Basten by and Through Basten v. United States

848 F. Supp. 962, 1994 WL 96780
CourtDistrict Court, M.D. Alabama
DecidedMarch 21, 1994
DocketCiv. A. 92-H-1417-N
StatusPublished
Cited by4 cases

This text of 848 F. Supp. 962 (Basten by and Through Basten v. United States) is published on Counsel Stack Legal Research, covering District Court, M.D. Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Basten by and Through Basten v. United States, 848 F. Supp. 962, 1994 WL 96780 (M.D. Ala. 1994).

Opinion

MEMORANDUM OPINION

HOBBS, District Judge.

The plaintiffs, Kathie J. Basten, Jonathan A Basten, and Claire Abigail Basten, have brought this action against the United States of America, pursuant to the Federal Tort Claims Act (FTCA), 28 U.S.C. §§ 2671-2678. This is a negligence action in which plaintiffs allege that the United States breached the standard of care governing the administration of fetal testing and genetic screening and is therefore responsible for all damages proximately flowing from this breach. Jurisdiction over this action, which was tried without a jury on January 24-25, 1994, is predicated on 28 U.S.C. § 1346(b).

The legal theories governing this case arise out of painful and difficult circumstances. Although the circumstances giving rise to this case touch upon the more vexing moral dilemmas of our time, today’s decision breaks no new ground; rather it stems solely from the currently entrenched legal doctrine governing actions for wrongful birth. See Keel v. Banach, 624 So.2d 1022 (Ala.1993). Having applied the dictates of Keel to the facts presently before the court, the court concludes that judgment is due to be rendered in favor of plaintiffs.

I. BACKGROUND

Neural tube defects constitute a significant class of commonly occurring congenital malformations. A neural tube defect results from an abnormality of the skull and spinal canal, occurs during the first few weeks of pregnancy, and produces a wide range of problems relating to the brain and spinal cord. There are three types of a common and serious neural tube defect known as spina bifida, with the most serious type known as spina bifida myelomeningocele. This occurs when the spinal cord, nerve roots, and a sac containing spinal fluid protrudes through an opening in the spinal column.

Depending on the severity of the defect and how high on the spinal column the defect occurs, persons born with spina bifida may have paralyzed limbs, no control of bladder or bowel function, and a life-threatening disorder of the drainage of spinal fluid from the brain, known as hydrocephalus. Spina bifida may or may not be consistent with long-term survival.

*965 Most neural tube defects can be reliably detected by performing a simple virtually risk free screening test which measures the amount of maternal serum alpha-fetoprotein (MSAF or AFP), a substance produced by the growing fetus. The test requires no more than obtaining a blood sample from the mother, but for clinical and practical purposes, it must be administered within a narrow time frame during pregnancy (sixteen-twenty weeks). A fetus with a neural tube defect produces abnormally large amounts of AFP, which may be measured by taking a sample of the mother’s blood. If the test indicates the possibility of a neural tube defect (NTD), it is repeated, and if still positive, other tests are done to confirm or refute the findings.

The AFP test is recommended even for women who would refuse to have an abortion, for in the event a defect is discovered, the doctor will know to make special preparations for the child’s delivery or it will alert the doctor to the child’s need for highly specialized care at another facility. Moreover, even if no AFP test is performed during the 16-20 week window of opportunity, some of the more severe instances of abnormality may be detected by using high resolution sonography.

AFP testing is highly reliable, inexpensive, and nonintrusive. When a neural tube defect is detected during an appropriate time during pregnancy, the fetus is aborted 90 percent of the time. By late 1986, the parties have stipulated that the offering of AFP testing, and the documentation of the acceptance or rejection of such offer, was an accepted part of the national standard of care. During the time of Kathie Basten’s pregnancy with Molly in 1988, AFP testing could only be offered and documented during a four-week window of opportunity which spanned from the sixteenth to the twentieth weeks of pregnancy.

II. FACTUAL FINDINGS

Kathie Basten became pregnant during the summer of 1988, while she was taking oral contraceptives. Dissatisfied with the care she was provided during her 1986 pregnancy with Abbie, her first child, Kathie Basten sought permission to obtain off-base care. Because her request was denied, she again attended the on-base clinic at Maxwell. After her pregnancy was confirmed, she obtained an appointment to begin obstetrical care at Maxwell.

On August 2, 1988, Kathie attended an orientation meeting for newly pregnant women which was held every other week at the library of the medical clinic at Maxwell. The meeting was attended by thirteen pregnant women and a few of their husbands, lasted for one arid a half hours or two hours, and was conducted (at least in part) by Major Altringer, a nurse/midwife. During the meeting, the women were provided with various pre-assembled written materials, some of which constituted information packets and some of which constituted records to be completed for the medical chart. Kathie recalls no information on AFP testing being included in the packets she received. Kathie gave urine and blood samples for several screening tests, listened to various speakers, and made numerous entries in her medicai chart. Part of the information Ms. Basten entered on her chart was that she had recently taken oral contraceptives.

Standard Maxwell policy required that the mother’s chart contain a form explaining AFP testing and including a place for the mother to indicate her acceptance or refusal of such test. A one-page brochure on AFP testing was also customarily clipped to the form in the chart; however, Kathie’s chart never contained either the form or the brochure. The women who attended the conference were told, as a group, that AFP was an optional test which would assay for birth defects and which the patient would discuss later with the health care provider. Both Ms. Basten and Ms. Jakel (another woman in attendance) testified that no one was informed that the burden to request AFP testing resided with the patient. No one was informed that she should identify the appropriate time within which to contact the hospital so that an appointment could be secured during the sixteen-twenty week window.

Kathie Basten was familiar with AFP testing only in the most general of terms. She knew nothing of the sixteen-twenty week *966 window, knew nothing of the necessity for identifying that window, and knew nothing of her purported responsibility to initiate discussion on AFP testing. Although Maxwell health providers enjoyed numerous opportunities to discuss AFP testing with Kathie, the subject was never again mentioned until after the sixteen to twenty week window had closed. At no time did Kathie Basten refuse an offer for AFP testing; at no time was she told she had to request the test; and at no time did she know that the test had to occur during the sixteen to twenty week interval.

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848 F. Supp. 962, 1994 WL 96780, Counsel Stack Legal Research, https://law.counselstack.com/opinion/basten-by-and-through-basten-v-united-states-almd-1994.