Legal: Costly failure to treat group B strep in labor

September 1, 2009

A pregnant woman who showed positive for group B strep when pregnant was overlooked at time of delivery and so no antibiotics were given until the following day.

A New York woman was pregnant in 1995 when a culture revealed that she was positive for group-B strep infection. In light of this infection, her obstetrician concluded that appropriate measures would be needed during delivery, and listed the administration of IV antibiotics in her chart. Three days later, she saw another physician who was covering for her doctor in the office, and later that day went into labor. The same covering obstetrician was on, but did not remember the positive culture so antibiotics were not given until the following day. Cefazolin was used because the patient's chart incorrectly identified her as being allergic to penicillin. The delivery occurred several hours later, and about a half hour after delivery the infant had a temperature of 101. The newborn was discharged 2 days later by the pediatrician. At home the infant was lethargic and not feeding, and the pediatrician's office instructed the mother to give Pedialyte. The infant did not take the Pedialyte, and the mother called again and was instructed to bring the infant to the office. The infant was sent to the hospital where he was dehydrated and hypoglycemic upon arrival. This led to a stroke affecting the left side of his body and leaving permanent damage. The infant suffers hemiparesis, severe vision problems, and a seizure disorder that requires continued medication. He also has mental deficiencies and performs several years below grade level.

The woman sued the physicians and claimed that the infant's extremely low blood sugar led to a seizure within 2 hours of readmission and that he suffered from a bacterial infection that caused his lethargy and poor feeding. She alleged that the 4-hour delay in administering antibiotics prevented her from receiving two full doses of antibiotics during delivery, which would have improved the infant's condition. She also claimed the hospital's pediatrics department was erroneously told there was no maternal fever and did not know the mother had received three doses of cefazolin. The pediatrician was accused of failing to properly assess that the newborn was not feeding properly and was discharged without proper consideration to his status as an at-risk newborn, due to erroneous notations in the medical record. The patient claimed the infant should have been kept for at least 24 more hours.

The defense claimed that information was properly communicated in the hospital and that there was no reason to delay the infant's discharge at the time and they contended there was no infection, citing negative cultures taken when the infant was readmitted. The patient countered that the negative cultures were misleading because they were taken after antibiotics were administered, rather than before. A $17 million settlement was reached during trial.