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Was your Child’s Cerebral Palsy Preventable? Unanswered Questions

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We are often asked by parents of children with cerebral palsy whether or not their child’s cerebral palsy may have been preventable with appropriate medical care. This is a question rarely addressed by the child’s treating physicians. Answering this question involves bringing together the medical opinions of a variety of carefully selected medical specialists who must each contribute their opinion on discrete areas of the medical care provided or the injury suffered by the child. Since this does not impact upon the medical treatment being provided to the child, this typically does not occur in the clinical setting. One exception is when the hospital performs a Quality Assurance Review in response to potential concerns about the quality of the medical care provided to a pregnant mother and/or her child; however, the results of these investigations are kept confidential and are not disclosed to the parents of the child with cerebral palsy.

This leaves many parents with unanswered questions. While they may receive fragments of information from various physicians, over the years an exhausted parent’s battle for answers quickly becomes displaced by the daily battle for resources such as therapy, support and equipment. The unanswered questions, however, continue to weigh on the parent’s mind, resurfacing from time to time, only to be buried again by weight of the day-to-day needs of their child.

We are frequently contacted by these parents – sometimes within weeks of their child’s birth, but often many years later. Parents always ask the same question: “Could my child’s injury have been prevented?”

It is understood that cerebral palsy can occur as a result of various medical conditions that are well-known and preventable with appropriate medical care. Some examples we are familiar with are as follows:

During Pregnancy :

  • Failure to diagnose and treat illness in the mother such as high blood pressure;
  • Failure to diagnose and treat symptoms such as maternal bleeding;
  • Failure to properly monitor the growth and development of the fetus; and
  • Failure to fully inform the mother of the risks associated with a VBAC (vaginal birth after caesarian section) delivery.

During Labour and Delivery :

  • Failure to properly monitor the fetal heart rate, and respond appropriately to signs of potential fetal distress;
  • Failure to properly administer oxytocin;
  • Failure to intervene to expedite the delivery of the baby when progress has slowed or stopped;
  • Failure to anticipate and properly manage shoulder dystocia; and
  • Failure to perform a caesarian section in a timely manner to avoid brain injury to the baby.

After Birth :

  • Failure to diagnose and properly treat certain conditions in the baby including hypoglycemia, jaundice and infection; and
  • Failure to properly administer medication, nutrition and/or fluid.

In these circumstances, if we are able to prove that a child’s cerebral palsy was preventable with appropriate medical care, the child is entitled to receive a significant financial settlement to allow the parents to provide for their child’s care, support and therapy, to help their child reach their full potential in life.

It is also understood that cerebral palsy can occur for reasons that are not (yet) understood by modern medicine and in circumstances in which it was not preventable. In these cases, knowing the child’s injury was nobody’s fault, can help relieve any anger or guilt parents may be feeling, and help them to put the circumstances of their child’s birth behind them, and to focus on their child’s future.

Either way, parents often feel it is better to know, rather than to continue to wonder.

If you are a parent of a child with cerebral palsy and have unanswered questions, please feel free to contact us. We will carefully review your concerns with you, conduct a detailed review of the medical records and consult with our experts (depending on the circumstances of each individual case), in order to answer your questions and determine if your child may be entitled to financial compensation.

We will review your case and answer your questions without charging you any fees for our investigation.

You may contact us at 604-685-2361 or toll free at 604-685-2361, or you may visit our website at www.pacificmedicallaw.ca

Paul McGivern spoke at the Birth Trauma Conference – June 7, 2013

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Paul McGivern  was an invited speaker and a panelist at the Birth Trauma Conference organized by CanLNC and held at the Vancouver Pan Pacific hotel on June 7, 2013. Susanne Raab and Natalia Ivolgina also participated in the conference. The conference featured top lawyers in the province practicing in birth trauma litigation and covered topics such as causes of cerebral palsy, standards of fetal monitoring, challenges in proving causation, and recent developments in the Supreme Court of Canada. Paul shared his knowledge in such areas as the use of experts in medical malpractice cases and recent pronouncements from the Supreme Court.

Paul highlighted the fact that birth trauma lawsuits are highly expert opinion driven which translates into enormous financial stakes for both the family and the law firm involved. Paul shared that in his practice, to minimize the risks he always investigates the case with the experts even before the lawsuit is commenced. Paul also discussed the types of experts usually required to build a winning case and how to work with the experts to ensure that their opinion is unbiased and that they would present as credible witnesses at trial.

Paul discussed the legal significance of Ediger and Cojocaru cases that he had recently won at the Supreme Court of Canada. In both of these cases the Court was critical of the physicians’ failure to properly inform the mothers of the risks involved in the treatment they recommended when obtaining their patients’ consent to the procedures. The Court essentially stated that it is not enough to simply inform the patients of the risks associated with a proposed treatment; it must be explained what these risks mean in terms of real-life consequences should they materialize.

In other words, it is not enough to simply say, “There is a risk of bradycardia” in the context of the facts in Ediger, for instance, where the physician decided to use a mid-level forceps procedure during the delivery. Instead, it must be explained that “there is a small risk of cord compression if I attempt this procedure. Cord compression may deprive your baby of oxygen. We would monitor for potential asphyxiation by paying attention to any signs of fetal bradycardia. However, in the event that cord compression occurs, I may not have enough time to organize an OR room and deliver the baby in time before a permanent brain injury occurs”. In Ediger, the physician did not warn the mother of any risks, and was found liable on the basis of failing to ensure that the emergency back-up was immediately available by calling the operating room before attempting the mid-forceps procedure which happened to be occupied with another surgery.

Similarly, in Cojocaru, the physician was found liable solely on the basis of her failure to bring the significance of the risks home to the mother when she recommended that she attempts vaginal delivery after having had a Cesarean section previously (commonly referred to as VBAC). The physician in Cojocaru only told the mother that there is a 1 in 200 risk of uterine rupture associated with a VBAC; she did not tell the mother that if this risk materializes there is a significant chance of her baby suffering permanent damage because there likely would not be enough time to recognize the signs of uterine rupture, arrange for an emergency Cesarean section and deliver the baby before a permanent brain injury is sustained.

Find full details of the conference here

Find full decision of Cojocaru v. British Columbia Women’s Hospital and Health Centre, 2013 SCC 30 here

Find full decision of Ediger v. Johnston, 2013 SCC 18 here

Supreme Court of Canada Win for Twelve-year old with Cerebral Palsy

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On Friday, May 24, 2013, the Supreme Court of Canada delivered a judgment that is of interest to judges and lawyers across the country, and has special significance for one BC family.

As a result of this decision, a child who suffered a significant brain injury as a result of medical negligence will obtain over $4 million in compensation to pay for the extensive therapy and support that he requires.

The Injury

Monica Cojocaru gave birth to her first child by ceasarean section. In the spring of 2001, when she was approaching the delivery of her second child, her physician recommended to her that she deliver the baby vaginally. A vaginal birth after a caesarean section is known as a VBAC delivery. Mrs. Cojocaru was not warned about the implications of this procedure with regard to the health of her baby should a uterine rupture occur.

During this delivery, her uterus did indeed rupture and the baby was extruded into the mother’s abdomen, depriving him of oxygen for over 20 minutes. As a result, Eric Cojocaru suffered a brain injury known as hypoxic ischemic encephalopathy. He was left with cerebral palsy, a severe and permanent condition that affects every aspect of his life. Described as a sweet-natured and likeable boy, Eric is not able to carry out the most basic daily activities and has memory problems and communication difficulties due to his brain injury.

The First Win at the BC Supreme Court

Eric and his mother sued the hospital, nurses and doctors for negligence causing his brain injury. The judgment from the BC Supreme Court was released in April 2009. The trial judge found the hospital, a nurse and three doctors liable in negligence and awarded Eric and his mother $4 million in damages.

Defence Appeals the Win

A substantial portion of the plaintiff’s submissions were copied into the judge’s decision, and the defence appealed the decision. The defence’s appeal centred primarily on the allegation that the reproduction of large portions of the plaintiff’s submissions showed that the trial judge had not given full and fair consideration to their position. The defence asked that the judgment be set aside and a new trial ordered.

In a judgment released in April 2011, the BC Court of Appeal did just that, stating that the judge’s reasons were “substantially a recitation of the [plaintiff’s] submissions” which, to their mind, was sufficient to displace the presumption of judicial integrity and impartiality.

This was a terrible loss for Eric and his mother, but they were not prepared to give up.

The Supreme Court of Canada

On November 13, 2013, Paul McGivern  argued Eric’s case in front of the Supreme Court of Canada. In his opening remarks Paul told the court that

“This case deals with a brain damaged child and his mother who are trying to deal with the ramifications of an issue which in many respects sits outside the legal disputes between the parties. …

The manner in which the judiciary expresses itself is something that my client has no control over. …

At the end of the day I need a judgment so this child can get the care that he needs.”

And that’s exactly what the Court did.

Victory for Eric

In a unanimous decision, the Court addressed the two major issues in the case.

They first addressed and clarified the law on judicial “copying.” This is a procedural matter of keen interest to judges and lawyers, but of interest to Eric and his mother only because it had the potential to send the case back for a new trial. The Supreme Court of Canada acknowledged that it would have been better if the trial judge had not copied extensively from the plaintiff’s submissions, but determined that was not reason enough to set aside the decision of the trial judge and require a new trial.

The Court then turned to the issue of liability and found one doctor negligent on the issue of informed consent. The Court found that the doctor did not provide Eric’s mother with the information she needed to make an informed decision about having a VBAC. The information which was provided fell short on two fronts. First, the doctor over-estimated the likelihood of a successful VBAC given Ms. Cojocaru’s particular situation. More importantly, the Court agreed with the trial judge’s finding that while the doctor discussed the statistical risks of a VBAC including the risk of uterine rupture, she didn’t explain what those statistics meant in terms of the risk to her life and the life of her baby if a uterine rupture were to occur.

The Supreme Court of Canada ordered that the doctor compensate Eric for his injuries. The original award of $4 million was reinstated. Over half of the award is for the costs of the care that Eric will need for the rest of his life to maximize his health and quality of life despite his permanent injuries. After years of struggling to manage the special challenges of a life with cerebral palsy, Eric and his mother will now be able to obtain the equipment, housing and care that Eric so desperately needs.

Read the Supreme Court of Canada judgment here

Read the BC Court of Appeal judgment here

Read the BC Supreme Court judgment here

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