IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF TEXAS

FORT WORTH DIVISION

Chasity Congious, by and through )

her Guardian, Kimberly Hammond, )

on behalf of herself and as Mother and )

Next Friend of Z.C.H., Deceased, )

)

Plaintiff, )

)

v. ) Case No. 4:22-cv-00092-O 

)

City of Fort Worth, et al., )

)

Defendants. )

APPENDIX IN SUPPORT OF 

PLAINTIFF’S MOTION FOR RELIEF FROM JUDGMENT

Dated: April 2, 2024 Respectfully submitted,

/s/ Jarrett Adams

Jarrett Adams, Esq.

LAW OFFICES OF JARRETT ADAMS, PLLC

40 Fulton St., Floor 28

New York, New York 10038

T: 646.880.9707

F: 646.880.9707

E: JAdams@JarrettAdamsLaw.com

Attorney for Plaintiff

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TABLE OF CONTENTS

Declaration of Jarrett Adams..............................................................................3

Email to Defendant Dr. Aaron Ivy Shaw...............................................................5

Expert Report of David A. Gutman, M.D., M.B.A....................................................9

Synopsis and Timeline of Events........................................................................15

Certificate of Service.......................................................................................16

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IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF TEXAS

FORT WORTH DIVISION

Chasity Congious, by and through )

her Guardian, Kimberly Hammond, )

on behalf of herself and as Mother and )

Next Friend of Z.C.H., Deceased, )

)

Plaintiff, )

)

v. ) Case No. 4:22-cv-00092-O 

)

City of Fort Worth, et al., )

)

Defendants. )

DECLARATION OF JARRETT ADAMS IN SUPPORT OF 

PLAINTIFF’S MOTION FOR RELIEF FROM JUDGMENT

1. I am one of the attorneys for Plaintiff in the above-captioned case.

2. I make this declaration in support of Plaintiff’s motion for relief from

judgment.

3. In December 2023, Defendant Tarrant County produced an email received

by Defendant Dr. Aaron Ivy Shaw on May 17, 2020 at 7:29 AM.

Pursuant to Title 28, United States Code Section 1746, I declare under penalty of 

perjury that the foregoing is true and correct. 

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Dated: April 2, 2024 Respectfully submitted,

/s/ Jarrett Adams

Jarrett Adams, Esq.

LAW OFFICES OF JARRETT ADAMS, PLLC

40 Fulton St., Floor 28

New York, New York 10038

T: 646.880.9707

F: 646.880.9707

E: JAdams@JarrettAdamsLaw.com

Attorney for Plaintiff

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7
8
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12/12/2023

Attn: Jeffrey Patza, Esq

Jarrett Adams Law

40 Fulton Street, Floor 28

New York, NY, 10038

Dear Mr. Patza,

Thank you for giving me the opportunity to review the medical records of Ms. Chasity Ahliacha 

Congious and her infant, Z.C.H. All the opinions I will be giving are presented to a reasonable 

degree of medical certainty.

My rank is associate professor of anesthesiology, and my primary employment is at the Medical 

University of South Carolina (MUSC) within the Department of Anesthesia and Perioperative 

Medicine. I have been a board-certified anesthesiologist since 2016. My subspecialty training is 

in obstetrical anesthesiology, for which I completed an additional year of fellowship training on 

top of the standard anesthesiology residency. 

I spend approximately 35 percent of my clinical time covering obstetrical anesthesia cases and 

65 percent of my clinical time doing non-obstetrical surgeries and procedures. I am an academic 

anesthesiologist, and I perform my own cases as well as medically direct anesthesia residents, 

medical students, student nurse anesthetists, and certified registered nurse anesthetists (CRNAs). 

My clinical experience with the subject matter of this case is broad. I routinely cover labor and 

delivery as part of my full-time clinical practice. This includes providing IV medication, inhaled 

nitrous oxide, and neuraxial procedures, such as epidurals in order to treat labor pain. Over the 

past 5 years, I have been directly involved with providing various forms of pain management to

over 3,380 laboring mothers 

I have been involved in many of the evaluations, procedures, and interventions that are at issue in 

this case. I care for patients from the time treatment decisions are made until they fully recover 

from their procedures and anesthetics. This starts well before the actual procedure, during the 

pre-operative evaluation stage. During this stage, I ensure that a proper history is taken, a 

physical exam is performed, the risks and benefits are explained to the patient, consent is 

obtained, an intra-operative plan is crafted, the plan is agreed upon, and the correct precautions 

are taken before proceeding with the operation or procedure. 

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In addition, I also plan for any anticipated complication associated with each patient that may 

arise during the procedure. My preparation may be related to, but is not limited to, airway 

management, pain management, intravenous access, anesthetic reactions, use of vasopressors, 

hemodynamic instability, invasive monitors, massive transfusion protocols, the need to escalate 

care, and aspiration precautions. 

I understand not only what the standard of care requires but also what is likely to occur if the 

standard of care is not met. Having provided anesthesia for many patients like Ms. Congious, I 

understand the principles of labor pain management very well. Anesthesiologists like myself are 

the party who are primarily tasked with treating and managing labor pain. To a reasonable 

degree of medical certainty, Ms. Congious experienced pain while laboring and delivering baby 

Z.C.H. on May 17th, 2020. Therefore, based on my education, training, experience, and active

clinical practice, I am qualified to render the opinions in this report.

In reviewing this case, I was presented with the following records (total: 4 records / 6858 pages):

1) Cook Children's Medical Records for Z.C.H on May 17, 2020 (33 pages)

2) JPS Medical Records for Chasity Congious from May 17-20, 2023 (87 pages)

3) Memo from TCJ Corporal Trostman to TCJ Captain Richardson, dated May 17, 2020 (1

page)

4) Email_2020-0517 Daily JPS Report_Redacted (3 pages)

According to The American College of Obstetricians and Gynecologists (ACOG)1:

“Labor causes severe pain for many women. There is no other circumstance in 

which it is considered acceptable for an individual to experience untreated severe 

pain that is amenable to safe intervention while the individual is under a 

physician's care. Many women desire pain management during labor and delivery, 

and there are many medical indications for analgesia and anesthesia during labor 

and delivery. In the absence of a medical contraindication, maternal request is a 

sufficient medical indication for pain relief during labor. A woman who requests 

epidural analgesia during labor should not be deprived of this service based on the 

status of her health insurance. Third-party payers that provide reimbursement for 

obstetric services should not deny reimbursement for labor analgesia because of 

an absence of “other medical indications.” Anesthesia services should be 

available to provide labor analgesia and surgical anesthesia in all hospitals that 

offer maternal care (levels I–IV).”

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Vaginal deliveries following labor are divided into 3 separate stages:

1) Stage 1: Onset of true labor through full cervical dilation (10cm)

a. Latent (early) labor: 0 – 6 cm

i. Contractions every 5-10 minutes

b. Active labor: 6 – 8 cm

i. Contractions every 3-5 minutes

c. Transitional phase labor: 6 – 10 cm

i. Contractions every 2-3 minutes

2) Stage 2: Full cervical dilation (10cm) until birth of baby

i. Contractions every 2-3 minutes

3) Stage 3: Delivery of baby until delivery of placenta

Different nerves are involved in pain transmission as the labor progresses through stages 1-3. 

Stage 1 labor pain is described as visceral, ranging from the T10-L1 nerves, and is dull and 

colicky in nature. It radiates to the abdomen and lower back regions and is cyclical, manifesting 

and abating with each contraction, which lasts between 20-60 seconds.

Stage 2 labor pain is described as somatic, ranging from the S2-S4 nerves, and is sharper and 

more localized. It correlates to perineal stretching as the baby moves down the vaginal canal.

Labor pain is very complicated. The experience of pain during labor is “the result of complex 

processing of multiple physiologic and psychosocial factors on a woman’s individual 

interpretation of nociceptive labor stimuli.2” This is a very sophisticated way of stating that labor 

pain hurts. 

Severe pain, as during unmedicated labor, can result in a neuroendocrine stress response that 

results in profound deleterious effects on multiple maternal organ systems.

“For most women, childbirth is associated with very severe pain, often exceeding 

all expectations. It is now well established that uterine contraction pain evokes a 

generalized neuroendocrinal stress response producing widespread physiological 

effects during the first stage of labor. They include increased oxygen 

consumption, hyperventilation, and respiratory alkalosis; increased cardiac output, 

systemic peripheral resistance and blood pressure; delayed gastric emptying; 

impaired uterine contractility and diminished uterine perfusion; and medical 

acidosis.3” 

Lastly, there is also a psychological toll. 

“The pain of childbirth is arguably the most severe pain most women will endure 

in their lifetimes. Severe, poorly controlled labor pain can also result in long-term 

consequences, such as increased risk of postpartum depression, post-traumatic 

stress disorder, and increased severity of postpartum pain.4”

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Anybody who has spent any time in the labor and delivery ward at a hospital can attest to the fact 

that the mothers are in pain. For this reason, anesthesiologists are frequently consulted to 

provide labor analgesia. This may take many forms and the gold standard of labor pain 

management is an epidural.

In reviewing Ms. Congious’s records, it is overwhelmingly likely that she experienced profound 

pain and suffering while laboring alone in her jail cell. Her delivery was unmedicated, 

unwitnessed, and unknown before it was incidentally discovered. The inability to articulate pain 

should not be confused with not feeling pain. Ms. Congious experienced pain while laboring and 

when delivering baby Z.C.H. 

The care of Ms. Congious from 05/16/2020 – 05/17/2020 is summarized below:

Ms. Chasity Ahliacha Congious was a 22-year-old woman when she 

was taken to John Peter Smith Hospital on 05/17/2020 following a precipitous delivery in her jail 

cell. Her past medical history included intellectual disability, substance abuse, depression, 

anxiety, bipolar disorder, and schizophrenia. She had no prior surgeries and had no known drug 

allergies. She was an inmate at Tarrant County Corrections Center and was 37 weeks + 4 days 

pregnant.

According to the daily report sent out on 5/17/2020 at 7:29 am, Ms. Congious refused breakfast 

and was “c/o abd cramps [complaining of abdominal cramps].” To a reasonable degree of 

medical certainty, those cramps were uterine contractions from Ms. Congious being in labor.

According to a memo from Corporal Trostman, she responded to an inmate medical emergency 

on 5/17/2020 at 09:07. “A small bundle still wrapped inside uniform pants” was discovered. 

This bundle was baby Z.C.H. Aid was administered to Z.C.H. and Ms. Congious. Considering 

the close temporal proximity to Ms. Congious’s abdominal cramps, documented at 07:29, this 

further bolsters the assertion that to a reasonable degree of medical certainty, that Ms. Congious 

was in labor and delivered 4.27 pound Z.C.H. sometime between 7 am and 9 am on 5/17/2020.

Ms. Congious was then transferred to John Peter Smith Hospital. She was found to have a 3(A)

degree perineal laceration, suffered during her unwitnessed delivery. The 3(A) laceration 

involves a tear of “less than 50% of the anal sphincter.” This was repaired with “20cc Lidocaine 

injected for anesthesia.” Of note, 3rd-degree perineal tears are associated with breakdown, 

infection, and symptoms of pelvic floor dysfunction such as incontinence and rectal prolapse.5

The care of baby Z.C.H. on 05/17/2020 is summarized below:

Z.C.H was delivered precipitously on 5/17/2020 by her mother Ms. Chasity Ahliacha Congious

“in her pants” 30 minutes before presenting to the emergency department at 10:04 am. She was

pulseless and in cardiac arrest. Bag-mask ventilation was ongoing and chest compressions were

being performed upon arrival. Z.C.H. was found to be in pulseless electrical activity and

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required multiple rounds of Pediatric Advanced Life Support (PALS) before return of 

spontaneous circulation.

The time of delivery for Z.C.H. was unknown, but Z.C.H was described as being found 

alongside the placenta in her mother’s pants. It is unclear what care was rendered to Z.C.H. 

upon being discovered. The standard resuscitative practices would be to warm, dry, and 

stimulate the newborn while performing Apgar scoring and monitoring their respirations. It is 

unlikely that this was done at the jail. 

Ultimately, upon being resuscitated at the hospital, Z.C.H.’s arterial blood gas demonstrated a 

pH of less than 6.97, and the standing diagnoses were “cardiopulmonary arrest in newborn” and 

“hypoxic-ischemic encephalopathy.” The prognosis was grave. 

Summary

Ms. Chasity Ahliacha Congious delivered baby Z.C.H on 05/17/2020, alone, in her jail cell. 

Ms. Chasity Ahliacha Congious experienced both physical and psychological pain and suffering 

by having an unmedicated, unsupported, and unwitnessed birth. 

Z.C.H. suffered distress at not being resuscitated after being born and this was followed by pain

and suffering upon going into cardiac arrest, requiring chest compressions and pediatric

advanced life support.

It is my opinion, within a reasonable degree of medical certainty, that had Ms. Chasity Ahliacha 

Congious received appropriate and standard obstetrical medical treatment, she would not have 

suffered as she did and the outcomes for Z.C.H. would have been different.

This report is being produced after reviewing the medical records of Ms. Chasity Ahliacha 

Congious and Z.C.H. at John Peter Smith Hospital, Tarrant County Corrections Center, and 

Cook Children’s Medical Center.

I hold these opinions to a reasonable degree of medical certainty. In reviewing the records, I have 

ruled out other plausible causes to a reasonable degree of medical certainty. It is not intended to 

comprehensively set forth all opinions that I may hold regarding the medical care and treatment 

of Ms. Chasity Ahliacha Congious and Z.C.H. My opinions are, therefore, expressly preliminary 

in nature. I reserve the right to revise, modify, and/or expand on the opinions set forth in this 

report. 

Thank you, 

David A. Gutman, MD, MBA, FASA

Associate Professor of Anesthesiology

Charleston, South Carolina, 29403

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References: 

1) ACOG Practice Bulletin No. 209. Obstetrics & Gynecology. 2019; 133(3).

2) Lowe NK. The nature of labor pain. American Journal Obstetrics and Gynecology. 2002

May; 186(5 Suppl Nature):S16-24.

3) Brownridge P. The nature and consequences of childbirth pain. European Journal

Obstetrics Gynecology and Reproductive Biology. 1995 May;59 Suppl:S9-15

4) Wong CA. Advances in labor analgesia. Int J Womens Health. 2010 Aug 9;1:139-54.

5) ACOG Practice Bulletin No. 165. Obstetrics & Gynecology. 2016; 128(1).

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CERTIFICATE OF SERVICE

I hereby certify that on April 2, 2024, I electronically filed the foregoing pleading 

with the United States District Court for the Northern District of Texas using the 

CM/ECF system, which will automatically serve a true and complete copy upon all 

counsel of record. 

/s/Jarrett Adams

Jarrett Adams, Esq.

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