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When Nathaniel Johns was born at St. Francis Hospital in Federal Way, Wash., on May 14, 1997, he had a blood clot underneath his scalp, a condition called cephalahematoma. The birth was otherwise normal and the boy weighed in at 8 pounds, 3 ounces. But the condition left him susceptible to developing jaundice, said plaintiffs’ attorney Joel D. Cunningham. Nathaniel was released from St. Francis within 24 hours of his birth, as per hospital policy. He was seen by a pediatrician a day later and showed no signs of developing jaundice. Over the next few days, however, he ceased nursing and his skin took on a yellowish tint. His parents made multiple calls to his pediatricians, but were never informed that these symptoms required immediate medical attention. At this point, the parents believed there was a problem with nursing and so they contacted a lactation nurse for assistance. The mother “thought the baby was not eating because she wasn’t breastfeeding properly,” said plaintiffs’ attorney James L. Holman. On the morning of May 20, the parents brought the child to a lactation nurse at St. Francis. “The baby was now pumpkin yellow, but the nurse sent the baby home,” Cunningham said. A blood test showed the baby’s bilirubin level was “really high,” he added. This required an immediate blood transfusion to prevent bilirubin from breaking through the blood-brain barrier and causing permanent brain damage. But, Holman said, because of a delay in getting the results of the blood test, the parents weren’t informed of the danger. Six hours after being released, the child was hospitalized and given a blood transfusion, but it was too late: He had suffered severe, irreversible brain damage. “He has normal intellectual function, but is a spastic quadriplegic. He can’t use his hands and he can’t talk,” Cunningham noted. “The baby would have been fine if he had had a blood transfusion” just two to three hours earlier, added Holman. This form of brain damage is “absolutely preventable.” James Degel, as guardian of the estate of Nathaniel Johns, sued the hospital owner, Franciscan Health System West, charging that the boy’s brain damage was caused by the failure to diagnose and treat the rising bilirubin levels until it was too late and by a failure to fully inform the parents of the gravity of the child’s condition. The plaintiff also sued several pediatricians who had been consulted by the parents; these pediatricians settled prior to trial on confidential terms. The hospital contended that the parents were responsible for the injuries to their son for failing to bring the child to a doctor when the symptoms appeared or when the lactation nurse advised them to do so. When it became clear that the parents would be blamed, they hired their own attorney. The parents pursued a separate claim against the hospital for loss of companionship. They also denied responsibility for the delay in treatment. “The hospital said the parents were told to call a doctor, but that the parents never did,” said Cunningham. The lactation nurse testified that she had expected the parents to bring the child to a pediatrician. She also testified, said Holman, “that he was the most jaundiced baby she ever saw.” The parents, however, contended that the nurse had never conveyed any urgency, even though they had informed her of the intentions to take the child to the pediatrician the following day. “The parents had no idea how serious it was,” Holman said. During their consultations with doctors or nurses, he added, “no one told the parents what would happen if the bilirubin was too high,” or that lethargy and lack of feeding were symptoms of rising bilirubin. The trial turned on the contention by the plaintiffs that even if the parents had failed to contact a doctor, “the nurses had an independent duty to call the doctor,” Cunningham said. “Our basic pitch was that they were like lifeguards at a pool. They had to step in” immediately because they recognized the danger to the child. “The nurses shouldn’t have allowed the baby to be taken home,” said Cunningham. The plaintiffs also contended that the hospital had failed to instruct and train its personnel in the handling of jaundice in newborns. As a result of early discharges of infants, Holman said, jaundice in babies generally does not appear until the child is taken home: “The hospital knew that early discharge was creating these risks, yet there was no policy or education of the nurses.” These nurses should have been informed by hospital management and through training sessions, he said, “that if there is significant jaundice, you need to act. You have to get a doctor involved. You don’t just send the baby home.” Defense counsel Amy Forbis said, “The health care providers at St. Francis handled the care appropriately.” On Oct. 30, a Seattle jury disagreed, and, after four days of deliberations, awarded Nathaniel Johns $10.065 million. The jury awarded the parents $662,000, but found them 20 percent responsible for their son’s current condition. As a result, the net award to the parents is reduced to $580,000, though Nathaniel’s verdict is untouched. The defense has made the decision not to appeal. Plaintiffs’ attorneys: Joel D. Cunningham and Robert N. Gellatly, Luvera, Barnett, Brindley, Beninger & Cunningham, Seattle, for Nathaniel Johns; James L. Holman, Law Offices of James L. Holman, Tacoma, Wash., for Jodie L. Johns and Douglas Johns. Defense attorneys: Amy Forbis and Kim Baker, Williams, Kastner & Gibbs, Seattle.

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