A woman receives prenatal care at about 26 weeks gestation at the Family Health and Birth Center (a non-profit in D.C. that is not named as a defendant).
One day, while she is in Columbia, Maryland, she begins to feel contractions. She is planning to drive to Baltimore to go to Johns Hopkins Hospital for an evaluation, due to its "Premier Academic Medical Center." She then remembers that Howard County General Hospital is affiliated with Johns Hopkins, so later that day she is taken via ambulance to Howard County General Hospital (HCGH).
She arrives at HCGH with labor pain and contractions. Shortly after her arrival, she is triaged into the labor and delivery unit. Fetal heart monitoring begins. She is examined and is 2-3 centimeters dilated and 90% effaced. She is evaluated by a doctor wearing a white coat with the Johns Hopkins Medicine logo, so she believes she is receiving care from a Hopkins' health provider.
The medical records reveal that she was in the category of Category II fetal tracing. She has an ultrasound, which notes fetal breathing but no movement. Additionally, her amniotic fluid index suggests a lack of amniotic fluid. The fetal heart rate begins to drop shortly after she arrives at the hospital, and has periods of minimal and absent variability. This means the heart rate is remaining steady which, counterintuitively, is not a good thing. Persistent minimal or absent heart rate variability is a major sign of fetal compromise.
The external fetal tracing is discontinued, and the plan is for an abdominal delivery. Once she is transferred to the operating room sixteen minutes later, she receives anesthesia and a spinal epidural. Half an hour later, her son, plaintiff, is born via cesarean section. He was born "meconium stained, limp, and apneic" with a heart rate of fewer than 100 beats per minute. He is intubated. His color and tone gradually improve after about five minutes. He continues to have irregular respirations and is transferred to the newborn nursery. Shortly after, he is vomiting and is dusky.
A neonatologist is called to evaluate plaintiff, and he is transferred to the NICU for an evaluation of cyanosis and respiratory distress. His first arterial blood gas is taken two hours after his birth and is consistent with metabolic acidosis. He is treated for sepsis, respiratory distress, hypoglycemia, and metabolic acidosis. However, he is not diagnosed with hypoxic-ischemic encephalopathy. He is noted to have an abnormal posturing of his right arm, consistent with neonatal seizures.
An EEG reveals frequent electrographic seizures from several brain areas. A full sepsis workup is done, including spinal fluid and blood cultures. The hospital plans to transfer him to Johns Hopkins with nitric oxide during transport.
Despite clinical indications of a hypoxic-ischemic event, plaintiff does not receive any form of therapeutic hypothermia while at HCGH. He stays at Johns Hopkins for seventeen days, where he is diagnosed with hypoxic-ischemic encephalopathy, seizure disorder, and persistent pulmonary hypertensions.
Plaintiff suffers from brain damage and cerebral palsy as a result of suffering hypoxic-ischemic encephalopathy near the time of his birth.
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