negotiated a settlement of $3,500,000 on behalf of a child who now suffers cerebral palsy and developmental delays after attending medical staff failed to treat a uterine rupture in a timely fashion. The mother was a VBAC patient (Vaginal Birth after C-Section) and was being monitored by several nurse midwives, under the supervision of obstetricians in the office of the defendant medical group. Upon admission, the mother was managed by the defendant midwife, who was in phone contact with the defendant obstetrician. Pitocin was started at 8:25 a.m. and the mother began complaining of pain about 2½ hours later. Her pain continued and, at 2:50 p.m., an epidural was started to relive her pain. The fetal monitor began to show heart decelerations, and at 3:05 p.m. the midwife ruptured membranes and found no fluid. Fetal heart decelerations continued so the midwife began an amnioinfusion shortly before 5 p.m. The obstetrician was then called and first saw the patient at 5:10 p.m. She noted severe decelerations and decided that the fetus needed to be delivered quickly. She attempted and failed to deliver the plaintiff with both a vacuum and forceps, and finally called for a crash C-section at 5:32 p.m. The baby was delivered about 20 minutes later, after being found in the abdominal cavity with a ruptured uterus and placental abruption. Due to his severe brain injuries, the plaintiff now requires 16 hours of daily LVN care.

The defense argued that all care was within standard because the fetal monitor strip did not show fetal distress requiring a Cesarean section until after the failed forceps attempt. In addition, the defense claimed that it was appropriate to attempt vaginal delivery, which would have been faster than a Cesarean section, if successful. Finally, it was argued that there was no need to call the obstetrician any earlier and none of the mother’s injuries were predictable or preventable.

Nevertheless, Dr. Fagel proved that the medical staff were indeed responsible for the plaintiff’s injuries. The midwife was negligent for not recognizing fetal distress earlier and calling the obstetrician. The obstetrician was also negligent for attempting to use a vacuum and forceps to deliver the baby. The standard of care required a C-section, which, if performed earlier, would have reduced the degree of the plaintiff’s injuries. Although the uterine rupture could not have been prevented or predicted, medical staff had ample time to properly respond to the complication and deliver the baby via C-section before significant injuries occurred.