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In Delivery Room, Baby and Doctor at Risk

But the labor dragged on for hours. When the baby's head finally started to emerge, the birth stalled, this time by a rare complication called shoulder dystocia -- which occurs when the shoulder becomes locked in the birth canal.

"You don't forget the moment these sort of catastrophic events occur," Kearney said later. "Shoulder dystocia, it's what you live in fear of, literally."

Kevin Kearney, at his Salisbury office, is giving up obstetrics because the malpractice insurance costs are too high. (James A. Parcell -- The Washington Post)

Ehrlich's Proposal

Maryland Gov. Robert L. Ehrlich Jr. has prepared draft legislation that he says will help resolve the medical malpractice insurance problem. His proposal includes the following provisions:

• It allows insurance companies to pay jury awards in periodic payments over time, rather than in a lump sum.

• It provides that an apology or expression of sympathy from the doctor is inadmissible as evidence of fault.

• It limits attorney's fees to 40 percent of the first $200,000 of any judgment, 33 percent of the next $200,000, 25 percent of the next $200,000 and 15 percent of anything over $600,000.

• It allows the Board of Physicians to take disciplinary action against a doctor based on a preponderance of the evidence, rather than the current burden, which requires clear and convincing evidence of malpractice.

• It requires the parties in a court case to participate in upfront mediation to resolve their dispute before going to trial.

SOURCE: office of Gov. Robert L. Ehrlich Jr.

The longer the baby was stuck, the more risks mounted. With his umbilical cord compressed and his lungs unable to expand, Dennis's baby could not breathe. Move too slowly, Kearney knew, and the infant's brain would be starved of oxygen. Twist the wrong way, and risk damaging the nerves running through the shoulder to the chest and arms.

As he plotted a course, "minutes felt like hours."

He first tried to get the baby out by force. Nurses pushed back hard on Dennis's legs and pressed downward on her abdomen. And Kearney pulled -- hard -- on the baby's head, first using forceps, then his hands. Nothing.

Kearney's next maneuver: to reach under the baby's armpit with one finger, and use it like a hook to yank one arm through the birth canal. That freed up room for the baby to emerge. In a matter of seconds, Richard Turner was born.

Kearney visited Dennis the next morning. By then, he had seen the lack of tone in Richard's right arm.

"He just told me what had happened in the delivery room, that he was sorry for what he had done," she said. "He was sorry about what happened to Richard's arm."

Kearney said he left the hospital heartbroken. He doesn't remember apologizing to Dennis but said that if he did, it wasn't to convey that he "goofed." In fact, he felt certain he handled the procedure correctly.

It may be the most vexing aspect of shoulder dystocia, he said. If the baby is born with an injury, there is no way to know whether it occurred during delivery or during the baby's descent. The only certainty, Kearney believes, is that the doctor handling the delivery will be sued.

Say the words "shoulder dystocia," Kearney said, "and you'll see a smile cross the face of any plaintiff's attorney."

Lifelong Financial Burden

John Schochor greeted the young woman from the Eastern Shore in the foyer of the Paulton, the restored brick mansion his firm owns in Baltimore.

Over three decades as one of Maryland's leading malpractice attorneys, Schochor had seen hundreds of birth injuries that started when a baby's shoulder became trapped. So when Dennis sank into a deep leather chair and handed him her son's medical charts, he knew just what to look for.

The pediatrician's diagnosis was Erb's palsy. Her son had "virtually no independent use of his right arm or hand," the chart said. "His arm is held at an awkward angle, close to his body, and his elbow and wrist are flexed. . . . The arm is wasted along its entire length and it is clear that this will become more noticeable."

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