Gorovitz & Borten, P.C.
Attorneys at Law

550 Cochituate Road, Suite 25
Framingham, Massachusetts
01701
Tel: (781) 890-9095
Maternal-Fetal - Death
In May 1997, the plaintiff's decedent, 34 years old, was then 31
weeks pregnant with her first child. On the morning of May 14, the
plaintiff's decedent contacted the office of her primary obstetrician
to report an elevated temperature of 104.9 F by tympanic
thermometer. She was advised by a nurse practitioner to take two
extra strength Tylenol and come to the office for an evaluation.  
The plaintiff's decedent presented to the office during the morning
hours and was seen only by a nurse practitioner. Following the
evaluation, the nurse practitioner made an assessment of "viral
versus urinary tract infection, check urine." She was then
discharged with instruction to take Tylenol every four hours, drink
fluids and rest. Although a prescription was given for an antibiotic,
the decedent reportedly was told not to fill the prescription until she
was contacted with results of urine culture. No bloods were drawn.

At approximately 3:30 p.m., the decedent called the office and
advised that she was still feeling sick, had a temperature of 101.7 F
and asked whether she should fill the prescription. The return
phone call was made by a student nurse practitioner, unsupervised,
and decedent was advised not to fill the antibiotic prescription, to
continue with the Tylenol, and call if symptoms persisted. This
information was reported to the nurse practitioner and placed in the
medical record, but the nurse practitioner made no follow-up call to
decedent and did not report these signs and symptoms to the
decedent's primary obstetrician (who was available) or the covering
obstetrician (also available), nor was the decedent referred to the
hospital.

During that evening, the plaintiff's decedent still felt nauseous, had
diminished appetite and was tired. She contacted her primary
obstetrician's office at approximately 9:30 p.m., and reported
continuing temperature and low pelvic pressure. She was advised
by the covering physician for the practice to report to Labor and
Delivery where she would be met by the covering physician.

At 10:54 p.m., the plaintiff's decedent presented to Labor and
Delivery where she was evaluated as a patient admitted with viral
syndromes and question of urinary tract infection. Temperature was
recorded shortly later at 102.6 F, together with paleness, and
absence of fetal movement since 9 p.m. The covering physician was
notified at 11:40 p.m. and arrived at approximately 12:20 a.m. on
May 15, 1997. Shortly thereafter a determination was made of an
intrauterine fetal death of the baby.  

By 3 a.m. on May 15, 1997, the plaintiff's decedent had received an
epidural anesthesia and the covering obstetrician performed an
artificial rupture of membranes, in which bloody stained amniotic
fluid was evident. Up to this time, although ordered during the
admission process, no blood work had yet been performed. Further,
no baseline laboratory studies were performed even though the
decedent presented with an admission temperature of 102.6 F
(despite several ingestions of Tylenol), up from the 101.7 reported
at 4 p.m. the preceding afternoon, and presenting symptoms
consistent with an incipient infectious process. The plaintiff's
decedent also showed signs and symptoms of hypotension,
tachycardia and elevated fever, which were consistent with signs
and symptoms of sepsis.

Taken together with the already reported intrauterine fetal death,
bloody stained amniotic fluid following the artificial rupture of
membranes and uterine irritability, the classic signs were present
and consistent with an assessment of a concomitant abruptio
placenta. The blood work, which had been ordered shortly after the
decedent's admission, was finally obtained at approximately 5:30
a.m. on May 15. The results showed a dangerously low 67,000
platelet count, which, if reported earlier and reviewed by the
covering physician, would have mandated a further work-up
regarding the decedent's coagulation abnormality.

Ongoing nursing notes also showed that Plaintiff's decedent was
exhibiting restlessness, confusion, disorientation, shaking, cold to
touch, cyanotic skin condition and deteriorating mental status. The
medical record also showed no evidence that the covering physician
did examine or evaluate the plaintiff's decedent for a critical period
of 3 1/2 hours following the artificial rupture of membranes. Further,
at 4:45 a.m., the covering physician reportedly ordered aspirin to
address an elevated temperature, but without having examined or
evaluated the patient in person, and not having the benefit of any
blood work. Also, the assigned nurse reportedly did not inform the
attending physician of the full scope of the patient's rapidly
deteriorating, medical condition, nor did she request an examination
by another physician.  

The deceased fetus was delivered at approximately 6:47 a.m. on
May 15, 1997, accompanied by dark red bleeding and a foul odor.
At 7:07 a.m., the plaintiff's decedent arrested and a code was
called. She was transferred to ICU where she suffered multiple
organ failure including liver, kidney and lungs, with fulminant DIC
(disseminated intravascular coagulation) and streptococcal toxemia.
She died at 7 p.m. on May 15, never regaining consciousness.

The plaintiff was prepared to show that the multiple deviations from
the standard of care by the nurse practitioner and the OB-GYN
practice contributed to the unnecessary and preventable death of
the child. The plaintiff was also prepared to show that the multiple
deviations from the standard of care by the hospital nurse and the
covering physician contributed to the unnecessary and preventable
maternal death. The plaintiff further was prepared to present expert
testimony regarding the multiple deviations from the standard of
care, and to their direct causal relationship in the deaths of the
31-week-old fetus and the decedent mother.

The defendants denied any wrongdoing or that any of their care
and treatment represented a deviation from the standard of care.

The trial court judge allowed one full day of mediation to take place
the day prior to the start of trial. The matter settled at mediation for
$ 2,500,000.00 with  a structured settlement valued at $
6,440,000.00.
Contact Information
If you, your child or a member of your family have been injured as a
result of receiving substandard obstetrical care, deficient medical
treatment or failure to be properly treated, please let
Dr. Borten and
our Boston area medical malpractice attorneys at Gorovitz & Borten
evaluate your case.
For a free confidential consultation and receive a response within 24
hours (when possible), please contact us by phone, fax or e-mail
with your question or concern.

Telephone:  781-890-9095     -     Fax:   781-890-9098
                                                                       
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