Findings Of Fact Jacob Baselice was born on July 19, 2010, at Memorial Hospital Miramar located in Miramar, Florida. Jacob weighed 6 pounds 2 ounces at birth. Donald Willis, M.D. (Dr. Willis), was requested by NICA to review the medical records for Jacob. In an affidavit dated December 3, 2014, Dr. Willis described his findings in pertinent part and gave the following opinion: It is my opinion that SHONA BASELICE’s term pregnancy ended with a spontaneous vaginal delivery of a healthy newborn. The newborn was not depressed. Apgar scores were 9/9. No resuscitation was required. The newborn hospital course was uncomplicated. Several months after hospital discharge, the baby was diagnosed with developmental delay and brain injury, documented by MRI. This child has a brain injury, as documented by MRI. However, the injury does not appear to be birth related. Unlike this case, babies with a birth related hypoxic brain injury are generally depressed at birth and have a complicated newborn hospital course. As such, it is my opinion 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. NICA retained Michael S. Duchowny, M.D. (Dr. Duchowny), a pediatric neurologist, to examine Jacob and to review his medical records. Dr. Duchowny examined Jacob on October 8, 2014. In a report dated October 14, 2014, Dr. Duchowny opined as follows: In summary, Jacob’s neurological examination reveals findings consistent with global developmental delay and a substantial mental and motor impairment. He evidences spastic quadriparesis, absence of expressive and receptive communication skills, and four limb involvement with hypotonia, dystonic postures and athetoid movement. He has dysmorphic features and unexplained corneal clouding. Jacob’s motor findings are consistent with a diagnosis of ataxic hypotonic cerebral palsy. I had an opportunity to review medical records which were sent on August 21, 2014. They reveal that Jacob’s mother was a carrier for cystic fibrosis and that her alpha- fetoprotein was elevated during pregnancy. Jacob was born after spontaneous rupture of membranes and delivered vaginally. His Apgar scores were 9 & 9 at 1 and 5 minutes and he had a loose double nuchal cord that was easily removed. He was resuscitated easily. His birth weight was 6 pounds 2 ounces. The amniotic fluid was clear. I believe that Jacob’s findings are most consistent with a prenatally acquired syndrome, given his dysmorphic features and corneal clouding. The medical records do not provide evidence to suggest that Jacob’s neurological impairment resulted from either oxygen deprivation or mechanical injury acquired in the course of labor or delivery. It would be useful, however, to review his MRI scans and I would request an opportunity to review them. However, pending any unexpected findings from the MRI review, I believe that Jacob should not be considered for compensation within the NICA program. In an addendum to his report dated November 19, 2014, Dr. Duchowny opined: I reviewed an MRI scan of the brain for Jacob Baselice obtained on August 24, 2011. This study revealed abnormalities consistent with periventricular leukomalacia as well as immature delayed myelination. These findings are consistent with both prenatal and perinatally-acquired brain injury. However, based on the clinical findings, I continue to believe that Jacob’s neurological problems did not result from either mechanical injury or oxygen deprivation at birth. Dr. Duchowny reaffirmed his opinions and conclusions in an affidavit dated December 4, 2014. A review of the file in this case reveals that there have been no 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 have been no contrary opinions filed that are contrary to Dr. Duchowny’s opinion that although Jacob has a substantial mental and motor impairment, the medical records and clinical findings do not provide evidence that his neurological injury resulted from either oxygen deprivation or mechanical injury acquired in the course of labor or delivery. Dr. Duchowny’s opinion is credited.
