Appeal from the Circuit Court of Cook County, Honorable Walter B. Bieschke, Judge Presiding.
Released for Publication July 14, 1994. Petition for Leave to Appeal Denied October 6, 1994.
O'connor, Campbell, Buckley
The opinion of the court was delivered by: O'connor
Justice O'CONNOR delivered the opinion of the court:
In July 1985, plaintiff, Cynthia Mundell, filed a two-count medical negligence suit against defendant Robert La Pata, M.D., on behalf of her daughter, Maureen, alleging that Dr. La Pata was negligent in both pre-natal and neo-natal care of her and Maureen, resulting in injury to Maureen.
Maureen Mundell was born on March 9, 1981, with a "brachial plexus" injury to her right arm. Brachial plexus is a paralyzing injury to the nerves which exit the spinal chord and run down the arms. Maureen apparently incurred this injury during birth, the result of emergency measures taken by Dr. La Pata to deliver her in the face of a complication called "shoulder dystocia." Shoulder dystocia, a condition in which a newborn's shoulder becomes lodged against the mother's pelvic bone, is a life-threatening complication of delivery in that when it occurs, the baby becomes stuck in the birth canal and its lungs, as well as the umbilical cord, become compressed in the birth canal, restricting breathing. The resulting risk of asphyxiation requires delivery to be effected within five minutes of the onset of shoulder dystocia.
Mrs. Mundell alleged that while she was pregnant with Maureen, she contracted gestational diabetes, a form of diabetes which affects pregnant women and then often disappears after delivery. Gestational diabetes can first be detected sometime between the 24th and 28th week of the pregnancy. This manifestation of the disease often results in a fetal condition called "macrosomia," or a largerthan normal -- over nine pounds -- baby. Diabetes-induced macrosomia generally results in fetal largeness below the neck. Macrosomia can result in "cephalopelvic disproportion," a disproportion in the size of a fetus to the mother's birth canal, i.e., the baby is too large to be born "spontaneously," without medical intervention. A possible complication of cephalopelvic disproportion is shoulder dystocia. The medical response to cephalopelvic disproportion includes delivery by cesarean section.
Mrs. Mundell's complaint was predicated upon her claim that she was a gestational diabetic. Count I of the complaint alleged specific negligent acts by Dr. La Pata in that he:
A. failed to establish a diagnosis of gestational diabetes during the prenatal period;
B. failed to recognize cephalopelvic disproportion, and;
C. effected a traumatic delivery.
Count II stated a claim under a theory of res ipsa loquitur, alleging that brachial plexus injuries do not ordinarily occur during delivery in the absence of negligence. At trial, the primary witnesses were Cynthia Mundell, Dr. La Pata, and two medical experts.
Cynthia Mundell's mother had suffered from diabetes. However, it was controlled by diet, rather than by insulin injections. The family also had a history of large babies. She began seeing Dr. La Pata for obstetric care when she discovered her pregnancy. She related her family history to Dr. La Pata. She visited Dr. La Pata on a monthly basis early in her pregnancy. Dr. La Pata performed urinalysis, took her blood pressure, and weighed her. As the pregnancy progressed, Cynthia became concerned that the fetus was a large one. After examinations at various points during the pregnancy, Dr. La Pata assured her that the fetus was of normal size.
Dr. La Pata recalled that Cynthia Mundell first visited him about her pregnancy on August 4, 1980. It was her first pregnancy, and she was thirty years old. Dr. La Pata took a family history and discovered that Cynthia's mother was a diet-controlled diabetic. On September 20, 1980, he gave Cynthia a complete physical examination, which was normal in all aspects. During the course of the pregnancy, Cynthia visited the doctor on approximately twelve occasions. On nine of these occasions, Dr. La Pata tested Cynthia's urine for glucose. The results were always negative, which is one indication that the patient does not have diabetes, although urinalysis is not a conclusive test.
Dr. La Pata listed the following among the factors indicating a patient's risk for gestational diabetes: (1) a family history of diabetes; (2) a prior pregnancy involving a macrosomic baby; (3) a history of fetal trouble; (4) a positive screening blood sugar test; (5) glucose inthe urine; (6) the current fetus is overly large; and (7) obesity in the mother. Dr. La Pata stated that unless two of these risk factors are present, he does not conclusively test a woman for gestational diabetes. *fn1 Thus, because the only risk factor that Cynthia Mundell presented to Dr. La Pata was a family history of diabetes, he never conducted conclusive screening testing for gestational diabetes because he believed her risk level for the disease to be very low. He stated that this satisfied the standard of care for obstetricians in the Chicago area in 1981.
At only one point during the pregnancy, in October 1980, did Dr. La Pata become concerned about the size of the baby. At that time, he ordered ultra-sound, from which he concluded that the fetus was of normal size. As far as Dr. La Pata was concerned, Cynthia's pregnancy proceeded normally until delivery. On March 9, 1981, Cynthia was admitted to Evanston Hospital, for delivery at 12:30 p.m. She proceeded through labor without incident until about 6 p.m., when Maureen's head began to emerge from the birth canal. At this point, Cynthia was no longer able to push Maureen out on her own. An anesthetic was administered. Dr. La Pata then began delivering ...