The government-run clinic that provided prenatal care for a mother who gave birth while she unknowingly carried streptococcus B has secured summary judgment extinguishing most of the claims brought against it.
But the clinic must still face a claim that it breached the standard of care by not telling the mother, Briana Winfield, that she had tested positive for the bacteria, which she passed on to her baby.
U.S. District Judge Harvey Bartle III of the Eastern District of Pennsylvania sided almost wholly with the Parkview Health Center on the medical malpractice action brought by Winfield and Rasheed Carter on behalf of themselves and their infant daughter, Zaya Winfield Carter.
“The motion of the government for summary judgment will be denied on the issue of whether Parkview breached the applicable standard of care in failing to inform Winfield of her positive GBS test results before August 5,” Bartle said, referring to the group B streptococcus, called GBS, that Winfield tested positive for shortly before she gave birth.
About 30 percent of women carry the bacteria, which can cause severe illness in newborns if it is transferred to them during birth. In an effort to reduce neonatal GBS, the Centers for Disease Control and Prevention developed guidelines calling for obstetricians to screen their patients for GBS at 35 to 37 weeks, so that antibiotics can be administered during delivery if the mother tests positive. Intravenous antibiotics administered during delivery dramatically reduce the likelihood that GBS will be transferred to the infant, according to the opinion.
Winfield’s doctor at Parkview gave her the test at the appropriate time, when she was just shy of 37 weeks, but the results were filed to be discussed with her at a follow-up visit scheduled for just before her due date. Winfield wasn’t told that her test results were abnormal, according to the opinion.
However, Winfield went into labor about two weeks before her due date and ended up giving birth at a different hospital than the one she and her doctors at Parkview had planned on. The hospital in which she gave birth didn’t have the records reflecting her GBS test results and she wasn’t given antibiotics during labor.
Four days after Winfield went home with her baby, the baby was admitted to a children’s hospital with GBS meningitis, obstructive hydrocephalus and GBS sepsis, according to the opinion.
Winfield and Carter then filed their suit alleging that Parkview breached its duty of care by failing to attach the GBS test results to Winfield’s chart, failing to notify the hospital where Winfield gave birth of the GBS test results in a timely manner, and failing to notify Winfield of the results and recommended course of treatment.
The evidence available about Hahnemann University Hospital’s efforts to contact Parkview before Winfield gave birth doesn’t necessarily show that Parkview had sufficient notice that the records were required, Bartle decided. Phone records indicate that two phone calls were made from Hahnemann to Parkview on the day Winfield gave birth; one was made in the morning before Parkview was open, according to the opinion.
“There is insufficient evidence in the record from which reasonable inferences can be drawn that Parkview had timely notice to send to Hahnemann Winfield’s positive GBS test results so that the appropriate antibiotics could have been administered to her to prevent serious injury to her baby. We will therefore grant the motion of the government for summary judgment on the plaintiffs’ claim insofar as it relates to any failure by Parkview to notify the Hahnemann delivery team of Winfield’s GBS status on August 5,” Bartle said.
However, Winfield’s claim that Parkview breached its duty by failing to tell her the results of her GBS test when it knew them survived, Bartle held.
Expert opinion offered by the plaintiffs in the case would pass muster under Pennsylvania case law interpreting the state’s Medical Care Availability and Reduction of Error Act, Bartle ruled. Parkview had argued that they weren’t competent to testify. The two experts weren’t physicians certified in obstetrics—the one discussed at length in the opinion had expertise in pediatric infectious disease and hospital epidemiology, according to the opinion.
Under a pair of Pennsylvania appellate cases—the Supreme Court’s 2010 decision in Vicari v. Spiegel on expert testimony in a cancer case, and the Superior Court’s 2013 decision in Renna v. Schadt on an expert pathologist’s testimony in a surgical case—Bartle concluded the plaintiffs’ experts were sufficiently qualified.
“The matter presently before this court is in many important respects similar to Vicari and Renna. Like the cancer treatment discussed in Vicari, the treatment of neonatal GBS disease is ‘complex and multidisciplinary,’” Bartle said, quoting from Vicari.
“An OB/GYN treats the pregnant woman and the prenatal child while the pediatrician treats the child once it is born,” Bartle said later. “This is a classic case where physicians with different specialties treat the patient ‘in a sequential but coordinated manner.’”
The experts presented by the plaintiffs are competent to testify as to the prudence of Parkview not informing Winfield about the results from her GBS test, Bartle held.
(Copies of the 23-page opinion in Winfield Carter v. United States, PICS No. 14-0200, are available from The Legal Intelligencer. Please call the Pennsylvania Instant Case Service at 800-276-PICS to order or for information.) •