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Nelson v. Upadhyaya

9/23/2005



Anthony Nelson suffered brain damage due to meningitis shortly after his birth in 1990. He and his mother sued his mother's obstetrician and his pediatrician for medical malpractice, alleging that the obstetrician should have treated his mother with prophylactic antibiotics and the pediatrician should have started treating him with antibiotics much earlier. The defendants contended that they fully complied with the 1990 standard of care. They used postoccurrence literature to support their theory that the standard of care later evolved to require prophylactic antibiotics for a case like plaintiff's. The jury returned a verdict in favor of both defendants.


On appeal plaintiffs challenge the sufficiency of the evidence and the use of postoccurrence literature. Although we find that experts provided sufficient credible support for the verdicts, we find that the trial court erred by permitting the use of postoccurrence literature, unavailable to the doctors at the time of treatment, to aid in interpretation of the applicable standard of care. We reverse and remand for a new trial.


BACKGROUND


On March 26, 1990, Tammy Nelson went to see her obstetrician, Dr. Varsha Upadhyaya (Dr. Varsha). Tammy, then about seven months pregnant, complained of pain she experienced while urinating. A laboratory test of Tammy's urine revealed that Group B streptococcus (GBS) bacteria had infected Tammy's urinary tract. Dr. Varsha prescribed an antibiotic, and that antibiotic apparently alleviated the problem.


Tammy came to Christ Hospital on May 23, 1990, around 3:30 a.m. The resident on duty ruptured her bag of waters around 7 a.m. and ordered administration of a drug to stimulate contractions. Dr. Varsha examined Tammy around 9 a.m. Throughout the day nurses charted "normal vital signs" at regular intervals. The nurses did not specify Tammy's temperature at any point between 11:30 a.m. and 11:30 p.m. on May 23, 1990.


Around 7 that evening Dr. Varsha decided that the labor had not progressed adequately. Dr. Varsha performed a cesarean section after 8 p.m. Tammy gave birth to a healthy, full-term infant whom she named Anthony. At 10:30 p.m. a resident notified the pediatrician, Dr. Vinod Upadhyaya (Dr. Vinod), of the birth. Tammy's temperature spiked to 102 degrees around 12:30 a.m. on May 24. The medical chart does not indicate that any resident or nurse informed Dr. Varsha or Dr. Vinod of the temperature. At 3:45 a.m. on May 24, a nurse ordered a complete blood count (CBC) for Anthony.


Dr. Vinod first saw Anthony at 2 p.m. on May 24, 1990. He found a normal, healthy baby with good vital signs. The record of the examination does not include a report of the earlier CBC. At 7:15 p.m. on May 24 a nurse noted that Anthony started moaning. A resident who examined Anthony ordered further tests. At 8:45 p.m. the hospital transferred Anthony to the special care nursery. Tests showed that GBS bacteria had infected Anthony's blood and spinal fluid. He suffered from streptococcal meningitis and septic shock.


The pediatric neurologist who examined Anthony in June 1990 found that Anthony had suffered a watershed ischemic infarct of the brain as a consequence of the meningitis. That is, a lack of blood supply to parts of Anthony's brain led to a stroke.


Anthony survived the meningitis, but later examinations showed certain areas of his brain did not fully recover. Some years later doctors began treating Anthony for attention deficit hyperactivity disorder (ADHD).


In 1994 Anthony and Tammy sued Dr. Varsha and Dr. Vinod for medical malpractice. Plaintiffs alleged that if the doctors had administered appropriate antibiotics pro

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