Case Name: Kimberly Kirkwood-Boulter (mother), Daniel J. Boulter M.D. (father), and Aiden Boulter, Minor, v. Carrie A. Coleman, M.D., Johanna Bateman R.N., Christina Zannieri CNM, Massachusetts General Hospital and Cross Country Staffing Inc.
Case Type: Medical Malpractice – Nurse; Childbirth; Birth Injury; Brain Injuries; Cerebral Palsy; Failure to Monitor
- brain – brain damage; cerebral palsy; encephalopathy
- other – physical therapy
- sensory/speech – speech/language, impairment of
- pulmonary/respiratory – hypoxia
- paralysis/quadriplegia – quadriplegia; spastic quadriplegia
- Benjamin R. Zimmermann; Sugarman and Sugarman, P.C
- David McCormack; Sugarman and Sugarman, P.C.
- Michael J. Racette; Morrison Mahoney LLP for Johanna Bateman , Cross Country Staffing Inc.
- Ellen Epstein Cohen; Adler, Cohen, Harvey, Wakeman and Guekguezian LLP for Carrie A. Coleman, Christina Zannieri
- Brent Gilbert; Adler, Cohen, Harvey, Wakeman and Guekguezian LLP for Carrie A. Coleman, Christina Zannieri
Case Outcome: Verdict – Plaintiff
Award Amount: $30,550,000.00
In January 2013, Kimberly Kirkwood-Boulter gave birth to Aiden Boulter at Massachusetts General Hospital. During the delivery, Kimberly and Aiden were under the care of obstetrician Carrie A. Coleman, M.D., nurse Johanna Bateman, and nurse/midwife Christina Zannieri. Nurse Bateman, who worked for Cross Country Staffing Inc., had the responsibility of monitoring the fetal heart rate during labor.
The delivery lasted eight hours. When Aiden was born, his umbilical cord had wrapped around his neck. Baby Aiden barely had a heartbeat. He was not breathing. The medical team resuscitated him. Sadly, the doctor determined Aiden had hypoxic-ischemic encephalopathy. The Kirkwoods—who had expected a normal, healthy baby—were devastated.
Deprived of Oxygen and Blood
The type of brain injury Aiden suffered during birth—hypoxic-ischemic encephalopathy (HIE)—happens when there is a decrease in oxygen or blood flow to the brain. HIE is known to occur prior to birth, during labor and delivery, or following the birth. The severity of brain damage can depend on how long the brain spends oxygen or blood flow.
Brain injury from HIE can delay a person’s development, impair their cognitive abilities, and cause cerebral palsy or epilepsy. Cerebral palsy affects the ability to move and sustain balance and posture. People with epilepsy suffer repeated seizures due to a temporary change in the brain’s electrical functioning. Sometimes, HIE effects become more noticeable as a baby develops.
As a result of Aiden’s oxygen deprivation at birth, he suffers from spastic quadriplegic cerebral palsy. With this condition, he is unable to walk, speak, or eat without assistance.
Allegations and Testimony
Following Aiden’s birth trauma and injuries, Aiden’s mother, Kimberly Kirkwood-Boulter, and father, Daniel Boulter, filed a negligence lawsuit against Dr. Coleman, M.D., Massachusetts General Hospital, nurse Bateman, nurse/midwife Cristina Zannieri CNM, and Cross Country Staffing Inc. The lawsuit alleged a failure to appropriately monitor Aiden’s heartbeat during labor. Both the father and mother also claimed loss of consortium. The couple indicated they were shocked when their baby suffered such severe injuries during birth when the expectation was for a healthy baby. In the end, their child will require significant care for a lifetime.
Before the case went to trial, Coleman, Zannieri, and Massachusetts General Hospital settled with the plaintiffs. As such, these three were dismissed from the lawsuit. In addition, just before trial, Bateman was voluntarily dismissed. Cross Country Staffing remained the sole defendant at trial.
The Boulter’s main claim was that an electronic fetal monitor should have been used for continuous monitoring of Aiden’s heartbeat once his mother’s second stage of labor went beyond three hours. The duration of Kirkwood-Boulter’s second stage of labor was allegedly five hours. Rather than apply continuous monitoring at hour four, the plaintiffs said that the medical team performed solely intermittent monitoring of the fetus’ heartbeat. Also, the Boulters suspected that the defendants possibly monitored the mother’s heart rate, rather than Aiden’s.
When the trial began, Aiden attended an elementary school that provided him with physical and speech therapy. The plaintiffs also claimed that their son would never be able to work. The Boulters estimated that by the time he’s 35 years old, Aiden’s future medical costs would total $14 million. The estimate included costs for 24/7 care and nursing services.
Expert Medical Standard Battle: Was Continuous Heart Rate Monitoring Called For?
Experts for the Boulters stated that the way the Mass General medical team monitored Aiden’s heartbeat would have been acceptable practice if the labor lasted less than three hours. However, when the labor exceeded three hours, the medical standard required continuous fetal heart rate monitoring. The experts went on to say that if the heart rate had been continuously monitored, the medical team could have recognized the dire situation. The team could’ve then used forceps or a vacuum to deliver the baby and reduce the oxygen deprivation to his brain.
On the other side, the defense experts testified that the standard of care was to employ intermittent fetal heart rate monitoring. The experts said that the fetal heart rate monitoring of Aiden showed a normal heart rate. The defense experts for Cross Country Staffing Inc. further opined that the standard of care mandated not to switch to continuous electronic fetal monitoring (CFM) after three hours, or any period of time. They said the standard did not require CFM for any reason at all.
The defense experts maintained that the nurse midwife had the responsibility for monitoring choices and any decision to switch to CFM during labor. The experts asserted that the nurse midwife was in the delivery room for virtually the entire second stage of labor. Furthermore, the experts noted that the midwife was monitoring the fetal heart rate most of the time.
The experts added their opinion that the periodic use of electronic fetal monitoring and pulse oximetry had confirmed that nurse Bateman and nurse-midwife Zannieri correctly identified the fetal heart rate as distinct from the mother’s heart rate.
In terms of when Aiden sustained his injury, the defense neuroradiology expert stated that the injury occurred shortly before delivery.
Who Won the Case?
After a nine-day trial and seven hours of deliberation, the jury awarded the plaintiffs $30,550,000. With fees and interest, the total payout was $44,400,489.10. Before jury deliberations ended, the parties agreed to settle the case for a sum tied to the verdict amount and the prior settlements.
The award broke out as follows:
- $2,500,000 personal injury of past pain and suffering
- $13,000,000 personal injury of future medical cost for 53 years
- $10,000,000 personal injury of future pain and suffering for 53 years
Daniel J. Boulter, M.D. (father):
- $200,000 personal injury of the past loss of society, affection, and companionship
- $1,400,000 personal injury of future loss of society, affection, and companionship for 43 years
- $250,000 personal injury of past loss of society, affection, and companionship
- $3,200,000 personal injury of future loss of society, affection, and companionship for 49 years
The plaintiffs retained expert witnesses in:
The defendants retained expert witnesses in:
This case reminds litigants that medical malpractice cases always hinge on the efficacy of expert witness testimony. Here, the jury heard diametrically opposed expert testimony on the required medical standard for heart rate monitoring. This jury believed the plaintiffs’ expert’s opinion that the medical team should have used continuous fetal heart rate monitoring to track Aiden’s condition after the three-hour mark and not the defense’s experts’ opinions on the standard of care.
Medical malpractice lawyers will want to secure the best available medical experts in the right specialty practices to defeat any off-base opinions offered by less-able experts.