A.Y.O. v. Enloe Medical Center

CourtDistrict Court, E.D. California
DecidedMay 6, 2022
Docket2:21-cv-00285
StatusUnknown

This text of A.Y.O. v. Enloe Medical Center (A.Y.O. v. Enloe Medical Center) is published on Counsel Stack Legal Research, covering District Court, E.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
A.Y.O. v. Enloe Medical Center, (E.D. Cal. 2022).

Opinion

1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 FOR THE EASTERN DISTRICT OF CALIFORNIA 10 11 | A.Y.O., a minor, by and through his guardian No. 2:21-CV-00285-KJM-JDP ad litem, Francis Ocasio, 12 FINAL PRETRIAL ORDER B Plaintiff, 14 v: 15 Enloe Medical Center, doing business as Enloe Medical Center - Esplanade, Defendant. 17 18 On April 15, 2022, the court conducted a final pretrial conference. Bronislav Draganov 19 | appeared for plaintiff A.Y.O. Chad Couchot appeared for defendant Enloe Medical Center. After 20 | hearing, and good cause appearing, the court makes the following findings and orders: 21 | JURISDICTION AND VENUE 22 Jurisdiction is predicated on 28 U.S.C. §§ 2674, 1346(b). Jurisdiction and venue are not 23 | contested. 24 | JURY / NON-JURY 25 The parties request a jury trial. The court will seat nine (9) jurors. 26 | /////

1 UNDISPUTED FACTS 2 1. This was the first pregnancy for Francis Ocasio, then 29 years of age. The patient 3 was known to be an insulin-dependent diabetic. From the time of admission on the 4 evening of November 5, 2018, through resuscitation of the newborn following 5 delivery, the patient was managed by nurses employed by ENLOE, as well as by 6 Dr. Green. 7 2. Francis Ocasio presented to ENLOE for admission on the evening of November 5, 8 2018. Initial fetal monitor assessments by nursing personnel at ENLOE 9 demonstrated a Category I fetal heart rate (FHR) tracing. 10 3. On November 7, 2018, during the 8:00 am hour, Dr. Green rounded on Mrs. 11 Ocasio and confirmed that she was completely dilated, completed effaced and fetal 12 station was +1. A vaginal delivery was anticipated. The nurse was documenting a 13 Category I tracing. She documented a caput (swelling of the head) at +1 station. 14 Dr. Green returned, another bag of Pitocin was hung and contractions resumed. In 15 her note of 9:06 am, Dr. Green wrote of an “arrest of progress.” She wrote that if 16 there was no significant change of station in the next hour, she would prepare the 17 patient for cesarean section. 18 4. Dr. Green returned to bedside just after 10:00 am and conducted the following 19 measures, among others, within the next 30 minutes: placement of a Fetal Scalp 20 Electrode (FSE), oxygen administration on the mother, removal of FSE due to it 21 not tracing the FHR well, placement of a vacuum that led to the fetal head 22 emerging from the introitus, development of shoulder dystocia. 23 5. Due to the shoulder dystocia, a silent CODE BLUE was called. An episiotomy was 24 cut. The CODE brought resuscitative personnel as well as the pediatric hospitalist. 25 The dystocia was relieved with a vaginal delivery at 10:33 am. A.Y.O. was born 26 without any discernible heart rate. 27 6. Apgar scores, a clinical assessment of the newborn, were documented to be at 0, 0, 28 3, 3, 3 at 1, 5, 10, 15 and 20 minutes of age. The cord arterial blood gas 1 demonstrated blood PH less than 6.89, PC02 greater than 98, P02 less than 15 with 2 an oxygen saturation of 12%. 3 7. The neonatal code record indicates that positive pressure ventilation was initiated 4 at 18 seconds with 21% oxygen; oxygen was increased to 100% and chest 5 compressions begun by 1 minute 45 seconds. The heart rate was noted to be 109 6 at 4 minutes 45 seconds on the pulse oximeter (monitor) but chest compressions 7 were continued because the heart rate could not be auscultated and pulses could 8 not be palpated. The patient was intubated at 5 minutes 57 seconds and a 9 peripheral IV was placed at 6 minutes 12 seconds; a 1 ml dose of epinephrine 10 (presumably 1:10,000 dilution) was delivered at 7 minutes. By 7 minutes 17 11 seconds a heart rate of 132 was noted on the pulse oximeter and confirmed by 12 auscultation and chest compressions were stopped. The patient was then 13 transported from the delivery room, arriving in the Special Care Nursery at 1047 14 (14 minutes after birth). 15 8. All experts have been deposed. A.Y.O. is now 3.5 years of age. A.Y.O. has 16 severe, global developmental delay, microcephaly, left hemiparesis, oral-motor 17 dyscontrol with G-tube dependence, and history of seizure disorder. 18 DISPUTED FACTUAL ISSUES 19 1. Whether Dr. Green was an actual agent of ENLOE and whether ENLOE is 20 vicariously liable for any of her actions or omissions to act both prenatally and 21 during intrapartum care. 22 2. Whether Dr. Green met the standard of care of a Board-Certified OB/GYN in her 23 care and treatment of the patient, and whether it caused injury to A.Y.O. 24 3. Whether all Labor and Delivery (L&D) nurses met the standard of care during 25 intrapartum care of this patient relative to the interpretation of the FHR, their 26 report to Dr. Green, and in their access to the chain of command, and whether that 27 caused injury. 28 ///// 1 4. Whether all post-partum resuscitative nursing personnel met the standard of care 2 relative to the resuscitation of the newborn, specifically whether the pediatric 3 hospitalist was informed of the depth of the ETT and whether their report or 4 omission to report to the hospitalist of same was within the standard of care, and 5 whether that caused injury. 6 5. What the nature, extent and cause of A.Y.O.’s neurological injury is. 7 6. What the cost of A.Y.O.’s future care will be. 8 7. What A.Y.O.’s loss of prospective earnings will be. 9 8. What assumptions should be used in for calculating a reasonable present value for 10 the projected likely costs of A.Y.O.’s future medical care. 11 9. What assumptions should be used in calculating a reasonable projection for the 12 lost earnings of A.Y.O. 13 SPECIAL FACTUAL INFORMATION 14 1. In accordance with Local Rule 281 (b) (6) and (b) 6) (iv), special information with 15 regard to this tort action is included in the sections on Undisputed and Disputed 16 Facts and relief sought. 17 DISPUTED EVIDENTIARY ISSUES 18 1. Plaintiff’s Motion in Limine to exclude evidence or argument that fetal monitoring 19 has not led to a decrease in the incidence of Cerebral Palsy. 20 2. Plaintiff’s Motion in Limine to exclude ENLOE nurses from offering any present 21 opinions as they were not identified in expert disclosures. 22 3. Defendant’s Motion in Limine to Preclude Any Evidence or Argument that Dr. 23 Akiba Green was an agent of Enloe Medical Center. 24 4. Defendant’s Motion in Limine to Preclude Opinions of Barbara Greenfield 25 Pertaining to Medical Anticipated Medical Charges as Unreliable and Irrelevant. 26 5. Defendant’s Motion in Limine to Preclude Duplicative/Cumulative Opinions by 27 Dr. Howard Mandel and Dr. Joseph Ouzounian. 28 6. Defendant’s Motion in Limine to Require Plaintiff’s Presence During Voir Dire. 1 STIPULATIONS / AGREED STATEMENTS 2 1. The parties have stipulated Dr. Green was not an ostensible agent of Enloe. 3 2. The parties have stipulated that the anticipated life expectancy of AYO is 35.3 4 additional years from the date of July 1, 2022. 5 3. Reference to or evidence of prior or subsequent medical malpractice proceedings 6 against Enloe Medical Center, Dr. Akiba Green or any other physician who may 7 testify in this case shall not be introduced or admitted at trial. 8 4. Reference to or evidence of Bruce Fagel, Plaintiff’s counsel, being a medical 9 doctor shall not be introduced or admitted at trial. 10 5. There will be no reference to medical literature outside of the narrow hearsay 11 exception articulated in F.R.E. 803(18), and the literature itself will not be 12 admitted as evidence. 13 6. Reference to or evidence of professional liability insurance shall not be introduced 14 or admitted at trial. 15 7. Reference to or evidence of the limitations of the Medical Injury Compensation 16 Reform Act of 1975 (MICRA) shall not be introduced or admitted at trial. 17 8.

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