Not all cases of cerebral palsy are the result of medical malpractice. Cerebral palsy is a broad term for damage in the mid-brain affecting motor function. Because this damage could be caused by many things, determining if cerebral palsy is the result of malpractice can be difficult.
The following flow chart lists common events associated with cerebral palsy. The events in bold are usually suspicious for medical malpractice. In general, the clearer the cause of the CP, the more viable the lawsuit. Keep in mind this chart is merely a guide of potential malpractice. It does not mean that medical malpractice-induced cerebral palsy.Prenatal Period (Before Birth)
1. Genetics: Are there mutated genes? Mutated genes, although rare, can cause cerebral palsy.
2. Infection: Did the mother or the child have any one of the following infections before birth (toxoplasmosis, rubella, cytomegalovirus, herpes simplex 1 or 2, or other viral infections such as syphilis)? Any one of these organisms could cause cerebral palsy.
3. Placental Insufficiency: Is there evidence the placenta did not form properly or was damaged? This could cause cerebral palsy.
4. Prematurity (< 37 weeks old): children born prematurely commonly have periventricular leukomalacia, which is a fancy way of saying an underdeveloped mid-brain that could cause cerebral palsy.Perinatal (During Birth)
1. Infection: Did the mother or the child have any one of the following infections during birth (toxoplasmosis, rubella, cytomegalovirus, herpes simplex 1 or 2, or other viral infections such as syphilis)? Any one of these organisms could cause cerebral palsy.
2. Oxygen Deprivation: Did the child suffer oxygen deprivation? This could be malpractice if it occurred during birth. Often evidence of oxygen deprivation shows up on Fetal Heart Rate (FHR) monitoring strips during delivery. As a result of the lack of oxygen to the brain, the baby's heart starts beating irregularly. When this occurs, an emergency c-section is usually necessary. This kind of injury could lead to cerebral palsy.Postnatal Period (After Birth):
1. Head Trauma: This could be malpractice if the baby suffered head trauma while being delivered or later in the neonatal unit. Common red flags are if forceps or suction devices were used during the delivery.
2. Oxygen Deprivation: This could be malpractice if oxygen deprivation occurred immediately after the delivery.
3. Stroke: Strokes can cause cerebral palsy.
4. Infection: The most common post-natal infection causing cerebral palsy is bacterial meningitis.
As you can see from the above, cerebral palsy can be the product of many different things. The key to a successful malpractice case is identifying the cause and ruling out other causes.
Useful tests for identifying potential cause are as follows:
1. Abnormal Fetal Heart Rate Monitoring Strips: Are there late heart decelerations or a prolonged loss of heart rate variability? These are indications of fetal distress and potential oxygen deprivation.
2. Low APGAR Scores: APGAR scores are a way of predicting health within the first couple of minutes of birth. In general, the lower the scores the more likely that there might have been malpractice.
3. Abnormal Cord Gases: Usually cord gases are measured at birth. Abnormal oxygen, carbon dioxide, or PH levels could indicate metabolic acidosis and oxygen deprivation. Normal cord gases are as follows:
- PH: Range is 7.35-7.45
- PO2: Range is 75-100
- PCO2: Range is 35 – 45
- HCO3: Range is 18-23
- Base Excess: Range is -8-0 (mmol/L)
4. Scans: Sometimes CT Scans, MRI, or Ultrasounds after birth identify damage to the areas of the brain involving motor function. These are good indicators for potential cerebral palsy.
It has been cited that approximately 2-3 in every 1000 live births results in cerebral palsy. But about 1 in every 12,000 live births are caused by something being done wrong by a doctor, nurse, or hospital resulting in oxygen deprivation. These are the types of cases that lend themselves to medical malpractice lawsuits. If it can be proven that the baby appeared to be progressing normally during pregnancy, but the child began showing signs of fetal distress and either someone did not act appropriately, or quickly enough, then there is a good chance that there is a basis for a lawsuit. The most common culprits are doctors but nurses can also make mistakes that can lead to CP.
Rarely do the victim's parents know one way or the other without hiring a lawyer and having them collect the medical records to see what actually happened. In general, the best cerebral palsy cases are the ones with a clearly defined cause of injury.Examples of Settlements and Verdict in Cerebral Palsy Cases
Statistics that show median and average cerebral palsy verdicts and settlements are not especially useful. Why? Because the amount of economic damages varies so wildly from case to case and does not correlate well with how severely injured the child is or how good the negligence case was against the doctor (which has a significant indirect impact on the amount of the verdict).
Below are some sample CP jury verdicts and settlement that might give some better indication as to the value of these cases. Again, as trite as it is to say, every case is different. It is impossible to figure out the value of your child's case by looking at statistics or even seeing the recovery in a case that sounds similar to yours.
- 2016, Pennsylvania: $7,270,000 Settlement. A woman becomes pregnant with her second child and seeks care from the same facility she treated with during her first pregnancy. Her prenatal course is uncomplicated. She goes to defendant hospital for induction of Pitocin and attempted vaginal birth. This was recommended to her during her prenatal care, even though her prior child was born via Cesarean section. When she is admitted to the hospital, the fetal heart monitoring is reassuring. However, by the evening, her membranes have ruptured and amniotic fluid is clear. She is fully dilated the next morning and spends five hours attempting to deliver her child. The infants head is delivered, but its nasal passages are filled with thick meconium. When the rest of the body is delivered, there is no respiratory effect. None of the doctors present during the delivery are qualified in neonatal resuscitation nor are they qualified to intubate. By the time emergency personnel arrive, the infant has been in respiratory distress for eight minutes and has suffered birth asphyxia. As a result, the infant suffers cerebral palsy with irreversible brain injury. Plaintiffs allege that the defendants were negligent in failing to implement a reasonable care plan for delivery based on plaintiff's history and by failing to properly resuscitate the infant in a timely manner. The parties settled for $7,270,000.
- 2016, Illinois: $53,000,000 Verdict. A newborn male is under the care of doctors at University of Chicago Medical Center during his birth. The staff at the hospital fails to diagnose and treat him, fails to perform a Cesarean section, and fails to maintain good quality electronic fetal monitoring, among many other allegations. As a result, the newborn suffers severe hypoxic ischemic encephalopathy, mental retardation, and cerebral palsy. The hospital denies liability, however a jury awards the infant plaintiff $53,000,000.
- 2016, Oregon:$13,000,000 Settlement. A woman goes to the hospital, planning to give birth underwater. She is told that she is an ideal candidate for this and that it is safe, even though the baby's fetal heart rate is abnormal. The heart rate is not continuously monitored. Eventually, she is taken out of the water and the baby is delivered. Due do the delay in realizing there was a problem, the baby's brain is damaged due to a deprivation of oxygen and blood. As a result, the baby suffers from cerebral palsy and is unable to walk or talk. The plaintiffs claim that the midwives told them they would consult the obstetricians during a water birth, and further that the doctors were negligent in not performing an immediate Caesarian section. The case settles before trial, with plaintiff being awarded $13,000,000.
- 2016, Kentucky:$18,270,052 Verdict. A woman arrives to the hospital to have her labor induced. The doctor gives her Pitocin and doctor leaves orders that she is not to have more than four contractions per hour. The nursing staff allows her to exceed this maximum number of contractions for more than six hours. As a result, the baby is deprived of oxygen and stuck in the birth canal, suffers a hypoxic brain injury. This trauma results in cerebral palsy and spastic quadriplegia. The woman claims that the staff and hospital was negligent as they failed to deliver the infant quickly and they failed to comply with the doctors orders. The defendants deny liability. A jury awards the plaintiff $9,000,797 in future medical expenses, $1,505,940 in impaired earning capacity, $2,800,000 in past suffering, and $4,500,398 in future suffering.
- 2015, New York: $52,681,017 Verdict. A female is administered Pitocin during her labor, but after the drug is administered, the doctors do not monitor the baby's fetal heart tracing. During the mother's labor, she develops tachysystole (more than the normal number of contractions), but as the doctors are not properly monitoring her, they do not realize, respond to, or correct this. As a result, the infant suffers brain damage, spastic cerebral palsy, motor delays, neurological and cognitive deficits, and is unable to walk. The plaintiff claims that the doctors departed from the standard of care, and a jury agrees, awarding her $52,781,017.
- 2015, New York: $5,681,818 Settlement. A woman has her baby delivered via a Cesarean section at the Women and Children's Hospital of Buffalo. However, the baby suffers from brain damage, cerebral palsy, developmental delays, and neurological/cognitive deficits. Plaintiff alleges that the doctors fail to realize the significance of vital signs, fail to develop a plan for delivery after reading the vital signs, fail to recognize the signs and symptoms of fetal distress, and fail to motor the fetus with a fetal heart rate monitor. The doctors deny any liability, but the parties settle for $5,681,818.18 prior to trial.
- 2015, California: $3,000,000 Settlement. A female is giving birth to her son when the doctors do not realize she is failing to dilate, and fail to order to perform a timely Caesarean section. As a result, the newborn suffers from severe encephalopathy, severe mental retardation, cerebral palsy, and a speech impairment. The plaintiffs contend the doctors were negligent in their rendering of medical care and treatment during delivery, and while the defendants deny liability, and jury agrees with the plaintiffs and awards them $3,000,000.
- 2015, California: $9,852,805 Verdict. A female, with two prior pregnancies and vaginal deliveries, is pregnant and receiving prenatal care at Northeastern Rural Health Clinic and experiences no problems throughout her pregnancy. She is admitted to a hospital while in labor, and quickly dilates. The fetal monitor tracing begins to show decelerations, and the cervical dilation begins to stop. The fetal monitor strip progressively begins to show deeper decelerations, so the doctor has the mother begin to push even though she is not completely dilated. After an hour, he orders a Cesarean section. In the operating room, the fetal heart tones are lost and the doctor asks for her to be given general anesthesia. Surgery begins, and the baby is delivered. The baby is resuscitated and transferred to the Medical Center for brain cooling. He is then diagnosed with hypoxic-ischemic encephalopathy, has occasional seizures, requires 24-hour care through a home health agency, and suffers from severe cerebral palsy. The plaintiff brings suit, arguing that the standard of care requires the C-section to be ordered earlier, and this would have prevented any the injuries to the newborn. The defendants deny this, however a judge agrees with the plaintiff and awards the infant $9,852,805.
- 2015, California:$3,500,000 Settlement. A mother and father argue that the doctors at Loma Linda University Medical Center failed to provide them with a Spanish interpreter during the labor and delivery of their child. Therefore, they were not adequately informed of the circumstances of the baby's condition, the risks, and the treatment options available. As a result, the newborn suffers from spastic quadriplegic cerebral palsy, microcephaly, cortical blindness, and intellectual disability. The mother suffers emotional distress. The defendants agreed to settle this claim for a lump sum settlement of $3,500,000.
- 2015, New York: $575,000 Settlement. A mother is at St. Luke's Roosevelt Hospital, giving birth to her daughter, when the doctors fail to diagnose and treat her baby's shoulder dystocia and fetal macrosomia, and fail to estimate fetal weight. The doctors do not perform a Cesarean Section, and end up applying excessive traction to the newborns head and neck. The defendants disputed the damages, and the parties settle for $575,000.
- 2015, California:$5,530,000 Settlement. A mother is under the care of Alta Bates Summit Medical Center during the delivery of her son. She alleges the doctors mismanaged her labor and her son's delivery, and as a result, that her son suffers from severe brain damage and cerebral palsy, and that she suffers from emotional distress. A settlement agreement is executed, awarding $5,530,000.
- 2015, Idaho:$7,200,000 Settlement. A mother, in good health and without any abnormal prenatal risk factors, presents to a Nampa clinic for routine prenatal care. About five months into her pregnancy, her fundal height begins slightly lagging, and this continues happening along with weight loss. These symptoms mean that a mother is at risk for intrauterine growth restriction. However, the clinic and physicians do not order testing, they do not classify the pregnancy as being at high risk, and they do not deliver the baby. As she continues to go for checkups, lab results show a concerning level of proteinuria, but still no consult with a specialist was ordered. She goes to the hospital experiencing contractions, with severely high blood pressure, and the doctor begins the labor and delivery flowsheet that night. The doctors at the hospital do not review her history from the clinic, and are unaware of the growth problems documented there. Throughout the night, the nurse notifies the doctor of the high blood pressure and the fetal heart rate concerns, and a pattern of terminal bradycardia manifests. Even though fetal distress is on the minoring strip, and there were fetal growth problems for weeks before, the doctors do not call for an obstetrical consult for a period of time in violation of the standard of care. Eventually, an emergency cesarean section is ordered, based on the same pattern of the monitoring strip that had persisted for over two hours. After the emergency cesarean section, a full resuscitation is done and the baby is in the NICU for about a month. As a result, the baby suffers from an irreversible brain injury and cerebral palsy. The case settles for $7,200,000.
- 2015, Florida: $23,197,134 Settlement. A woman goes to Peace River Regional Medical Center, where she has been receiving prenatal care, with decreased fetal movement and high blood pressure. She is discharged the same day. Three days later, she returns, with a very high blood pressure, and gives birth to her baby. As a result of the failure to properly treat the mother's preeclampsia, the baby is born with a severe brain injury resulting in cerebral palsy. A jury awards the infant $23,187,134.
- 2015, Wisconsin: $1,400,000 Settlement. During delivery, an infant demonstrates a fetal heart rate pattern that requires immediate delivery. However, the doctors fail to recognize this and fail to perform the appropriate delivery. As a result, the infant suffers a hypoxic ischemic brain injury, cerebral palsy, and epilepsy. The parties settle for $1,400,000.
- 2014, New York: $5,000,000 Settlement. A woman goes to Mount Sinai Hospital for the birth of her daughter. The doctors fail to diagnose her intrauterine growth restriction, and do not note that she had a history of miscarriages. The doctors also do not tell her that the fetus is not growing properly. As a result, the infant suffers prematurity, growth restriction, respiratory distress, permanent hypertonic cerebral palsy, and many other disorders. The defendant denies any liability, but settles the claim for $5,000,000.
- 2014, New York: $3,065,899 Settlement. A mother is under the care of midwives during the delivery of her son. She begins showing objective signs of fetal distress such as meconium staining and non-reassuring fetal heart readings, but the mid-wives fail to convert the delivery to a Cesarean section delivery. As a result, the infant suffers spastic dyskinetic cerebral palsy as his brain was oxygen deprived and he suffered a neurologic injury during the vaginal birth. The parties agree to settle for $3,065,899.17.
- 2014, Virginia: $5,550,000 Verdict. A woman is in labor at Chesapeake Regional Medical Center when she begins to show non-reassuring fetal heart tracings. The doctors fail to take the appropriate actions, and fail to respond to pain and bleeding that occurs. The doctors do not perform an emergency Caesarean Section, and as a result, the male child suffers from hemiplegic cerebral palsy and developmental delays, which were caused by birth injuries including asphyxia and sepsis among other injuries. The jury awards the plaintiff $5,550,000, which a judge later reduces to $1,265,000 based on a statutory maximum settlement amount with the co-defendant.
- 2014, Pennsylvania: $7,000,000 Settlement. An eight-month old goes to the ER three times within ten days. Each time, he is diagnosed with either an ear infection, upper respiratory infection, or resolving fever, and given antibiotics, fever reducers, and cough medicine, and discharged. Two-days after the last visit, he returns, and he is diagnosed with sepsis and immediately transferred to the Children's Hospital where he stays for about three months. As a result of the delay in recognizing the symptoms of occult bacteremia and sepsis, he suffers from cerebral palsy, seizures, cortical blindness, and neurological dysfunction. He brings suit against the doctors and hospital, and the parties settle for $7,000,000.
- 2014, Massachusetts:$5,250,000 Confidential Settlement. A pregnant female arrives at the emergency room, complaining of extreme leg pain. The obstetrician and surgeon discharge her despite her extreme pain and abnormal lab results. 24 hours later, she comes back, as the infection is becoming more severe, and she is told she is suffering from severe sepsis. Her infant is delivered pre-term, and due to the mothers sepsis, suffers severe hypoxic brain damage and is diagnosed with cerebral palsy. They bring a claim against the physicians for medical malpractice, and the matter is resolved for $5,250,000 in a confidential settlement.
- 2014, Pennsylvania:$32,800,000 Verdict. A pregnant female goes to Phoenixville Hospital after going into labor, and is placed on a fetal heart monitor. The baby begins to suffer a heart deceleration, which becomes bradycardia. However, the nurses fail to inform the physician of this, and as a result, the infant sustains brain damage and cerebral palsy. The mother files a suit for malpractice, and while the defendant denies the accusations, the jury awards $31 million in future medical expenses, $1 million in non-economic damages, and $800,000 for lost earning capacity.
- 2012: $4,380,000 Massachusetts Settlement –Mother presents for labor and delivery and comes under the care of Defendant labor and delivery nurse and Defendant second-year resident. There are a lot of malpractice cases that come from giving residents too much responsibility. Anyway, the child is born with a profound injury to its basal ganglia and is diagnosed with cerebral palsy as a result of the neurological damage that occurred before birth. Plaintiff files suit contending that the Defendants failed to properly monitor the infant by failing to employ intrauterine measures to monitor labor. Plaintiff further contents that they were unable to realize that there were signs of fetal distress through her second stage of labor that were there to be seen. Usual defense: the child’s neurological injuries were unrelated to the care and treatment. The parties reached a confidential settlement of $4,380,000 before trial.
- 2012: $36,737,660 Florida Verdict – Plaintiff presents to a women’s center and is advised that she is 22.3 weeks into a pregnancy. Due to the gestational age and complications involved with a prior delivery of another child, Plaintiff decides to terminate the pregnancy. She is given the first injection of Cytotec, as well as one injection of RU-486. The injections occur over an 11-hour period without an examination by a physician. After failing to have completed the abortion, the Plaintiff leaves the facility. Several hours later Plaintiff presents to a medical center where a child is delivered via C-section. The child suffers from severe cerebral palsy and cannot speak, walk or take care of herself. Plaintiff files suit on her child’s behalf and contends that if she’d been seen by a doctor and given a sonogram, there was a reasonable expectation that the doctor would have determined that her fetus was viable and that abortion was no longer an option. Plaintiff contends there was no medical personnel available at the facility. Defendants argue that if Plaintiff had stayed, the abortion would have been completed. The case was initially dismissed but later reversed and reinstated in 2009. The jury awarded $18,737,660.16 in compensatory damages to the Plaintiff including $432,305.16 for past medical damages and $18,275,355 for the child’s future life care. This jury was also pretty mad, awarding an additional $18,000,000 in punitive damages.
- 2012: $21,000,000 Verdict in Maryland. A Glen Burnie, Maryland couple allege their son's doctors at Johns Hopkins should have delivered him by c-section instead of a prolonged vaginal birth that leads to oxygen deprivation and cerebral palsy. Doctors argued that ultrasounds showed no brain swelling after the birth, which is what you might expect a lack of oxygen to the brain. Thankfully, the child suffered no mental injuries but had a myriad of physical problems. Still, the jury awarded $18 million for future medical expenditures, $2 million for future lost wages, and $1 million for non-economic pain and suffering.
- 2012: $5,000,000 Settlement in Washington. A baby girl is born, limp and pale, with no respiratory effort, and a heart rate of 30. She is resuscitated and taken to the nursery for observation. Spontaneous rupture of the membranes occurred over four hours before the delivery, and the fluid was clear at that time. At 25-27 hours of life, the infant develops seizures and is transferred to a children’s hospital. Months later, the infant is eventually diagnosed with cerebral palsy and dystonic quadriplegia. Doctors at the children’s center had difficulty determining the underlying etiology of the infant’s hypoxic ischemic injury, but medical records indicate that the fetal heart monitoring strips show “good beat-to-beat variability” indicating that the injuries may have occurred before labor and delivery. The treating neurologist indicates that her injuries may have occurred during a period of delayed fetal movement earlier in the pregnancy, while other treating physicians indicate that there are multiple causes of cerebral palsy including infection, genetic disorders, trauma, and others. Plaintiffs allege that Defendants failed to identify signs of fetal distress including uterine hyperstimulation and also that Defendants lost the fetal heart tracing for the last hour and a half of labor. Defendants testify that there was no violation of the standard of care and that she did not fit the strict criteria for having sustained an intrapartum hypox ischemic injury. They claim the injury occurred before labor and delivery. After an unsuccessful mediation, the parties eventually reached a settlement one week before trial.
- 2012: $103,075,618 Verdict in New York. A woman in her 25th week of gestation presents to the hospital with complaints of a painful condition of her abdomen. Several hours later, it is determined that she was experiencing labor. Delivery is promptly performed and she gives birth to twins, concluding a difficult final state of pregnancy. Two weeks before this event, she experienced a premature rupture of her amniotic membrane, was admitted to the hospital, monitored, and prescribed rest. It is determined that one of the twins has cerebral palsy. Suit is filed. Plaintiffs allege that the infant’s cerebral palsy is the result of a failure to prevent the child’s premature delivery. Plaintiffs sue multiple entities including the medical center and the OB/GYN. Plaintiffs further claim that the resulting injury was a product of a failure to recognize the onset of labor, that the contractions were not recognized by the hospital’s staff though confirmed on the monitor’s readings. Plaintiffs additionally contend that the injury was the result of trauma that occurred during the infant’s passage through her mother’s vagina, and that the injury could have been prevented by an episiotomy or Caesarean delivery. Defendants contend that they properly managed the delivery and the prenatal period. Plaintiffs are awarded $103,075,618 broken down several ways. $17,000,000 for past pain and suffering; $60,000,000 for future pain and suffering; $247,219 for future surgeries; $1,785,161 for rehabilitation (60 years); $8,240,175 for medical equipment and other medical expenses (for 60 years); $10,022,315 for assisted living (30 years); and $5,780,449 for future lost earnings (40 years).
- More CP verdicts and settlements
As you can see by the above examples, there are so many different errors that can occur during the birth of a baby. Sometimes, it is the mom can often pick up on mistakes the doctors are making.What parents tell us about the labor and delivery process can be key. It pays to be vigilant and aware of what is going on during the pregnancy, labor and delivery. Did the doctor let the labor go on too long? Did something not feel right inside your body, but no one would listen? The earlier you start talking about these things, the more clearly you and everyone involved will remember all the little details that could make a difference in your case.
If your child's condition could have been avoided if things had been done properly, it makes sense to try to get restitution for those mistakes. Can any amount of money can ever fix the mistakes? No. But at least you may be able to get the best care, the best equipment, and the best chance to make their life as normal and happy as possible. As the years go on, more and more innovations are being developed to make life as easy as possible for these precious children, but these things always come at a very hefty -understatement of the year - price. Lawsuit help pay that price.Getting the Right Advocate
If you are concerned your child may have a birth injury, and you think a doctor could be responsible for the harm that was done, call 800-553-8082 or get a free no obligation Internet consultation.