Hernandez ex rel. Telles-Hernandez v. U.S.

• Citation: 665 F.Supp.2d 1064
• Decision Date: 16 October 2009
• Docket Number: Case No.: C 06-3350 SBA.
• Parties: Cruz HERNANDEZ, a minor, by and through his Guardian ad Litem, Alicia TELLES-HERNANDEZ, Plaintiff, v. UNITED STATES of America, Defendant.
• Court: U.S. District Court — Northern District of California

665 F.Supp.2d 1064

Cruz HERNANDEZ, a minor, by and through his Guardian ad Litem, Alicia TELLES-HERNANDEZ, Plaintiff, v. UNITED STATES of America, Defendant.

Case No.: C 06-3350 SBA.

United States District Court, N.D. California, Oakland Division.

October 16, 2009.

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Stanton T. Mathews, Marcia Ellen Depew, Ronald Burton Funk, Jr., Mathews Funk & Associates, A Law Corp., Laguna Hills, CA, Jonathan Unruh Lee, United States Attorneys Office, San Francisco, CA, for Plaintiff.

Edward A. Olsen, Jonathan Unruh Lee, Melanie Lea Proctor, United States Attorney's Office, San Francisco, CA, for Defendant.

AMENDED FINDINGS OF FACT AND CONCLUSIONS OF LAW¹

SAUNDRA BROWN ARMSTRONG, District Judge.

FINDINGS OF FACT²

A. PRENATAL COURSE BEFORE RUPTURE OF MEMBRANES

1. Alicia Telles-Hernandez learned she was pregnant in March 2002. Reporter's Transcript (RT) 360:12-16. She received prenatal care from her primary physician, Dr. Don Carlos Steele (hereinafter Dr. Steele or Defendant) at the Sonoma County Indian Health Project. RT 359:19-360:10.³

2. The Sonoma County Indian Health Project (SCIHP) is a nonprofit corporation providing health care to Native Americans in the Northern California area, which does not have an Indian Health Service hospital. RT 582:2-13. SCIHP provides medical, pharmaceutical, dental, and behavioral health care services. RT 582:14-21. SCIHP serves an under-represented population because the ratio of population to physicians is much greater among Native Americans than other groups. RT 582:23-583:11.

3. Dr. Steele is a family physician who, following his education at Dartmouth Medical School and residency at the Oregon Health Sciences University, became licensed to practice medicine in California in the early 1990s. He began his family practice at Sonoma County Indian Health Clinic Project in 1993. RT 576:22 581:24. At the time of the events at issue, he had privileges at Sutter Santa Rosa Medical Center, including obstetrical privileges. RT 577:21-22. He had privileges to assist at surgery but not operate as the primary surgeon. RT 811:4-11. In approximately April 2002, Mrs. Telles-Hernandez had an urinary tract infection, which Dr. Steele treated with antibiotics. RT 585:11-587:1.

4. During her last trimester, Mrs. Telles-Hernandez had a mildly elevated blood pressure, which Dr. Steele reviewed and assessed, and which presented no further problem. RT 587:2-25.

B. EVENTS OF OCTOBER 9-10, 2002

5. At approximately 10:00 to 11:00 p.m. on October 9, 2002, Mrs. Telles-Hernandez arrived at Sutter Santa Rosa Medical Center, reporting that her membranes had ruptured a couple of hours earlier. RT 588:7-13, 23-24. When she arrived at the hospital, she was in the latent phase of labor, meaning her cervical dilation was less than four centimeters. RT 589:18-590:10. All indications were that Mrs. Telles-Hernandez (and her fetus) were in good health when she entered the hospital. RT 88:3-6.

6. Mrs. Telles-Hernandez strongly desired to have a vaginal delivery. However, there were four factors present at the time of her admission to the hospital that militated against the likelihood that she would be able to deliver her baby in that manner: (1) she was only eighteen years-old, which is a certified American College of OB/GYN (ACOG) risk factor; (2) she was of an under-served population that has more complications in labor than the ordinary population; (3) she was 5'1" tall and weighed 212 pounds, making it more likely that she would have a small pelvis combined with a larger baby; and (4) she presented at minus-two station, whereas a Primip (a female during her first pregnancy) at term with ruptured membranes should be at least zero station, meaning that the fetus' head should be level with the mid-pelvis and no centimeters above it. RT 82:10-83:13.

7. At approximately 11:00 p.m. on October 9, 2002, Dr. Steele wrote a chart note called "admit note," which was received in evidence. Def's. Exh. B at 000082; RT 595:5-597:1. The admit note documented Dr. Steele's initial examination of Mrs. Telles-Hernandez on that evening, noting that her status was irregular, she had sporadic uterine contractions with 1.5 centimeters dilation, and there was spontaneous rupture of membranes (SROM). RT 597:10-600:21.

8. In the morning of October 10, 2002, Mrs. Telles-Hernandez was started on Pitocin, a drug intended to induce labor; however, over the course of the day, the induction failed. RT 86:22-25.

9. Around noon on October 10, 2002, Dr. Steele prescribed prophylactic antibiotics to Mrs. Telles-Hernandez intended to prevent infection. RT 500:15-21, 594:6-15. Dr. Kahl confirmed this. RT 755:16-19. The standard of care for prescribing prophylactic antibiotics is usually 12 hours after the membranes have ruptured. RT 594:6-11.

10. Dr. Steele continued to monitor Mrs. Telles-Hernandez throughout the day on October 10, 2002. He documented this in his note summarizing the events of the day, which was received into evidence. Def's. Exh. B at 000084; RT 623:7-25.

C. EVENTS OF OCTOBER 11, 2002 UNTIL 3:00 P.M.

11. Dr. Steele spent the night of October 10-11 at the hospital. RT 593:1-3. Early on the morning of October 11th, Dr. Steele wrote a summary note, which was received into evidence. Exh. B at 00084; RT 623:7-25.

12. In this record, Dr. Steele noted that there had been no real change in Mrs. Telles-Hernandez' progress since the previous note, her cervical dilation was now at 3 centimeters and his plan was to place internal monitoring equipment and continue with Pitocin. RT 606:6-607:22. The internal equipment included the intrauterine pressure catheter (IUPC) to measure uterine contractions and the fetal scalp electrode, which measures uterine contractions and fetal heart tones simultaneously, but through separate electrodes. RT 607:23-609:1.

13. At about 12:00 p.m. on October 11, 2002, Dr. Steele asked Natasha Kahl, M.D., for a consult regarding Mrs. Telles-Hernandez' blood pressure readings during the labor course. RT 685:3-12. Dr. Kahl has been an obstetrician and gynecologist, with surgical privileges and practicing at Sutter Santa Rosa Medical Center since September 1999. RT 682:11-25.

14. This first consultation was to check on Dr. Steele's concern Mrs. Telles-Hernandez' potential for preeclampsia, which is a condition peculiar to pregnancy involving elevated blood pressures, the spillage of urine protein, and often other end organ problems such as liver or kidney problems. RT 685:13-686:1.

15. Dr. Kahl came to the hospital, reviewed Mrs. Telles-Hernandez' medical records, met with her, performed a physical assessment and documented her opinions. RT 686:2-8. The assessment included an examination of Mrs. Telles-Hernandez' abdomen and review of the fetal heart rate tracing and uterine activity. RT 686:8-687:18. Dr. Kahl determined that Mrs. Telles-Hernandez did not have abdominal pain and that her uterus was relaxing between contractions, despite an elevated uterine pressure shown on the monitor. RT 687:19-690:10.

16. At 10:15 a.m., Mrs. Telles-Hernandez was 3 centimeters dilated and 5 centimeters dilated at 12:30 p.m., thus indicating that she had entered the "active" phase of labor (4 centimeters or greater). RT 591:13-592:9. However, Dr. Kahl reported that Mrs. Telles-Hernandez was not in active labor at the time of her first consultation which occurred "midday." RT 685:10, 690:15-16.

17. At 1:00 p.m. on October 11, 2002, Dr. Steele entered a note in the medical chart, which was received into evidence. Def.'s Exh. B at 000093; RT 623:7-25. This note indicated that Mrs. Telles-Hernandez' lab work regarding the possible preeclampsia had checked out as normal and she was making slow progress in labor with Pitocin, with cervical dilation at 5 centimeters. RT 609:9-614:22.

18. At 2:45 p.m., Mrs. Telles-Hernandez was 6 centimeters dilated and the baby was fine. RT 112:21-23.

19. From 12:30 p.m. to 4:30 p.m., Mrs. Telles-Hernandez' uterine contractions were "mild" with only one recorded entry in the nursing chart that reached the normal level of 60 millimeters of mercury. RT 803:22-805:9.

D. EVENTS OF OCTOBER 11, 2002 FROM 3:00 P.M. TO 7:00 P.M.

20. Nurse Catherine Clark was a labor and delivery nurse working at Sutter Santa Rosa Medical Center on October 11, 2002. RT 508:6-8. Her shift started at 3:00 p.m. and she was assigned to manage the labor and delivery of Mrs. Telles-Hernandez. RT 508:9-23.

21. As the labor and delivery nurse assigned to Mrs. Telles-Hernandez, Ms. Clark reviewed the fetal heart tracing between 3:00 p.m. and 8:30 p.m. RT 519:20-24. She testified that the heart rate showed good variability throughout the entire time. RT 519:25-520:9. She noted "there was nothing we were concerned about in terms of the fetal heart rate on this baby in terms of variability." RT 520:8-9.

22. Ms. Clark palpated Mrs. Telles-Hernandez' uterus between 3:00 and 8:30 p.m. RT 520:24-521:6. Her observations of the uterine contractions during that time period were not consistent with the uterus being in constant contraction without relaxation. RT 521:7-12. On cross-examination, Ms. Clark explained that due to problems with the monitoring equipment and Mrs. Telles-Hernandez' body position at different points, the tracing of uterine contractions was inaccurate. RT 549:10-555:15. On redirect, Ms. Clark noted the specific times—5:00 p.m. and 6:05 p.m., when the monitoring equipment was changed due to inaccurate or difficult readings. RT 566:16-567:24. Dr. Steele confirmed this. RT 807:23-24, 809:7-18.

23. Ms. Clark testified that at 3:45 p.m. she recorded Mrs. Telles-Hernandez' temperature as 100 degrees. RT 523:6-19. At that time, she recorded fetal heart tone as "130s," variability as "moderate," and uterine contractions as 25-35 millimeters of mercury. RT 524:5-12; Def.'s Exh. 3 at 000128.

24. Ms. Clark documented maternal...