New Mexico Injury Attorney Blog

Shoulder dystocia refers to the condition that occurs when a baby's head is delivered but the shoulders get stuck inside the mother's body. The word "dystocia" actually means slow or difficult labor or delivery. In most cases, once the baby's head is delivered the rest of the baby's body follows easily.

In some instances where the baby's shoulders and chest are larger than the baby's head, the shoulder may become lodged behind the mother's pelvic bone. It is estimated that shoulder dystocia occurs in anywhere from 1 to 8 out of every 1000 births.

In most cases where shoulder dystocia is handled appropriately by the healthcare providers the baby and the mother do not sustain any permanent birth injuries. However, if the healthcare providers responsible for the labor and delivery of the baby do not react quickly and appropriately shoulder dystocia can lead to serious and permanent injury to the baby.

These injuries include 1) damage to the sensitive nerves in the baby's neck, commonly referred to as a brachial plexus injury, 2) low oxygen levels leading to brain damage and cerebral palsy, and 3) bone fractures caused by the force used to dislodge the shoulder.

While there are risk factors for shoulder dystocia, healthcare providers generally cannot predict or prevent shoulder dystocia from happening.

Some risk factors include the following:

1. A very large baby.
2. A mother with diabetes.
3. Being pregnant with more than one baby.
4. Obesity in the mother.
5. Delivery of the baby after the baby's due date.
6. A previous history of delivering a baby with shoulder dystocia.

Yet it should be remembered that shoulder dystocia can occur when there are no risk factors at all.

Prevention
Doctors can take steps to prevent injuries caused by shoulder dystocia. This often includes repositioning the mother and/or the baby during delivery to allow the baby to pass while using gentle pushing and pulling techniques. More serious procedures may include breaking the mother's pelvic bone or the baby's collar bone or performing an emergency cesarean section.

Medical Negligence
If the doctors and/or nurses responsible for the delivery of the baby fail to recognize signs of shoulder dystocia or fail to respond in an appropriate manner they may constitute medical negligence. When the healthcare providers are found to be negligent they can be held responsible for any injuries caused to the baby as a result of their unreasonable conduct.

Medical malpractice claims are quite complex. It is to contact an experienced personal injury attorney to conduct a careful review of the medical records and determine whether the baby's injuries were caused by the negligence of the medical providers.

There are numerous unique deadlines and other requirements that must be considered. So it important to make these determinations as soon as possible if you suspect medical negligence. Delay can result in a missed deadline which may bar your claim completely.

Related Reading:
High Burden of Proof in New Mexico Birth Injury Lawsuits
Cesarean Sections: An Essential Tool in Prevention of Cerebral Palsy
Cerebral Palsy Birth Injuries: Devastating, Costly and Sometimes Avoidable!

Collins & Collins, P.C.
Albuquerque Attorneys

Oxygen deprivation during the birth process can result in serious injuries to the newborn. Studies have found that oxygen deprivation can result in death rates as high as 60%, and of those newborns that survive many sustain brain damage that often results in cerebral palsy, cognitive impairments or hearing and vision loss. While many newborns that suffer from insufficient oxygen during birth may not experience detectable brain damage they remain at a higher risk for learning disabilities, language delays and memory deficit.

Fortunately, The National Institute of Child Health and Human Development Neonatal Research Network has discovered a method that has been shown to reduce the rate of death and disability caused by insufficient oxygen and decreased blood flow to the newborn's brain at birth. This new procedure involves reducing the "whole body temperature" of newborns with brain injuries during the hours immediately after birth.

To do this, specially designed cooling blankets are used to lower the whole body temperature of the newborns to 92.3 degrees Fahrenheit for 72 hours immediately after birth. By providing this whole-body cooling immediately after birth the effects of oxygen deprivation and lack of blood flow are slowed down. This reduces the detrimental effects that usually result from oxygen deprivation. Initial studies found that this cooling process significantly lowered the risk of death and disability by more than 15 percent.

Researchers have learned that brain injuries resulting from insufficient oxygen and blood flow during birth generally occur in two phases. The first phase happens during the birth process when the baby is deprived of sufficient oxygen due to inadequate blood flow supplying oxygen to the baby's brain. The second phase happens in the hours just following birth and is due to a secondary energy failure. When the brain and body are cooled, less energy is needed for the brain to function and this minimizes the brain injury.

In order for this to be effective the cooling blanket must be used within the first six hours after birth. The cooling blankets induce hypothermia and minimize the damage. In some cases this prevents the baby from experiencing the second phase of brain injury. It is hoped that this new treatment will significantly decrease the damages caused by oxygen deprivation.

Inducing whole body hyperthermia is now becoming the standardized treatment for oxygen deprivation in brain injured newborns. Neonatal departments around the world are adopting this cooling technique to reduce the risk of death and disability among infants showing signs of brain injury indicating oxygen deficiency.

Researcher have also noted that this hypothermia therapy is useful for treating adult patients who experience oxygen deprivation and is being used to treat adults that have suffered from of heart attacks, strokes, spinal cord injuries and other forms of trauma that cause injury to the brain due to oxygen deprivation.

Medical malpractice claims require that the medical provider fell below the standard of care in the medical profession. Once standard practices are in place, failure to adopt those practices may by definition suggest the medical provider fell below the standard of care. If your baby has suffered oxygen deprivation and resulting brain injury or cerebral palsy, you should contact an experienced personal injury attorney to determine if you have a possible medical malpractice claim.

Related Reading:
Cerebral Palsy Birth Injuries: Devastating, Costly and Sometimes Avoidable!
Cesarean Sections: An Essential Tool in Prevention of Cerebral Palsy
New Techniques to Fight Cerebral Palsy in the Womb

Collins & Collins, P.C.
Albuquerque Attorneys

Cerebral palsy is a devastating condition that affects the brain and central nervous system. It can arise during pregnancy, during the birth process, or during early infancy. The symptoms of cerebral palsy can be mild or severe and cause uncontrollable reflex movements, intellectual disabilities, seizures, and vision and hearing problems. Cerebral palsy is one of the most common causes of permanent disability in children; it is estimated that it occurs in 2 to 2.5 out of every 1000 births.

Signs, Symptoms and Diagnosis of Cerebral Palsy
The most common symptoms of cerebral palsy are related to motor difficulties as a result of brain damage to the newborn. These symptoms include gait disorders, difficulty with fine and gross motor skills, developmental motor delays, and speech delays. It is important to remember that not all children will suffer from the same problems. Some will have more severe problems while others may only experience mild difficulties.

A thorough medical history and physical examination is the first step in diagnosing cerebral palsy. This exam is often done by a pediatric neurologist. While there is no single test used to diagnose cerebral palsy, there are many tests that are helpful in making the diagnosis. The most common tests include blood and urine examinations to identify metabolic abnormalities and chromosomal and genetic studies. CT scans and MRI scans of the child's brain may also be helpful in identifying cerebral palsy.

Treatment for Cerebral Palsy
There are no specific or curative treatments for cerebral palsy. Instead, because of the wide range of problems that a child with cerebral palsy suffers from, treatment includes various therapies involving multiple medical professions. Some of the treatments that can be expected include:

1. Physical therapy to evaluate muscle tone and strength.
2. Occupational therapy to review the child's ability to perform self-help tasks like feeding and dressing.
3. Speech therapy to evaluate the child's ability to speak and understand.
4.Mental health counseling to evaluate emotional issues.

In many cases highly specialized care will be necessary for the lifetime of the child. The typical cost of care after the child reaches the age of 21 can be as much as $200,000 per year. This number does not include lost earnings for the child or the pain and suffering that goes along with this condition.

Cerebral Palsy and Medical Negligence
The medical providers caring for the mother and baby are responsible for providing adequate care during the pregnancy, delivery, and immediately after delivery. These medical providers have certain standard of care that they must follow. Failing to meet these standards may make them liable for any damages that result from their negligence.

Some examples of failing to provide adequate care include:

1. Failure to respond to changing conditions of the mother or the infant during pregnancy and labor.
2. Failure to order necessary tests and/or to interpret those test results correctly.
3. Failure to perform a cesarean section when there is fetal distress.
4. Excessive use of vacuum extraction.

Cerebral Palsy Litigation
If your child has cerebral palsy that may have resulted from a birth related injury it is important to speak an experienced personal injury attorney. These cases are quite complete. Most cerebral palsy and birth injuries are beyond the control of medical providers. Others may occur on close judgment calls for which there will be no liability. It must be shown that the actions or inactions of medical providers fell below the standard of care for a finding of medical negligence. And only after a very thorough review of all the medical records can this be determined.

Related Reading:
Cesarean Sections: An Essential Tool in Prevention of Cerebral Palsy
Preterm Births: A Growing Health and Economic Crisis
New Techniques to Fight Cerebral Palsy in the Womb

Collins & Collins, P.C.
Albuquerque Attorneys

Hyberbilirubinemia, commonly called jaundice, is a condition that occurs when there is too much Bilirubin in the blood. It is not uncommon in newborns. Typically, it will cause no lasting harm to a child. However, it can in rare situations be very harmful to a newborn.

Jaundice causes a newborn's skin and the whites of their eyes to look yellow. As mentioned, Jaundice is usually not a serious problem, but in some cases too much Bilirubin in the blood can cause cerebral palsy, brain damage, hearing loss, mental disability and behavior problems among other injuries.

Bilirubin is made when your body breaks down old red blood cells. Normally Bilirubin is removed from the body through the urine and stool. When you are pregnant your body removes Bilirubin from your baby through the placenta. However, after birth the baby's body must get rid of the Bilirubin on its own. Jaundice occurs when your baby's body has more Bilirubin than it can get rid of.

Your baby's doctor can diagnose jaundice by doing a physical exam and getting a complete medical history about your baby. The medical history will include such things as whether your baby was born full-term, your baby's eating and elimination habits, and whether your baby has gained or lost weight since birth. Tests may be done if your doctor thinks that a health problem is causing too much Bilirubin in your baby's blood. A blood test for Bilirubin may also be necessary to determine if your baby needs treatment.

In most cases, no treatment is needed for jaundice and it will usually go away on its own. However, more serious cases must be treated medically in a timely manner. Left untreated in these cases, jaundice can cause very serious harm to a baby. As such, it is extremely important to immediately report any symptoms to your medical providers.

When jaundice is left untreated, it can lead to a specific kind of brain damage known as Kernicterus. Kernicterus can lead to permanent conditions like cerebral palsy, which is a chronic and permanent condition that affects a child's development and motor skills. A child with irreversible brain damage or cerebral palsy faces a lifetime of physical challenges.

It is very important that your baby's doctor monitor your baby for signs and symptoms of jaundice. If your doctor fails to recognize the symptoms of jaundice and/or fails to provide proper treatment, your baby could suffer serious and irreparable injuries. If your baby is harmed as a result of a failure to diagnose and treat jaundice, you may have a claim against the doctor, medical provider, or facility for medical malpractice.

Birth injury cases are complicated and difficult to pursue. In most cases, there will not be a sufficient level of negligence to merit a medical malpractice claim. Because these cases are so difficult and often expensive to pursue, it is important to thoroughly evaluate the claim as soon as possible. This is particularly so in light of the unique deadlines associated with medical malpractice claims in New Mexico.

As such, you should contact an experienced medical malpractice attorney as soon as possible.to fully protect your rights and the rights of your baby. Delay could in some cases be very harmful to your claims and as a general rule is never a advisable.

Collins & Collins, P.C.
Albuquerque Attorneys

The twentieth century saw a 99% reduction in the risk of death associated with pregnancy, One technology that played a major role in this reduction is the appropriate use of the cesarean section when the unborn baby shows signs of fetal distress. The medical team taking care of the mother and baby are responsible for monitoring the progress of the labor and delivery for signs of fetal distress, and when appropriate, performing a cesarean section.

Many things can happen during birth that cause fetal distress and the need for a cesarean section. A few include: an infant that is too large to pass through the birth canal; labor not progressing because the cervix has stopped dilating; and/or the infant is in a breech position, with its feet coming out first instead of the head.

Monitoring of the fetal heart rate is one of the important ways that the medical team monitors the baby during labor and delivery. Changes in the fetal heart rate are an indicator of fetal distress and that the infant is not getting sufficient oxygen. This is referred to fetal hypoxia. When this situation arises, a decision to perform a cesarean section may be critical to the health of the infant. An infant suffering from hypoxia during delivery can develop cerebral palsy.

Cerebral palsy is a crippling condition that affects the brain and central nervous system. The symptoms of cerebral palsy can be mild in some cases. In severe cases, cerebral palsy can cause uncontrollable reflex movements, intellectual disabilities, seizures, vision and hearing problems and other very serious physical injuries and permanent disabilities.

Cerebral palsy is one of the most common causes of permanent disability in children. However, not all children with cerebral palsy will suffer from the same problems. Some will have more severe problems while others may only experience mild difficulties.

The National Institute of Health recently published a statement concluding that the appropriate use of cesarean section when there are signs of fetal distress has reduced the number of cases of cerebral palsy even though the overall rate of cerebral palsy has not decreased. The NIH explains this anomaly by pointing out that cesarean sections have also increased the overall survival rate of newborns.

The healthcare providers caring for the mother and infant during the labor and delivery process owe the mother and the baby a legal duty of care. If the healthcare providers do not respond to an emergency situation, such a fetal distress/fetal hypoxia, in accordance with the accepted standard of care, the healthcare provider has violated this duty of care.

When this happens and the mother or infant are injured the healthcare providers may be liable for medical malpractice and responsible for the past and future medical costs along with other recoverable damages associated which in the case of severe cerebral palsy can be extraordinary.

If you believe your child has suffered birth injuries as a result of the failure to provide a timely C-section, an experienced personal injury lawyer can review the circumstances of your case with you and ensure that your legal rights and the rights of your child are protected.

Related Reading:
Placental Cerebral Infarction - A Serious and Sometimes Avoidable Birth Injury
Negligent Failure to Perform C-sections Resulting in Cerebral Palsy
Risks of Pre-Term C-Section Should be Understood by the Patient

Collins & Collins, P.C.
Albuquerque Attorneys

When a baby is born before 38 weeks of gestation the birth is considered a premature birth. The results of study authored by Dr. Geeta Swamy, assistant professor of obstetrics and gynecology at Duke University Medical Center, published in the Journal of American Medical Association concluded that 1 in every 8 births in the United States is premature.

The study also found that 60% of babies born at 26 weeks of gestation will develop long-term disabilities. These include chronic lung disease, blindness, deafness, and neuro-developmental problems. This number decreases to 30% for babies that are born at at least 31 weeks gestation. Another recent study in the June publication of the Lancet reported that approximately 12% of American babies are born before 37 weeks gestation.

Some premature births happen spontaneously and simply cannot be avoided. In other situations, the doctor decides rightly that it is best for both the mother and the baby that the baby is born early.

Thanks to cutting edge medical care more than half of the babies born at 25 weeks or sooner in the United States survive. Unfortunately, the cost of caring for these premature babies in this country alone is nearly $26.2 billion a year, which translates to $51,600 per premature infant.

The initial neonatal treatment required is not the only economic burden faced by families of premature infants. After the infant is discharged from the hospital there continues to be substantial cost incurred for healthcare, education, and social services for the infant and affected the family. Babies born sooner than 27 weeks are 10 times more likely to suffer from intellectual disabilities and 80 times more likely to have some variety of cerebral palsy-- a neurological condition that cause physical disabilities.

Clearly, it is not unusual for expecting mothers to develop complications leading to premature birth. Often times, the mother will be placed on bed rest along with other measures for extended periods of time to delay the birth. Unfortunately, these measures will not always be successful with the birth coming early despite the efforts of medical providers.

The emotional and physical toll of a premature birth can be significant. The financial toll can be devastating. Medical costs can run into the hundreds of thousands of dollars. Even with insurance, the costs could be ruinous. For those without insurance, the medical costs will surely cripple the family financially for years to come.

Collins & Collins, P.C.
Albuquerque Attorneys

Few experiences in life are more emotional than the birth of a baby. We all hope that our children come into this world happy and healthy. Unfortunately there are many different conditions that can impact your baby's development both during your pregnancy as well as during the labor and delivery process. One very serious condition is called Placental Cerebral Infarction or PCI. Placental Cerebral Infarction affects the blood flow going to the fetus from the placenta. PCI is a form of cerebral hypoxia or a decrease of blood flow and oxygen to the baby's brain.

There are a number of developmental causes for PCI including:

1. Maternal diabetes.
2. Preclampsia, which is high blood pressure in the mother during pregnancy.
3. Fetal anemia.
4. Lung malformation.
5. Cardiac disease.
6. Congenital fetal infections.
7. Blood flow problems to the placenta

Placental Cerebral Infarction can also occur if the doctor must perform an operative procedure during pregnancy or a Caesarean section. These types of procedures can cause the placenta to bleed or even rupture which affects the supply of oxygen to the baby's brain. If this occurs the doctor must respond to the situation quickly so that no harm results to the baby. However, if the doctor fails to respond promptly, and the baby's brain is without adequate oxygen for too long, serious birth injuries can result.

The types and seriousness of the injuries caused by cerebral hypoxia are largely dependent upon which portion(s) of the brain are denied adequate oxygen, as well as the severity of the hypoxia. In cases where the lack of oxygen to the brain is mild, the brain injury, if any, will be less serious. Such injuries can include short-term memory loss and/or difficulty mastering complicated tasks. In the most severe cases of cerebral hypoxia, coma and brain death can result.

In serious cases of PCI, another common result is cerebral palsy birth injury. Cerebral palsy can lead to brain damage of varying degrees causing moderate to sever learning disabilities, mental retardation, seizure disorders impaired mobility and other injuries.

In situations where it appears that PCI was caused by medical negligence you may be entitled to file a medical malpractice claim to recover for damages to your child, including medical expenses (past and future), lost earnings (over a lifetime), and pain and suffering.

If you suspect that medical negligence is the cause of your child's PCI, it is very important that you contact an attorney experienced in medical malpractice claims as soon as you suspect that there may be a problem as there are very strict and unique deadlines associated with New Mexico medical malpractice claims. Failure to file your claim within these time frames will result in your inability to bring the claim at all.

Related Reading:
Infant Asphyxia and Hypoxic-Ischemic Encephalopathy
Negligent Failure to Perform C-sections Resulting in Cerebral Palsy
Risks of Pre-Term C-Section Should be Understood by the Patient

Collins & Collins, P.C.
Albuquerque Attorneys

Doctors at Monash Medical Centre in Melbourne, Australia announced a new medical trial that will use melatonin in an effort to prevent prenatal fetal brain injuries, including cerebral palsy. The trial will involve 20 women and will go on for 12 months. Even though results are not expected until 2013, there is reason to be cautiously optimistic.

According to the Centers for Disease Control (CDC) one in every 303 children in the U.S. suffers from cerebral palsy. Cerebral palsy describes a group of brain and nervous system disabilities that affects movement, hearing, sight, thinking, and learning. Cerebral palsy is caused by damage to the brain that can occur during pregnancy, birth, and early childhood. However, in a large majority of cerebral palsy cases, the damage occurs during pregnancy.

Whatever the cause, cerebral palsy greatly inhibits a child's development and quality of life. The severity of symptoms can range from moderate to severe. Many children with cerebral palsy require life-long, around-the-clock care.

The Monash study builds on previous research by its scientists and doctors who have found a link between intrauterine fetal growth restriction (IUGR) and injuries to the developing brain of the fetus. According to the specialists at Monash Medical Centre, one in 20 pregnant women exhibit IUGR, a situation where the placenta does not provide sufficient nutrients and oxygen to the developing fetus' brain. IUGR is responsible for a large number of cerebral palsy cases, but currently there is little doctors have been able to do in the way of treatment. The Australian study represents new hope in this field.

The doctors and specialists at Monash Medical Centre have spent the last five years studying and observing the causes of brain injuries and IUGR. Their research has established that the brain injury is caused by oxidative stress, where an excess of free radicals causes tissue damage. Free radicals are highly reactive chemicals associated with cell damage.

According to the doctors and scientists at Monash, doses of melatonin could prevent oxidative stress by protecting fetal brain cells. Melatonin is produced by the pineal gland, and besides regulating important functions in the body, such as the wake-sleep cycle, it is also a powerful antioxidant. With its ability to easily cross cell membranes and from blood to brain cells, scientists at Monash hope that melatonin will prevent oxidative damage to cells caused by free radicals.

The Monash study will include 20 pregnant women who will be administered melatonin orally in tablet form if they exhibit IUGR. Research at Monash has already shown that free radical levels in cord blood of IUGR births are higher than in normal births. The trial will also test the cord blood of babies who were given melatonin for free radical levels to see whether the treatment was successful. If successful, a second trial will include 100 women and two- and three-year follow-up exams of babies to test for development of cerebral palsy.

The trial, if successful, could represent major progress in prenatal treatment and hopefully prevent cerebral palsy in some children. There will still be those instances of cerebral palsy caused by medical negligence. The study does not address those cases. If your child has been the victim of medical negligence, then it is important to seek the counsel of an experienced personal injury attorney as soon as possible due to the unique deadlines associated with medical malpractice claims.

Collins & Collins, P.C.
Albuquerque Attorneys

Injuries sustained by an infant during the labor and delivery process can lead to a lifetime of special needs and care. The services and supplies needed to bring some sort of normalcy to the injured child can quickly deplete even the most financially stable of families. Compensation for medical negligence or malpractice may ease some of the financial burdens of caring for a special needs child. Yet, this compensation can be quite challenging to obtain due to a wide variety of defenses that may be asserted in a birth injury lawsuit.

In attempting to obtain a legal remedy for a birth injury related to medical malpractice, it is the duty of the plaintiff, the one bringing the suit, to prove the injury resulted when the medical professional breached their responsibility to provide reasonable medical care. This seems like a fairly strait forward statement on the surface; yet, differing interpretations of the terms "duty," "breach" and "reasonable" can complicate proving one's claim.

Defining the standard of care can also present a major obstacle for the plaintiff. The standard of care can differ from medical facility to medical facility, as well as from physician to physician when faced with the same medical event. The standard of care usually must be explained by an expert witness, who describes their opinion regarding the proper response to or method used during the injuring event in question. Both the plaintiff and the defendant are allowed to introduce experts, and these experts can and often do present contradictory positions regarding the proper standard of care, particularly in situations involving a judgment call.

Causation is another factor that can diminish the plaintiff's case, as the defense may allege other possible reasons for the birth injury, like fetal developmental issues, maternal complications or genetic defects. The presence of any of these potential causes may limit or negate the responsibility of the medical professional in the eyes of a judge or jury even where there was medical negligence.

Defense counsel may also rely on how foreseeable a birth injury may or may not have been, given all the data and diagnostics a reasonable physician has at the time of delivery. If risk factors for certain birth injuries are not known beforehand, a medical provider may be able to successfully argue that he was not able to foresee the possibility of birth injury and thus, he did not breach his duty to provide reasonable medical care.

There may be many other defenses that can be alleged to challenge a medical malpractice claim involving birth injuries. Due to the huge level of damages in many birth injury cases, these cases are fought very hard by medical professionals and facilities. The costs and stress of a suit can be significant on the family. It is therefore important that the case be properly evaluated from the outset by an experienced personal injury attorney.

Collins & Collins, P.C.
Albuquerque Attorneys

A few weeks ago, the Florida legislature had before it a bill that would approve a $30.8 million claim against a public hospital for medical negligence. Even though a jury issued the ruling against the hospital, the plaintiff in the case has been forced to get an actual bill passed through the state legislature before collecting any part of the award. Actually collecting an award after a legal determination is often no easy task. In fact, many corporate and insurance interests continue to push for more and new ways to make collection even harder by limiting the rights of injury victims via tort reform.

What is almost always forgotten in these cases is that if the wrongdoer is not required to pay for the consequences of these errors, then the cost is borne by taxpayers through Medicare, Medicaid, Social Security Disability, home healthcare, rehabilitation, vocational training, unemployment benefits and so on. Judicial fairness, therefore, ensures that the public is not required to pay for the negligence of medical professionals.

In the Florida case, a jury found in favor of 14-year-old plaintiff and his parents in a suit alleging that the hospital's negligence during plaintiff's birth resulted in his cerebral palsy. In 2007, a jury awarded the plaintiff $30.8 million, mostly for future 24-hour care and therapy that he will need for the rest of his life which runs into the millions, and more precisely by the jury's estimation, $30.8 million.

The hospital claims that it does not have insurance coverage and that it would have to cut several of its programs to pay the claim. Having no other remedy, the plaintiff and his parents filed a claims bill with the Florida legislature to force the hospital to pay the award. During the four years since the jury verdict, the hospital has done little to try to settle the claim or negotiate with the plaintiff, with one Florida Senator describing its actions as "stiff-arming" the family. Unfortunately, the hospital's conduct in this suit reflects a trend where insurance companies and large private and public entities seek to intimidate plaintiffs in an expensive game of attrition.

The result is that insurance companies, which have actually seen profits rise in recent years, are able to keep more money it their coffers. Instead, the injured family is forced to lean on the public for resources to provide the day-to-day care needed.

Unfortunately, some continue to push for new laws which would shift responsibility away from wrongdoers and toward the public even further.

At the same time that this Florida case was making national news, Tennessee was in the midst of a very different tort -related debate. Emboldened by the passage of the Tennessee Civil Justice Act of 2011 (Act), the business coalition that supported the bill is now pushing for further liability protection for business, insurance, and health care organizations.

The 2011 Act caps punitive damages at $500,000 and non-economic damages, including pain and suffering, at $750,000. Additionally, the Act restricts the claims that can be brought under the state Consumer Protection Act.

Business coalitions in Tennessee now seek to pass a series of bills that would further curtail individuals' rights to recovery in tort claims. The gist of the legislation is to keep injured people out of court by making these extremely costly and risky lawsuits dramatically more so for plaintiffs. One such bill forces a plaintiff to pay the litigation costs of a defendant if the plaintiff refused to settle and wins less that 75% of the settlement offer at trial. A similar bill would compel a party who loses in a motion to dismiss to pay the litigation costs of the winning party.

Proponents of these bills say that they would prevent the mythical frivolous medical malpractice lawsuits. As insurance industry profits continue to soar while medical malpractice claims decline, it is not hard to see the motive or the interests behind the false logic. The fact is these limits simply shift the burden of these injuries to the public and away from the responsible parties and more importantly their insurers who are picking pockets on both sides of the equation.

Collins & Collins, P.C.
Albuquerque Attorneys

Malpractice insurance premiums for obstetricians are often higher than for any other medical profession. Perhaps it is because the average payment in an obstetrical medical malpractice suit is around $947,000, more than double the payment for other medical malpractice suits.

CRICO Strategies, a Massachusetts-based medical risk management company, released a study in June 2010 of 800 obstetrics-related malpractice cases between 2005 and 2009. The study focused on the top reasons for medical malpractice claims against obstetricians and identified the risks that lead to these suits.

The study found that the top claims in obstetric malpractice suits involved substandard medical judgment or judgment errors (77%), miscommunication (36%), technical error (26%), and inadequate documentation (26%). Other claims included administrative failures and inadequate supervision.

The study also found that 65% of obstetric medical malpractice cases entail "high severity" injuries, which include the death of the mother, the child or both. The three most common allegations within these cases dealt with delay in treatment of fetal distress, improper performance of vaginal delivery, and improper pregnancy management.

A routine delivery can turn into a life-and-death situation for both mother and child in a matter of seconds. In emergency situations the attending obstetrician and medical team must be aware of countless factors in order to make the correct decision and act accordingly. Unfortunately, healthcare providers sometimes lack all of the pertinent information or are too caught up in managing the constantly changing situation to recognize signs of fetal or maternal distress in time to remedy it.

Communication between team members during critical times of problematic and emergency deliveries is paramount. However, since labor complications are infrequent, many healthcare providers lack the necessary communication skills and structures to make decision-makers aware of all of the factors involved.

The CRICO study found that 43% of claims brought against smaller hospitals involve issues that relate to training and education. At other times, especially during second-stage labor, precise surgical maneuvers and specialized equipment may require extensive training and real-time experience. Medical teams may lack the familiarity and preparation to ensure that no harm is done to the mother or child.

In these cases, most of the time it is not one single incident that causes the problem, but a confluence of small mistakes and oversights that combine to create the crisis situation, according to the study. Often, these small mistakes and lapses in communication are not caught in time to remedy the situation. However, had the proper decisions been made and had communication and training channels been in place, most of these situations could have had a better chance for a favorable outcome.

The study emphasizes that accurate interpretation of data and symptoms, controlled and structured communication, and collective decision-making can make all the differences in most cases. Additionally, electronic fetal monitor (EFM) training and frequent, regular opportunities to apply this training are crucial in avoiding many mistakes that result in malpractice claims. The study also emphasizes the value of contingency plans in situations where time is of the essence. Finally, it encourages prenatal healthcare providers to be alert and communicate with their patients and other members of their team about potential risk factors during pregnancy.

If you or your baby have suffered injuries during birth, it is important to contact an experienced personal injury attorney to help identify the specific causes and help you navigate the complicated process of filing a personal injury claim against your healthcare provider.

Collins & Collins, P.C.
Albuquerque Attorneys

A typical, healthy infant begins to breathe immediately after birth. If one minute has gone by and a regular breathing pattern has not been established, the child may be suffering from asphyxia, or a lack of oxygen. Asphyxia affects approximately 5% of newborn infants.

After delivery, medical personnel monitor a child's vital signs to insure proper oxygen delivery. These signs include: the child's color, breathing pattern, heart rate, muscle tone and response to stimulation. Asphyxia may be present if an infant's tongue is not pink, if there is any gasping or lack of breathing, if heart beats fall below 100 beats per minute, if there is minimal movement or limpness or if there is minimal response or no response to stimulation.

Asphyxia can be resolved in most infants with resuscitation; however, asphyxia can result in
hypoxic-ischemic encephalopathy (HIE). HIE is brain damage that occurs in infants either before, during or shortly after birth from asphyxia. It occurs most among infants that are full-term, and is a leading cause of impairment which can include motor difficulties, developmental delays, epilepsy and cognitive deficits.

Risk factors for HIE include, but are not limited to:

• placental abruption, when the placenta detaches from the uterus before birth


• prolapsed umbilical cord, when the cord descends through the cervix before the fetus


• maternal hypotension, or low blood pressure


• uterine rupture, including intrauterine hemorrhage


• maternal or fetal cardiac complications


• birth trauma, when injury occurs from instruments or other force used during delivery


• medical negligence

HIE can be detected immediately after birth and diagnosed by neuro-imaging procedures, like an MRI or CT scan. Most likely, however, it is a parent, caregiver or medical professional that notices signs of HIE, like delayed development or impaired motor control as the child ages.

While HIE is usually sudden and unexpected, some preventative measures can be taken to help eliminate the risk. Proper labor management and early awareness of fetal distress by medical personnel may provide some protection. Attention to risk factors can also lead to better preparation for possible complications.

More importantly, expectant parents should go into the delivery process well informed. This includes understanding the importance of fetal monitoring equipment, insuring that fully qualified and properly trained physicians are available during delivery, and knowing patient rights, particularly when it comes to decision-making and second opinions.

In those cases where HIE results from medical negligence, it is important to immediately seek the advice of an experienced personal injury attorney. There are important and unique deadlines in medical malpractice claims that must not be missed.

Collins & Collins, P.C.
Albuquerque Attorneys

In birth injury cases, a lack of oxygen is the most common cause of damage to an infant's brain. Oxygen deprivation can come in the form of asphyxia, a blockage to the airways, or hypoxia, a blockage of oxygen-rich blood to the brain. While a lack of oxygen can occur for many reasons, one cause may be due to a common medical practice: immediate cord clamping (ICC).

ICC generally occurs right after an infant's delivery. The umbilical cord that unites mother and child is clamped then cut, typically within 30 seconds after the baby has emerged. The process is thought to prevent hemorrhaging in the mother and allow the infant to be quickly transferred to a resuscitation station for further evaluation.

Recent studies suggest that clamping and/or cutting the cord too soon may lead to massive blood loss into the placenta. This reduces the nutrient-rich blood and oxygen supply a child needs when taking its first breaths. Certain infants are more susceptible to problems from this decrease in oxygen and blood, leading to a possibility of brain hemorrhage or breathing difficulties. Both of these risks can result in brain damage and a wide range of long-term disabilities.

Some experts, including the World Health Organization, recommend that three minutes should pass before cutting the umbilical cord. This will allow blood from the placenta to flow to and nourish the newborn, while the baby establishes a proper breathing pattern and starts to depend on its own bodily systems. It is advised that all signs of pulsation within the cord should cease before the cord is clamped and cut.

Experts believe the amount of blood transferred through the cord may amount to 30-50% of an infant's eventual blood volume. Studies show that infants have a built-in reflex system that will shut off the flow of blood from the cord once they have received the optimal amount. And, this nutrient-rich blood could impact the health of the infant long past birth, reducing the chance of iron deficiency in children as old as 8 months.

Traditional treatment of an infant displaying a lack of oxygen has been to re-oxygenate their systems. Unfortunately, they may be in need of blood volume replacement instead, something that is typically not addressed. Interestingly, rates of oxygen deprivation are much lower in deliveries involving professional midwives. Often, midwives delay the cutting of the umbilical cord until delivery of the placenta.

Dr. George Morley, MB, ChB, FACOG, a board certified OB/GYN states emphatically that "Perinatal and neonatal care is less successful in saving brains than saving lives." He also believes that the cause of oxygen deprivation in newborns has been misdiagnosed, leading to no real decline in cerebral palsy rates, despite intensive interventions.

While this is just one theory involving infant brain damage, expectant parent should discuss ICC with their medical providers. Many physicians may simply be following current trends in obstetric medicine by practicing ICC, without being fully aware of the possible risks this procedure may present.

If your baby has suffered a birth injury, including brain injury, it is important to contact an experienced personal injury attorney right away. There are unique medical malpractice statutes of limitation and other deadlines.

Collins & Collins, P.C.
Albuquerque Attorneys

Approximately 4 million women give birth in the U.S. each year, and more than 60% of them receive epidural anesthesia during labor. Epidural anesthesia is a process where pain management medication is injected near the nerves in the mother's lower back. And, while this process may ease pain and discomfort for the mother, it can in some circumstances create a greater risk of injury to the baby.

Epidural anesthesia has been found to increase a mother's temperature. While the link between epidural anesthesia and fevers is not well understood, one belief is that an inflammation response is triggered, generally in the fetal membranes and placenta. Other studies suggest that epidural anesthesia may decrease the mother's ability to dissipate heat at a time when she is expending energy due to the labor process.

Dr. Scott Segal at Tufts Medical Center in Boston, a teaching hospital, explains that this rise in temperature is not seen with other types of pain control or drug-free labor. Nor is there an effective, safe method for preventing maternal fever from epidural. He also cites that maternal fever in general is known to complicate up to 1/3 of all deliveries.

According to a recent study published in Pediatrics, a possible link has been found between birth injuries and women with elevated temperatures who received epidural anesthesia. The study suggests the higher the mother's temperature, the greater the likelihood the infant would experience problems at birth. These problems included breathing difficulties, poor muscle tone and even seizures.

The study documented that 19.2% of the women who received an epidural developed temperatures above 100.4 degrees. If the fever was over 101 degrees, the infant had a 2-6 fold increase in the risk for problems. Interestingly, the study revealed there was no difference in an infant's outcome for women who did not develop a fever after epidural injection versus those who did not have an epidural at all.

Many infants who experienced problems after a delivery involving a maternal fever overcame the issues associated shortly after birth; however, others did not. Maternal fever has been linked to infant brain injury resulting in cerebral palsy, muscle atrophy and learning disabilities.

And, while other factors could be at work, namely, intrauterine infections, maternal fever is certainly a risk factor that should be discussed with one's physician before delivery. Even if a mother has no plans to rely on epidural anesthesia, plans can change once labor sets in. It is best to know the risks ahead of time without the added pressure of making decisions while in the grips of a painful contraction.

These are all issues that should be discussed between an expecting mother and her physician. Only through understanding can a patient make informed decisions in the midst of delivery.

Collins & Collins, P.C.
Albuquerque Attorneys

According to the Center for Disease Control (CDC), cerebral palsy is the most common motor disability among children in the US. In a number of cases, cerebral palsy is caused by a doctor's negligent failure to perform a C-section when conditions deem it necessary.

Juries around the country have recognized that failure to perform a timely C-section when medically necessary is a significant deviation from reasonable standards of care. As a result they often return sizeable medical malpractice verdicts in favor of affected children and families.

The CDC estimates that one in every 303 children in the US suffers from cerebral palsy. Cerebral palsy is the name for a group of brain and nervous system disabilities that affects movement, hearing, sight, thinking, and learning. Cerebral palsy greatly affects a child's development and quality of life. The severity of symptoms can range from moderate to severe, and many affected children require life-long care.

Cerebral palsy is caused by damage to the brain that can occur during pregnancy, birth, and early childhood. Most children display symptoms of cerebral palsy by age three. Around 20% of cerebral palsy cases are attributed to brain damage during birth. In many of these situations, the brain damage that leads to cerebral palsy is caused by lack of oxygen to the brain, known as fetal hypoxia. According to the CDC, fetal hypoxia accounts for roughly 10% of cases of cerebral palsy. Even though only a small percentage of all cerebral palsy cases can be prevented by the timely performance of a C-section, failure to do so can have devastating results for a child and family.

In a number of cases, possible brain damage from lack of oxygen to the brain can be prevented by the timely performance of a C-section. Situations when a C-section becomes medically necessary include when: (1) the baby does not progress through the birth canal and is deprived of oxygen, (2) the umbilical cord is wrapped around the child's neck and the problem cannot be corrected, and (3) prolonged attempts to induce labor have not been effective and the child remains in the birth canal for too long.

When these problems develop, medical professionals often have mere minutes to react before irreversible damage is done to mother and child. There are several ways that healthcare providers can monitor the child for signs of distress that can lead to deprivation of oxygen to the brain. Fetal hypoxia is often accompanied by a change in the baby's heart rate, which should be carefully monitored by healthcare professionals if there are any signs of complications during birth or if there are risk factors associated with the pregnancy.

Unless doctors and nurses are well trained and vigilant, and the hospital has standard procedures in place, these warning signs may go unnoticed and precious time may be lost. In some situations, there is no way to identify signs of distress in time. However, in a large number of cases, the signs are obvious and the physician or medical team simply does not address the need for a C- section in a speedy manner, causing injury and even death to the child. In these cases, doctors and hospitals deviate from the medical standard of care and may be deemed negligent under civil law.

As indicated, medical negligence is not always or even the most common cause of cerebral palsy. However, if your child suffers from cerebral palsy and you suspect medical negligence, it is important to make the determination as early as possible. An experienced personal injury attorney can help you do just that.

Collins & Collins, P.C.
Albuquerque Attorneys