Douzart v. Jones
| Decision Date | 04 May 1988 |
| Docket Number | No. 19552-CA,19552-CA |
| Citation | 528 So.2d 602 |
| Parties | Ambrose DOUZART, Individually and as Administrator of the Estate of the Minor Child, Andranita D. Douzart, Plaintiff-Appellant, v. Dr. Emily JONES, et al., Defendants-Appellees. 528 So.2d 602 |
| Court | Court of Appeal of Louisiana — District of US |
Donald R. Miller, Shreveport, for plaintiff-appellant.
Mayer, Smith & Roberts by Caldwell Roberts, Shreveport, for defendants-appellees.
Before MARVIN, FRED W. JONES, Jr. and NORRIS, JJ.
In this medical malpractice action for damages to a child injured at birth, the parents appeal a judgment based on a jury verdict rejecting their demands.
The issues concern the credibility of the mother of the child and whether the defendant doctor breached the standard of care. We find no manifest or clear error and affirm. Virgil v. American Guar. & Liability Ins., 507 So.2d 825 (La.1987).
In a medical malpractice action against a physician-specialist, the plaintiff has the burden of proving the degree of care ordinarily practiced by physicians within the involved medical specialty and is not restricted to proof of the standards of care and skill within the defendant's community or locality. LRS 9:2794A(1); Ardoin v. Hartford Acc. & Indem. Co., 360 So.2d 1331 (La.1978).
The plaintiff must also prove that the defendant either lacked the expected degree of knowledge and skill or failed to use reasonable care and diligence and his or her best professional judgment, in the particular application of that skill in the undertaking. Plaintiff must prove, as well, that the injury complained of was the proximate result of the defendant's breach of the professional duty. LRS 9:2794A(2), (3).
The doctor's conduct is evaluated in terms of reasonableness under the circumstances existing when the professional judgment is exercised. Neither a general practitioner nor a specialist is held to a standard of perfection or evaluated with the benefit of hindsight. See and compare Matthews v. La. State Univ. Medical Center, 467 So.2d 1238 (La.App. 2d Cir.1985).
The delivery of this infant in January 1981 was complicated by shoulder dystocia which is caused when one shoulder of the infant becomes trapped behind the mother's pelvis during delivery or exit of the infant's head. If the shoulder is not quickly dislodged by maneuvering the infant or enlarging the delivery canal, breathing becomes increasingly impaired and death by suffocation is threatened.
When shoulder dystocia occurs, the doctor should make a maximum incision on the back wall of vagina to enlarge the space to accommodate the child as much as possible, after which an attempt is made to rotate the baby or reposition its arms to facilitate delivery. If these methods do not succeed, an attempt is made to manually fracture the collar bone of the child to reduce the diameter of the shoulders. As a last resort, the doctor manually attempts to force the child out of the predicament by pulling on her head.
Defendant Dr. Jones testified that she attempted each maneuver before succeeding on the final maneuver. 1 Bruises on the child's shoulder corroborated Dr. Jones's unsuccessful attempt to break the collar bone. Fortunately the child did not advance into acute respiratory distress before or after her birth.
Dr. Jones acknowledges that the pressure she applied in her successful attempt to force delivery caused damage to the nerves in the brachial plexus. This nerve damage produces Erb's palsy in the arm, a condition that causes weakness and not paralysis. The infant's condition was diagnosed as a mild Erb's palsy and causes the child to be able to extend her right arm to only 85 percent of its capacity. Dr. Jones also acknowledges that if she had delivered the child by Cesarean section shoulder dystocia would have been avoided, but replaced by known surgical risks to both the mother and the child.
Plaintiffs contend Dr. Jones should have anticipated that shoulder dystocia might occur and should have done a C-section at the outset because she knew of Mrs. Douzart's excessive weight gain during the pregnancy; she knew the baby was large; and she knew or should have known that shoulder dystocia and a similar birth injury had occurred when Mrs. Douzart delivered another large baby several years earlier, while under the care of a different doctor.
Plaintiffs have two other daughters who are twelve and five years older than the third. The first weighed 8 lbs. 12 oz. at birth and was delivered without complications. The delivery of the second, who weighed 10 lbs. 11 oz. at birth, was also complicated by shoulder dystocia. The second daughter has Erb's palsy in her left arm. The third child, delivered by defendant Dr. Jones in January 1981, weighed 10 lbs. 15 1/2 oz. at birth and has Erb's palsy in her right arm because of the nerve injury at birth. This condition prevents her from fully extending her arm or straightening her elbow but does not impair any motor functions of her arm or hand.
Mrs. Douzart first saw Dr. Jones in July 1980, when she was about three months into the third pregnancy. According to the doctor's records, Mrs. Douzart reported that her last baby weighed over 10 pounds. Doctors consider a baby "large" if it weighs over 8 1/2 to 9 pounds at birth. Dr. Jones knew Mrs. Douzart was carrying another large child but felt she could have a normal delivery because her pelvis was large and she had previously delivered a "large" baby.
Dr. Jones said the only prior delivery difficulty Mrs. Douzart reported to her was long labor. Dr. Jones said that Mrs. Douzart did not tell her about the prior difficult delivery or the other child's palsy, and that they discussed a C-section only for the purpose of avoiding long labor. Dr. Jones explained to Mrs. Douzart that a C-section would cause pain after delivery instead of before, as in normal childbirth.
The hospital records contain three forms signed by Mrs. Douzart. One is a release of responsibility for valuables. Another authorizes Dr. Jones to perform "Obstetrical Delivery and such additional operations or procedures as are considered therapeutically necessary on the basis of findings during the course of said operation." The third form, entitled "Medical History," asked about Mrs. Douzart wrote "2--Health good."
The size or width of the baby's shoulders cannot be accurately measured during pregnancy. One factor which should alert the doctor that shoulder dystocia may occur is a long second stage of labor, from complete cervical dilation to delivery. Mrs. Douzart's second stage of labor was "short," lasting only 14 minutes. The first stage of labor, from onset to completion of cervical dilation, lasted about 10 hours, and was not considered unduly long.
Mrs. Douzart, in her late thirties, was 5' 6" tall. She...
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