Pennsylvania Verdicts

Amount:

$32,882,860

Type:

Verdict-Plaintiff

State:

Pennsylvania

Venue:

Chester County

Court:

Chester County Court of Common Pleas

Injury Type(s):

Case Type:

Medical Malpractice – Nurse, OB-GYN, Hospital, Childbirth, Birth Injury, Failure to Treat, Failure to Consult, Failure to Monitor, Negligent Treatment

Case Name:

Lillian Marie Ciechoski, a minor, by her parent and natural guardian, Leslie Proffitt v. Amy Jane Cadieux, M.D., Women’s Health Care Group of Pennsylvania, LLC d/b/a Women’s Health Care Group of PA, Phoenixville Hospital Company, LLC d/b/a Phoenixville Hospital and Phoenixville Hospital of the University of Pennsylvania Health System,
No. 2012-05117

Date:

January 17, 2014

Plaintiff(s):

Leslie Proffitt (Female, 18 Years), 

Lillian Marie Ciechoski (Female, 1 Years)

Plaintiff Attorney(s):

Warren A. Hampton;
Hampton & McCreary;
Pottstown,
PA,
for
Leslie Proffitt, Lillian Marie Ciechoski ■ Robert A. Bracken;
Archinaco/Bracken LLC;
Pittsburgh,
PA,
for
Leslie Proffitt, Lillian Marie Ciechoski ■ Jason A. Archinaco;
Archinaco/Bracken LLC;
Pittsburgh,
PA,
for
Leslie Proffitt, Lillian Marie Ciechoski

Plaintiff Expert(s):

Abe Chutorian;
M.D.;
Pediatric Neurology;
New York,
NY called by
Warren A. Hampton, Robert A. Bracken, Jason A. Archinaco ■ B.A. McGettigan;
R.N.;
Life Care Planning;
Downingtown,
PA called by
Warren A. Hampton, Robert A. Bracken, Jason A. Archinaco ■ David Acker;
M.D.;
OB-GYN;
Boston,
MA called by
Warren A. Hampton, Robert A. Bracken, Jason A. Archinaco ■ Royal Bunin;
M.B.A.;
Economics;
Wynnewood,
PA called by
Warren A. Hampton, Robert A. Bracken, Jason A. Archinaco ■ Cydney Menihan;
C.N.M.;
Nursing;
Kingstown,
RI called by
Warren A. Hampton, Robert A. Bracken, Jason A. Archinaco ■ Marcus Hermansen;
M.D.;
Neonatology;
Nashua,
NH called by
Warren A. Hampton, Robert A. Bracken, Jason A. Archinaco ■ Richard Bonfiglio;
M.D.;
Physical Medicine;
Murrysville,
PA called by
Warren A. Hampton, Robert A. Bracken, Jason A. Archinaco

Defendant(s):

Amy Jane Cadieux, 

Phoenixville Hospital Co. LLC, 

Women’s Health Care Group of Pennsylvania LLC, 

Phoenixville Hospital of the University of Pennsylvania Health System

Defense Attorney(s):

Nancy K. Raynor;
Raynor & Associates, P.C.;
Malvern,
PA,
for
Amy Jane Cadieux, Women’s Health Care Group of Pennsylvania LLC ■ Andrew R. McCumber;
McCumber, Daniels, Buntz, Hartig & Puig, P.A.;
Tampa,
FL,
for
Phoenixville Hospital Co. LLC, Phoenixville Hospital of the University of Pennsylvania Health System ■ Judy May Packett;
Raynor & Associates, P.C.;
Malvern,
PA,
for
Amy Jane Cadieux, Women’s Health Care Group of Pennsylvania LLC ■ Elaine M. Ross;
McCumber, Daniels, Buntz, Hartig & Puig, P.A.;
Eagleville,
PA,
for
Phoenixville Hospital Co. LLC, Phoenixville Hospital of the University of Pennsylvania Health System

Defendant Expert(s):

Chad Staller;
Economics;
Philadelphia,
PA called by
Andrew R. McCumber, Elaine M. Ross ■ Mark Kuhn;
OB-GYN;
Langhorne,
PA called by
Nancy K. Raynor, Judy May Packett ■ David Shulkin;
Hospital Administration & Procedures;
Morristown,
NJ called by
Andrew R. McCumber, Elaine M. Ross ■ Endla Anday;
Pediatrics;
Philadelphia,
PA called by
Nancy K. Raynor, Judy May Packett ■ Daniel Small;
OB-GYN;
Lawrenceville,
NJ called by
Andrew R. McCumber, Elaine M. Ross ■ Joseph Schulman;
Neonatology;
Linden,
NJ called by
Andrew R. McCumber, Elaine M. Ross ■ Valerie Parisi;
Life Care Planning;
Doylestown,
PA called by
Andrew R. McCumber, Elaine M. Ross ■ Catherine Cochell;
Nursing;
Lowell,
MI called by
Andrew R. McCumber, Elaine M. Ross

On Nov. 14, 2009, plaintiff Leslie Proffitt, an 18-year-old who at the time was more than 38 weeks pregnant with her first child, presented to Phoenixville Hospital. Soon after her arrival, at roughly 9:30 p.m., she was fitted with a fetal heart monitor, and she was admitted at about 11:00 p.m. During that time period, the fetal heart rate reportedly was within normal limits (around 120 beats per minute). At approximately 1:07 a.m., the baby’s fetal heart rate dropped to 60 beats per minute. Proffitt was being attended by nurse Christine Winter, who recognized the fetal heart rate deceleration, prompting her to perform position changes, administer oxygen, and increase intravenous fluids. At 1:09, Winter rang the emergency-call bell. According to Proffitt, Winter failed to contact attending obstetrician-gynecologist Amy Jane Cadieux, and further failed to contact the nursing supervisor (as she allegedly was required to do under relevant chain-of-command procedures). Winter reportedly was aware that at this time, Cadieux was on the floor assisting the only other laboring patient experiencing a similar fetal-heart deceleration. About three minutes after Proffitt’s baby’s fetal-heart rate dropped, nurse Lana Jones-Sandy, responding to the call bell, appeared to assist Winter. According to Proffitt, although Cadieux was only a few feet down the hall in another patient room, neither nurse went to notify Cadieux of the situation, although they rang the emergency call bell a second time at 1:12 a.m. Cadieux allegedly did not appear until 1:20 a.m., which was approximately 18 minutes after the fetal heart rate had dropped. Proffitt alleged that when Cadieux finally presented to the room, she did not act with requisite urgency. Instead, she continued performing changes that Winter had unsuccessfully performed several minutes earlier, along with a vaginal exam. Cadieux and Winter allegedly then wasted time attempting to troubleshoot the fetal monitor because they mistakenly believed it was not working accurately. At 1:34 a.m., Cadieux called a code to initiate an emergency Caesarean section, and Proffitt was taken to an operating room. Her daughter Lillian Marie Ciechoski was born at about 1:49, about 42 minutes after the fetal heart rate had dropped. Upon her birth, Lillian was treated for spastic-quadriplegia form cerebral palsy. Proffitt filed a medical-malpractice suit on Lillian’s behalf against Phoenixville Hospital (in its various corporate forms) and Cadieux and her employer (Women’s Health Care Group of Pennsylvania). (Winter and Jones-Sandy were not directly named as defendants in the action, but their names appeared on the verdict sheet for the purposes of assessing negligence. In addition, there was evidence indicating that Winter had asked a third nurse for assistance, but that this nurse had declined to help; that nurse’s name also was included on the verdict sheet for the purposes of assessing negligence.) The suit filed on Lillian’s behalf alleged that by the time Cadieux had entered Proffitt’s room, the baby had already sustained a bradycardia; that Cadieux and Winter had refused to accept the fetal monitor readings and appreciate the dire circumstances they presented; and that instead of trying to troubleshoot the equipment and question the veracity of the information being provided by it, Cadieux should have taken Proffitt to the operating room for an emergent Caesarean section. Proffitt’s counsel maintained that Winter was fresh out of nursing school at the time, and had only had been a practicing nurse for six months. Although she had completed an orientation program at Phoenixville Hospital, she allegedly had not been provided advanced education in fetal monitoring, which was only offered to Phoenixville Hospital nurses who had completed six months of employment. However, in this case, Winter appropriately responded to the fetal heart deceleration with appropriate nursing intervention, and called for help via the call-bell system, it was argued. According to Proffitt’s medical experts, fetal heart rate decelerations can be dangerous, particularly if they are sustained in length, as they demonstrate a lack of blood flow to the infant. Each minute such a situation is permitted to exist, the risk of harm to the infant, including brain damage and death, is drastically increased, the experts opined. Proffitt’s expert in obstetrics and gynecology cited a few small differences in what he would have done with respect to monitoring Proffitt — for example, not giving Terbutaline as a fetal resuscitative measure — but acknowledged that doing so was a valid component of the American Congress of Obstetricians and Gynecologists algorithm in such a circumstance. The expert concluded that Cadieux had not breached the standard of care, and that the delay was attributable to the hospital’s conduct. Proffitt’s expert maintained that the hospital lacked the foresight in handling simultaneous emergencies, and had not adequately prepared in advance for an emergency situation like the one that occurred on the night of Lillian’s birth, as there were no adequate procedures and drills in place. Instead, the nursing staff squandered precious minutes scrambling around, thereby allowing a delay in Lillian’s birth and its resulting consequences, the expert contended. Proffitt’s expert in nursing opined that once the prolonged deceleration had occurred for two minutes, from 1:07 to 1:09 a.m., Winter and Jones-Sandy should have immediately informed Cadieux and the nursing supervisor, but they failed to do so. Upon cross-examination of Cadieux by Proffitt’s counsel, the physician did not directly criticize the hospital, but made statements indicating that she was upset that she had not been called earlier and that the medical staff could not get mobilized for the operating room more quickly. Cadieux said that she moved very quickly once she got to the patient’s room, and made the decision to do a Caesarean section within about five minutes; however, the hospital could not get a surgical team assembled, and the operation underway, for approximately 15 more minutes. When Cadieux arrived at Proffitt’s room at about 1:20, she claimed, she immediately did a vaginal exam to check for fetal descent, prolapsed cord, abruption — anything that could account for the drop in the fetal heart rate. She stated that she simultaneously ruptured the membrane and placed an internal fetal scalp electrode, to get a more accurate reading of the fetal heart rate. Cadieux further testified that upon arriving in the room she reviewed the last several minutes of the monitoring strip; spoke with the nurse for a summary of what had happened and which interventions had been done; called for Terbutaline and anesthesia support; and asked that the operating room be opened and prepped. She also put in place a Foley catheter within a few minutes of entering the room, which her counsel described as a clear indicator that she was planning to timely move to a Caesarean section. Cadieux also pointed out that it was the middle of the night at the time, meaning that the medical staff did not have a unit clerk to help acquire medication present and perform other necessary duties. At the conclusion of Proffitt’s case, Cadieux’s counsel motioned for non-suit; this motion was unopposed by counsels for Proffitt and the hospital. In granting the non-suit, the judge instructed the jury that he had found as a matter of law that Proffitt had not provided sufficient evidence as to negligence on the part of Cadieux. Defense counsel for the hospital maintained that the nurses had responded appropriately by ringing the call bell for assistance and administering interventions during the initial 10 minutes of the deceleration. Furthermore, it was argued, Cadieux, who arrived at 1:17, 10 minutes after the call bell, had waited an additional 17 minutes to call for an emergency Caesarean section. The hospital’s expert in nursing credited Winter and Jones-Sandy in their treatment of Proffitt until Cadieux was able to present to the room. The hospital’s expert in obstetrics and gynecology opined that Winter had met the standard of care by responding immediately and performing necessary intervention measures. According to the hospital’s expert in hospital administration and procedures, Phoenixville Hospital had adequate policies and procedures in place to handle situations such as the one involving Proffitt. Had Cadieux not already been on the premises, the hospital would have initiated its backup system, in which an obstetrician-gynecologist would have been contacted and presented at the hospital within 30 minutes.

Upon her birth, Lillian reportedly was bluish gray and limp, and required resuscitation. The baby’s Apgar scores were two at one minute, four at five minutes, four at 10 minutes, five at 15 minutes, and seven at 20 minutes. Lillian then was transferred to a children’s hospital in Philadelphia, where she was diagnosed with hypoxic ischemic encephalopathy, seizures, and perinatal depression. Proffitt’s expert in neonatology discussed the timeline of the labor and how the deprivation of oxygen had injured the baby, concluding that if Lillian had been delivered 15 minutes earlier, she would have sustained little or no brain damage. Lillian, who is permanently wheelchair-bound, suffers from spastic quadriplegia and has severe speech deficits and developmental delays. She receives botulinum toxin injections in attempts to treat her spasticity, and undergoes physical, occupational, behavioral, and speech therapies. Based on Proffitt’s expert in physical medicine’s outline of Lillian’s future-care needs (the expert said that improvement in the girl’s condition is possible with proper care), the suit filed by Proffitt sought to recover a future life-care plan of $7,794,966, with this amount including costs of therapies, medications, equipment, transportation services, and home modifications. Proffitt’s expert in economics calculated a future lost earning capacity that was contingent upon different scenarios: whether Lillian would have graduated high school, received an associate’s degree, or had a bachelor’s degree. The lost-earnings estimates ranged from $4,585,165 to $9,157,038; in present value, the damages ranged from $527,260 to $1,056,585. Lost fringe benefits were calculated to present value at a range of $105,452 to $211,317. Under the first contemplated scenario of Lillian’s future medical costs, which accounted for rates of inflation, the expert calculated a figure of $31,643,039, which accounted for home placement of the child; under the second scenario, which accounted for Lillian’s being placed in a facility at the age of 21, expenses totaled $44,323,476. Proffitt’s suit further sought to recover unspecified amounts of noneconomic damages, for past and future pain and suffering. Defense counsel for the hospital argued that Proffitt’s own expert in neonatology had acknowledged that Lillian’s brain damage did not occur until 15 to 20 minutes after the deceleration began. The hospital’s expert in life-care planning presented a life-care plan lower in cost than the one put forward by the opposing experts, due in part to the exclusion of physical therapy, since Lillian has been receiving such treatment three times a week through her school district, which has publicly funded the treatment. Using a different interest-rate model, the hospital’s expert in economics calculated a potential damages range of between approximately $315,000 and $20 million.

The jury found that Winter and Jones-Sandy had been negligent and that their negligence had been a substantial cause of harm to Lillian. No negligence was found against the third nurse allegedly involved in the underlying events, or against the relevant hospital corporate entity (Phoenixville Hospital Company LLC). The jury determined that Lillian should receive a total of $32,882,860 in damages, which included future medical expenses through 2091. After the verdict was rendered, the verdict was molded as against the hospital.

Lillian Marie Ciechoski: $31,082,860 Personal Injury: Future Medical Cost; $800,000 Personal Injury: Future Lost Earnings Capability; $50,000 Personal Injury: past non-economic loss; $950,000 Personal Injury: future non-economic loss

Judge:

Robert J. Shenkin

Demand:

$29,000,000

Trial Length:

2
 weeks

Trial Deliberations:

9
 hours

This report is based on an article previously published in The Legal Intelligencer, a fellow ALM publication, and on information that was provided by counsels for all parties involved in the litigation.