J.F. v. Anonymous Medical Center

Dr. Fagel achieved a settlement of $10 million on behalf of a child born prematurely. The child now suffers from short-bowel syndrome, developmental delays and will require total Parenteral Nutrition for the rest of his life.  These injuries resulted from a failure to correctly diagnose an imperforated anus and a delay in the diagnosis of the bowel obstruction.

The minor plaintiff was delivered vaginally on Nov. 23, 2004. His mother, aged 18, entered the hospital in active labor and delivered the child 31 weeks prematurely. The child was delivered healthy and received normal Apgar scores. After delivery, the minor plaintiff's abdominal circumference was measured at 22 cm. At this time, both the nurse practitioner and a hospital neonatologist did not note any abnormalities regarding the child's anus. The next morning, the abdominal circumference was noted at 22.5 cm and by that night the child had become irritable and was crying. On the morning of Nov. 25, the baby began having episodes of apnea and bradycardia, which were treated. By this time, the child's abdominal circumference had increased to 26 cm and the child had yet to have a bowel movement. A third neonatologist examined the child and confirmed zero abnormality in regards to the rectum.

By 5:00 the circumference had increased an additional cm and the neonatologist noted a fistula at the base of the rectum with some stool in the fistula and a dimple where the anus should be located. X-rays showed a perforation of the bowel and the child was transported to Loma Linda University Medical Center. Although a colonoscopy was placed, further surgery has found that most of the small bowel was found to be necrotic as a result of Necroticizing Enterocolitis.

Three surgeries have been conducted since the minor plaintiff's birth and he has been hospitalized 10 times. After the third surgery, the minor plaintiff was left with 17.5 cm of small bowel and was placed on TPN. He receives nursing care at home for his TPN management.

The defendants alleged that all care was conducted within the standard of care. According to the defendants, the necrotic bowel was caused by NEC, a known complication of premature delivery, and was not connected to the initial bowel perforation.

Dr. Fagel was able to refute the various claims made by the defendants and demonstrated that the care center was negligent in failing to correctly diagnose the imperforate anus. Additionally, Dr. Fagel was able to show that the delay in the diagnosis of the bowel obstruction was a significant factor in causing the NEC.