Sara Kahler, individually and as next friend for K.K., a minor, and Tylor Kahler v. United States of America, et al.

Summary

Findings of Fact and Conclusions of Law in a Federal Tort Claims Act medical malpractice action arising from prenatal care and the delivery of K.K. at Tripler Army Medical Center. The court addresses alleged medical negligence and negligent failure to obtain informed consent concerning fetal-weight estimation, shoulder dystocia management, and K.K.’s subsequent ischemic stroke. The excerpt begins the court’s legal analysis but does not include a disposition.

Holdings

1. Plaintiffs failed to prove that Defendant breached the applicable medical standard of care. For a patient such as Sara with no clinical indication for an ultrasound, the applicable standard permitted obtaining an estimated fetal weight by either Leopold examination or ultrasound before delivery, and Dr. Pyskir was sufficiently experienced to perform the Leopold examination.
2. Plaintiffs failed to prove by a preponderance of the evidence that the alleged failure to use ultrasound or a more experienced practitioner, or the maneuvers used to relieve shoulder dystocia, was a substantial factor in causing the complained-of injuries.
3. Plaintiffs failed to prove that Sara's physicians owed a duty to offer a caesarean delivery or that they breached an informed-consent duty.

Questions Presented

1. Whether Tripler personnel breached the Hawai‘i medical-negligence standard of care by using a Leopold examination rather than an ultrasound to estimate fetal weight or by having a less-experienced physician perform the examination.
2. Whether Plaintiffs proved that the alleged breach was a substantial factor in causing K.K.’s injuries.
3. Whether Sara’s physicians had a duty to offer a caesarean delivery and thereby breached the Hawai‘i informed-consent standard.
4. Whether Plaintiffs proved that a different fetal-weight estimation method or practitioner probably would have produced an estimated fetal weight of at least 5,000 grams and triggered a duty to discuss caesarean delivery.

Disposition

other