Boughton, Vivian Lee b/n/f Boughton, Scott P. b/n/f Boughton, Cayce vs. Saint Thomas Midtown Hospital

Case Background

On September 24, 2019, Cayce and Scott Boughton filed a birth injury lawsuit against St. Thomas Midtown Hospital alleging negligence for the careless delivery of their daughter, Vivian Lee Boughton. The medical malpractice case was heard before the Tennessee 6th Circuit Court, Davidson County. Judge Thomas W. Brothers presided over this case. [Case number: 19C2245]

Cause

In January 2018, Cayce and Scott Boughton discovered they were expecting their first child. The pregnancy proceeded normally with no complications. Cayce arrived at Ascension St. Thomas Midtown Hospital for labor and delivery at 40 weeks on the afternoon of September 2018. Dr. Sa Cara Shaw, the on-call OB-GYN, was assigned to her case.

Starting at 1:30 a.m., fetal decelerations were detected. Nurse Jackie Smith, who was on duty, informed Dr. Shaw of these findings at 4:28 a.m. Shaw assessed Cayce at 4:58 a.m.

Throughout the following hours, fetal decelerations and signs of fetal distress persisted, especially between 8:00 and 9:00 a.m. Nurse Melissa Groome had taken over from Smith by then. The evidence of distress was technical.

At 9:15 a.m., Dr. Shaw performed an episiotomy. Vivian was delivered three minutes later. At birth, her APGAR score was 1. The baby appeared lifeless, limp, and gray. They immediately transferred her to Vanderbilt Hospital after she suffered a hypoxic-ischemic encephalopathy (HIE) event during birth.

Injury

As a result of the staff’s medical negligence, Vivian suffered severe birth injuries. She was diagnosed with hypoxic-ischemic encephalopathy (HIE), a severe brain injury caused by a lack of oxygen. Vivian now suffers from permanent brain damage, cerebral palsy, epilepsy, developmental delays, and gait disturbances, among other disabilities. She also developed a severe seizure disorder, which, although not immediately, medication eventually controlled several years later.

Damages

Under this medical negligence lawsuit, Vivian sought economic damages for future medicals and lost earning capacity. They also requested non-economic damages in five categories as well as future medicals and lost earning capacity.

Key Arguments and Proceedings

Legal Representation

Key Arguments and Remarks by Counsel

Dr. Shaw’s attorney James Sperring said in a statement that Shaw denied that she caused any injuries to Vivian Boughton throughout the proceedings of the case.

“Dr. Shaw secured multiple experts in her defense with decades of experience, each of whom was prepared to testify the care she provided to Mrs. Boughton and her daughter was appropriate and complied with the standard of care,” attorney James Sperring said.

The Boughton family settled their claims with Shaw and Tennessee Women’s Care before the trial, without any admission or determination of fault. As a result, the trial in April was focused solely on the hospital. With respect to this, attorney Sperring said.”Dr. Shaw’s presence on the verdict form was only the result of a comparative fault defense by the hospital and does not constitute a judgment against Dr. Shaw,”

K&L Gates LLP, the law firm representing the family said the verdict is the largest of its kind in Tennessee history.

“On behalf of the Boughton family, we thank the jury in this case for their commitment over the course of the weeks-long trial,” a statement from Charles Malone, one of the family’s lawyers from firm K&L Gates LLP, reads in part.

Claims

In this lawsuit, Vivian, represented by her parents, sued the hospital nurses, Smith and Groome. She claimed they were negligent for not recognizing her concerning fetal heart rate patterns that showed decelerations. They breached the standard of care. Additionally, she alleged that they failed to promptly inform Dr. Shaw of these issues. These combined errors caused the hypoxic-ischemic encephalopathy (HIE) event, which an earlier delivery could have prevented.

The Plaintiffs also filed a lawsuit against Dr. Shaw, alleging she failed to monitor the labor effectively and deliver Vivian promptly. A few weeks before the trial, Dr. Shaw reached a confidential settlement with Vivian. Judge Brothers approved this minor settlement.

Subsequently, the case proceeded to trial against the hospital, focusing on the alleged negligence of the nurses. During the trial, the jury was permitted to assign fault to Dr. Shaw, who had already settled.

Defense

St. Thomas Midtown Hospital denied all allegations of negligence, malpractice, and wrongdoing. It maintained throughout that it was not liable for any damages. However, if in case, it was found liable it argued Plaintiff’s comparative negligence. It asserted that the Plaintiff’s non-economic damages need to be capped at $750,000 under the provisions of the Tennessee Civil Justice Act of 2011, and the economic damages were to be limited under Tenn. Code. Ann Sec. 29-26-119.

The hospital mounted several defenses in the case. First, it denied any breach of the standard of care. Although fetal decelerations were noted, the hospital argued they were intermittent and not concerning. Additionally, the hospital claimed that the nurses consistently communicated with Dr. Shaw. The hospital also suggested an alternative defense, arguing that Dr. Shaw shared some responsibility for the situation.

Expert Testimony

Vivian built her case with a team of expert witnesses. The primary Ob-Gyn expert, Dr. Steven Powers criticized the nurses for failing to recognize fetal distress at 1:30 a.m. and for not expediting the delivery. Nurse expert Elizabeth Uzzle addressed issues of liability. Causation experts included Dr. Lisa Hutchinson in Pediatric Neurology and Dr. Jonathan Cohen in Neonatology.

Vivian’s case involved substantial damages, and she consulted several experts to address this. Dr. Robert Eilers, who specialized in Physical Medicine, detailed her injuries and the future care she would require. Caitlin Mitchell, an expert in life care planning, provided a detailed plan for her ongoing needs. Additionally, Vivian consulted economists Robert Johnson and Gary Albrecht to assess the economic impact.

On the other hand, the hospital identified Dr. Joseph DeWane, an Ob-Gyn from Memphis, who believed Dr. Shaw should have delivered the baby 20 minutes earlier, before 9:00 a.m. DeWane asserted that an earlier delivery would have prevented Vivian’s injuries. Kelly McNany served as the nurse standard of care expert.

In terms of causation, Dr. Karsten Gammeltoft, a Pediatric Neurologist, explained it was unclear whether Vivian’s condition was due to HIE or the prolonged period during which seizures went uncontrolled. Dr. Michael Cotten, a Neonatologist from Duke, focused on causation and noted that it was indeterminate when the HIE event occurred during labor or if it could have been prevented. Other causation experts included Dr. David O’Bannion from Developmental Pediatrics in Atlanta, Christen Holder in Pediatric Neuropsychology from Knoxville, and Asim Choudhri in Pediatric Neuroradiology from Memphis.

The hospital also engaged David Bateman, a Special Education expert from Shippensburg, PA. Bateman discussed Vivian’s future development, expressing optimism that her functioning would improve significantly over the 17-year special education course.

Jury Verdict

The trial lasted three weeks, starting on April 8, 2024, and concluding 18 days later. Deliberations took three days, from April 24 to April 26, and lasted approximately 16 hours. Finally, the Nashville jury delivered its verdict on April 26, 2024.

The jury found that both Nurse Smith and Nurse Groome were liable for negligence. It also determined that the hospital had demonstrated that the settled Dr. Shaw had breached the standard for a reasonably competent physician.

In assessing comparative fault, the jury assigned 60% of the responsibility to Smith, 15% to Groome, and 25% to Shaw. Consequently, St. Thomas, as the employer of the nurses, was found to be 75% at fault.

Regarding damages, Vivian received $330,000 for past pain and suffering and $4.2 million for future pain and suffering. Her past loss of enjoyment of life was valued at $330,000, while the future loss was set at $12.6 million. The jury awarded $3,433,500 for permanent injury, totaling $20,923,500 in noneconomic damages.

The economic damages included $23,500,000 for future medical expenses and $2,570,000 for lost earning capacity. The total verdict amounted to $46,993,500.

After accounting for comparative negligence, the hospital’s liability was calculated at $35,245,125.

Court Documents:

Available upon request

Press Release:

The Tennessean