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Morrell v. Finke11/3/2005
ken two hours after Madeline's birth, a September 12, 1997 MRI taken when Madeline was two and a half years old, a November 27, 2000 MRI taken when Madeline was almost seven years old, and Madeline's clinical history. Dr. Vezina, the Defendants' pediatric neuroradiologist, likewise reviewed these films. Both Dr. Jones and Dr. Vezina agreed concerning the objective findings in the films, but they drew different conclusions from those findings.
Dr. Jones testified that the CT scan after Madeline's birth revealed a "little bit" of birth trauma with some swelling and some molding of the skull. He saw no hemorrhage, congenital deformities, or edema. He would not expect the CT scan done two hours after birth to document hypoxia.
Dr. Jones next reviewed the MRI performed in 1997 and testified that it showed abnormal increased signal around the ventricles, raising a concern about periventricular leukomalacia (PVL), most commonly caused in term babies by hypoxic ischemic encephalopathy. PVL is an abnormal development of the white matter next to the ventricle. Dr. Jones explained that since Madeline was only about two years old at the time of the 1997 MRI, the finding could be simply an instance of immature myelination that would resolve itself. He explained, however, that when immature myelination occurs it usually is visible equally on both the left and right sides of the brain, not as in Madeline's MRI, only on the left side. Consequently, in his opinion, because the finding was not symmetrical, it was more likely a finding of some type of PVL. The most common cause of PVL in a term infant is a hypoxic or lack-of-oxygen injury at the time of birth.
Madeline's November 27, 2000 MRI confirmed an asymmetric finding that Dr. Jones considered "very characteristic, even more characteristic than the earlier MRI, of what one would see with periventricular leukomalacia," "this pattern is quite typical and characteristic of what you see in hypoxic ischemic disease." Additionally, he said that Madeline's clinical history presented a picture consistent with hypoxic ischemic induced PVL: Madeline was born acidotic and had hypotonia, seizures, apnea, and had low Apgar scores--all findings Dr. Jones commonly sees with babies who have suffered a hypoxic injury . Dr. Jones testified that all of Madeline's symptoms and the results of the tests performed upon her are consistent with a hypoxic brain injury.
By contrast, Dr. Vezina testified that the films showed no evidence of any hypoxic ischemic event when Madeline was born. He agreed that the two-hours-after-birth CT scan would not show any hypoxia; it was too soon. But he testified that a January 5, 1995 ultrasound and an April 5, 1995 CT scan likewise show no evidence of a hypoxic birth injury . According to Dr. Vezina, the September 1997 MRI did not show any atrophy or scarring of the brain, two features one would expect to see following a hypoxic event. He said that the white spot noted as PVL by Dr. Jones was simply immature myelination. He testified that, in the term infant, PVL is usually not caused by a hypoxic ischemic event at birth;
most of the time what you find is that there was no hypoxic ischemic event at the time of delivery, at the time of term. And oftentimes what we try to find with varied success are insults or things that happened during pregnancy when the fetus is much younger before 34, 35 weeks gestation.
Finally, concerning the November 2000 MRI, Dr. Vezina testified that the remaining white spot is a "small" "non-specific" area, but not PVL. He said he "doubt " this small spot of brain injury has caused or contributed to Madeline's developmental delays.
Dr. Ater, Plaintiffs' ca
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