On Dec. 22, 2009, claimant Andrea Lopez was delivered vaginally by her mother, who had gestational diabetes, at Kaiser Harbor City. Andrea suffered a permanent brachial plexus injury to her left upper extremity at delivery. Andrea’s mother, Laura Lopez, was previously informed by Kaiser that a blood glucose test confirmed she had gestational diabetes on Oct. 6, 2009, and she was started on insulin for management on Nov. 27, 2009. When Lopez returned to Kaiser for a non-stress test on Dec. 22, 2009, she was 38 weeks and 5 days gestation, based on an ultrasound performed at 27.2 weeks. She also weighed 258 pounds, with a body mass index of 41.64 kg/m2. A physician obtained a history, performed a physical examination and then attempted to perform the Leopold’s maneuver by palpating the mother’s abdomen in an effort to obtain an estimated fetal weight. The physician noted that it was a difficult exam due to the patient’s weight and body index, causing the physician to be unable to feel the head, a critical part of the Leopold’s maneuver, making it impossible to accurately estimate the fetal weight using this method. As a result, the physician estimated the fetal weight as being 3,800 grams and admitted Lopez for induction of labor at 10:14 a.m. Another physician then arrived at Kaiser between 5:30 p.m. to 6 p.m., and assumed the patient’s care from the first physician. This second physician never obtained any estimated fetal weight and first met the patient for the first time when delivery was imminent. As a result, the fetal head was delivered by the new physician at approximately 8 p.m. Following delivery of the fetal head, the physician diagnosed a left anterior shoulder dystocia, which lasted approximately six minutes. After a few minutes, the physician called for help and two other physicians responded to the call. One of those physicians immediately performed the corkscrew maneuver and was able to successfully deliver the posterior arm, followed by the anterior arm. Andrea was ultimately delivered at 8:06 p.m., and weighed 10 pounds, 5.8 ounces (4,700 grams) at birth. Andrea sued Kaiser Foundation Health Plan Inc., Kaiser Foundation Hospitals and Southern California Permanente Medical Group. She alleged that the defendants were failed to properly estimate her size prior to delivery, failed to properly perform the delivery, and failed to offer her mother the option of a Cesarean section delivery. She alleged that these failures ultimately caused her injury and constituted medical malpractice. Claimant’s counsel contended that during the remainder of Lopez’s prenatal care, her gestational diabetes was poorly controlled. Counsel also contended that the initial physician failed to use an ultrasound to accurately ascertain the fetal weight and that had he done so, it would have shown the fetus to be 4,000 grams or greater — macrosomic. Claimant’s counsel contended that, most significantly, no one at Kaiser offered Lopez the treatment option of a Cesarean section prior to delivery. Counsel asserted that the standard of care required the physicians to discuss with Lopez the risks of gestational diabetes, macrosomia and vaginal delivery, including the risk of shoulder dystocia, as well as to recommend the option of a Cesarean section delivery. Counsel contended that had Kaiser abided by the standard of care and Lopez undergone a Cesarean section delivery, Andrea would not have suffered shoulder dystocia or a brachial plexus injury. The Kaiser respondents contended that, at all times, their physicians complied with the standard of care. Specifically, Kaiser contended that the first physician appropriately obtained an estimated fetal weight of 3,800 grams, and that the standard of care did not require a discussion with the patient regarding the risks of gestational diabetes, macrosomia or shoulder dystocia. Additionally, Kaiser contended that a C-Section was never indicated. Kaiser also contended that once the shoulder dystocia was encountered, none of the Kaiser physicians involved in the delivery did anything wrong to cause the child’s injury., Andrea sustained a right proximal humeral fracture and a permanent left brachial plexus injury as a result of shoulder dystocia during her delivery. She subsequently received occupational therapy for several months and one injection of Botox. All the experts agreed that Andrea is a candidate for a shoulder surgery in the future to improve her range of motion.