Standard of Care: A Claim Study

Neonatal jaundice is a yellowish discoloration of the white part of the eyes and skin in a newborn baby due to high bilirubin levels. Other symptoms may include excess sleepiness or poor feeding. Complications may include seizures, cerebral palsy, or kernicterus (a bilirubin-induced brain dysfunction). Neonatal jaundice is not an uncommon physiological occurrence in newborns. For the majority of these infants, hyperbilirubinemia resolves within the first week of life with maturing of the liver. However, worldwide, it is estimated that 10.5% of live births require phototherapy for jaundice.¹

In a case outside of Louisiana, a child was born on June 4, 2014 via C-Section. Her gestational age was 38 weeks and five days, and she weighed eight pounds and 14.8 ounces. Her bilirubin levels drawn two hours after her birth were 5.5 and her skin color was noted as normal. The Complaint alleged that “a 5.5 bilirubin level only 2 hours after birth indicates a high risk of hyperbilirubinemia (jaundice), a potentially life-threatening and brain-damaging condition that is also completely treatable and preventable.”

The mother and baby had incompatible blood types, and the baby was breastfed, two additional alleged risk factors for hyperbilirubinemia. The mother’s older child had also required phototherapy for jaundice after birth. There were at least three nursing notes in the first two days after birth that indicated “slight” or “mild” jaundice. The child was discharged by the defendant physician approximately 48 hours after birth and no follow-up blood work was ordered to re-check the bilirubin levels. The parents were not given any special instruction relative to the treatment and risks associated with neonatal jaundice.

On June 9, three days after discharge, the parents noted that the infant was lethargic and increasingly yellow. They called the defendant physician’s office and reported these symptoms. The child was seen by the defendant physician on the morning of June 12. Blood work showed an extremely high bilirubin level of 33.4. The child was immediately sent to the hospital and phototherapy begun in an effort to reduce the bilirubin levels. After two hours, the infant was transferred to a children’s hospital for a higher level of care. However, the child suffered severe and irreversible brain damage. The child is likely confined to a wheelchair for life, unable to speak, and will require round-the-clock care.

During the discovery and trial phases of the case, in addition to the lack of repeat bloodwork, it was emphasized that the family had not been given proper discharge instructions specific to the risks of jaundice and the need for earlier follow-up than what was noted on the discharge papers. The defendants argued that the standard of care is different in rural areas and that the jaundice symptoms were very mild at discharge so the instruction to follow-up with the defendant physician in 10 days was reasonable.

A jury clearly rejected the theory that local standards of care still exist in this day and age of technological access to all areas of medical conditions and treatment. A verdict was rendered, awarding the child and family $46 million.

Learn more about the standard of care relative to the risks of and treatment for neonatal jaundice:

https://www.mayoclinic.org/diseases-conditions/infant-jaundice/diagnosis-treatment/drc-20373870

http://pediatrics.aappublications.org/content/141/3/e20161472

https://www.rcm.org.uk/news-views-and-analysis/news/jaundice-in-newborns-standard

Sources

1. Incidence of and Risk Factors for Neonatal Jaundice Among Newborns in Southern Nepal Carolyn Scrafford, Luke Mullany, Joanne Katz, Subarna Khatry, Steven LeClerq, Gary Darmstadt and James Tielsch; Tropical Medicine/International Health, Sept 2013