Williams v. Thomas

1

2024 IL App (1st) 221622-U

ARIANA WILLIAMS and BRANDON STEELS, Individually, and as mother and father of JARRON STEELS, a minor, Plaintiffs-Appellants, v. JOSEPH THOMAS, M.D., Defendant-Appellee.

No. 1-22-1622

Court of Appeals of Illinois, First District, Fifth Division

May 24, 2024

This order was filed under Supreme Court Rule 23 and is not precedent except in the limited circumstances allowed under Rule 23(e)(1).

Appeal from the Circuit Court of Cook County. No. 2017 L 8130 Honorable James Varga, Judge Presiding

JUSTICE LYLE delivered the judgment of the court. Justices Mikva and Navarro concurred in the judgment.

ORDER

LYLE JUSTICE

¶ 1 Held: We affirm the circuit court's judgment where there was no abuse of discretion to admit defendant's expert witness testimony and where jury instructions were proper.

¶ 2 Plaintiffs-Appellants Jarron Steels and his parents, Ariana Williams and Brandon Steels, filed a medical malpractice action against the delivering obstetrician Defendant-Appellee, Dr. Joseph Thomas, alleging Jarron suffered injuries proximately caused by Dr. Joseph Thomas during delivery. The matter proceeded to jury trial. Plaintiffs now appeal the jury verdict finding in favor of Dr. Thomas. For the reasons that follow, we affirm.

¶ 3 BACKGROUND

¶ 4 Dr. Thomas was the delivering obstetrician for the delivery of Ariana Williams and Brandon Steels's child, Jarron Steels. Complications arose during the delivery, interfering with the baby's exit from the birth canal. Dr. Thomas believed baby Jarron had shoulder dystocia; a condition where after the baby's head exited the birth canal, one of the baby's shoulders was stuck in the pubic symphysis. After Jarron was delivered, Jarron was diagnosed with a permanent brachial plexus injury to his left arm and shoulder, a permanent injury to the nerve roots. Plaintiffs brought suit against Dr. Thomas, alleging that he negligently assisted the baby through the canal proximately causing Jarron's injury. The matter proceeded to jury trial where the jury returned a verdict for the defendant.

¶ 5 At trial, Dr. Thomas testified that he encountered Ms Williams when she had progressed in labor and was fully dilated. He stated that Jarron's posterior (left) shoulder had been forced past the sacral promontory, or the bump in the spine of the mother. According to Dr. Thomas, the force of Ms. Williams' contractions was insufficient to complete delivery at that time. He decided to use a Kiwi vacuum, or a small handheld device, to assist Ms. Williams with her labor. As the baby's body did not deliver, Dr Thomas determined that the anterior (right) shoulder was stuck against Ms. Williams's pubic bone.

¶ 6 Believing this was a shoulder dystocia event, Dr. Thomas attempted the McRoberts maneuver and suprapubic pressure to release the baby from the mother's pubic bone. To utilize the McRoberts maneuver, Dr. Thomas, with the help of nurses, pulled the mother's legs back towards her shoulder to increase the space between her pubic bone and sacrum. Dr. Thomas explained that suprapubic pressure occurs when the nurse uses her hand to put pressure on the pubic bone to release the baby's shoulder. He stated that the nurse pushed down on the bone to push the baby's shoulder underneath the public bone. He then explained the corkscrew maneuver, stating that the baby is manually rotated to deliver the posterior shoulder.

¶ 7 Dr. Thomas stated that after the head was delivered but before the corkscrew maneuver was attempted, he did not move the baby's head right ear to right shoulder. He explained that he would never do so for multiple reasons. According to Dr. Thomas, the first reason is that lateral flexing on the head would occur, which he stated he does not do. The second is that pushing the head up would defeat the purpose of using suprapubic pressure and the McRoberts maneuver to release the shoulder from the mother's pubic bone.

¶ 8 According to Dr. Thomas, there was no finding that during delivery, the left posterior shoulder was trapped by any of the bony structures. When asked whether he had an opinion as to what caused Jarron's brachial plexus injury, he stated that he didn't have one and that "no one knows" what caused the injury. He stated that his conduct during the delivery complied with the standard of care.

¶ 9 Dr. Thomas testified that, based on his knowledge and experience, if the posterior shoulder becomes impacted on the sacral promontory, the head of the baby is not outside of the mother at that time. He stated that impact on the sacral promontory point could be a cause for an injury to the posterior shoulder. He agreed that an obstetrician cannot see a baby's shoulder stuck in the sacral promontory, but medical literature has documented cases of the event occurring.

¶ 10 Dr. Richard Luciani testified as Plaintiffs' obstetrician-gynecologist expert. Based on his review of the medical record, Dr. Luciani concluded that Dr. Thomas deviated from the accepted standard of obstetrical care. He stated that a permanent brachial plexus injury could not have been caused by the natural forces of labor. He described the maternal forces of labor, using figures and models, and concluded that such forces would not cause Jarron's injury. Specifically, he stated Dr. Thomas utilized excessive lateral traction during the delivery, leading to permanent brachial plexus injury in multiple nerve roots of Jaron's left shoulder. He testified that it is impossible for maternal forces of labor to cause this injury. He concluded that the only mechanism of injury could only be from excessive traction. He denied that the impaction of the posterior shoulder on the sacral promontory can cause shoulder dystocia.

¶ 11 On cross-examination, Dr. Luciani agreed that there was no documented record that Dr. Thomas applied excessive lateral traction during the course of the delivery. However, he stated that the brachial plexus injury was self-evidence that Dr. Thomas used excessive upward traction. In his opinion, absent a tumor, a "brachial plexus injury that occurs is the result of excessive lateral traction by the delivering physician." He admitted to not contributing to the literature in this field but stated that he had read almost every piece of literature available.

¶ 12 Dr. Daniel Adler, Plaintiffs' pediatric neurologist expert, testified that he believed that the material forces of labor could never create the injury suffered by Jarron. He stated that "it's never been reported, there's no medical literature, no one has written a paper saying this is possible. I've never personally seen it, and I would say in this particular case it could not possibly be the cause." He went on to say that the "injury is sufficient to prove" that excessive lateral traction was used. Dr. Adler concluded that "the head must have moved after the delivery in a way that was lateral so that the right ear moved towards the right shoulder. Otherwise, the injury would have never occurred."

¶ 13 On cross examination, Dr. Adler agreed that there was no documented evidence in the hospital record or statements by individuals who witnessed the delivery that Dr. Thomas moved the head upward during the delivery. Dr. Adler restated that the injury sustained by Jarron is evidence that his head was moved during delivery. He was "not aware" of medical literature that contained case reports of permanent brachial plexus injury without application of traction.

¶ 14 Defense expert Dr. Steven Clark testified that he performed research and studied the pathophysiology of brachial plexus injuries after he encountered a case where the posterior shoulder was injured. Plaintiffs objected, stating that Dr. Clark's statement goes into his personal practice. Defense replied that the statement went to his background and training, which the trial judge agreed and overruled Plaintiffs objection.

¶ 15 Dr. Clark went on to explain that "several decades ago, it was thought that the only way a baby got a brachial plexus injury" was when a "doctor encounters shoulder dystocia, that it was that pulling, that tugging, that would cause brachial plexus injury" and that was "the end of the story." In that case, Dr. Clark explained that the "baby was delivered by the posterior arm, not the arm stuck under the pubic bone, was the one that turned out to have the injury. No amount of pulling and tugging that a doctor could do could possibly injure the posterior arm in a baby with a shoulder dystocia."

¶ 16 Since that case, Dr. Clark stated that the medical literature has expanded and has now described four ways for a baby's brachial plexus to be injured. He explained that "most of these injuries have nothing to do with what the doctor does" while trying to relieve the shoulder dystocia. He went on to describe the four ways brachial plexus injuries could occur. He stated that "any time I have twisting or turning of my head in one direction, I'm going to be stretching the brachial plexus in the other direction."

¶ 17 Dr. Clark then explained that the first possible cause of a brachial plexus injury is in utero crowding. The second is cardinal movements of labor. Referencing his prior testimony, Dr. Clark explained that "if there is a disproportion between the shoulders and the head of the baby and the pelvis of a mother***the brachial plexus may be stretched unduly or stretched abnormally, and brachial plexus injury can occur that way." According to Dr. Clark, this is a known cause because "half of all babies with brachial plexus didn't have a shoulder dystocia" which indicates that stretching occurred while the baby was naturally moving down the birth canal.

¶ 18 The third possible cause could be lifesaving maneuvers such as the...