$46.5M Record Verdict: Animated Infant Brain Injury After Failure to Treat JaundiceStuart Ratzan, Esq., and Stuart Weissman, Esq., Ratzan Law Group, Miami, FL
Ratzan Law Group returned the largest medical malpractice verdict in the history of Arkansas after showing how doctors chose not to treat an infant's jaundice until it worsened into an irreversible brain injury.
Stuart Ratzan, Esq., and Stuart Weissman, Esq., needed to demonstrate to jurors that doctors ignored obvious red flags of jaundice that they should have easily recognized. But in order to help jurors understand why these flags were so obvious, they also needed to simplify some enormously complex medical issues most jurors might not understand, such as "What is jaundice and how can it cause a brain injury?"
Mr. Ratzan and Mr. Weissman tasked us with building them a visual presentation that would simplify complex medical concepts so they could focus on conveying the key points of how and why the defendants' negligent actions resulted in their client's brain injury.
The following visual presentation helped convince an Arkansas jury to award their client a $46.5M verdict.
This was a very complicated case and High Impact was able to help us simplify the complex medical issues, making it clear to a jury exactly what happened, how high levels of bilirubin causes jaundice, and how, if not treated, it can lead to brain injury. It sounds like a mouth full, but exactly how to take these complex medical issues and make them simple for the jury is a big part of why we won the case.
Stuart Ratzan, Esq., Ratzan Law Group, Miami, FL
What is Jaundice?
Jaundice is a potentially life-threatening condition that most noticeably causes yellowish, greenish pigmentation of the skin and eyes. It occurs when the bloodstream contains an excess of bilirubin. Bilirubin is a brownish yellow substance that releases from the breakdown of red blood cells, as animated below.
Normally, the bilirubin level is prevented from rising too high because the liver converts it into a form that is removed by the kidneys and intestine. However, in some newborn babies, bilirubin increases above normal levels, causing jaundice.
How Is Jaundice Normally Treated?
Phototherapy is the most common treatment for reducing high bilirubin levels that cause jaundice. The baby lies in an incubator and is exposed to a fluorescent light that is absorbed through the skin. The light from phototherapy converts the bilirubin to a form that can be removed by the kidneys.
Jaundice rarely leads to serious complications as long the baby's bilirubin levels are monitored. But if left untreated, jaundice can cause irreversible brain damage. This is so rare and preventable, the U.S. Department of Health and Human Services lists it as one of 27 medical errors that should never happen.
Why Did The Defendants Choose Not To Treat Jaundice?
In this case, the hospital and doctor conducted a blood test approximately two hours after the infant's birth, which determined that bilirubin levels were extremely high. The baby was at significant risk for injury without treatment, as demonstrated in the animation below.
Rather than understanding and acting on this grossly abnormal result, the doctor and hospital chose to send the baby home with no treatment. The doctor and hospital also ignored additional significant risk factors, which included:
- The mother's previous baby was born with jaundice and required phototherapy.
- The mother and baby had ABO incompatible blood types, a known risk factor for hyperbilirubinemia (as animated below).
- The baby was noticeably jaundiced within the first 24 hours of birth.
- Jaundice symptoms were documented six times by nurses.
- The baby's skin pigment was dark and looked visibly jaundice.
- The baby was exclusively breastfeeding, another known risk factor of jaundice.
Ignoring all these red flags, the defendants discharged the family with a jaundiced baby who had a grossly abnormal bilirubin level. Proper procedure for discharging a jaundiced baby typically requires a follow-up appointment two days after discharge. The defendants scheduled a follow-up appointment for 10 days after discharge.
The baby was given no phototherapy, the family was given no education on jaundice, and the doctor did not even inform them that their baby might have jaundice. The doctor instead told the family that all the tests were normal and everything was fine.
How Did Jaundice Injure the Brain?
Over the next six days, the baby's brain would be irreversibly damaged as excess bilirubin gradually concentrated in the basal ganglia region of the brain that controls movement. The animation below explains this rare type of brain damage, known as kernicterus.
Kernicterus only occurs in infants with severe jaundice. Symptoms include extreme sleepiness, lethargy, high-pitched crying, and movement problems. Once a baby has kernicterus, brain damage has already occurred.
How Long Was Brain Damage Neglected?
Three days after discharge, the plaintiff’s parents noticed their daughter acting very lethargic. The family called the clinic, which advised them to bring the baby in for a check-up in four days.
Two days later - five days after discharge - the baby continued to be lethargic and also seemed to be extremely irritable. The mother called her doctor to seek help, but had to leave a message. That evening a nurse called back and advised the family to bring the baby in the next morning, six days after discharge.
The next morning, a blood test found the baby’s bilirubin level to be at 33.4 - indicating the baby was suffering a brain injury. The baby was placed under phototherapy lights in an effort to reduce her extremely high bilirubin levels - but it was too late.
The baby was transferred via ambulance to a major hospital in Little Rock, AR, where it was later confirmed that the baby had developed kernicterus due to untreated bilirubin. As a result, the baby suffered an irreversible brain injury in the form of bilirubin staining of the basal ganglia.
As a direct and proximate result of the above-described negligence set forth in each Count herein, [my client] suffered a permanent, profound, severe brain injury and kernicterus.
Complaint by Stuart Ratzan, Esq., Ratzan Law Group
How Severely Was the Brain Damaged?
Once the attorneys had established clear liability with the visuals above, they needed to drive home the depth and magnitude of the brain injury. The Diagnostic Slice Chooser enabled them to interactively present the child's MRI scans with three-dimensional, colorized context.
Whereas traditional MRI scans display a 2D black-and-white snapshot of damage, the Diagnostic Slice Chooser adds context by placing multiple slides within a 3D model of your client's skull. This DIS familiarized jurors with the location and extent of the brain injury in a way they could more easily understand.
How Has the Baby Recovered?
The child must now use a wheelchair and is expected to require expensive care for years to come, but one major change she will also have to live with for the rest of her life is a stimulator device that was implanted inside her brain. This animation shows what that surgery entailed.