Case details

Subdural hematoma not due to spinal anesthesia: defense

SUMMARY

$0

Amount

Verdict-Defendant

Result type

Not present

Ruling
KEYWORDS
brain, brain damage, brain injury, language, sensory, speech, subdural hematoma
FACTS
On Feb. 18, 2015, plaintiff Rebecca Derohanian, a woman in her 30s who worked for studio companies in the entertainment industry, underwent a cesarean section for the delivery of her baby. The procedure was perform by an OB-GYN, Dr. Michael Tahery, at Cedars-Sinai Medical Center, in Los Angeles. Forty hours later, on Feb. 20, 2015, Derohanian suffered a subdural hematoma. As a result, the bridging veins that connect the brain to the skull tore, resulting in a significant bleed that caused uncal herniations at the skull base. Derohanian sued Tahery; another OB-GYN, Dr. Sara Churchill; and Cedars-Sinai Medical Center. Derohanian alleged that defendants were negligent in the performance of the C-section and in failing to obtain her informed consent. She also alleged that the defendants’ negligence constituted medical malpractice. Churchill and Cedars-Sinai settled out of the case, and the matter proceeded against Tahery only. Derohanian’ counsel argued that a C-section should not have been performed because of the baby’s growth factors and that the spinal anesthesia before the C-Section caused a significant loss of cerebrospinal fluid that led to brain sag and a tearing of the bridging veins. Plaintiff’s counsel noted that Derohanian’s baby had Intrauterine growth restriction (IUGR), which is when a fetus does not grow as expected, as at 32 weeks, it was determined that the baby was at the bottom 2 percentile for its gestational age. The baby continued to be at the 10th percentile of growth based on its fetal weight and abdominal circumference. Ultimately, the baby’s fetal weight was above 10 percent, but its abdominal circumference was below 10 percent, and either percentage could be used for a diagnosis of IUGR. Plaintiff’s counsel contended that since the fetal weight of the baby was a higher percentile — though the other metrics were okay and the baby could have just been small and delivered by induction — a C-section should not have been performed. The plaintiff’s OB-GYN expert testified about a 20-factor list that looked at other parameters to determine how a baby is doing, and opined that those factors indicated that Derohanian’s baby was doing fine. Plaintiff’s counsel further contended that the spinal anesthesia needle caused Derohanian’s cerebrospinal fluid to leak and that the leak was so significant that it caused hypotension in her brain. In addition, counsel contended that the hypotension caused Derohanian’s brain to sag and tear the bridging veins, which resulted in a significant bleed. The plaintiff’s neurology expert opined that the venous sinuses indicated a brain sag and low cerebrospinal fluid. The expert further opined that, based on the post-operative report of the subdural hematoma evacuation, the subdural hematoma was on the opposite side, bilateral, and was not spontaneous, and that it was caused by the brain sag. Tahery claimed that he informed Derohanian that because the baby’s fetal weight was above 10 percent, but its abdominal circumference was below 10 percent, the baby should be delivered between 38 and 38.9 weeks. He also claimed that he informed Derohanian that the baby could be delivered spontaneously, by C-section or by induction, but that there was a risk if the baby was carried to term, as there was a higher chance of stillbirth. Tahery claimed that Derohanian ultimately chose to undergo a C-section to deliver her baby. Defense counsel argued that a C-section was indicated based on the persistently low abdominal circumference, which was below the 10th percentile, and that Derohanian partially elected to have the C-section due to the choices to deliver the baby before term. Counsel also argued that the baby was proven to be below the 10th percentile for that gestational age when it was delivered and that the alternative to the C-section would have used an epidural, which required a bigger gauge needle and had a greater chance of accidental dural punctures. As for the subdural hematoma, defense counsel contended that it was shown to be on the opposite side during the evacuation because Derohanian’s head was turned, causing the fluid to collect at that location. Counsel also contended that the alleged brain sag that the plaintiff’s neurology expert testified about was not present and that, instead, the subdural hematoma was pushing down on the brain to the base of skull. In addition, counsel contended that there was no indication that Derohanian had any spinal headache until 15 minutes before she went comatose. As such, defense counsel argued that Derohania suffered a rapid, spontaneous hematoma and that it was an arterial rupture and not a venous rupture., Derohanian claimed she suffered a subdural hematoma that caused a brain herniation and a permanent, severe disability. She alleged that as a result, she requires 24/7 at home care and 24/7 assistance. She also alleged that she can no longer speak or perform any activities of daily living. Plaintiff’s counsel asked for Derohanian to attend a NeuroRestorative facility, an acute rehabilitation facility for those with brain , where participants would learn skills so that they would hopefully require a lower level of care than needed before and be able to be discharged. Counsel presented a life care plan that estimated Derohanian’s future care as totaling $12 million to $13 million. Derohanian’s husband, Zoltan Csizmadia, presented a derivative claim, seeking recovery for his loss of consortium. Plaintiff’s counsel asked the jury to award $15 million in total damages. Defense counsel contended that Derohanian was beyond the type of care that NeuroRestorative could provide, as Derohanian was out of the window to receive helpful care, and that rehabilitation would not help her.
COURT
Superior Court of Los Angeles County, Los Angeles, CA

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