The claimant, a baby girl, was in the process of being delivered by a perinatologist at a health maintenance organization, when the physician reached into the mother’s vaginal outlet and felt the baby’s shoulder impacted under the mother’s symphysis pubis. The mother had been pushing effectively and was making progress, as there was no fetal distress and fetal monitor strips were reassuring. The baby’s head was also near completely delivered when the perinatologist discovered the baby’s impacted shoulder. Rather than allow the vaginal delivery to continue, the perinatologist abandoned the vaginal delivery and ordered a Caesarean section. The mother was subsequently transferred on a gurney to an operating room, with the baby’s head nearly out between her legs. In the operating room, the perinatologist pushed the baby’s head back into the uterus and performed a C-section extraction. There were 19 minutes between when the vaginal delivery was abandoned and the baby was delivered via C-section. Upon delivery, the baby was determined to be unresponsive in that there were no spontaneous movements or spontaneous respirations. Her APGARs were 1 at 1 minute, 3 at 5 minutes and 3 at 10 minutes. The baby was subsequently intubated and transferred to the neonatal intensive care unit, where she was resuscitated and diagnosed as having suffered severe birth asphyxia. Subsequent MRI studies confirmed the diagnosis of hypoxic ischemia, and severe and permanent brain damage. The mother, acting as the mother and natural guardian of her baby daughter, sued the HMO and the perinatologist for her baby’s birth . She alleged the defendants were negligent in the delivery of her daughter and that this negligence constituted medical malpractice. The matter went to arbitration before a three member panel. The claimants’ counsel contended that the perinatologist was negligent for abandoning the vaginal delivery and ordering a crash C-section when the delivery was progressing appropriately, in that the baby’s head was nearly completely delivered and there was no fetal distress. The perinatologist’s fingers were on the baby’s anterior shoulder when he “felt it was impacted” under the symphysis pubis, which is a shoulder dystocia. Claimants’ counsel contended that all the perinatologist had to do was rotate the shoulder to the oblique and/or order suprapubic pressure, two standard maneuvers to safely deliver a shoulder dystocia. Counsel contended that the baby’s shoulder would have then become “disimpacted” and the baby would have been safely delivered within seconds. Claimants’ counsel asserted that by abandoning the vaginal delivery when the baby’s head was nearly delivered, the baby suffered 19 minutes of umbilical cord compression, resulting in oxygen and nutrient deprivation to the brain, causing asphyxiation and brain damage. The HMO and the perinatologist claimed that they acted within the standard of care at all times and did not cause or contribute to the baby’s brain damage. The respondents’ counsel contended that since the baby’s head was not “completely delivered,” the perinatologist was within the standard of care to abandon the vaginal delivery and perform the C-section. Counsel also contended that the baby did not suffer cord compression and that, based upon a pre-natal ultrasound, the injury to the baby’s brain occurred days before the delivery., The baby suffered severe birth asphyxia, leaving her with severe permanent hypoxic ischemic brain damage, blindness, deafness, hypertension and diffuse spasticity. The claimants’ counsel contended that the baby suffered asphyxiation and brain damage as a result of oxygen and nutrient deprivation to the brain during the 19 minutes between when the vaginal delivery was abandoned and the baby was delivered via C-section. Counsel contended that the baby suffered an umbilical cord compression during that time. The baby is now tracheostomy and gastrostomy tube dependent, and requires 24-hour-a-day licensed vocational nursing care. The claimants’ counsel contended that the baby has a 30-year life expectancy as a result of her . Thus, counsel asserted that the baby will suffer a loss of a future earnings in a range of $800,000 to $1.3 million present value. The mother also sought recovery of $8 million in damages for her daughter’s future medical care and $250,000 in MICRA general damages. The respondents’ counsel denied the baby’s occurred as a result of her delivery and contended that the baby did not suffer cord compression. Instead, counsel asserted that, based upon a pre-natal ultrasound, the injury to the baby’s brain occurred days before the delivery. In addition, the respondents’ counsel contended that the baby has a 10-year life expectancy and disputed the need for 24-hour-a-day licensed vocational nursing care.