Quiroz ex rel. Quiroz v. Covenant Health
| Decision Date | 08 March 2007 |
| Docket Number | No. 08-05-00196-CV.,08-05-00196-CV. |
| Citation | 234 S.W.3d 74 |
| Parties | Isaiah Levon QUIROZ, A Minor, by and Through Debra QUIROZ, as Parent and Next Friend, Appellant, v. COVENANT HEALTH SYSTEM, A Texas Corporation, Lubbock Methodist Hospital, A Texas Corporation, A & D Medical Center, L.L.C., A Limited Liability Company, and David William Davison, M.D., Appellees. |
| Court | Texas Court of Appeals |
Kathleen McCartan, Mueller Law Offices, Austin, for Appellant.
Jim Hund, Hund & Harriger, L.L.P., Lubbock, Michelle E. Robberson, Copper & Scully, Dallas, for Appellees.
Before CHEW, C.J., McCLURE, and BARAJAS, C.J. (Ret.).
This is another tragic birth asphyxia case. Following a jury trial, the trial court entered a take nothing judgment in favor of Covenant Health System, A & D Medical Center, L.L.C. and Dr. David Davison, M.D.1 Debra Quiroz, as parent and next friend of her son Isaiah Levon Quiroz, filed a medical malpractice suit alleging the negligence of Covenant and Dr. Davison proximately caused her son's devastating and permanent brain injuries.2 Quiroz challenges the factual sufficiency of the evidence to support the jury's verdict as well as several evidentiary rulings. For the reasons that follow, we affirm.
Isaiah was born in Ward Memorial Hospital on August 8, 1998. The hospital is a small county-owed facility in Monahans, Texas. Dr. Davison, the treating physician, attended Quiroz throughout her prenatal course without any problems. Isaiah was born by emergency Caesarean section with the umbilical cord wrapped tightly around his neck. Isaiah's skin was blue, he was not breathing, his heart rate was questionable, and his body was floppy. According to the medical record, he suffered from "hypoxic ischemic encephalopathy" and has cerebral palsy. Although Isaiah is expected to live into his seventies, he will never live independently or hold a job. He is not expected to walk on his own and his ability to communicate is severely limited.
Quiroz alleged that Covenant's hospital manager had been negligent in operating the hospital and had contributed to Isaiah's injuries. The hospital is owned by Ward County and operates under the control of a hospital board of directors. The board is made up of members of the community, many of whom are farmers, ranchers, and local business people. In early 1998, the county considered closing the facility due to severe financial problems. After negotiating with several potential candidates, the hospital board of directors entered into a management agreement with Covenant on May 26, 1998. Covenant and the hospital were operating under this agreement seventy-four days later when Isaiah was born.
Our discussion of the events surrounding Isaiah's birth requires a basic understanding of fetal heart monitoring and the interpretation of monitor strips. A fetal heart monitoring machine is a mechanical device which, when attached to a laboring mother's abdomen, records both uterine contractions and the baby's heart rate. The two readings are produced simultaneously so that the physician can track how the baby's heart rate responds to the increased stress of labor. The uterus contracts during labor, putting pressure on the umbilical cord. Even in a normal labor pattern, the increased pressure causes the baby's heart rate to drop during contractions because there is less blood and oxygen moving through the cord from the placenta. According to expert testimony, fetal monitoring is the best way to evaluate the status of the baby as labor progresses.
The monitor's measurements are recorded on the monitor strip as continuous lines which rise and fall according to the baby's heart rate and uterine pressure. The monitor strip is divided into two parts. The top line measures the baby's heart rate. The bottom line, printed simultaneously, measures the pressure created by contractions.
The normal heart rate for a full term baby is between 110 and 160 beats per minute. A fetal heart rate in the normal range is called "reassuring." When the baby's heart rate drops below the normal range it is referred to as "nonreassuring." The longer and more frequently the heart rate drops, the more there is cause for concern. Changes in the baby's heart rate produce a "squiggly line" on the monitor strip, which is referred to as variability. The key to a normal monitor strip is that heart rate changes mirror the pressure of the contraction. The baby's heart rate should be at its lowest when the pressure of the contraction peaks; then, as the contraction subsides, the heart rate should recover.
The baby's heart rate can have both short-term and long-term variability. Short-term variability refers to the beat-to-beat changes in the heart rate. Long-term variability measures the number of large oscillations on the monitor strip in one minute. Long term variables are measured in relation to a baseline which is simply the average heart rate over a ten minute period without a contraction. An acceleration is a fifteen beat increase above the base line that lasts for at least fifteen seconds. Accelerations are positive news for the patient because they indicate there is plenty of oxygen flowing through the placenta. Concern develops when there is a variable deceleration and the heart rate is slow to return to baseline. Because the goal is for the variables to match the contractions, a slow return to baseline indicates the baby is under stress and having trouble compensating for a lack of oxygen even as the contraction ends. Variable decelerations are usually associated with umbilical cord compression of some kind.
A late deceleration begins after the contraction starts. The low point of the deceleration occurs after the height of the contraction. This is called uteroplacental insufficiency. The amount of blood traveling through the placenta is insufficient to give the baby's heart enough oxygen to recover properly from the stress of the contraction. Without enough blood passing through the umbilical cord from the placenta, the baby develops hypoxia, a decrease of oxygen. The decreased blood flow is called "ischemia."
When the heart rate monitor shows signs of cord compression, the standard of care requires intrauterine resuscitation to relieve the pressure on the cord and restore blood flow. Methods to relieve cord pressure include repositioning the mother on her side or into the "Trendelenburg position," where her feet are higher than her head; pushing the baby's head back up into the birth canal; increasing fluids; and administering oxygen.
Presentation Until 7:50 a.m.
Quiroz presented at the hospital shortly after 2:45 a.m. on August 8, 1998. The fetal monitor machine began recording at 2:45 a.m., and the next couple of hours were relatively uneventful. She received an epidural for pain at 5:10 a.m.
At 6:40 a.m., the monitor strip showed a series of three or four contractions without full uterine relaxation between, as well as late decelerations with slow returns. The baby was beginning to experience some stress but his body was able to compensate. From 7 a.m. until 7:15 a.m., there were additional long contractions without relaxation. The monitor recorded a late deceleration and a variable where the heart rate dropped down to 90 and was slow to return to the baseline. The return to baseline indicated again that although the baby was stressed, he was still compensating after the contractions.
Dr. Davison arrived at 7:15 and reviewed the chart and monitor strip. From 7:20 until 7:35, the decelerations became more frequent but were still not indicative of an emergency. Dr. Davison ordered the surgical scrub nurse to be called in to prepare for a C-section if needed.3 The on-site nurses tried to relieve stress on the baby by repositioning Quiroz on her sides, administering oxygen, and stimulating the baby's heart rate though scalp massage.
Quiroz began pushing at 7:30. The monitor strip showed variable decelerations with each push, another indication of cord compression. Quiroz pushed for ten minutes and although the deceleration became more and more severe, the baby's heart rate continued to climb back to the baseline. The pattern repeated itself several times with moderate variability when the baby experienced compensatory tachycardia. His heart accelerated back to and above the baseline, which is an indication of hypoxia and severe stress.
7:50 a.m. Until Delivery
At approximately 7:50 a.m., the baby stopped descending through the birth canal and was in serious trouble. The scrub nurse clocked in at 8 a.m. Dr. Davison testified that he could not perform the C-section safely without the scrub nurse to assist him. Without a surgical option, Dr. Davison attempted to deliver Isaiah vaginally with the help of a vacuum extractor called the "Mity-vac." The device is designed to work as an alternative to forceps. The Mity-vac is made of a cup which attaches to the baby's head through light suction. A pump increases the suction during a contraction, allowing the physician to pull the baby through the pelvis. At the end of the contraction, the suction releases and the process starts again for another pull as the next contraction begins.
Dr. Davison applied the Mity-vac between 7:50 and 8:10, over the course of six contractions. He testified that on each of the first five pulls, he felt movement and believed Isaiah would be delivered any second. On the last pull, there was no movement and Davison ordered a C-section. As Quiroz was prepped for the move to the surgical unit, the baby's heart rate dropped dramatically and variability disappeared.
Whether Isaiah was delivered at 8:27 a.m. or 8:39 a.m. is disputed.4 There are several notations in the medical records indicating that Isaiah was delivered at 8:27 a.m. There is also a notation on the fetal monitor...
To continue reading
Request your trial
- In re J. G. S.
-
Faust v. Bnsf Ry. Co.
...expert testimony, we may not substitute our own judgment for that of the jury's. See, e.g., Quiroz ex rel. Quiroz v. Covenant Health Sys., 234 S.W.3d 74, 84–85 (Tex.App.-El Paso 2007, pet. denied) (holding evidence factually sufficient to support jury's failure to find defendants negligent)......
-
Taber v. Roush, 14-08-00089-CV.
...the scientific method is the premise that the conclusions reached are the result of analysis. Quiroz ex rel. Quiroz v. Covenant Health Sys., 234 S.W.3d 74, 89 (Tex.App.-El Paso 2007, pet. denied). Coming to a firm conclusion first and then doing research to support that conclusion is the an......
-
Nabors Well Servs., LTD v. Romero
...To be sure, the non-physician must be qualified on the very issue before the court. In Quiroz ex rel. Quiroz v. Covenant Health System, 234 S.W.3d 74, 86 (Tex.App.–El Paso 2007, pet. denied), we affirmed the exclusion of testimony from a hospital administrator on how administrative policy c......
-
CHAPTER 5.I. Motion Authorities
...before the trial court which would qualify the expert to given an opinion on that particular subject."). Quiroz v. Covenant Health Sys., 234 S.W.3d 74, 88 (Tex. App.—El Paso 2007, pet. denied) (physician's expert opinion regarding the link between a child's permanent brain injury and cerebr......
-
Witness
...malpractice case, not every engineer is qualified in every products liability case. Quiroz ex rel Quiroz v. Covenant Health System, Sys., 234 S.W.3d 74, 88-89 (Tex. App.—El Paso 2007, pet. denied). Trial court properly excluded expert testimony of a doctor where he testified to the complexi......
-
CHAPTER 8.I. Motion Authorities
...speculation, or surmise, does not assist the jury and cannot support a judgment."). Quiroz ex rel. Quiroz v. Covenant Health Sys., 234 S.W.3d 74, 87 (Tex. App.—El Paso 2007, pet. denied) (opinion based on unreliable scientific data is inadmissible as it is nothing more than the expert's sub......