411 F.Supp.3d 413
S.D. Ill.2019Background
- Plaintiff Yong Juan "Maggie" Zhao sued under the FTCA on behalf of her son Steven, alleging negligent obstetrical care by Dr. Paul Cruz (a federally deemed Public Health Service employee) caused shoulder dystocia at birth and permanent right brachial plexus injury.
- Mrs. Zhao had prior vaginal births including an 11 lb 12 oz (macrosomic) infant; late-term fundal heights in May–June 2014 were enlarged (40–42 cm) but Dr. Cruz did not obtain an ultrasound and used his idiosyncratic "Sicurenza" clinical weight estimate.
- Labor: Mrs. Zhao pushed >1.5 hours, was exhausted; Dr. Cruz attempted vacuum extraction, the head delivered but shoulders were impacted; shoulder dystocia lasted nine minutes before relief by a second physician.
- Infant Steven was resuscitated, diagnosed with right brachial plexus avulsion and required nerve graft surgery and ongoing therapy; experts agreed injuries are permanent and will limit function, require future care, and affect earning capacity.
- The bench trial (Apr 2019) found multiple deviations from the standard of care (no ultrasound, failure to recommend timely cesarean, improper vacuum use, failure to perform episiotomy, excessive traction) and awarded $8,297,967.77 in damages to Steven.
Issues
| Issue | Zhao's Argument | United States' / Cruz's Argument | Held |
|---|---|---|---|
| Whether Dr. Cruz breached the standard of care by failing to obtain an ultrasound for suspected macrosomia | Fundal heights and prior macrosomic birth required ultrasound to assess fetal weight | Ultrasound not required; fundal height was "concordant" and ultrasound would not necessarily change management | Court: breach — ultrasound was required and would likely have shown macrosomia; failure fell below standard of care |
| Whether Dr. Cruz should have recommended a primary or intrapartum cesarean | Given risk factors and prolonged second stage, cesarean should have been recommended and risks explained | Prior successful vaginal macrosomic birth and no fixed fetal-weight threshold for elective cesarean; management reasonable | Court: breach — should have recommended/fully informed re: cesarean and risks of vaginal/operative delivery |
| Whether using vacuum extraction and failing to perform episiotomy/proctoepisiotomy violated the standard of care | Vacuum was contraindicated given suspected macrosomia and cephalopelvic disproportion; episiotomy was indicated to obtain space | Vacuum use and episiotomy not contraindicated here; shoulders already impacted before vacuum | Court: breach — vacuum use and failure to perform episiotomy were negligent and contributed to dystocia |
| Causation: whether excess traction or the dystocia itself caused the brachial plexus avulsion | Excessive traction by Dr. Cruz was a proximate, substantial factor causing avulsion | Injury could be caused by the dystocia itself; traction not necessarily the cause | Court: held proximate causation — more likely than not Cruz applied excessive traction and his negligence caused the injury |
Key Cases Cited
- United States v. Muniz, 374 U.S. 150 (FTCA jurisdictional principle)
- Sullivan v. Edward Hosp., 209 Ill.2d 100 (Ill. 2004) (medical-malpractice elements and expert testimony requirements)
- Purtill v. Hess, 111 Ill.2d 229 (Ill. 1986) (expert witness foundational requirements)
- Morisch v. United States, 653 F.3d 522 (7th Cir. 2011) (proximate cause and expert proof in medical malpractice)
- Palay v. United States, 349 F.3d 418 (7th Cir. 2003) (cause-in-fact as substantial factor)
- Zurba v. United States, 318 F.3d 736 (7th Cir. 2003) (administrative exhaustion under FTCA)