PRACTICE AREAS

Cerebral Palsy, Brain Damage, Erb's Palsy and Brachial Plexis Palsy
Litigators, Incorporated, devotes almost all of its time to cerebral palsy, brain damage, Erb's palsy and brachial palsy cases. Here is some information concerning these disorders and how we as lawyers prove that it is related to medical negligence.

Types of Cerebral Palsy
Spastic--Difficult and stiff movements
Ataxic--Loss of depth perception and sense of balance
Athetoid--Uncontrolled and involuntary movements

Effects of Cerebral Palsy
Cerebral Palsyis a term used to describe a group of disorders affecting body movements and muscle coordination. It is caused by damage to different areas of the brain before, during or shortly following birth. "Cerebral" refers to the brain and "palsy" refers to muscle weakness and lack of control. The effects, depending on which areas of the brain have been damaged, include:

· Mental Retardation
· Seizures
· Impairment of Speech, Hearing or Sight
· Abnormal Perception and Sensation
· Problems in Gait and Mobility
· Involuntary Movement
· Muscle Spasm or Tightness

Causes of Cerebral Palsy
There are many causes of cerebral palsy. One of the most important causes of cerebral palsy is an insufficient amount of oxygen reaching the newborn or fetal brain. Oxygen supply can be interfered with by the placenta separating prematurely from the uterus wall, an unusual birth position of the baby, labor that is either too long or too quick, or a problem with circulation in the umbilical cord.

Many times when there is a lack of oxygen the doctors and nurses should be able to identify fetal distress by interpreting the fetal monitor strip correctly. If the doctor fails to do a C-Section, or to do it quickly, the child will lose oxygen and develop cerebral palsy or brain damage.

Conditions for Cesarean Section
· Maternal medical condition with obstetric indication
· Cephalopelvic disproportion-- the fetal head is disproportionate to the maternal pelvis
· Placentia previa-- the placenta is implanted in the lower segment of the uterus
· Fetal malpresentation--faulty presentation of the fetus; presentation of any part other than the occiput (back of head)
· Selected cases of abruptio placentae--tearing away of the placenta
· Umbilical cord prolapse--the presentation of the umbilical cord ahead of the fetus
· Fetal distress--a threatening or adverse condition of the fetus caused by stress. Some criteria for recognition of fetal distress are:

a. Cardiac arrhythmia (irregular heartbeat)

b. Bradycardia (slow heart beat, under 60 beats per minute)

c. Tachycardia (rapid heartbeat over 100 beats per minute)

d. Passage of meconium (the first intestinal discharge of the newborn)

Brachial Plexus Palsy
The brachial plexus is a group of nerves that run from the shoulder to the spine. These control muscle movement in the hands, arms and shoulder. Sometimes when a doctor is negligent by not providing proper obstetrical care, damage to the nerves can result. These injuries usually occur during the natural delivery of a larger infant. When the baby is too large to pass through the mother's pelvis, his or her shoulder may become lodged behind the mother's pubic bone after the head has been delivered. Many times the doctors attempt to continue with a natural delivery, as opposed to a C-section and can stretch the neck excessively causing nerve damage.

Erb's Palsy is the damage to the upper plexus ( C5 to C7)

Klumpke's Palsy is damage to the lower plexus (C8 to T1)

Doctors can be negligent when they don't properly identify a large baby and perform a C-section, or use appropriate delivery techniques once they encounter shoulder dystocia.

Children with Erb's Palsy have lack of movement in the arm and shoulder, while children with Klumpke's Palsy have diminished movement in the wrist and hand. Doctors should be able to identify the potential for a large baby by the following factors:

a. Gestational diabetes - which generally is associated with larger babies. A doctor should always prenatally timely screen and treat for this condition.

b. Excessive weight gain during pregnancy. The chance of a large baby is greatly increased if there is excessive weight gain, especially for mothers over 30 years old.

c. Obesity. An obese mother has a greater risk of giving birth to a large infant.

d. Maternal history. If a mother has previously delivered a large infant, there is a greater chance that the next infant will also be very large.

e. The fundal height or McDonald measurement . These measurements recorded during pre-natal visits to her doctor is an external measurement from the top of the pubis to the top of the uterus. If these measurements are too large the physician should be able to determine if there is a large baby.

Doctors should recognize the above indicators of a probable large baby and confirm his suspicion through the use of ultrasound. Accordingly, the doctor may be liable if he doesn't use the correct delivery technique, including the McRoberts maneuver, Wood's corkscrew maneuver, as well as suprapubic pressure. A cesarean section should also be done where appropriate.

Proving Medical Negligence
Many times we, as birth trauma lawyers, can prove doctors were negligent in preventing cerebral palsy and brain damage by carefully studying the medical records. If a child suffers a period of oxygen deprivation, this can result in fetal distress which, if a doctor doesn't act quickly, may lead to permanent damage or death. A lawyer has to look for deviations from the standard of care and carefully examine the neonatal records as well as the fetal heart monitor strip. The labor and delivery records must be examined for irregular readings on the fetal heart monitor, meconium staining, and fetal scalp blood pH determination.

Trained staff must be available to activate the fetal heart monitor, inspect and analyze the strip continuously and intervene where fetal distress is observed. Cardiac arrhythmia (irregular heartbeat), bradycardia (slow heartbeat), and tachycardia (rapid heartbeat) are all signs of fetal distress.

Meconium or the fetal feces, can also cause fetal distress. A lawyer must determine if there is resulting fetal hypoxia which is insufficient oxygen to the tissues. A doctor must always determine if there is an abnormal blood pH. There is a decrease in the blood pH, or acidosis, when there is a buildup of acid level in the blood due to the fetus not receiving enough oxygen. There is a long history of linking oxygen deprivation and the pH reading to babies born with brain damage. Too low a pH level will establish fetal distress and in many cases an immediate C-section should follow.

By carefully evaluating and studying all medical records, a lawyer can determine if there was a deviation from the standard of care by the doctors or medical staff resulting in unnecessary brain damage to the child.