Peter Spataro and Bryce Pfalzgraf obtained a defense verdict for their physician and obstetric practice clients in a medical-negligence/wrongful death jury trial in St. Louis County. The case involved the death of a mother and birth-related injuries of her child. The plaintiffs’ original demand of $4 million was reduced to $2 million after learning of the insurance policy limits and were again reduced to $1.5 million during trial. The plaintiffs asked for more than $12 million from the jury.
The mother, a Jehovah’s Witness, received prenatal care from the defendant physician. She informed him her faith would not allow her to accept blood products, including autologous blood transfusions and/or reinfusion using cell-saver technology. She was prescribed iron supplements to raise her hemoglobin levels in case of a blood-loss event. The patient developed placenta previa, and the fetus was noted in the breech position early in the pregnancy, both of which could have indicated a Cesarean-section delivery. Both conditions resolved prior to labor, allowing the mother to proceed with vaginal delivery.
When the mother was six days past her due date, the defendant physician recommended induction of labor. She reiterated and signed several hospital forms confirming her refusal to accept blood products of any kind. She received medication to ripen her cervix and Pitocin infusion to induce contractions. Over the course of labor, variable decelerations and a brief period of fetal tachycardia were noted on the electronic fetal heart monitor. These were almost always in the presence of moderate beat-to-beat variability, a reassuring sign of fetal well-being. Actions were taken to alleviate the decelerations and tachycardia including the use of amnioinfusion, positional changes, and intermittent lowering or stopping of the Pitocin infusion. The baby was presenting in the occiput posterior, or facing up, which can make head descent into the birth canal more difficult. The defendant physician was hopeful the baby would change positions during decent which often occurs, allowing for the head to descend into a position for vaginal delivery. After a trial of pushing, the patient was placed in a knee-chest position in order to alleviate noted variable decelerations and to allow her to stop rest and promote rotation of the baby to occiput anterior position. Following repositioning, the electronic fetal heart tracing was reassuring for fetal stability with good beat-to-beat variability.
After approximately 45 minutes, the patient suddenly complained of severe fundal (lower abdominal) pain, and bright-red blood was noted on her hospital gown. The fetal heart rate, for the first time in her labor, dropped to a sustained bradycardia with around 60 beats per minute and rapid, repetitive maternal contractions were noted. The defendant physician promptly diagnosed a placental abruption. For the baby, the abruption prevented the delivery of oxygenated blood through the umbilical cord/placenta. The change in condition required an emergency C-section delivery. The baby was promptly delivered and handed over to the pediatric team for emergent resuscitation and was transferred to St. Louis Children’s Hospital to receive hypothermic cooling due to suspected hypoxic ischemic encephalopathy.
The mother’s blood loss was initially estimated at 1200 ml. However, at the conclusion of the surgery, when she was lifted off the operating room table, an additional 1000 ml of blood loss was noted on the sheet under where she was positioned for the surgery. The uterus also unexpectedly expelled an additional 800 ml of blood, raising the total blood loss volume to 3,000 ml, an amount over half of her total blood volume. The defendant physician took steps to control the blood loss with administration of medications and placement of a device to tamponade the uterine bleeding. While still conscious, with her husband at her side, the mother was told she could die without a blood transfusion. She reaffirmed her refusal of blood products.
In the ICU, the mother was administered multiple medications and treatments to address her blood loss, including cryoprecipitate and an experimental bovine blood product obtained on a compassionate-use basis. Unfortunately, the patient succumbed to end-organ failure and died a week later.
The baby’s condition improved, but she was eventually diagnosed with cerebral palsy affecting her gait and fine motor function. Her speech is also somewhat impaired but cognitive brain function is intact.
Plaintiff’s sole standard of care and causation obstetrician expert was critical of the defendant physician for not performing a C-section earlier. He testified there was a hostile uterine environment evidenced by concerning electronic fetal monitor readings and failure of the labor to progress. These criticisms were also supported by plaintiff’s nursing expert who criticized the nursing care. The obstetrician expert also criticized the defendant physician for failing to perform an emergent hysterectomy once the 3000 ml of blood loss was calculated at the conclusion of the C-section surgery, which he felt would have prevented the patient’s death. He was also critical of the planning and preparation for labor and delivery, including failure to research or otherwise recommend alternative blood products such as Hemopure given the patient’s refusal to accept blood products.
The defendant physician and his experts testified his treatment before and during labor/delivery met the standard of care. They testified no other planning or preparation, such as use of the non-FDA-approved blood products, was warranted. Second, they stressed the electronic fetal monitor strips, in conjunction with labor progression, did not necessitate an earlier C-section. They noted first-time mothers often take longer to deliver and, while the mother and baby are stable, labor can proceed. However, the placental abruption, which was neither foreseeable nor preventable, caused a sudden loss of oxygen to the baby, requiring the emergency delivery. Finally, the defendant and his experts testified he correctly withheld performing a hysterectomy as she would have likely not survived the additional surgery. They based this opinion on the already significant blood loss and because blood tests revealed she developed disseminated intravascular coagulopathy, a condition interrupting the blood’s ability to clot. The only treatment that could have saved her life could not be administered due to her refusal to accept blood transfusions.
Plaintiffs presented evidence demonstrating the functional disabilities of the child. The father claimed her cerebral palsy necessitated significant accommodations and future care as detailed by his experts and an extensive life care plan. He also claimed she would experience vocational impairments and lost income. In contrast, defendants contended that while the child had certain limitations, they were not nearly to the degree claimed by plaintiff’s experts as she was compensating well with therapy interventions. Defendants presented evidence that she did not require the extent of accommodations or future care needs as claimed.
The three-week trial concluded with a verdict in favor of the defendant physician and obstetric practice on January 28, 2025, after approximately six hours of deliberation. The jury also returned a verdict in favor of co-defendant Missouri Baptist Medical Center for the treatment provided by its obstetric nurse. However, plaintiff was awarded a separate verdict, only against Missouri Baptist Medical Center, referable to its failure to timely provide medical records upon request, per R.S.Mo. §191.227 of the Missouri statutes.