October 2011 Archives

A vaginal birth after a cesarean section (VBAC) is an attempt by the medical community to allow women who have had a prior cesarean section to undergo a trial of labor because studies have shown that 60% to 80% of women who have had one prior c-section can successfully deliver a baby vaginally for their second or subsequent pregnancies.  The problem with VBACs is the one percent of the time when a uterus ruptures, the results can be catastrophic for the child if the VBAC is undertaken in a hospital that is not equipped to be able to deliver the baby literally within 5 to 10 minutes of the rupture, which is generally seen as a drop or severe drop in the fetal heart rate on the fetal heart rate monitor.

In the 1990's when VBACs were encouraged, many hospitals which were not able to have physicians in the hospital for both anesthesia and obstetrics were doing VBACs and were unable to deliver the baby in less than 25 or 30 minutes from the time there was a problem and those baby's invariably ended up with severe brain damage or died.   So the new guidelines while they talk about the advantages of VBAC, it's important that they be performed only in hospitals that are able to deliver babies quickly, including having 24 hour in house anesthesia and 24 hour in house obstetricians. Academic medical centers or facilities that do a large number of deliveries have that capability and can successfully do VBAC, but smaller hospitals should not be doing them.

Visit VBAC information video for more information.

C-section information:  When doctors believe that a fetus may be harmed by allowing a vaginal birth to proceed, must consider a caesarean section or C-section.  A C-section is a surgical procedure where incisions are made through the mother's abdomen and uterus to deliver a baby.

Reasons doctor's may perform a C-section include: 

• The baby is too large for a vaginal delivery
• There is an abnormal heart rate in the fetus
• Fetal distress
• The mother has HIV or genital herpes
• Breech position
• Uterine rupture

Surgical malpractice is a terrifying occurrence that kills and injuries thousands of Americans every year.  Surgical mistakes or surgical malpractice involves technical errors or judgment errors made by the surgeon.  Surgical mistakes can lead to catastrophic injuries or even death for the patient.  Because of the complications of surgery, surgical mistakes sometimes occur and the surgeon doesn't even realize the mistake was made, until it is too late. Surgical mistakes can be made by skilled surgeons as well as with inexperienced surgeons, and can occur with simple operations as well as the complex ones. 

Surgical mistakes occur in medical centers, including for elective procedures, such as cosmetic surgery.  In situations like this, the medical center may not have a trained medical staff prepared to deal with an emergency situation.  For example, many surgical centers and doctor's offices do not have a full staff of operating room nurses, critical care nurses, or board-certified anesthesiologists available for surgery or on-call if an emergency arises.

However, even in hospitals, where a trained staff of medical professionals may be available, mistakes can still be made, and severe injuries or even death can result from medical negligence.  It is important to remember that even in hospitals, a doctor or surgeon may not be available during a critical emergency.  If the hospital fails to properly prepare its staff for a sudden emergency, a surgeon that is needed during an emergency operation may be involved with another surgery, or offsite.  In situations involving emergencies, every minute counts.  If a surgeon arrives too late, the patient may be permanently injured or even die as a result of the delay.

Surgical malpractice includes:

• Puncture of an organ near the surgical site, which could lead to dangerous bodily fluids entering the organ, causing an infection, even death.
• Surgery on the wrong side of the patient's body or removal of the wrong body part
• Unsanitary or contaminated medical products

In addition to non-elective surgery mistakes, elective surgery malpractice occurs as well.  These areas include bariatric and cosmetic surgery.

Bariatric surgery:

• Laparoscopic or lap band
• Gastric bypass
• Stomach stapling
• Liposuction

Cosmetic surgery:

• Liposuction
• Breast augmentation
• Facelifts
• Rhinoplasty or "nose job"

Many deaths and severe injuries resulting from medical negligence and medical malpractice occur in hospitals.  Cases may involve the doctors, nurses, anesthesiologists, and medical staff.  Although most of the nurses are employees of the hospitals, most doctors are independent contractors.  This creates an extra shield of legal protection for the hospital if medical malpractice occurs due to the negligence of the doctor.  In fact, patients even sign forms, including the condition of admission which states that the doctors are not employees of the hospital, but rather independent contractors.  Patients who are victims of medical malpractice therefore need to name the doctors as defendants, as well as the hospital.

To make matters even more complicated, many patients enter the hospital with preexisting medical problems, therefore, it may be difficult to prove that the medical negligence caused the patient extreme injuries or even death.  The doctor's may defend that the preexisting condition of the patient naturally caused the outcome, rather than the medical malpractice. This is where retaining the services of an experienced medical malpractice attorney, especially one who understands how to interpret the medical records and look for signs of negligence, will be critical to proving and winning the medical malpractice case.

Add to the problem, overcrowding of patients who are waiting for care at the hospital, including the overcrowding of emergency rooms, along with an overworked staff, and the risk of negligence increases.  If the hospital happens to be understaffed, many patients who need urgent medical care may not get a thorough examination or be examined in a timely fashion.  If the hospital is understaffed, it may even bring in less experienced replacement workers to help fill the void.  This can lead to severe injuries or even death to patients, as was the case with the patient at Alta Bates Summit Medical Center in Oakland who died from a medication error provided by a replacement nurse, during the massive nursing strike.     

If the medical negligence leads to the death of a patient, then a wrongful death claim can be initiated.  A wrongful death claim must be able to prove that the negligence by the hospital or medical staff caused the death of the patient.

Two main types of injures may occur during the birth delivery process, injuries from a lack of oxygen to the brain and injuries from trauma. Both types of injuries can result in birth paralysis.  If the birth injury is caused by medical negligence, there are usually two causes.  The first cause would be the failure of the doctor to take immediate action if a C-section is required.  This could cause a lack of blood and oxygen flow to the baby's brain.  If the oxygen and blood supply are cut off long enough, this can result in paralysis, including cerebral palsy.  The cerebral palsy can range from mild to severe.

The second type of birth injury can result from trauma, due to improper delivery techniques.  If the doctor is having a difficult type removing the baby from the birth canal, for example if the head of the baby is too big to fit through, the doctor may need to use forceps to assist.  The doctor may need to twist and turn the head of the baby to help the infant exit the birth canal.  If the doctor uses too much force, this can cause nerve damage to the spinal cord, the shoulders, arms, or legs, resulting in paralysis.  One example of this is brachial plexus injury which can result in erbs palsy.  The brachial plexus are nerves that run from the spine through the neck and armpit area of the arm.  These nerves supply the arm with nerve impulses. If the doctor uses too much force, these nerves can be damaged or even avulsed, which means they are pulled from their attachment to the spinal cord, which will cause complete paralysis to the arm or hand.

Different types of paralysis caused by medical malpractice:

Medical negligence can lead to paralysis on various parts of the infant's body.  The extent of the paralysis can be mild to severe. These include:

• Paraplegia - Paralysis of the legs
• Quadriplegia - Paralysis of both arms and legs
• Diplegia - Paralysis of symmetrical parts of the body. This may include diplegia in the arms, legs, or face
• Klumpkes Palsy - Paralysis of the lower arm, wrist, and hand
• Erbs Palsy - Paralysis of only the shoulder and upper arm
• Cerebral Palsy - refers to a number of neurological disorders which permanently affect muscle coordination and body movement.  Unlike the paralysis areas listed above, cerebral palsy is not caused by irregularities in the muscle or nerves, but instead by abnormalities in the areas of the brain that control muscle movement

The decision whether or not to turn off life support for a loved one can be among the most difficult situations for families to go through.  They raise all sorts of ethical issues among the physicians, nurses, and social workers.  In many occasions, when a child is delivered and suffers severe brain injuries from lack of oxygen, is on a ventilator, and the physicians come to the parents and say the child's prognosis is so poor the child will never recover or is brain dead, parents are left with a most difficult choice.  Also, situations where an adult goes through some type of elective surgery, there is an anesthesia problem and the patient does not get an adequate supply of oxygen, ending up in a coma, so the family members are encouraged to institute a "do not resuscitate" or actually disconnect the patient from a ventilator.  

These are very difficult situations.  Unfortunately the times when there is an underlying medical negligence with the delivery process, an anesthesia error, or some other incident in the hospital, the physicians are not going to come to the family and explain that they made a mistake and your family member is in a coma and they want you to turn off life support, because under the law in California and some other jurisdictions, where there is a limitation of non-economic damages recovery, and the patient dies, the case is now set at a maximum recovery of $250,000 for the defendants. The physician is not going to further admit that if the individual lives and requires ongoing care, therapy, attendant care, ongoing medical care, where there is no limitation on the recovery for the family member or the child for their future care needs, this can run into several million dollars.  Therefore, it is a very difficult situation because physicians will never admit they may have a motive or reason why they want the family to turn off life support.  The family is put into the most awkward position of all because they are trying to make a decision as to what they think is best for the family member in this situation, and they are not aware the doctors or hospital may have an underlying financial motive for this type of request.  

We have seen this happen with some frequency and what we try to do with the family is make them aware of the legal and financial implications for these type of decisions so the family can make their own decision in an unbiased manner.

Any major delay with a child reaching specific milestones in their development, including walking, talking, learning, language, or social skills, may be categorized as a developmental delay.  These delays may have been caused by complications during the labor or delivery of the baby.  In some cases, the child may simply be slower than other children in acquiring these skills; however, it may also be a sign of a birth injury, particularly a brain injury.  

Developmental delays may also be attributed to genetic disorders passed from the mother or father to the child, or could be the result of drug or alcohol abuse by the parent.  Some developmental delays may not be so easily traceable to a root cause.

The first few years of the child are critical to detecting the developmental delay and taking action.  If developmental delays are not detected or treated during these early years, the child will have a more difficult time learning these skills later in life.  Also, if medical negligence or medical malpractice from the doctor, nurse, or medical staff was responsible, there is a statute of limitations which may limit the time for the family to take legal action and receive proper compensation to help them address the developmental delay.  In California for example, while most statute of limitations limit the time a victim of medical malpractice may take action to one year from the time the action was discovered or should have been discovered, for children below the age of six, the amount of time is extended to three years. There are even specific circumstances where this time frame may be extended for even longer.  However, with the amount of time it may take to discover a developmental delay, the statute of limitations poses a tough challenge for a family of a child who is experiencing a developmental delay.

Some developmental problems may require a life time of care to be provided for the child, therefore, if medical negligence by a doctor, nurse, obstetrician, or other medical professional was the cause, the family should be compensated for this lifetime of medical care and expenses.  While no parent wants to admit their child may have a developmental delay, if you discover a developmental delay, and you suspect a medical professional or medical facility may have been the cause, you should consult with a professional medical malpractice attorney who specializes in birth injuries and developmental delays.  

Birth asphyxia or hypoxia occurs when an infant does not receive an adequate supply of oxygen before, during, or immediately following birth.  Although many babies receive a smaller supply of oxygen during the birth process, the uterus provides a reserve supply of oxygen and blood to the baby through the placenta.  Most babies who experience hypoxia can be treated with some stimulation after birth and rarely suffer any major injury to their brain.

However, hypoxia, if not detected and treated quickly, can lead to permanent damage to the baby's brain, heart, lung, kidneys, and other organs.  Hypoxia can also lead to developmental delays, impaired vision, even paralysis, including cerebral palsy.  Some of the causes of birth asphyxia include prolapse of the umbilical cord during delivery, compression of the umbilical cord during labor or delivery, rupture of the uterus, separation of the placenta before the delivery, insufficient oxygen in the mother's blood before or during the birth of the child, improper blood pressure in the mother, serious infections with the mother or infant, a long or difficult birth process, or the infant's airway is blocked.

Doctors and nurses can monitor the condition of the baby using a fetal heart rate monitor, which shows the baby's heart rate during labor.  If for example there is a compression of the umbilical cord during labor or delivery, including the umbilical cord being wrapped around the baby's neck or body, and this causes a lack of blood flow or oxygen to the baby, the fetal heart rate monitor can show the baby is in distress.  It is imperative that the medical staff pay attention to this and act quickly to resolve the problem.  Failure to recognize a problem such as birth asphyxia and taking quick action, can result in permanent and severe damage to the baby, even death.  Medical negligence or medical malpractice lawsuits frequently involve the failure of the medical staff to correctly interpret the fetal monitor strip or the delay in notifying the doctor of the problem.  

In a situation involving birth asphyxia, the baby may need to be delivered immediately, including through the use of a C-section.  While most hospitals can deliver a baby by a cesarean section within 30 minutes notice from the doctor, this may be too long.  The baby may need to be delivered by C-section within 15 to 20 minutes or even less, to prevent serious injuries to the baby's brain.  One simple act of negligence in a critical area such as asphyxia can cause permanent and severe injuries to the baby, which may require the baby to receive medical care for the rest of his or her life. 

Several hundred USC University Hospital workers went on strike Wednesday, picketing outside the Keck Medical Center of USC.  Workers who went on strike include certified nursing assistants, X-ray technicians, and housekeeping staff.

The National Union of Healthcare representing the workers state they have been in negotiations with the hospital for over a year.  The union is demanding the workers have a better say in how the hospital is staffed. The union claims there is a serious short-staffing problem, a one year freeze in wages, and the workers are excluded from the university's tuition and retirement benefits plan.  There are additional issues as well.  A respiratory technician, Noemi Aguirre stated, "we have a lot of units where we are just plain short-staffed and they haven't addressed those issues for us." Aguirre also commented, "One sticking point deals with patient care committees, which are set up by union workers so they have a voice in patient care."

The National Labor Relations Board in Los Angeles will address the workers demands later this month.  Hospital spokesman Mitch Treem stated, "While we are unable to discuss the specifics of our proposal publicly, we can say that our NUHW employees are among the highest paid in the region."

With the recent hospital worker strikes, including the 34 hospitals in Northern California, mistakes can be made. One such tragedy occurred during the recent nursing strike at Alta Bates Summit Medical Center, where a cancer patient died after a temporary replacement nurse mistakenly administered the wrong medication to the patient.  Dr. Bruce G. Fagel, a licensed medical doctor and medical malpractice attorney was quoted by the San Jose Mercury News and Contra Costa Times, September 26, 2011, "having replacement or temporary nurses working in hospitals for extended periods increases the risk of medical mistakes that harm patients."

Governor Jerry Brown signed a law requiring private accrediting firms to inspect outpatient centers at least once every three years, including surprise inspections.  The bill also requires these accrediting firms to demand improvements or revoke certification if a surgery center does not meet the proper safety standards.

The outpatient surgery centers include medical facilities that perform Lap-Band and liposuction procedures.  The author of the bill, state senator Curren Price Jr. (D-Los Angeles) became interested in this bill after singer Kanye West's mother died from liposuction and breast augmentation surgery at an outpatient surgery clinic.  Momentum increased for the bill after five patients died from having Lap-Band weight loss surgeries at outpatient surgery centers affiliated with the 1-800-GET-THIN marketing company.

This bill was enacted to protect the public's health and safety.  Previous legislation allowed loop holes for surgical centers that ran into violations by allowing them to shop for multiple accreditation firms that issued approvals.  Therefore, if a surgical center lost their accreditation from one agency, due to safety violations, they could apply to another agency for approval.  This bill will help ensure outpatient surgery centers meet safety standards including cleanliness and proper use of medication.   The law requires that the state medical board must notify the public through its website if a surgery center's license has been suspended or if the surgery center has been placed on probation or reprimanded.  

One of the supporters of the bill, Betty Brown, is the sister of a victim of Lap-Band surgery, Tamara Walter, who died after having Lap-Band surgery at an outpatient clinic in Beverly Hills.  The coroner's report placed the blame with the anesthesiologist, who was on probation at the time.  Brown testified to state lawmakers before they approved the bill.  Brown believes this new legislation would have prevented her sister's accident.  "With more regulation, there would be less a chance something like this happening.  This shouldn't continue to happen."  The Walter family and Betty Brown have filed a wrongful death lawsuit.

Senator Price stated, "It brings oversight that's long overdue over these clinics...It's going to protect the public's health and safety."

For more information about this law, read the article in the Los Angeles Times, "Tighter scrutiny for outpatient surgery centers" October 10, 2011, by Stuart Pfeifer.  Or visit the online version.

Governor Jerry Brown signed a law requiring private accrediting firms to inspect outpatient centers at least once every three years, including surprise inspections.  The bill also requires these accrediting firms to demand improvements or revoke certification if a surgery center does not meet the proper safety standards.

The outpatient surgery centers include medical facilities that perform Lap-Band and liposuction procedures.  The author of the bill, state senator Curren Price Jr. (D-Los Angeles) became interested in this bill after singer Kanye West's mother died from liposuction and breast augmentation surgery at an outpatient surgery clinic.  Momentum increased for the bill after five patients died from having Lap-Band weight loss surgeries at outpatient surgery centers affiliated with the 1-800-GET-THIN marketing company.

This bill was enacted to protect the public's health and safety.  Previous legislation allowed loop holes for surgical centers that ran into violations by allowing them to shop for multiple accreditation firms that issued approvals.  Therefore, if a surgical center lost their accreditation from one agency, due to safety violations, they could apply to another agency for approval.  This bill will help ensure outpatient surgery centers meet safety standards including cleanliness and proper use of medication.   The law requires that the state medical board must notify the public through its website if a surgery center's license has been suspended or if the surgery center has been placed on probation or reprimanded.  

One of the supporters of the bill, Betty Brown, is the sister of a victim of Lap-Band surgery, Tamara Walter, who died after having Lap-Band surgery at an outpatient clinic in Beverly Hills.  The coroner's report placed the blame with the anesthesiologist, who was on probation at the time.  Brown testified to state lawmakers before they approved the bill.  Brown believes this new legislation would have prevented her sister's accident.  "With more regulation, there would be less a chance something like this happening.  This shouldn't continue to happen."  The Walter family and Betty Brown have filed a wrongful death lawsuit.

Senator Price stated, "It brings oversight that's long overdue over these clinics...It's going to protect the public's health and safety."

For more information about this law, read the article in the Los Angeles Times, "Tighter scrutiny for outpatient surgery centers" October 10, 2011, by Stuart Pfeifer.  Or visit the online version.

Most medical professionals who provide radiation therapy rarely report near-misses or errors, not because of the amount of time it takes or the complications of using the on-line error reporting systems, but rather, fear of getting into trouble and embarrassment.  In fact a recent survey by Johns Hopkins places the number at 90% of providers who witness near-misses or errors and never report them, because they are embarrassed and don't want to get their co-workers or themselves in trouble.  See John Hopkins Survey titled, "Survey Reveals Reasons Doctors Avoid Online Error-Reporting Tools."   

Investigators who emailed anonymous surveys to physicians, nurses, radiation physicists and radiation specialists at John Hopkins, North Shore Long Island Jewish Health Systems in New York, Washington University in St. Louis, Missouri, and the University of Miami, asked questions about near misses and errors in delivering radio therapy in order to better address problems associated with these procedures and how to improve the quality.    

The results show that the complexity of the software is not the problem, nor the amount of time it takes to file the reports, but rather the personnel want to avoid embarrassment to themselves or their co-workers, and avoid getting anyone into trouble, when mistakes are made or narrowly avoided.  This survey presents valuable feedback that could relate to other medical areas as well, and most importantly can help medical facilities set standards that encourage the reporting of errors and near-misses, rather than hide them.  If the systems are used not to punish the medical professionals who report mistakes but rather to improve the process, perhaps the safety record can be improved and everyone will benefit, from the patients, to the medical staff, to the medical facilities, to the insurance companies.  Johns Hopkins radiation oncology resident Kendra Harris, M.D. remarked, "It is important to understand the specific reasons why fewer physicians participate in these reporting systems so that hospitals can work to close this gap.  Reporting is not an end in itself, it helps identify potential hazards, and each member of the health care team brings a perspective that can help make patients safer."

Most of the respondents in the survey said they would be interested in participating in a national reporting system for radiotherapy near-misses and errors.  A national system would be able to collect all the shared data and look for trends, which could help medical professionals improve safety standards.

Medical negligence and medical malpractice cases can be the most complex legal cases to pursue.  The majority of the victims of medical negligence or medical malpractice cases do not have the experience, vast resources, or finances necessary to pursue a medical malpractice case on their own.  This is where the services of an attorney are critical.

However, an attorney who does not specialize in medical malpractice, or who does not have extensive court room experience, will place the victim of malpractice at a tremendous disadvantage when dealing with the medical personnel or medical facility responsible.  Why?  Because medical personnel and medical facilities have powerful resources to defend themselves in a lawsuit.  Their attorneys and insurance companies are less likely to settle a case involving a plaintiff who is represented by a lawyer who has little trial experience, or doesn't have a strong background in medical malpractice.  This places the plaintiff at a severe disadvantage, as he or she is far more likely to receive a much smaller settlement.

The most important item when selecting a lawyer for representation in a medical malpractice or medical negligence lawsuit is experience. This includes extensive court room experience, with a proven track record of winning cases.  Another area that is important when selecting an attorney, is finding a lawyer who specializes in medical malpractice.  While many attorneys claim they specialize in medical malpractice cases (often it's one of many specialties they list), they also specialize in other areas such as product liability or personal injury.

Dr. Bruce Fagel has extensive medical malpractice lawsuit experience.  In fact, medical malpractice cases are the only cases Dr. Fagels' law firm will handle.  This type of specialization allows him and his staff to focus their expertise exclusively on medical malpractice, and this translates to doctor's and medical facilities settling cases for the highest amounts.  Dr. Fagel also has extensive court room experience, with a strong track record of winning cases.  Finally, one of the core differences that separates Dr. Fagel from the majority of medical malpractice attorneys is Dr. Fagel is also a licensed medical doctor with over 10 years experience in practicing emergency room medicine.  This combination of being a doctor and a medical malpractice attorney gives Dr. Fagel the expertise necessary to understand exactly where medical malpractice or negligence has occurred with a medical malpractice case.  

In 1975, doctors in California helped push through legislation limiting the amount of damages victims of medical malpractice could obtain from lawsuits.  This resulted in the Medical Injury Compensation Reform Act (MICRA).  MICRA caps the amount of recovery a victim of medical malpractice can obtain for non-economic damages, such as pain and suffering and emotional distress at $250,000.  However, economic damages remain unlimited.  Economic damages include such items as medical care and lost wages, including a life time of lost wages and medical care necessary for some victims, such as a child who becomes paralyzed for life due to medical negligence resulting in a birth injury. 

Unfortunately MICRA has not changed or even increased since 1975 because of the difficulties of convincing the legislature to do so.  This includes a very powerful lobby against any kind of increases from the California Medical Association and California Hospital Association.  So the limitation on non-economic damages in California has basically resulted in decreased value of pain and suffering and emotional distress since 1975, however the cost of increased medical care has increased so much and so dramatically since 1975 that the economic damages which have not been limited in California still result in very sizable damages for victims of medical malpractice, especially when we are talking about the cost of future medical care.  

A birth injury victim with severe cerebral palsy will likely require 24 hours a day, 7 days a week medical care for his or her entire life time.  This may require a full time care giver to handle everyday activities from feeding to bathing to dressing.  Also this victim will likely require expensive medical care and treatment for the rest of his or her life.  The amount of care and resources for a victim like this may be well into the millions of dollars over his or her lifetime.  In addition to medical care, there is the amount of lost wages a victim of medical malpractice loses for a lifetime of being out of work.  This is why a victim of medical malpractice in California may receive a multi-million dollar verdict or settlement, when the cap on medical malpractice awards for non-economic damages is $250,000 maximum recovery.

Bilirubin is a brownish-yellow substance found in bile.  When the liver breaks down old red blood cells, it produces bilirubin.  This substance is then removed from the body through the stool.  Too much bilirubin in the system of a newly born baby can cause brain damage, by what is called kernicterus.  Other problems from an elevated bilirubin level may include physical abnormalities, eye movement problems, hearing loss, mental retardation, and even death.  Bilirubin levels that are high can cause the whites of the eyes and skin to appear yellow or jaundiced.

There is treatment for newborns that develop jaundice, and that is using blood transfusion or phototherapy (which involves using special lights to reduce the jaundice).  For example, to treat hyperbilirubinemia, newborn babies need to be placed under bilirubin lights for treatment.  The baby's eyes are shielded to prevent damage from the lights.

Although it is common for newborns to have elevated bilirubin levels, once the liver begins to mature, the bilirubin levels should become normal as the extra red blood cells are broken down and removed from the body.  Failure to treat elevated bilirubin levels may result in a rare type of brain damage known as kernicterus.  The bilirubin left untreated can spread to the brain, where it will cause long-term damage to the child. This is one reason why it is important to treat jaundice before the bilirubin levels become too high.

Symptoms of kernicterus include:

• An abnormally high pitched cry
• Poor muscle tone, such as unusual muscle flexing
• A fever
• Seizures
• Extreme lethargy and sleepiness

A doctor can diagnose kernicterus with a physical exam, including blood tests. Through the proper recognition, testing, and treatment, kernicterus can be prevented.  If your child has developed kernicterus, you should consider retaining the services of a child attorney medical malpractice specialist, who deals with medical malpractice.  Dr. Bruce Fagel is both a medical malpractice attorney and a licensed medical doctor.  This combination gives Dr. Fagel the ability to examine the medical records and review the medical history to determine if medical negligence or medical malpractice was the cause of kernicterus or a birth injury.  Each state has a different statute of limitations, which limits the amount of time a family can bring forth a medical malpractice case, so time is of the essence in filing a claim if medical negligence has occurred.