Should Dystocia Lawsuit in Baltimore County

Spence v. Franklin Square Hospital Center

maryland psychiatric malpracticeThis lawsuit, filed in Health Claims Arbitration on March 7, 2017, is a shoulder dystocia medical malpractice case alleging a birth injury due to medical malpractice during childbirth. It is the 114th medical malpractice case filed in Maryland in 2017.

Summary of Plaintiff's Allegations

At 39-weeks pregnant, plaintiff goes to Franklin Square Hospital in Baltimore. When she is admitted, she is reported to have cervical insufficiency and gestational diabetes. A plan of care is developed, which includes admitting her for inpatient observation and induction of labor, along with using sliding-scale insulin for her gestational diabetes.

After being admitted to labor and delivery, the woman has concerning fetal heart rate patterns. The doctor is able to improve the heart rate after repositioning her and administering supplemental oxygen. He orders an epidural. A pelvic exam is done, and an artificial rupture of the membranes occurs while an intrauterine pressure catheter is inserted by defendants. The fetal heart rate continues to decelerate periodically.

Due to the concerning fetal heart pattern, a vacuum is used to assist in the delivery. The doctor notes mild shoulder dystocia to the left anterior shoulder with a 'controlled' level of traction. The baby is born with a decreased range of motion in her left shoulder, and she is diagnosed as a having a possible brachial plexus injury. She is discharged from the hospital with left shoulder dystocia, and later undergoes a surgery at Johns Hopkins to repair the injury.

After the surgery, the girl had to go through physical therapy and wear splints, but she continues to struggle with balance issues. She has a weak left arm and hand, and has limited use with her left hand.

Additional Comments
  • Plaintiffs' argument is that if the mother had been properly advised of the risk of shoulder dystocia and brachial plexus injury with the correct estimated fetal weight, she would have requested a cesarean section and the shoulder dystocia and brachial plexus injury would have been avoided. The was allegedly no discussion of the risk of shoulder dystocia and brachial plexus injury to an infant with this estimated fetal weight and the risks verses benefit of induction of labor and vaginal delivery verses cesarean section.
  • One critical claim here is that the doctors negligently failed to ascertain the approximate fetal weight which would have changed the mother's options. The risk of shoulder dystocia increases with birth weight. Obstetricians have a duty to estimate the fetal weight at or near the delivery date and assess the risks of a fetus with excessive weight.
  • Plaintiffs also claim excessive traction which is often a more difficult case to bring. The standard of care is that once a shoulder dystocia has been diagnosed, there should be no use of traction on the fetal head until the shoulder has delivered.
  • The big defense to this case is going to be the American College of Obstetrics and Gynecology (ACOG) Practice Pattern, Number 7 that says "shoulder dystocia cannot be predicted or prevented because accurate methods for identifying which fetuses will experience this complication do not exist." They are also going to point to the same source that there should not be a planned c-section in women without diabetes unless the estimated fetal weight is 5000 grams or greater. This child weighed 3,731 grams. Of course, the defendants' problem in this case is that the mother had gestational diabetes which clearly puts the child at greater risk for shoulder dystocia.
Jurisdiction
  • Baltimore County
Defendants
  • Franklin Square Hospital Center, MedStar Franklin Square Medical Center
  • A Glen Burnie OB/GYN
  • An OB/GYN who was either in Baltimore and moved out state or vise versa
Hospitals Where Patient was Treated
  • Franklin Square Hospital
Negligence
  • Failure to accurately determine the estimated fetal weight and likelihood of safe vaginal delivery
  • Failure to properly appreciate plaintiff's risk factors for shoulder dystocia
  • Failure to counsel plaintiff regarding her delivery options in light of increased risk of shoulder dystocia
  • Failure to arrange proper support personnel to be present to assist with corrective measures
  • Failure to properly perform maneuvers to correct the shoulder dystocia without harm
  • Using excessive downward traction after signs of shoulder dystocia were apparent
  • Failure to expedite the delivery
  • Failure to manage plaintiff's labor in accordance with the standards of care
Specific Counts Pled
  • Medical Negligence
  • Medical Negligence/Family Expenses
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