A Philadelphia jury has sided with the Hospital of the University of Pennsylvania in a medical malpractice suit in which the legal guardian of a minor with cerebral palsy accused the hospital of failing to timely diagnose the child’s mother with preeclampsia during her pregnancy.
On Nov. 12, following a two-week trial before Philadelphia Court of Common Pleas Judge Gary F. DiVito, a 12-member jury voted 10-2 that the defendant hospital, along with co-defendants University of Pennsylvania Medical Center and the Trustees of the University of Pennsylvania Medical Center, had not been negligent.
In Deeds v. University of Pennsylvania Medical Center, according to the plaintiff’s pretrial memorandum, plaintiff Julia Renzulli, the legal guardian of minor Niajah Deeds, alleged that Deeds’ mother, Tamika Peterson, who was not a party to the case, presented to the University of Pennsylvania Hospital on Jan. 18, 2001, with a headache, blurred vision and elevated blood pressure.
Peterson had already received regular prenatal care at the hospital for five months prior to that date without any complications, the plaintiff’s pretrial memorandum said.
The plaintiff’s memorandum alleged that Peterson’s symptoms Jan. 18 were classic signs of preeclampsia, which is pregnancy-induced hypertension that, if untreated, can result in the premature separation of the placenta from the uterus causing hemorrhage and possible asphyxiation of the fetus.
According to the plaintiff’s memorandum, had Peterson been diagnosed with preeclampsia Jan. 18, the only definitive treatment would have been to admit her to the hospital immediately for delivery.
Instead, the plaintiff’s memorandum said, Peterson was discharged with “‘preeclamptic instructions’” and told to return Jan. 20.
But by the time Peterson came back Jan. 20, she had abdominal pain and bleeding and was admitted to the hospital for an emergency cesarean section, which was performed about 20 minutes after her arrival, according to the plaintiff’s memorandum.
A surgical attending confirmed that there had been placental abruption and, despite never receiving a diagnosis of preeclampsia Jan. 20, Peterson had elevated blood pressure and high levels of protein in her urine, both of which are evidence of preeclampsia, the plaintiff’s memorandum alleged.
According to the plaintiff’s memorandum, Deeds was born severely depressed and was immediately transferred to the neonatal intensive care unit, where she was resuscitated and given sodium bicarbonate in an attempt to reverse the acidosis in her blood that occurred as a result of the asphyxiation.
Deeds, who is now 12 years old, has been diagnosed with cerebral palsy, choreiform, and suffers from frequent spastic movements, seizures, developmental delay, microcephalus, retinopathy of prematurity and visual impairment, the plaintiff’s memorandum said.
She cannot speak, sit unsupported, dress herself or use the bathroom and receives her food through a tube, according to the plaintiff’s memorandum.
The plaintiff’s memorandum alleged that, during Peterson’s Jan. 18 visit to the hospital, staff failed to perform either a fundus examination of her eyes or 12- or 24-hour urine screens to check for preeclampsia.
The plaintiff’s memorandum also alleged that the nurses who assessed Peterson reported Jan. 18 that there were no baseline blood pressure readings despite Peterson’s previous examinations at the hospital. Peterson’s blood pressure readings also were not timed or signed and were still elevated at the time of discharge.
According to the plaintiff’s memorandum, obstetrics expert Dr. Yvonne S. Thornton opined that Peterson should have been admitted to the hospital Jan. 18 so that a diagnosis of preeclampsia could be made and Deeds’ injuries could be avoided.
The University of Pennsylvania Hospital argued in its own pretrial memorandum, however, that when Peterson came to the hospital Jan. 18, she denied epigastric pain and reported a history of migraines, no blurry vision and reflux, as well as admitting that she had used cocaine a week before.
Peterson also denied having had prenatal care and her blood pressure was only slightly elevated, the hospital said in its pretrial memorandum. In addition, her urine was negative for protein and glucose and preeclampsia labs came back normal.
The hospital said in its memorandum Peterson did not return Jan. 20 for a follow-up as instructed, but instead came to the emergency room with a fetal heart rate in the 30s and vaginal bleeding she said had been going on for a day.
Peterson was admitted to the hospital and told staff she was smoking five cigarettes a day with no alcohol, according to the hospital’s memorandum. She also admitted to cocaine use but refused to say when she did it last. She was also described as being malnourished.
But the plaintiff’s memorandum said Peterson’s toxicology screens throughout her pregnancy, up to and including Jan. 20, were negative for cocaine and any other illicit drugs.
However, the hospital said in its memorandum that Deeds’ diagnoses at the time of discharge Feb. 17, 2001, were “intrauterine growth retardation, intrauterine cocaine exposure, placental abruption, severe perinatal asphyxia, renal insufficiency, presumed sepsis, severe hypoglycemia, seizure activity, apnea and bradycardia, ischemic damage to the basal ganglia, poor oral intake and [nasogastric intubation] feed dependent.”
The hospital argued in its memorandum that its staff met the applicable standard of care.
“Based on the test results, the patient did not have preeclampsia on Jan. 18, 2001,” the hospital said. “The patient was discharged with extremely specific instructions, with regard to when to return to the hospital. Specifically, she was told to return for an evaluation on January 20, 2001. Ms. Peterson did not follow that instruction, nor did she follow the instructions to return if she had vaginal bleeding.”
The hospital further maintained in its memorandum that the cause of the placental abruption could have been Peterson’s smoking, drug use or an injury.
The University of Pennsylvania Medical Center and the Trustees of the University of Pennsylvania made similar arguments in their own pretrial memorandum.
Ultimately, the jury agreed with the defendants.
Counsel for the hospital, Kathleen M. Kramer of Marshall Dennehey Warner Coleman & Goggin in Philadelphia, could not be reached for comment at press time.
Counsel for the other defendants, Thomas M. Savon of Naulty, Scaricamazza & McDevitt in Philadelphia, also could not be reached.
Plaintiffs counsel Thomas J. Duffy of Duffy + Partners in Philadelphia said the case had some “difficult issues.”
“There was no real offer and we went forward doing what we thought was best for the client—trying the case to verdict,” Duffy said, adding that he plans to file post-trial motions.