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Nelson v. Upadhyaya9/23/2005
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Dr. Varsha's expert acknowledged that at the time of trial, any competent obstetrician would treat with antibiotics any woman who had recovered from a urinary tract infection shortly before the birth, especially if the woman had suffered a GBS infection. But in 1990, " was not considered a risk factor for injury to the fetus." The expert recited the factors listed in the 1992 ACOG publication as grounds for administering prophylactic antibiotics to pregnant women in 1990. The expert found that Tammy exhibited none of the risk factors listed in the 1992 publication. In his opinion, Dr. Varsha complied with the applicable standard of care at all times. He acknowledged that the ACOG publication explicitly stated that it did not "define a standard of care."
The neonatologist who testified for plaintiffs found that Dr. Vinod breached the standard of care by failing to institute appropriate evaluations for Anthony. Dr. Vinod should have obtained the results of the CBC ordered at 3:45 a.m. on May 24, 1990. Because Dr. Vinod did not include any notation concerning the CBC, the expert concluded that he never obtained the results. The CBC, in the expert's opinion, indicated infection. Dr. Vinod should have ordered further testing based on the CBC and he should have started treating Anthony with antibiotics immediately. If Dr. Vinod had done so, Anthony would not have suffered such a severe illness from the infection.
Dr. Jerome Klein, an expert in pediatric infectious diseases, testified that in his opinion the GBS meningitis caused plaintiff to develop ADHD. From 1979 to 1982 Dr. Klein edited "the Red Book," the common name for the Report of the Committee on Infectious Diseases of the American Academy of Pediatrics (AAP). The Red Book provides "guidelines for the practice of pediatrics and infectious diseases." On cross-examination Dr. Klein admitted that the 1995 edition of the Red Book included, as a risk factor that should lead doctors to administer prophylactic antibiotics, asymptomatic GBS colonization of the mother's urinary tract. According to Dr. Klein, the 1988 edition said only:
" o specific recommendation for the prevention of neonatal GBS disease can be made. Chemoprophylaxis should be considered on an individual * basis.
* dministration of ampicillin to high risk colonized women [(]e.g., those with premature onset of labor, premature rupture of membranes or fever throughout labor[)] has resulted in a decreased transmission of GBS to the infant and decreased rates of infection in infants."
An expert who testified on Dr. Vinod's behalf emphasized that on Dr. Vinod's visual examination, Anthony was a normal, healthy baby, feeding well, with good vital signs. The expert believed that Dr. Vinod requested the CBC information when he found that a nurse had ordered one. The CBC, in the expert's opinion, did not indicate infection, as all values but one showed no abnormality. The CBC as a whole did not signal a need for antibiotics, especially when one views the CBC in the context of Dr. Vinod's physical examination of Anthony. Nothing in the medical record indicates that anyone informed Dr. Vinod of Tammy's third-trimester GBS infection. The standard of care did not require Dr. Vinod to look beyond the record for evidence of potential problems. The hospital staff did not contact Dr. Vinod later that day when Anthony first showed symptoms of infection.
The expert testified that the 1992 AAP guidelines did not mention any special treatment for babies whose mothers had had urinary tract infections. The 1997 guidelines, on the other hand, specifically identified a history of urinary tract infection as an indication to treat a mother in
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