Findings Of Fact Ian Ocasio was born on April 20, 2010, at Winnie Palmer Hospital for Women and Children in Orlando, Florida. Ian weighed 2,749 grams at birth. Donald Willis, M.D. (Dr. Willis), was requested by NICA to review the medical records for Ian. In a medical report dated September 20, 2013, Dr. Willis opined: In summary, the baby was delivered by Cesarean section due to preterm labor and a recent genital herpes outbreak. Herpes cultures from the baby were negative. There was no fetal distress during labor. The baby was not depressed at birth and did not require any resuscitation. Umbilical cord blood gas was not done. Apgar scores were normal. There was no apparent obstetrical event that resulted in loss of oxygen or mechanical trauma to the baby’s brain during labor, delivery or the immediate post delivery period. A review of the file does not show any contrary opinions, and Petitioners have no objection to the issuance of a summary final order finding that the injury is not compensable under the Plan. The opinion of Dr. Willis that Ian did not suffer a neurological injury due to oxygen deprivation or mechanical injury during labor, delivery, or the immediate post- delivery period is credited.
Findings Of Fact Antonia was born on March 14, 2012, at Plantation General Hospital located in Plantation, Florida. Antonia weighed 3,665 grams at birth. Donald Willis, M.D. (Dr. Willis), was requested by NICA to review the medical records for Antonia. In an affidavit dated September 19, 2013, Dr. Willis opined the following: It is my opinion that the pregnancy was complicated by poorly controlled Diabetes with a large-for-gestational age baby and resulting in dystocia at delivery. The baby was depressed at birth, but “rapidly improved.” The baby suffered a brachial plexus injury from the shoulder dystocia, but there was no evidence of brain injury. As such, it is my opinion that delivery was complicated by a shoulder dystocia with resulting brachial plexus injury. However, there was no apparent brain or spinal cord injury from loss of oxygen or mechanical trauma. Michael S. Duchowny, M.D., a pediatric neurologist, was retained by NICA to examine Antonia. Dr. Duchowny examined Antonia on August 28, 2013. In an affidavit dated September 18, 2013, Dr. Duchowny opined as follows: It is my opinion that Antonia’s neurological examination reveals evidence of a complete left brachial plexus palsy involving nerve roots C5 to T1. She thus has both an Erb’s and Klumpke’s paralysis which is judged to be severe. There appears to be little benefit from her previous surgery as she most likely had an avulsive type injury. In contrast, Antonia’s cognitive status and motor ability in her other three extremities are well preserved. I had an opportunity to fully review the medical records that were sent on July 25, 2013. The records confirm the family’s history of shoulder dystocia at birth. Antonia’s Apgar scores were 0, 6 & 8 at 1, 5 and 10 minutes. Her brachial plexus palsy was recognized immediately. She was intubated in the delivery room but extubated at 10 minutes of age. Of note, an MRI of Antonia’s brachial plexus performed on June 29, 2012[,] revealed pseudomeningocele formation at the C7 and T1 levels. As such, it is my opinion that Antonia’s brachial plexus palsy places her damage outside the central nervous system as it involves cervical and upper thoracic root segments. Although her injury was likely acquired as a result of mechanical forces during delivery, the location of her impairment is outside the central nervous system (brain and spinal cord). I therefore believe that Antonia should not be considered for compensation with the NICA program. A review of the file does not show any contrary opinions to those of Dr. Willis and Dr. Duchowny. The opinions of Dr. Willis and Dr. Duchowny that Antonia did not suffer a brain or spinal cord injury due to oxygen deprivation or mechanical injury during labor, delivery, and resuscitation during the post- delivery period are credited.
Findings Of Fact Lennox Wiles was born on May 11, 2014, at Tallahassee Memorial Hospital located in Tallahassee, Florida. Lennox weighed in excess of 2,500 grams at birth. Donald Willis, M.D. (Dr. Willis), was requested by NICA to review the medical records for Lennox, to determine whether an injury occurred to the brain or spinal cord caused by oxygen deprivation or mechanical injury occurring in the course of labor, delivery, or resuscitation in the immediate post-delivery period. In an affidavit dated January 23, 2017, Dr. Willis set forth his findings and opinion in pertinent part as follows: It is my opinion the mother was not in labor, so the injury did not occur during labor. Delivery was by Cesarean section, so hypoxic brain injury did not occur during delivery. The baby was crying at birth, again suggesting there was no significant brain injury during delivery. Respiratory distress occurred shortly after delivery and required bag and mask ventilation for 30 seconds. Apgar score was 9 by 5 minutes. Spontaneous respiratory activity resumed and the baby was left with the Labor and Delivery staff. Once the NICU staff left the baby with the L & D staff, this would indicate the baby was stable and would end the immediate post- delivery period. It would be unlikely that significant hypoxic brain injury occurred during post-delivery period, which would be the brief period from delivery until the baby was left with the L & D staff. Based on this information, it does not appear this child suffered oxygen deprivation sufficient to cause brain injury during the labor, delivery or the immediate post delivery period. In conclusion, there was no apparent obstetrical event that resulted in loss of oxygen or mechanical trauma to the baby’s brain during labor, delivery or the immediate post delivery period. NICA retained Laufey Y. Sigurdardottir, M.D. (Dr. Sigurdardottir), a pediatric neurologist, to examine Lennox and to review his medical records. Dr. Sigurdardottir examined Lennox on October 19, 2016. In an affidavit dated January 19, 2017, Dr. Sigurdardottir summarized her findings from the medical evaluation and opined as follows: Lennox is found to have substantial motor and mental impairment at this time. At the age of [2-1/2], he is dependent on his caretakers for all care and although he can grab toys and indicate wants and needs in a very simple manner, he has what seem to be significant cognitive delays. His motor disability is significant. There is evidence of decreased fetal movement and nonreassuring fetal heart rate. This led to his cesarean section. The patient did have signs of ischemia including coagulopathy at birth and went into a persistent pulmonary hypertension suggestive of fetal distress. His current clinical picture is that of cerebral palsy. The injury is likely to have occurred prenatally, prompting decreased fetal movements. The mother was however not in active labor at time of delivery. At this time, Lennox’s prognosis for life expectancy is excellent, but for full recovery is extremely guarded as he has substantial mental and physical impairment and is not sitting at this time. In light of the above details, and the absence of active labor at time of delivery, I do not recommend Lennox being included in the Neurologic Injury Compensation Association Program. A review of the file in this case reveals that there have been no expert opinions filed that are contrary to the opinion of Dr. Willis that there was no apparent obstetrical event that resulted in loss of oxygen or mechanical trauma to the baby’s brain during labor, delivery or the immediate post- delivery period. Dr. Willis’ opinion is credited. There are no expert opinions filed that are contrary to Dr. Sigurdardottir’s opinion that while Lennox has substantial motor and mental impairment, Lennox’s cerebral palsy is likely to have occurred prenatally and there was no active labor at the time of delivery. Dr. Sigurdardottir’s opinion is credited.
Findings Of Fact Harmony Donaldson was born on February 22, 2016, at Bethesda Memorial Hospital in Boynton Beach, Florida. Harmony weighed in excess of 2,500 grams at birth. NICA retained Donald C. Willis, M.D. (Dr. Willis), to review Harmony’s medical records. In an affidavit dated September 16, 2016, Dr. Willis made the following findings and expressed the following opinion: In summary, this child was delivered by what appears to be an uncomplicated vaginal birth. The baby was not depressed at birth. Apgar scores were 9/9. Mother and baby were stated to be stable in the delivery room and the baby was taken to the well nursery. However, the baby did suffer an intracranial hemorrhage, which became clinically apparent about 8 hours after birth. The brain does not appear to be a birth related hypoxic or traumatic event. There was no apparent obstetrical event that resulted in loss of oxygen or mechanical trauma to the baby’s brain during labor, delivery or the immediate post delivery period. Dr. Willis’ opinion that there was no apparent obstetrical event that resulted in loss of oxygen or mechanical injury to the baby’s brain during labor, delivery or the immediate post-delivery period is credited. Respondent retained Michael Duchowny, M.D. (Dr. Duchowny), a pediatric neurologist, to evaluate Harmony. Dr. Duchowny reviewed Harmony’s medical records and performed an independent medical examination on her on August 17, 2016. Dr. Duchowny made the following findings and summarized his evaluation as follows: IN SUMMARY Harmony’s neurological examination today reveals no specific focal or lateralizing findings. She appeared cognitively intact and her motor development is proceeding at age level. There is no evidence of oromotor dysfunction and her clavicular fracture has obviously healed well. I have not yet had an opportunity to review medical records and I will issue a final report once the review process is complete. After reviewing Harmony’s medical records, Dr. Duchowny wrote an addendum to his earlier report in which he stated: ADDENDUM: Review of medical records reveals that Harmony was born at term and had 1 and 5 minute Apgar scores of 9 and 9. Desaturations thought to be seizures (accompanied by right arm and leg jerking) occurred at 8 hours of age. Her PTT was slightly prolonged but INR and fibrinogen was normal, and there was no evidence clinically of DIC. Factors 7, 10 and 13 levels were normal. A head ultrasound on March 5, 2016 revealed haziness of the thalami which was not observed on an MRI scan after the transfer to NCH. This later study did however reveal bilateral parietal intraparenchymal hemorrhage, hemorrhage in the frontal gray-white interface and punctate hemorrhage in the sylvian aqueduct. The basal ganglia were normal; MRA and MRV were likewise WNL. Based on review of the medical records and the neurological evaluation, I do not believe that Harmony has a substantial mental or motor impairment, and did not suffer from substantial intrapartum oxygen deprivation or mechanical injury. I am therefore not recommending Harmony for inclusion in the NICA program. Dr. Duchowny stated his ultimate opinion in an affidavit dated September 7, 2016, in which he opined, “I do not believe that HARMONY has a substantial mental or motor impairment and did not suffer from substantial intrapartum oxygen deprivation or mechanical injury.” Dr. Duchowny’s opinion that Harmony does not have a substantial mental or motor impairment and did not suffer from substantial intrapartum oxygen deprivation or mechanical injury is credited. A review of the file in this case reveals that there have been no expert opinions filed that are contrary to the opinion of Dr. Willis that there was no apparent obstetrical event that resulted in loss of oxygen or mechanical trauma to the baby’s brain during labor, delivery or the immediate post- delivery period. There are no expert opinions filed that are contrary to Dr. Duchowny’s opinion that Harmony does not have a substantial mental or motor impairment.
Findings Of Fact D’Taveus Drummond was born on September 3, 2010, at Heart of Florida Regional Medical Center located in Davenport, Florida. D’Taveus weighed more than 2,500 grams at birth. Donald Willis, M.D. (Dr. Willis), was requested by NICA to review the medical records for D’Taveus to determine whether an injury occurred to the brain or spinal cord caused by oxygen deprivation or mechanical injury occurring in the course of labor, delivery, or resuscitation in the immediate post-delivery period. In a medical report dated May 12, 2015, Dr. Willis described his findings in part as follows: Spontaneous vaginal delivery was complicated by a shoulder dystocia. Birth weight was 3,766 grams or 8 lbs 5 oz’s. The baby was depressed at birth, but responded quickly to resuscitation. There was no respiratory effort at birth. Apgar score at one minute was 5. Bag and mask ventilation was given for one minute and an injection of narcan was given to reverse the respiratory depression effects of narcotics given during labor. The baby responded to resuscitation efforts and the Apgar score was 8 by five minutes. The baby did not move the right arm after birth. Erb’s palsy was diagnosed. Otherwise, the newborn hospital course was uncomplicated and the baby was discharged home with the mother two days after birth. MRI of the spine at 4 months of age identified a traumatic neuroma of the right, but no abnormalities of the cervical spine. MRI of the brain was normal. Nerve graph was done at about 6 months of age. Neurology evaluation at that time stated the child was developmentally on target at 6 months of age. In summary, delivery was complicated by a shoulder dystocia and resulting brachial plexus injury. The baby did not have problems related to birth hypoxia. Newborn course was complicated only by the brachial plexus injury. There was no apparent obstetrical event that resulted in loss of oxygen or mechanical trauma to the baby’s brain or spinal cord during labor, delivery or the immediate post delivery period. Dr. Willis reaffirmed his opinion in an affidavit dated December 11, 2015. NICA retained Laufey Sigurdardottir, M.D. (Dr. Sigurdardottir), a pediatric neurologist, to examine D’Taveus and to review his medical records. Dr. Sigurdardottir examined D’Taveus on November 4, 2015. In an affidavit dated February 19, 2016, Dr. Sigurdardottir opined as follows: Summary: Here we have a 5-year 1-month old boy with known shoulder dystocia leading to right bracial plexopathy which occurred at birth. He has required multiple procedures to address his traumatic neuromas as well as increase his functional ability but yet has significant disability in the functional abilities of his right upper extremity. There is no history given or relayed to us regarding his mental abilities, but on observation during his visit, he is noted to be verbal and have no clear major mental impairment. Result as to question 1: The patient is found to have mild or no mental impairment. * * * In light of the above-mentioned details including his normal or near normal mental capacity and limited motor disability to his upper extremity, I do not recommend D’Taveus to be included into the Neurologic Injury Compensation Association (NICA) Program. A review of the file in this case reveals that there have been no expert opinions filed that are contrary to the opinion of Dr. Willis that there was no apparent obstetrical event that resulted in loss of oxygen or mechanical trauma to the baby's brain or spinal cord during labor, delivery, or the immediate post-delivery period. Dr. Willis’ opinion is credited. There are no contrary expert opinions filed that are contrary to Dr. Sigurdardottir’s opinion that D’Taveus has mild or no mental impairment with normal to near normal mental capacity. Dr. Sigurdardottir’s opinion is credited.
Findings Of Fact Jinger-Anne Nobles was born on February 14, 2011, at Leesburg Regional Medical Center located in Leesburg, Florida. Jinger-Anne weighed in excess of 2,500 grams at birth. Donald Willis, M.D. (Dr. Willis), was requested by NICA to review the medical records for Jinger-Anne. In a medical report dated July 14, 2014, Dr. Willis opined as follows: I have reviewed the medical records for the above individual. The mother, Katherine Johnson, was a 26 year old G4 P2 with no significant prenatal problems. The mother presented to the hospital in early labor at 38 weeks gestational age. Antibiotics were given during labor for a positive vaginal culture for Group B Streptococcus. Amniotic membranes were ruptured with clear fluid. Fetal heart rate (FHR) monitor tracing during labor was reviewed. Baseline heart rate was 135 bpm with normal variability. There was no fetal distress during labor. Spontaneous vaginal delivery was uncomplicated. Birth weight was 2,890 grams. Apgar scores were 8/9. The newborn was not depressed. No resuscitation was required. The baby was taken to the nursery and stated to be in stable condition. Newborn hospital course was uncomplicated. The baby was re-admitted to the hospital twice during the first two weeks after birth. The first was two days after newborn hospital discharge. This admission was for elevated bilirubin level. The second was for choking and vomiting with possible cyanosis. No etiology was discovered and the baby was discharged home. In summary, the baby was delivered at term by spontaneous and uncomplicated vaginal birth. There was no fetal distress during labor. The newborn was not depressed and had a normal hospital course. There was no apparent obstetrical event that resulted in loss of oxygen or mechanical trauma to the baby’s brain during labor, delivery, or the immediate post delivery period. Dr. Willis reaffirmed his opinion in an affidavit dated December 29, 2014. NICA retained Michael S. Duchowny, M.D. (Dr. Duchowny), a pediatric neurologist, to examine Jinger-Anne and to review her medical records. Dr. Duchowny examined Jinger-Anne on October 1, 2014. In an affidavit dated December 22, 2014, regarding his independent medical examination of Jinger-Anne, Dr. Duchowny opined as follows: In summary, Jinger-Anne’s examination reveals findings consistent with a substantial mental and motor impairment. She evidences spastic quadriparesis, microcephaly, cortical visual impairment, optic nerve atrophy, no evidence of receptive or expressive language development, and generalized hyperreflexia. I have had an opportunity to review medical records sent on May 21, 2014. They document the pre and perinatal history and provide evidence of hyperbilirubinemia, but only to a level of 15. Jinger-Anne’s mother had presented to the hospital in early labor and had artificial rupture of membranes. Her mother had a postpartum tubal ligation. Jinger-Anne’s Apgar scores were 8 and 9 at 1 and 5 minutes and her birth weight was 6 pounds 6 ounces. Cord blood gases were not drawn and apart from hyperbilirubinemia, her postnatal course was uncomplicated. Her readmission on February 18 documented a rapid rise in bilirubin, reaching a peak level of 15.4. She was also diagnosed with an acute life-threatening event which after evaluation was believed to be caused by gastro esophageal reflux. I have not yet received either of the MRI scans. Although Jinger-Anne’s course would be extremely atypical of kernicterus as most affected individuals have normal cognitive status and present with findings consistent with athetotic cerebral palsy, I believe it is prudent to review the MR images in this case before making a final recommendation with regard to consideration for acceptance into the NICA program. ADDENDUM: I have reviewed the brain MR images obtained on July 8, 2011. The study reveals no significant abnormalities. Of note, the basal ganglia and thalami are normal. The study findings support my initial impression that Jinger-Anne’s neurological problems did not result from hyperbilirubinemia, mechanical injury or oxygen deprivation acquired in the course of labor, delivery or the immediate post- delivery period. A review of the file in this case reveals that there have been no expert opinions filed that are contrary to the opinion of Dr. Willis that there was no apparent obstetrical event that resulted in loss of oxygen or mechanical trauma to the baby's brain during labor, delivery, or the immediate post- delivery period. Dr. Willis’ opinion is credited. There are no expert opinions filed that are contrary to Dr. Duchowny’s opinion that although Jinger-Anne’s examination reveals findings consistent with a substantial mental and motor impairment, her neurological problems did not result from hyperbilirubinemia, mechanical injury or oxygen deprivation acquired in the course of labor, delivery or the immediate post-delivery period. Dr. Duchowny’s opinion is credited.
Findings Of Fact Daniel was born on March 13, 2013, at the Medical Center located in Vero Beach, Florida. At the time of Daniel’s birth, Dr. Prieto was a “participating physician” who participated in the Plan for the year in which the injury occurred. See § 766.302(7), Fla. Stat. Upon receiving the Petition, NICA retained Donald Willis, M.D., an obstetrician/gynecologist specializing in maternal-fetal medicine, to review Daniel’s medical records. NICA sought to obtain an opinion whether an injury to Daniel’s brain or spinal cord at birth caused by oxygen deprivation or mechanical injury occurred in the course of labor, delivery, or resuscitation in the immediate post-delivery period, and whether that injury rendered Daniel permanently and substantially mentally and physically impaired. After reviewing Daniel’s medical records, Dr. Willis opined that, within a reasonable degree of medical probability: [T]here was no apparent obstetrical event that resulted in oxygen deprivation or mechanical trauma to the brain or spine during labor, delivery and the immediate post-delivery period. Based on the opinion and conclusions of Dr. Willis, NICA determined that Petitioners’ claim was not compensable. A review of the file reveals that no contrary evidence disputes Dr. Willis’ findings. His opinion is credible and persuasive. NICA subsequently filed the Unopposed Motion for Summary Final Order asserting that the Petition should be dismissed for two reasons. First, NICA asserts that Daniel has not suffered a “birth-related neurological injury” as defined by section 766.302(2). Second, NICA declares that Petitioners’ claim is untimely because Petitioners filed their Petition more than five years after Daniel’s birth. Therefore, under section 766.313, Petitioners’ claim for compensation on behalf of Daniel is time-barred. Both of NICA’s arguments have merit. Petitioners do not oppose NICA’s motion.
Findings Of Fact Noah Klee was born on March 30, 2009, at Winnie Palmer Hospital in Orlando, Florida. Noah weighed 4,259 grams at birth. Donald Willis, M.D. (Dr. Willis), an obstetrician specializing in maternal-fetal medicine, was requested by NICA to review the medical records for Noah and his mother. In an affidavit dated February 14, 2013, Dr. Willis summarized his findings as follows: The purpose of my review of the medical records of NOAH KLEE and AMANDA KLEE was to determine whether an injury occurred in the course of labor, delivery or resuscitation in the immediate post-delivery period in the Hospital due to oxygen deprivation or mechanical injury occurring in the course of labor, delivery, or resuscitation in the immediate post-delivery period in the Hospital. * * * In summary, the pregnancy was complicated by insulin dependent diabetes with decreased fetal movement and onset of severe preeclampsia at 37 weeks gestational age. Emergency Cesarean section was done for suspected fetal distress on the FHR monitor. The patient was not in labor. The baby was depressed at birth, but Apgar score was normal by 5 minutes and the umbilical cord blood gas pH was above 7. The baby did suffer brain injury, but the above findings suggest the injury did not occur during labor, delivery or resuscitation in the immediate post-delivery in the Hospital. The patient was not in labor. There was no apparent obstetrical event that resulted in loss of oxygen or mechanical trauma to the baby's brain during delivery or resuscitation in the immediate post-delivery in the Hospital. As such, it is my opinion that there was no oxygen deprivation or mechanical injury during the course of labor, delivery or resuscitation in the immediate post-delivery in the Hospital. A review of the file in this case reveals that there have been no expert opinions filed that are contrary to the opinions of Dr. Willis. The opinion of Dr. Willis that Noah did not suffer a neurological injury due to oxygen deprivation or mechanical injury during labor, delivery, or immediate postdelivery period is credited.
