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Ms. Rodriguez – A $6,500,000 Verdict Case

Cooper Law Group obtained a $6.5 million medical malpractice negligence verdict on April 6, 2023 against Yale University and several of its maternal fetal medicine physicians on behalf of its 37 year old client Jomayra Rodriguez and her baby boy (“AJ”) who died from asphyxia and other traumatic injuries during attempted vaginal delivery at Yale-New Haven Hospital on June 19, 2016.

Ms. Rodriguez was 31-years-old and just shy of 37 weeks gestation when a routine prenatal ultrasound identified a condition known as abdominal ascites which is an abnormal fluid collection in the baby’s stomach. Surprisingly, AJ’s stomach had grown so distended from fluid that his sonographic abdominal circumference measurement had increased to greater than 46 cm which was greater than the 97th percentile for full-term babies. He was also measuring large for gestational age, with an estimated fetal weight above the 95th percentile, a more significant finding given Ms. Rodriguez’s likely diagnosis of gestational diabetes, which further increased the risk that he could get stuck in the birth canal.

Out of concern for AJ’s growth and a more serious fetal condition known as non-immune hydrops fetalis which is a life-threatening condition associated with high perinatal mortality rate involving abnormal fluid collections in two or more parts of the baby’s body, Ms. Rodriguez was referred to Yale-New Haven Hospital’s Maternal Special Care Unit, a highly specialized inpatient multi-disciplinary service directed by full-time Yale School of Medicine Maternal Fetal Medicine specialists.

At the time of her admission to Yale, Ms. Rodriguez had a bedside ultrasound by one of Yale’s MFM specialists that demonstrated a live baby boy with a normal liver, bladder, kidneys, brain and middle cerebral artery, with a large amount of abdominal ascites, but no evidence of hydrops. Due to the limited imaging capabilities of the portable ultrasound, a decision was made to obtain a targeted ultrasound to get a better look at the baby, and all decisions regarding treatment of AJ and route of delivery were deferred pending additional information.

When the targeted ultrasound was completed by a different MFM specialist later that day, several key details of the exam including fetal biometric measurements (i.e., biparietal diameter, head circumference, abdominal circumference, femur length) and estimated fetal weight were curiously omitted. Estimated fetal weight is important to provide adequate and accurate counseling about the risks of vaginal delivery (especially with a big baby); while fetal abdominal circumference is essential to get a clear picture of the size of the baby’s abdomen and to properly assess risks of shoulder and body dystocia (i.e., baby becoming stuck in the birth canal) with vaginal delivery.

At the conclusion of the exam, which was estimated to take less than 12 minutes to complete, a decision was made to induce Ms. Rodriguez’s labor with a uterine contraction promoting drug called Oxytocin towards a vaginal delivery. On day 2 of her admission, Ms. Rodriguez’s induction course began.

After approximately 36 hours of IV Oxytocin with little to no change in her cervix or progression of her labor, a diagnosis of failure to progress was made and a cesarean section delivery was scheduled. However, for reasons not entirely known other than difficulty assembling the appropriate team for a highly coordinated delivery on a Saturday evening the night before Father’s Day, a caesarean was not done, and the induction process was restarted. Unfortunately, the plan reverted back to an artificial progression toward a doomed vaginal delivery.

On the morning of June 19 at approximately 5:40 a.m., following a two-day induction process, Ms. Rodriguez was fully dilated and encouraged to begin pushing. When she was examined by the new MFM attending at approximately 10:36 a.m., she was prepped for vaginal delivery notwithstanding the fact that she had been pushing for more than 4 1/2 hours with virtually no progress of AJ’s head being delivered.

At approximately 11:00 a.m., with more than ample time to still do an emergency cesarean section, a decision was made by the delivery team to perform an obstetrical maneuver known as Ritgen’s in which the doctor manually extracts the baby’s head from the birth canal. Unfortunately, disaster ensued because AJ wasn’t coming out. Not only did he develop bilateral shoulder dystocia requiring extreme obstetric maneuvers resulting in severe shoulder fractures and brachial plexus injuries, his body became stuck in Ms. Rodriguez’s pelvis preventing him from being fully delivered.

After several minutes of abdominal dystocia resulting in severe compression of the umbilical cord causing prolonged hypoxia from lack of oxygen to the brain, the umbilical cord tore off from the placenta and AJ eventually died. Attempts at delivering AJ vaginally resulted in traumatic injuries to his neck and internal organs including a broken neck, severed esophagus, severed trachea and transection of his bilateral subclavian arteries.

Notwithstanding these attempts, AJ was not able to be delivered until one of the on-call MFM specialists arrived at the Hospital approximately 25 minutes after AJ had already passed in order to perform a fetal abdominal paracentesis procedure to drain the fluid from AJ’s stomach and allow him to be delivered deceased.

The month-long trial was held in New Haven Superior Court before the Honorable Judge Robert E. Young. Ms. Rodriguez and AJ were represented by attorney Jeffrey Cooper. Attorney Cooper’s case strategy revolved around management of the labor and delivery issues, and he argued that there were several indications to perform an immediate cesarean which would have eliminated the risks of shoulder and abdominal dystocia completely. Given AJ’s size and the clear dangers associated with a vaginal delivery, Attorney Cooper argued that a scheduled cesarean would have been the standard of care. In the alternative, he argued that if Yale was insistent on delivering AJ vaginally, which he never conceded was appropriate, it would have at the very least required a fetal paracentesis prior to the time of delivery.

According to Attorney Cooper and his two experts in Maternal Fetal Medicine, both procedures would have mitigated the risks of the catastrophic abdominal dystocia that occurred during the delivery, and would have given AJ a chance at life with appropriate neonatal intervention. Had any one of Yale’s doctors accepted the fact that AJ posed too great a risk to be delivered vaginally due to his size and opted for a cesarean delivery, the outcome would have been different. Attorney Cooper stressed the fact that high-risk pregnancies like Ms. Rodriguez’s require extra care, which is why she was sent to Yale in the first place. For reasons unknown, Yale ignored risk after risk that AJ was not going to be able to be delivered safely without a cesarean delivery.

The defending maternal fetal medicine doctors conceded that cesarean delivery would have likely delivered AJ alive, but argued that there were no obstetrical standards or guidelines establishing a maximum abdominal circumference for safe vaginal delivery. The defense argued that Yale’s doctors collective experience in delivering babies with abdominal ascites safely via vaginal delivery justified their decisions in this case. Yale also defended the case on grounds that AJ’s condition on autopsy was in fact indicative of non-immune hydrops fetalis, which would have made his chance of survival slim no matter what. They further argued that nothing that they did caused AJ’s death, as he had suffered from chronic hypoxia from low placental fluid prior to the time of death, which was evidenced by a neuropathological condition called chronic which matter asctrocytosis.

The jury deliberated for five hours and returned a verdict in favor of Ms. Roriguez for $5,000,000 for past and future mental suffering. The jury also returned a verdict for $1,500,000 for the wrongful death of AJ. The verdict for AJ is believed to be one of Connecticut’s largest medical malpractice awards ever on behalf of the wrongful death of a “stillbirth” baby.