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Cruz v. Paso Del Norte Health3/29/2001
This is the tragic story surrounding the birth of Sergio Cruz, Jr. (Sergio). Diana Cruz, individually and as next friend (Cruz), filed a medical malpractice suit against Paso Del Norte Health Foundation f/k/a and d/b/a Providence Memorial Hospital (Providence) for injuries to her son allegedly sustained during labor. Following a lengthy trial, a jury found that the alleged negligence of two labor and delivery nurses was not a proximate cause of Sergio's severe brain injury and the trial court rendered a take-nothing judgment in favor of Providence. Cruz brings three issues on appeal complaining that the jury's adverse findings are against the great weight and preponderance of the evidence. We affirm.
FACTUAL SUMMARY
Fetal Monitoring
Central to this appeal is the science of fetal monitoring. Readings from a fetal heart monitor can reveal, among other things, whether the baby is in danger due to oxygen deprivation, known as hypoxia. In such a case, the readings will show what are referred to as nonreassuring patterns that may reflect fetal response to hypoxia and the continuing depletion of oxygen reserves which could result in brain damage. A warning fetal heart rate pattern includes tachycardia while a nonreassuring pattern includes severe tachycardia. In a fetus, the normal heart rate is somewhere between 110 and 160 beats per minute, almost double the adult heart rate. A heart rate of more than 160 beats per minute is considered tachycardia, and more than 179 beats is considered severe tachycardia. Severe tachycardia reflects an hypoxic fetus who is decompensating. The decompensatory pattern refers to the point at which the baby no longer has placental reserves or the ability to cope with the normal stress of labor and demonstrates an inability to compensate for the stress. Tachycardia per se is not an indication of fetal distress without other nonreassuring signs.
The policies and protocols adopted by Providence characterize tachycardia as 160 beats per minute lasting ten minutes or more and severe tachycardia as 180 beats per minute lasting ten minutes or more. "Bradycardia" refers to a heart rate typically below 120 beats per minute. There are four main periodic changes in the fetal rate. One is described as reassuring, one as benign, and two as cause for concern. Accelerations that are spontaneous due to fetal movement, when occurring in a normal fetus who is not experiencing a decreased oxygen level or asphyxia, will elevate its heart rate for fifteen beats above the baseline for at least fifteen seconds or longer. Other periodic changes in the fetal heart rate are called decelerations. The benign pattern, called an "early deceleration," is uniform and mirrors the uterine contraction. It typically occurs once labor has become established since it is caused by pressure to the head of the fetus. "Variable decelerations" occur during the contraction cycle and are variable in shape rather than uniform. The cause is generally umbilical cord compression resulting from the cord dropping down or wrapping around the neck. "Late decelerations" typically occur later in the contracting cycle. When the contraction begins, the heart rate decelerates and does not return to the baseline until after the contraction is completed. The cause of late decelerations is uteroplacental insufficiency. According to one expert, "this pattern is ominous and certainly not reassuring." There are also two types of variability in the fetal heart rate, which will become significant. As one witness explained it:
There is what is called short term variability, or short term changes, where from each heart beat you literally will see changes in --tiny changes. Each of us that
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