Findings Of Fact By stipulation filed January 18, 1994, petitioner and respondent stipulated as follows: That pursuant to Chapter 766.301- 766.316, Fla. Stat., a claim was [filed] on behalf of the above-styled infant against NICA on behalf of JORDAN KYLES, DENISE DESIR (the "Petitioners") for benefits under Chapter 766.301-766.316 Fla. Stat. That a timely filed Claim for benefits complying with the requirements of Section 766.305, Fla. Stat., was filed by the Petitioners and a timely Notice of Non- Compensability Setting forth that NICA denied the claim was filed on behalf of NICA. That the infant, JORDAN KYLES was born at Mercy Hospital on November 1, 1990, and Mercy Hospital was a licensed Florida Hospital and the attending physician, Dr. Luis G. Martinez, was a participating physician within the meaning of Chapter 766, Fla. Stat. The Division of Administrative Hearings has jurisdiction of the parties and the subject matter of this claim. Section 766.302(2), Fla. Stat. states that a "birth-related neurological injury" means injury to the brain or spinal cord of a live infant weighing at least 2500 grams at birth caused by oxygen deprivation or mechanical injury occurring in the course of labor, delivery, or resuscitation in the immediate post-delivery period in a hospital, which renders the infant permanently and substantially mentally and physically impaired. The parties agree that JORDAN KYLES suffers from a left brachial plexus palsy injury. A brachial plexus palsy injury is not an injury to the brain or spinal cord and further does not result in any mental injury. The parties stipulate to the authenticity of the medical records and/or medical reports of Michael Duchowny, M.D., including in particular his report dated September 2, 1993. A copy of this report has been attached hereto and incorporated herein as Exhibit 1. The parties stipulate that there are no other pertinent medical facts to be considered by the Division of Administrative Hearings. The parties further stipulate that if the parties were to proceed to a hearing on the merits no further proof would be offered and traditional burdens of proof would apply. Based upon the stipulation, the parties request the hearing officer rule on Petitioners' claim based upon this Stipulation, and the attached medical record. The stipulation and neurological examination of Jordan reveal that he suffered a left brachial plexus palsy injury, and that a brachial plexus palsy injury is not a brain or spinal cord injury and further, does not result in mental injury. Moreover, Jordan's mental functioning is age appropriate and not impaired due to any birth related complications.
Findings Of Fact Dream was born on February 14, 2018, at Winnie Palmer Hospital, located in Orange County, Florida. Donald Willis, M.D. (Dr. Willis), was requested by NICA to review the medical records for Dream. In a medical report dated October 8, 2019, Dr. Willis summarized his findings and opined, in pertinent part, as follows: In summary, labor was induced at about 33 weeks for preclampsia. FHR tracing during labor did not suggest any significant fetal distress. Delivery was by Cesarean section. Umbilical cord blood gas pH was within normal limits at 7.12. There was no seizure activity noted after delivery. No EEG or head imaging studies were done during the newborn hospital course. The child suffered brain injury at some time prior to the MRI at 11 months of age, which was consistent with encephalmalacia. However, the brain injury does not appear to be birth related. There was no apparent obstetrical event that resulted in oxygen deprivation or mechanical trauma to the brain or spinal cord during labor, deliver or the immediate post-delivery period. NICA retained Michael S. Duchowny, M.D. (Dr. Duchowny), a Board- certified pediatric neurologist, to examine Dream and to review his medical records. Dr. Duchowny examined Dream on November 26, 2019. In a medical report dated November 27, 2019, Dr. Duchowny summarized his examination of Dream and opined, in pertinent part, as follows: In summary, Dream’s evaluation reveals findings consistent with a substantial mental and motor impairment. The evidences spasticity and hyperreflexia of all extremities, a profound delay in motor milestones and absence of meaningful communication. He also has oromotor dysfunction and a borderline right exotropia. Review of medical records forwarded on November 12, 2019 reveal that Dream was the 2900 gram product of a 34 week gestation complicated by insulin-dependent gestational diabetes, polyhydramnios, pregnancy-induced hypertension and pre-eclampsia. He was delivered by Caesarian section because of worsening pre- eclampsia and non-reassuring fetal heart tones. Dream was a large-for-gestational-age neonate and had Apgar scores of 6 and 7 at one and five minutes. His neonatal course was prolonged although he remained on CPAP for only one day. A brain MR imaging performed on January 14, 2019 (age one month) revealed bilateral multifocal cystic periventricular leukomalacia. Given Dream’s relatively stable intrapartum and postnatal care, I would like to review Dream’s brain imaging before making a final recommendation regarding acceptance to the NICA program. On February 14, 2020, Dr. Duchowny provided an addendum to his neurological evaluation of Dream, following the review of brain imaging studies. Dr. Duchowny and Dr. Willis conferred regarding Dream’s medical records and current neurological status as well. In his February 14, 2020, addendum, Dr. Duchowny opined: It is our combined opinion that the findings on re- review do not support the presumption that Dream’s severe neurological outcome and MR imaging abnormalities were acquired in the course of labor, delivery or the immediate post-natal period as a result of either oxygen deprivation or mechanical injury. 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 to Dream’s brain during labor, delivery, and the post-delivery period, which resulted in brain injury. Dr. Willis’ opinion is credited. There are no expert opinions filed that are contrary to Dr. Duchowny’s opinion that Dream should not be considered for inclusion in the NICA program. Dr. Duchowny’s opinion is credited. Dr. Willis reaffirmed his opinion in an affidavit dated April 17, 2020. Dr. Duchowny reaffirmed his opinion in an affidavit dated April 17, 2020.
The Issue Whether Intervenor North Broward Hospital District d/b/a Broward Health Coral Springs a/k/a Coral Springs Medical Center (BHCS) satisfied the notice requirements set forth in section 766.316, Florida Statutes.
Findings Of Fact Rhea was born a live infant on August 18, 2017, at BHCS, located in Coral Springs, Florida. At the time of birth, Rhea weighed at least 2500 grams. BHCS is a “hospital,” as defined by section 766.302(6), Florida Statutes. Obstetrical services were delivered by Alison T. Clarke DeSouza, M.D., in the course of the subject labor, delivery, or resuscitation in the immediate post-delivery period in a hospital; BHCS. At the time of Rhea’s birth, Dr. DeSouza was a “participating physician,” as defined in section 766.302(7). Dr. DeSouza satisfied the notice requirements of section 766.316. Donald Willis, M.D., an obstetrician specializing in maternal-fetal medicine, was retained by Respondent to review the medical records for Rhea and her mother. In his affidavit dated June 16, 2020, Dr. Willis opines to a reasonable degree of medical probability, as follows: There was an apparent obstetrical event that resulted in oxygen deprivation to the brain during labor, delivery and continuing into the immediate post-delivery period. The oxygen deprivation resulted in brain injury. Respondent further retained Luis E. Bello-Espinosa, M.D., a pediatric neurologist. Dr. Bello-Espinosa was retained to review the available medical records and conduct an examination of Rhea to determine whether she suffers from an injury which rendered her permanently and substantially mentally and physically impaired; and whether such injury is consistent with an injury caused by oxygen deprivation or mechanical injury occurring during the course of labor, delivery, or the immediate post-delivery period in the hospital. Dr. Bello-Espinosa conducted the examination on June 12, 2020. In his affidavit dated June 16, 2020, he opines to a reasonable degree of medical probability, in pertinent part, as follows: In summary, Rhea is a 34-month old girl with a history of severe hypoxic-ischemic encephalopathy of birth. She was documented in the NICU to have acute refractory electroclinical and electrographic seizures, as well as MRI of the brain which were all indicative of a neonatal hypoxic-ischemic injury. On her examination, today is evident Rhea has severe neurological sequela. At 34-months of age, she has marked delayed acquisition of language and motor skills with salient signs on her neurological examination. She has mild axial hypotonia, moderate hypertonia in her left arm and both legs, including sustained dystonic posturing of her left hand, extensor posturing of her feet, and inability to walk, all of which are signs indicative of combined athetoid spastic triplegic cerebral palsy. Rhea is found to have substantial mental and physical impairments at this time. Rhea’s mental and physical impairments are permanent. In reviewing all of the available documents, the evolution of her symptoms, the acute brain MRI changes, her acute neonatal electroclinical seizures, it is evident that she had an acute hypoxic event perinatally. The injury is felt to be acquired due to oxygen deprivation of the brain. The injuries are felt to be birth-related. In summary, it is felt that the permanent and substantial mental and physical impairments accrued during the perinatal period of labor and delivery. The undisputed opinions of Dr. Willis and Dr. Bello-Espinosa are credited. Based on their opinions, the undersigned finds that Rhea sustained an injury to the brain caused by oxygen deprivation occurring in the course of labor, delivery, or resuscitation in the immediate post-delivery period in a hospital, which rendered Rhea permanently and substantially mentally and physically impaired.
Findings Of Fact Petitioners are the parents and natural guardians of Yahsir. On April 8, 2019, Ms. Mallory gave birth to Yahsir, a single gestation of 39 weeks, at the Hospital. Yahsir was delivered by cesarean section and weighed 3,786 grams at birth. Ted Robertson, M.D., and Megan Bagwell, M.D., provided obstetrical services and delivered Yahsir. The undisputed evidence in the record consists of signed reports of two physicians—Donald Willis, M.D., an obstetrician, and Michael Duchowny, M.D., a pediatric neurologist who conducted a remote evaluation of Yahsir. Dr. Willis reviewed the medical records and summarized his opinions about Yahsir’s delivery in a report, dated October 9, 2020. According to Dr. Willis, Ms. Mallory suffered from elevated blood pressure at 34 weeks gestational age and was diagnosed with preeclampsia after a brief hospital evaluation. As a result of the preeclampsia, she was admitted to the Hospital on April 7, 2020, for induction of labor at 39 weeks. Yahsir was delivered the next morning by cesarean section due to a non- reassuring fetal heart rate pattern and suspected placental abruption. Yahsir was depressed at birth with APGAR scores of two at one minute, five at five minutes, and eight at ten minutes. Yahsir’s heart rate was less than 60 bpm at birth. Positive pressure ventilation was initiated without the need for chest compression and bag and mask ventilation continued for three minutes. Oxygen was weaned and Yahsir was transferred to the NICU. Yahsir arrived in the NICU with an oxygen saturation of 95 percent on room air and no further respiratory distress occurred before his discharge. The medical records noted that Yahsir was “without clinical encephalopathy.” No seizure activity occurred during his stay in the Hospital. At Yahsir’s pediatric follow up appointment at four days old, he was noted as having a bilateral upper extremity tremor. Neurological evaluation was scheduled and, at five months old, Yahsir was diagnosed with spastic cerebral palsy. An MRI conducted at seven months was normal. Based on the medical records, Dr. Willis opined that Yahsir’s neurologic issues do not appear to be birth related. Although the labor was complicated by a non-reassuring fetal heart rate pattern, Yahsir was initially depressed at birth with low APGAR scores, and was later diagnosed with cerebral palsy, Dr. Willis noted that Yahsir suffered no multi-system organ failures or seizure activity at the Hospital and had a normal MRI finding at seven months old. Dr. Duchowny reviewed the medical records, conducted a virtual neurological evaluation by Zoom on October 30, 2020, and summarized his opinions in a report, dated November 6, 2020, as to whether Yahsir suffers from permanent and substantial mental and physical impairment caused by an oxygen deprivation event. Yahsir was 18 months old at the time of the evaluation. He was previously diagnosed with cerebral palsy and leg tightness has been his major issue. He began physical therapy at four months old and began walking independently at eight months old. He can run, climb stairs, and has no motor regression. He can use both hands cooperatively and has no required medical treatment for spasticity. His previous MRI findings were normal. Yahsir’s communication is delayed. He did not say any words until about 12 to 13 months old and only seems to repeat what he hears, but he understands spoken language without difficulty. Yahsir’s speech sounds are unclear, but his hearing and vision are good. He has no significant feeding issues and has gained weight steadily. Yahsir has significant sleep issues and he is prone to temper tantrums, but his overall health is otherwise stable. He attends daycare five days per week. Dr. Duchowny found Yahsir to be an alert, well-developed, and well- nourished infant. Although Yahsir showed mild speech delay, Dr. Duchowny believed that would improve with speech therapy. Based on the medical records and evaluation, Dr. Duchowny did not believe that Yahsir has a substantial mental or physical impairment.
