Fla. mom awarded $10M in ambulance birth lawsuit

[Dustdevil]

Wow... very interesting case. I don't think I'll be hiring that lawyer anytime soon.

http://www.ems1.com/pediatric-care/articles/804294-Fla-mom-awarded-10M-in-ambulance-birth-lawsuit/

Fla. mom awarded $10M in ambulance birth lawsuit

Jury found the EVAC ambulance service negligent in the premature birth of boy

WESH.com

VOLUSIA COUNTY, Fla. — A jury awarded a Volusia County woman $10 million after finding the EVAC ambulance service negligent in the premature birth of a boy, now 6 years old and suffering with cerebral palsy.

Margarita Chess was just over 6 months pregnant, when, in labor, she arrived at Bert Fish Medical Center in New Smyrna Beach.

Halifax Medical Center didn't take her and instead, EVAC was called to transport Chess to Arnold Palmer Hospital in Orlando.

The baby was born in the ambulance and though paramedics did CPR, the infant was deprived of oxygen.

The hospitals and doctors settled with Chess for $1.4 million but EVAC went to trial and, according to the jury, is responsible for $8.6 million.

EVAC spokesman Mark O'Keefe said "EVAC Paramedics have to care for the tragic consequences of illness and injury everyday. We stand behind our paramedics and intend to appeal this verdict."

[Jeepluv77]

Seriously? The baby was born 4 months premature and it doesn't sound like the medics can be faulted for that. Seems to me the first hospital should be held accountable if anyone. I'd really have to see the facts in this case. However, notice the one that went to court to defend themselves is the one that got screwed? I'm sorry, but the litigous nature of this society really needs to be put in check at some point. It's tragic that her child has cerebral palsy and my heart goes out to her. However, that's unfortunately a common occurance with extreme prematurity even when delivered in ideal conditions. This is exactly why a lot of areas are having trouble keeping enough doctors/nurses to keep patient load managable. It's nearly impossible to find a high-risk ob/gyn here now because of lawsuits like this.

[paraloco]

See kids, you really need to listen to the voice in your head that says don't transfer an unstable patient. You may get a lot of grief/retaliation from your supervisor. Might even get fired when the ER director calls your company's owner. There are other EMS jobs down the road. The crew could have insisted a neonate nurse and a respiratory therapist accompany them. Maybe they were a young crew, just glad to be there. It's not worth it.

[VentMedic]

The baby was at a hospital which offered a more stable environment for the birth than the back of an ambulance even if the hospital staff were not comfortable with it. As a hospital, they are still required to have a code cart with the necessary equipment and staff with at least the basic NRP cert as well as some expertise in their professions.

The mother was in labor with a preterm infant. You have two patients with the potential need to resuscitate both of them depending on the cause of the preterm labor. The Paramedic knew this was a 25 week preterm infant about to be born and even in ideal situations that is a sick baby which requires special care. Just a little knowledge of NRP is not enough for the acceptance of this patient.

Preparation for the birth of the infant must be given consideration for a 60 mile trip by ambulance or any mode of transportation. You are leaving a hospital that at least provides some of the necessary equipment and staff.

The American Academy of Pediatrics has guidelines that suggests stabilization and transport should be done by a specialized team. In this area there are at least 2 teams that have OB/Neonatal teams who can also get access to a helicopter if needed and could probably reach the referring hospital in the same time it would take the ground ambulance to have been called and run real fast to Orlando. The specialty physicians at the receiving hospital who are involved with the transport teams can generally talk even the most freaked out general practice doctor in an ED or tiny ICU through some emergent steps to stabilize the mother and baby until the team arrives.

However, the details concerning how much conversation was done with the hospital in Orlando are sketchy or if they were given a chance to send their team by EVAC already starting to roll. I believe the other hospital, Halifax, which was the first destination is still just a Level 2 NICU.

AAP website with some good information:

http://www.aap.org/

In this situation the mother and baby ended up at another little general hospital emergently because the ambulance diverted and the Children's hospital still had to come for the baby.

The sending physician(s) should not have been the one making the decision as to what was best for this patient and her soon to be born baby for transport. The physician(s) may not have known the abilities of the Paramedics or were led to believe transport was no problem either due to greed, ego or lack of adequate training/education/experience to where they didn't know how little they know.

Diesel can not be relied on to treat a preterm baby especially when you are accepting a known situation and taking a patient from what might already be a more stable environment. This is where lack of adequate education/training/experience will allow emotions to take over and poor judgement may come to play. This may also make for a very unsafe transport for the crew, patient, baby and the public with the use of L&S for 60 miles. And you know the legal ambulance speed may not be adhered to.

Even some Flight and CCT transports must be aborted at the sending facility due to lack of appropriate equipment or expertise as well as a very unstable patient and no means to stabilize them for a safer transport. Neonatal/Pedi Specialty teams may spend hours at the sending facility doing what they would do in their own ICU with their protocols and guidelines to stabilize the baby before transport. They are in no hurry to move unless surgical intervention is needed because they are the higher level of care with the equipment and expertise. But, even for the cardiac babies that will require surgery, they will not go to the OR until certain other problems are stabilized.

Here is the rewrite for the Florida statutes that was initiated after this incident. The accepting physician with specialty expertise will now determine how to transport and not the sending physician who just wants the patient to go some place fast or an overly eager ambulance service and crew.

http://www.doh.state.fl.us/DEMO/EMS/RulesStatutes/RulesPDFS/NoticeChangePublishedFAW12112009.pdf

This may have also come about from some of the several other incidents with poor outcomes due to a scoop and run mentality that is practiced by some ALS/CCT and even Flight teams which are not all created equal. In EMS some are quick to criticize the EMT-B who does not call for an ALS intercept but then these same people will accept a CCT to where even as a Paramedic they are little more than an EMT-B when it comes to the level of expertise and skills required to move that patient safely from point A to point B.

This situation is also not much different than the scenario thread, "Threw up and can`t breathe", DartmouthDave started with the unstable airway.

Disclaimer: I have no direct involvement in this particular case but it has initiated several conversations and changes in Florida as well as the OB/Neo/Pedi medical professions. The AAP has also been taking notes but then this is the type of situation they have tried to prevent from occurring for many years.

Edited April 7, 2010 by VentMedic

[akflightmedic]

I have nothing to add other than excellent post Vent.

[VentMedic]

For those of you who may not be familiar with what goes into one of these lawsuit cases, here is the court case number:

Case Number: 2004 30861 CICI

Court: Circuit Court, Volusia County, Florida

http://www.clerk.org/menu/index.jsp

Go to: Public Records > Case Inquiry

[Dustdevil]

JEMS article about this suit, with commentary by JEMS Editor-in-Chief.

http://www.jems.com:80/news_and_articles/news/2010/04/jems_editor_in_chief_aj_heightman_comments_on_this_case_and_the_jury_award.html

[VentMedic]

JEMS article about this suit, with commentary by JEMS Editor-in-Chief.

http://www.jems.com:80/news_and_articles/news/2010/04/jems_editor_in_chief_aj_heightman_comments_on_this_case_and_the_jury_award.html

That article gave in detail examples of points I was trying to make in my earlier post although I don't believe the author sees it the same as I do.

Highlights:

Known high risk at 25 weeks gestation.

Contractions at 4 minutes apart.

Ground transport of over 60 miles.

1 Paramedic. (article only mentions one Paramedic being honored by EVAC for a good job)

Must consider both the mother and the baby to be patients and SICK.

No fetal monitor mentioned for a 60+ mile transport.

Only a silver swaddler with a known possibility of a 25 week preemie being born.

8 minutes of CPR without ETI or a missed tube since the baby "gave a weak cry". NRP is clear about ETI and prolonged resuscitation on a neonate. CPR

Had to divert to another little hospital.

This was an IFT...not an emergency from field.

The patient was at a hospital which is still capable of delivering a baby which can then have a neonatal specialty team transport.

The sending hospital should have weighed the risks of sending this patient without more transport preparation. That can be considered an EMTALA violation. Fish Hospital must have realized they mucked up and settled.

One would hope the Paramedic had voiced concerns but sometimes when babies and children are involved, people tend to let their emotions lead them rather than good medical practice.

Some must also realize the limitations of NRP just like those who take ACLS and expect to be proficient at intubation and resuscitation. Also, when asked can you as a Paramedic intubate a neonate, most will reply yes because it is in their state's scope of practice and they may have a protocol for it. However, that does not necessary mean YOU can intubate if you have never attempted it on a human baby.

Considering the distance, the birthing and the resuscitation, this was a transport that could have had an even worse outcome for all involved with an emotional and stressful L&S emergency run.

This would also be a good case review to have with your medical director which might get you more education for babies, peds and the many new technology dependent patients such as those with LVADs, various vascular access devices and ventilators. Some good things can come out of situations like this if the opportunity is taken to learn something. Of course as I mentioned earlier Florida has rewritten its IFT neonatal transport statute which some in EMS have criticized because it increases the requirements of the transporting Paramedic who must also have a neonatal nurse accompanying the baby.

[Dustdevil]

That article gave in detail examples of points I was trying to make in my earlier post although I don't believe the author sees it the same as I do.

It's pretty rare that I see things as he does, so I wouldn't worry about it.

[JPINFV]

Even some Flight and CCT transports must be aborted at the sending facility due to lack of appropriate equipment or expertise as well as a very unstable patient and no means to stabilize them for a safer transport. Neonatal/Pedi Specialty teams may spend hours at the sending facility doing what they would do in their own ICU with their protocols and guidelines to stabilize the baby before transport. They are in no hurry to move unless surgical intervention is needed because they are the higher level of care with the equipment and expertise. But, even for the cardiac babies that will require surgery, they will not go to the OR until certain other problems are stabilized.

Serious question. What sort of expertise and equipment can be expected to be found at a community hospital that doesn't even offer OB services? While I have questions regarding destination and transport choices (for example, Medical Center of Daytona has NICU capabilities and is only 17 miles and a few turns away. I'd argue that any NICU is better than an emergency room at a hospital with zero L&D services past a physician whose last uncomplicated delivery was God knows when), I also have serious questions as to just how much better a community ED is especially if the possibility exists that the transport can be completed prior to delivery.

As far as the verdict, all the jury needs to hear is "injured baby" and you get your checkbook out. There's a reason why OB/Gyn has enormous malpractice insurance premiums, and I refuse to believe that OB/Gyn is just filled with idiots who don't know how to practice. Of course malpractice suits often have more to do with outcome than actual malpractice.