Infant Lung Collapse and Wrongful Death Lawsuit

Mugar v. Johns Hopkins Hospital

Central LineThis wrongful death claim was filed in Baltimore City after a baby suffered fatal lung collapses. It was filed in Health Claims Arbitration on February 23, 2018, and it is the 95th medical malpractice case filed in Maryland this year.

Summary of Plaintiff's Allegations

A baby girl was born at Johns Hopkins Hospital following a C-section delivery. She was intubated shortly after birth and admitted to the neonatal intensive care unit. By her eighth day of life the baby was progressing well. She was stable, breathing on her own, being fed via nasogastric tube and receiving parenteral nutrition via umbilical venous catheter, but an x-ray revealed that the tip of the catheter was in her liver. Her parents gave the doctors consent to attempt a replacement of the catheter with a PICC line, but the attempts were unsuccessful. The doctors considered a plan to replace the umbilical venous line with a surgically placed central line (a catheter in a large, central vein).

Without asking the parents for consent, a neonatology fellow went ahead with the surgical procedure to place a central line. The baby was still stable and did not urgently require this intervention. After six failed intubation attempts, the doctors medicated the baby with a rapid sequence of drugs. A neonatologist finally arrived 33 minutes after the first intubation attempt. While the neonatologist was watching, the doctor performed a seventh unsuccessful intubation. The neonatologist attempted one more intubation herself, which appeared successful; however, the baby's condition did not improve.

Four more minutes went by before the neonatologist finally diagnosed a collapsed lung, at which point the doctors emergently began a small needle aspiration to remove trapped air from the baby's chest cavity. A much more effective strategy would've been to insert a full chest tube, which would have rapidly removed the trapped air that was preventing the baby from breathing.

Five more critical minutes went by before the doctors decided to call a code. A variety of health care providers, including the neonatology fellow, the neonatologist, and a general pediatric surgeon made additional intubation attempts over the next twenty minutes. Ultimately, the baby was pronounced dead just 85 minutes after the first intubation attempt.

Additional Comments
  • According to the claimant's expert witness, a neonatologist, the baby's lungs were most likely traumatized during the failed intubation attempts. The baby had been breathing spontaneously in room air, but after the intubation attempts she required mask ventilation with 100% oxygen - and still, her oxygen saturation levels were low. The expert witness believes that the unsuccessful intubation attempts and ventilation forced air into the baby's chest cavity, causing her lungs to collapse. At that point, the baby's condition was still reversible but the doctors, using the wrong aspiration method, were not able to evacuate the excess air from her chest cavity fast enough to save her.

  • The statement of claim includes a lot of timestamps: the first six failed intubation attempts occurred over a span of 11 minutes, 22 more minutes went by before the seventh intubation attempt, a total of 44 minutes passed before a code was called, and 41 minutes later the baby was pronounced dead. The whole incident occurred over one hour and twenty-five minutes. Timing is important in this case because each passing moment that the baby was unable to breathe created a greater risk for more severe brain damage to occur as a result of oxygen deprivation. Since the baby's lungs were likely traumatized in the intubation attempts, she did not have enough oxygen in her bloodstream to adequately supply her brain for at least 74 minutes.

  • During the autopsy, the baby's lungs appeared completely healthy apart from the traumatic lung collapses. Plaintiff's claim she showed no other significant pathologic issues and could've expected to live a full and normal life if not for this tragic incidence of medical malpractice.

Jurisdiction
  • Baltimore City
Defendants
  • The Johns Hopkins Hospital
  • The Johns Hopkins Health System Corporation
  • A neonatal-perinatal medicine fellow
  • A Baltimore neonatologist
Hospitals Where Patient was Treated
  • Johns Hopkins Hospital
Negligence
  • Failing to properly treat and evaluate the baby.
  • Failing to obtain parental consent before placing a surgical central line and starting non-emergent intubation.
  • Failing to obtain appropriate supervision for the neonatology fellow.
  • Failing to obtain timely emergency assistance once it became clear that the first four intubation attempts were unsuccessful.
  • Failing to emergently insert a full chest tube rather than performing needle aspiration.
Specific Counts Pled Plaintiff's Experts and Areas of Specialty Getting a Lawyer for Your Malpractice Claim

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