Opinion ID: 6317300
Heading Depth: 2
Heading Rank: 1

Heading: Complications During DALR's Birth

Text: Rodríguez-Valentin gave birth to DALR by caesarean section at Doctors' Center in Puerto Rico in late September 2008. A few months after his birth, DALR was diagnosed with cerebral palsy. Rodríguez-Valentin alleged that DALR's cerebral palsy resulted from, or was exacerbated by, medical malpractice by treating physicians and nurses during the late stages of her pregnancy and DALR's delivery. This appeal by Doctors' Center is pertinent only to the medical care provided by treating nurses employed by Doctors' Center. The nurses' alleged malpractice occurred during DALR's birth. Doctors' Center's nurses, per a physician's order, began administering the pharmaceutical drug Pitocin to RodríguezValentin at about 9:31 A.M. on September 25 while she was in labor. - 2 - The Pitocin was intended to aid delivery by reducing the time between Rodríguez-Valentin's contractions. Soon after the nurses administered Pitocin, however, DALR's heart rate variability, as documented by a monitor placed on Rodríguez-Valentin's abdomen, dropped to a very minimal level. At trial, Rodríguez-Valentin's expert witness, Dr. Bruce Halbridge, testified that DALR's heart rate variability had been within an appropriate range before the nurses administered Pitocin. Dr. Halbridge explained that the drop in heart rate variability from that appropriate range showed that DALR was not receiving enough oxygen, glucose, or blood through the placenta. Dr. Halbridge noted that such a loss of heart rate variability is the most important signal that a soon-to-be-born baby lacks sufficient oxygen. Dr. Halbridge identified where and when the nurses should have seen the changes in heart rate variability. Specifically, according to Dr. Halbridge, DALR's heart rate variability issues occurred in several, sometimes prolonged, episodes throughout Rodríguez-Valentin's labor. Dr. Halbridge testified that, in his opinion, by the third episode of decreased heart rate variability, the treating nurses should have stopped administering Pitocin, placed Rodríguez-Valentin on her left side, increased her IV fluid intake, provided her with an oxygen mask, - 3 - and notified a physician about the drop in DALR's heart rate variability. Rodríguez-Valentin's labor continued for eight hours after the nurses began administering Pitocin. During this time the treating nurses failed to recognize or act on the drop in DALR's heart rate variability, failed to stop administering Pitocin, and failed to notify any physician about the change in DALR's heart rate variability. Dr. Halbridge testified that oxygen deprivation during the delivery increased DALR's brain damage and aggravated his cerebral palsy. Dr. Halbridge noted that, had the nurses notified a physician, the caesarean section could also have been expedited, which likely would have reduced the severity of DALR's injuries because he would have spent less time without sufficient oxygen. In defense of the nurses' conduct, Doctors' Center offered the testimony of two expert witnesses in obstetrics, Dr. Alberto de la Vega Pujol and Dr. Edgar Solis. These physicians disagreed with Dr. Halbridge, opining that DALR's heart rate variability was adequate during labor and that there was no evidence that DALR suffered any oxygen deficiency during delivery. Dr. Solis also testified that neuroradiological testing conducted after DALR's birth supported his opinion that DALR did not suffer from oxygen deficiency during delivery. - 4 -