I.P. v. United States, 2:13-cv-01012-JAM-CKD
| Decision Date | 28 October 2015 |
| Docket Number | No. 2:13-cv-01012-JAM-CKD,2:13-cv-01012-JAM-CKD |
| Court | U.S. District Court — Eastern District of California |
| Parties | I.P., A MINOR, BY AND THROUGH HER GARDIAN AD LITEM, FACUNDO PALACIO DIEZ; MICAELA PALACIO, Plaintiffs, v. UNITED STATES OF AMERICA, Defendant. |
Plaintiff I.P., a minor, and her mother, Micaela Palacio (collectively, "Plaintiffs") originally sued the hospital where I.P. was born for negligently failing to perform a timely C-section, causing I.P. brain damage that rendered her severely and permanently disabled. That case proceeded in Lassen County Superior Court. Upon learning that the United States employed the two doctors involved in the delivery - Drs. Paul Davainis and Paul Holmes - Plaintiffs brought this action against the United States ("Defendant") under the Federal Tort Claims Act ("FTCA"), 28 U.S.C. § 2671 et seq. This Court is vested with jurisdiction pursuant to 28 U.S.C. § 1346(b).
Plaintiffs' federal complaint alleged three causes of action: negligence as to I.P., and negligence1 as well as negligent infliction of emotional distress as to Micaela Palacio. Facundo Palacio Diaz, I.P.'s father, also asserted a claim against the hospital in the Lassen County case, but appears in this FTCA action only as I.P.'s guardian ad litem. In July 2015, this Court confirmed a settlement between the hospital, I.P. and her father. In the federal action, the parties proceeded to trial.
This Court conducted a nine-day bench trial beginning September 24, 2015. The parties offered testimony from percipient witness including I.P.'s parents, both doctors, and a nurse, as well as expert testimony on each doctors' negligence, causation, and several damages issues. The Court also considered the parties' stipulations reached prior to and during trial (Docs. ##98, 131) as to certain causation and damages issues.
After the close of Plaintiffs' case, the government moved for partial judgment as to the issue of Dr. Holmes's negligence. The Court agreed with the findings of fact and conclusions of law argued and submitted by the government (Doc. #153), and granted the motion pursuant to Federal Rule of Civil Procedure 52(a)(1)and (c). Because the Court concluded that Dr. Holmes was not negligent and his actions did not result in injury to Plaintiffs, all issues involving Dr. Holmes are resolved and this Order does not address them.
As to Dr. Davainis, the Court's findings of fact and conclusions of law pursuant to Rule 52 follow.
1. Banner Health is a nonprofit corporation that owns BLMC, a 25-bed hospital that provides medical care in Lassen County, California.
2. Micaela Palacio presented to BLMC around 11:00 PM on the evening of April 29, 2012, in active labor. She was at 39 weeks of gestation and had delivered two prior children vaginally without complications.
3. Facundo Palacio Diaz is I.P.'s father and Mrs. Palacio's husband.
4. Mrs. Palacio and her husband were both 34 years old as of April 2012.
5. In April 2012, Dr. Paul Davainis and Dr. Paul Holmes were Northeastern Rural Health Clinic employees.
6. Northeastern Rural Health Clinic is located in Susanville, California and is a Federally Qualified Health Center.
7. Dr. Davainis and Dr. Holmes are doctors with a specialty in Family Medicine who were in April 2012 deemed federal employees pursuant to the Federally Supported Health Centers Assistance Act.
8. In April 2012, Kelly DelCarlo was a registered nurse and a Banner employee.
9. Ms. DelCarlo and Ms. Ginger Leeth were working at BLMC the evening of April 29, 2012 and provided nursing care to Mrs. Palacio.
10. Dr. Davainis was on call for Obstetrics during the evening of April 29, 2012. Dr. Davainis was at his home when he was called to come in by the nursing staff around 2:00 AM on the morning of April 30, 2012.
11. At that time, the nursing staff informed him that Mrs. Palacio had dilated to 9 cm and that her membranes had spontaneously ruptured. The nursing notes state that Mrs. Palacio remained at 9 cm dilation from 2:00 AM until the C-section.
12. Dr. Davainis had not provided Mrs. Palacio's prenatal care, and the early morning of April 30 was the first time the two had met. He examined her medical records that morning, but he was not generally familiar with her or her medical history.
13. The nurses and Dr. Davainis monitored I.P.'s wellbeing prior to birth by using an external electronic fetal heart rate monitor. The heart rate was measured on a tracing strip between approximately 11:06 PM and 5:07 AM. Dr. Davainis looked back at the entire strip when he arrived, and continued to examine it throughout Mrs. Palacio's labor.
14. The first stage of labor involves dilation of the cervix. Once the cervix is fully dilated, labor moves to the second stage, in which contractions push the baby down the birth canal.
15. At 2:15 AM when Dr. Davainis arrived, it was expected that Mrs. Palacio would fully dilate and deliver within the hour, because she had dilated rapidly since arriving at the hospital, she had a history of two prior vaginal deliveries without complication, and in general, the last part of dilation is the most rapid.
16. When Dr. Davainis examined Mrs. Palacio around 2:15 AM, he determined that she had dilated to between 8 and 9 cm and that the cervix "seemed loose."
17. Around 2:15 or 2:30 AM, Mrs. Palacio had an urge to push, so Dr. Davainis turned down the epidural and directed her to attempt pushing. They then abandoned the attempt because it caused swelling of the cervix. Dr. Davainis turned the epidural up and the swelling subsided.
18. Over the next hour to hour and a half, Dr. Davainis observed that Mrs. Palacio went from "between 8 and 9 cm" to 9 cm dilated. The nurses administered oxygen, IV fluids, and changed her position.
19. At 4:00 AM, Mrs. Palacio had a "rim of cervix." The cervix did not dilate any further. Mrs. Palacio never reached the second stage of labor, because her cervix never fully dilated.
20. Between 4:00 and 5:00 AM, Dr. Davainis had Mrs. Palacio resume pushing as he attempted to reduce the cervix.
21. Dr. Davainis felt the baby's head slightly descending at times between 4:00 and 5:00 AM. He considered that the baby might be in occiput posterior position, which could slow labor, or that there was cephalo-pelvic disproportion, which couldprevent vaginal delivery.
22. At 5:00 AM, Dr. Davainis called for a C-section. He described his reasons in a preoperative note recorded at 5:01 AM, indicating that the fetal heart rate tracing was worsening and he felt that "a vaginal delivery [was] too far off for this baby and that she will have a difficult time tolerating any prolonged pushing." He also was "afraid [cephalo-pelvic disproportion would] be proven."
23. Dr. Holmes was at his home when he was called at 5:00 AM on April 30, 2012, to assist with the delivery of I.P.
24. After Dr. Davainis called for a C-section, the nurses prepared Mrs. Palacio for surgery.
25. In preparing her for surgery, they disconnected the fetal heart rate monitor at approximately 5:07 AM.
26. I.P. experienced a hypoxic ischemic injury of the acute profound pattern due to near-total cessation of oxygenated blood through the umbilical cord sometime between approximately 5:08 and 5:13 AM.
27. This injury led to neonatal encephalopathy, which ultimately resulted in spastic quadriplegic cerebral palsy, cortical visual impairment, and severe global development delay.
28. The nurses reconnected Mrs. Palacio to the fetal heart monitor once inside the operating room, around 5:13 AM. The nurses were unable to find a fetal heart rate. Dr. Davainis observed a heart rate, but a very slow one.
29. Dr. Davainis immediately thereafter performed a C-section on Mrs. Palacio, assisted by Dr. Holmes.
30. I.P.'s time of birth was sometime between 5:24 and 5:28AM. I.P. had APGAR scores of 0, 2, and 3 at 1, 5, and 10 minutes of life, respectively.
31. After I.P. was delivered, Dr. Holmes resuscitated her and was assisted by hospital staff in the resuscitation.
32. I.P. was later transferred to U.C. Davis Medical Center NICU.
33. I.P. was cared for at U.C. Davis Medical Center from April 30, 2012 to June 5, 2012.
Further findings of fact are described and explained below.
The FTCA makes the United States liable for the negligent actions of its employees. 28 U.S.C. § 1346(b)(1). Because the allegedly negligent medical care in this case was provided in this state, California law applies. Id.; Hernandez ex rel. Telles-Hernandez v. United States, 665 F. Supp. 2d 1064, 1076 (N.D. Cal. 2009) (citing Richards v. United States, 369 U.S. 1, 11-12 (1962)).
To prove negligence, Plaintiffs must demonstrate by a preponderance of the evidence that (1) Dr. Davainis had a duty to use such skill, prudence, and diligence as other members of his profession commonly possess and exercise (the standard of care);2 (2) he breached that duty; and (3) the breach was theproximate cause of (4) Plaintiffs' injuries. Hanson v. Grode, 76 Cal.App.4th 601, 606 (1999) (citing Budd v. Nixen, 6 Cal.3d 195, 200 (1971) & Gami v. Mullikin Med. Center, 18 Cal.App.4th 870, 877 (1993)); Mgmt. Activities, Inc. v. United States, 21 F. Supp. 2d 1157, 1174 (C.D. Cal. 1998).
1. Negligence of Dr. Davainis
Dr. Davainis breached a duty owed to his patients if he failed to "exercise that reasonable degree of skill, knowledge and care ordinarily possessed and exercised by members of [his] profession under similar circumstances." Alef v. Alta Bates Hosp., 5 Cal.App.4th 208, 215 (1992); see Burgess v. Superior Court, 2 Cal.4th 1064, 1069 (1992) (). The central issue in dispute is whether Dr. Davainis complied with the standard of care by calling for a C-section at 5:00 AM, or whether that...
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