Last year, a jury in Volusia County, Florida awarded a $10 million professional negligence verdict against a local EMS service, EVAC, in connection with the premature birth of a boy in the back of one of its ambulances. The plaintiffs were Margarita Chess and her son, Addison, who has brain damage and cerebral palsy.
Shortly after the verdict, there was a great deal of understandable shock and dismay within the EMS community. It sounded like a classic case of overwhelming jury sympathy unsupported by any legitimate evidence of professional negligence. The initial news coverage of the verdict was spotty and superficial, with very little detail about the factual basis for the verdict. Here is an example:
More information is now available about the facts that led to the verdict. Ms. Chess was six months pregnant when she presented to Bert Fish Medical Center in New Smyrna Beach for premature labor pains. The ER physician at that hospital decided to transfer her to another facility because his hospital didn’t have an obstetrician or, in his opinion, the proper equipment to handle a significantly premature baby.
The ER physician tried to get an obstetrician at Halifax Medical Center to accept the transfer, but that doctor refused to accept the transfer because he believed his facility was not capable of handling such an extremely premature baby. Subsequently, the ER physician at Bert Fish persuaded a doctor at Arnold Palmer Hospital for Children in Orlando to accept the transfer. Unfortunately, that hospital was an hour and fifteen minutes away. EVAC was called to perform the transfer.
About fifteen minutes into the transport, Ms. Chess’s water broke. The paramedic, who was in the back of the unit with Ms. Chess, instructed the EMT who was driving to pull off of the interstate and find a fire station for first responder assistance, but the EMT could not find a fire station and became lost in an unfamiliar area. Unfortunately, this transport quickly became a classic example of the old adage that “anything that can go wrong will go wrong.”
The delivery in the back of the ambulance was a breech birth, and the child suffered hypoxia that allegedly caused his brain damage and cerebral palsy. (According to materials published by the Mayo Clinic, http://www.mayoclinic.com, hypoxia during birth is believed to be one potential cause of cerebral palsy.) It is amazing that the baby–weighing only 1.7 pounds and being so extremely premature–even survived, but he did.
The plaintiffs originally sued the transferring hospital, the receiving hospital and both doctors as well as EVAC EMS. All of the defendants settled before trial except EVAC, which decided to take its chances with the jury.
The standard of care expert who testified for the plaintiffs criticized the EVAC ambulance crew on several points:
1. The most likely complications to arise if the baby was born during transport were respiratory difficulties, temperature control problems and/or blood sugar issues. To address those, the ambulance would need a size 00 laryngoscope blade, a size 2 ET tube, a neonatal bag-valve-mask and a warmer. The EVAC ambulance had none of those items. The ER at Bert Fish Medical Center did.
2. The EVAC ambulance crew did not advise the ER physician at Bert Fish Medical Center of its equipment limitations.
3. The EVAC ambulance crew did not contact its medical director or even a supervisor for guidance before accepting the transport.
4. The EVAC ambulance crew did not request that staff from the ER ride along to provide assistance in the event of complications or call to determine whether a specialized neonatal transport or helicopter transport was available.
The plaintiff’s expert seemed to focus on the ambulance crew’s failure to be more assertive in its discussions with the ER physician at the transferring hospital. In the critical care paramedic class that I teach a couple of times a year at a local college, we spend a good deal of time discussing the importance of communicating any concerns to the physician or nursing staff, and reaching some resolution of those concerns, prior to initiating a facility-to-facility transport. In this Florida case, that might have made a big difference in the outcome.
An interesting article about the expert’s critique in the Florida case can be found here: