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DEEPLY IMPACTED FETAL HEAD AT DELIVERY, NEWBORN SKULL FRACTURE
A 34 year old woman underwent an induction of labor after preterm premature rupture of membranes at 35 weeks gestation. Arrest of cervical dilatation was diagnosed at 8 cm so the patient underwent a cesarean delivery. At the time of the surgery a deeply impacted fetal head in the maternal pelvis was encountered so additional maneuvers were required to deliver the infant. The newborn was diagnosed with a skull fracture at birth. At issue was whether the management of labor and delivery contributed to the newborn injury.
CHRONIC ABRUPTION, FETAL DEMISE
A 25 year old woman was admitted to the hospital at 30 weeks gestation with complaints of vaginal bleeding. A chronic abruption was suspected on ultrasound. Fetal testing was reassuring and the patient was discharged home after four days of inpatient observation. She presented three days later with a fetal demise. At issue was whether the fetal demise could have been prevented.
MISMANAGEMENT OF INTRAUTERINE GROWTH RESTRICTION, POOR NEWBORN OUTCOME
Early onset intrauterine growth restriction (IUGR) was diagnosed in a 24 year old woman's pregnancy. The antepartum management of the IUGR fell below the standard of care including failure to appropriately interpret ultrasound images and failure to perform appropriate tests necessary to properly manage the pregnancy. The patient ultimately underwent an indicated preterm delivery at 34 weeks. At issue was whether the mismanagement of her pregnancy contributed to the poor neonatal outcome.
MATERNAL DEATH, DELAY IN DIAGNOSIS
A 35 year old woman underwent a cesarean section. Abnormal vital signs were recorded by the nursing assistant upon transfer of the patient to the postpartum floor but were not recognized by the nurse caring for the patient. One hour later the patient was in hypovolemic shock from unrecognized intraabdominal bleeding. The patient ultimately died. At issue was whether the nurse’s delay in assessing and addressing the postop patient led to her death.
SEVERE PREECLAMPSIA, FAILURE TO APPROPRIATELY MANAGE, PREMATURE DELIVERY
A 39 year old pregnant woman presented at 26 weeks with signs and symptoms of early onset severe preeclampsia and was sent home. She returned the following day and required an emergency cesarean delivery. Issues to be evaluated were whether the initial and subsequent management of the patient fell below the standard of care and if delays in treatment contributed to the need for premature delivery.
NEONATAL ENCEPHALOPATHY, DELAY IN DELIVERY
A 26 year old woman presented to the hospital in early labor at 40 weeks. Fetal tracing changed from Category I to Category II and the newborn was delivered via cesarean section. Issues to be evaluated included whether there were breaches in medical and nursing standards of care with regard to the time frame in which the delivery occurred and whether these breaches were causative factors of the resultant neonatal encephalopathy.
FETAL MACROSOMIA, FAILURE TO DIAGNOSE
A 29 year old woman with gestational diabetes had a vaginal delivery of an 11 ½ pound infant sustaining maternal and newborn injury. Estimated fetal weight was 8 ½ pounds via ultrasound two weeks prior. The issue to be evaluated was whether the Maternal-Fetal Medicine physician who performed the estimated fetal weight by ultrasound deviated from the standard of care and contributed to the injuries.
COMPLICATED TWIN PREGNANCY, WRONGFUL EMPLOYMENT TERMINATION
A Maternal-Fetal Medicine physician was terminated from employment at a hospital due to what the hospital claimed was mismanagement of several complex high risk obstetrical cases. I was asked to review medical records of a case of complicated monochorionic twins to determine if the care provided by this physician was appropriate and if it met the standard of care, or if he may have been wrongfully terminated.
BICYCLE VERSUS TRUCK ACCIDENT, PELVIC FRACTURE
A 27 year old woman involved in a bicycle versus truck accident suffered a pelvic fracture requiring multiple corrective surgeries. In the lawsuit brought against the trucking company, she claimed if she were to become pregnant in the future, the pelvic injuries she sustained would necessitate cesarean delivery as opposed to labor and natural birth. I was asked to comment on the validity of her claim from an obstetrical standpoint.
FAILURE TO PLACE CERCLAGE, TWINS, PREMATURE DELIVERY
A 33 year old woman pregnant with monochorionic/diamniotic twins was found to have incidentally noted cervical shortening on routine ultrasound at 23 5/7 weeks. Four days later she presented to the hospital in preterm labor and went on to deliver the babies. Both twins suffer from complications of extreme prematurity. At issue was whether a cerclage should have been placed when cervical shortening was discovered at 23 5/7 weeks.
MISREPRESENTATION OF FACTS BY OPPOSING EXPERT ELUCIDATED
This case involved defending a physician against allegations of failure to diagnose fetal growth restriction in a timely manner and failure to promptly transfer the patient to a tertiary facility. In my written affirmation, misrepresentation of the medical facts of the case and misstatements about the standard of medical care by the opposing expert were delineated. Upon receipt of my affirmation, the opposing attorney withdrew the case.
AIRPLANE COLLISION, HARM TO EARLY PREGNANCY
A 27 year old passenger was prescribed x-rays and steroids by a doctor who evaluated and treated a back injury she sustained when two commercial airplanes had a minor collision while taxiing. The patient was unknowingly pregnant at the time. In a lawsuit brought against the airline, the woman claimed damages to her early pregnancy from the medication and radiation exposure to which she was subjected because of the accident. I was asked to opine on the legitimacy of her claims.
FETAL HYDROPS, DELAY IN DIAGNOSIS
A 32 year old woman was admitted to L&D at 32 weeks complaining of decreased fetal movement. Fetal tracing was abnormal. No fetal ultrasound was performed until the next day when fetal hydrops (abnormal swelling) was diagnosed. Issues to be evaluated were whether the delay in addressing the abnormal fetal tracing and whether the delay in diagnosis of fetal hydrops contributed to the development of periventricular leukomalacia (brain injury) of the newborn.
DELAY IN PERFORMING CESAREAN SECTION
A morbidly obese 29 year old woman was evaluated at 36 weeks and noted to have a category III tracing. A decision was made to proceed with emergency cesarean delivery. Ninety minutes passed until the baby was delivered. At issue was whether this delay caused fetal injury.
FAILURE TO TIMELY DIAGNOSE RUPTURED MEMBRANES
A 40 year old woman had chorioamnionitis (an intraamniotic infection) in labor. Her newborn was diagnosed with neonatal pneumonia and had a lengthy, complicated hospital course. The mother was suspected to have had rupture of membranes for a prolonged period of time. One week prior, she was seen and evaluated for a complaint of leakage of fluid. At issue was whether the pneumonia would have occurred had the rupture of membranes been diagnosed on exam a week prior.
FAILURE TO PREVENT NEWBORN DEATH
A 17 year old female had a vaginal delivery of a full term infant. The newborn had a severe metabolic acidosis at birth and was diagnosed with persistent pulmonary hypertension of the newborn (PPHN). At issue was whether this could have been predicted and/or prevented.
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