Federal Judge Awards $5.26 Million to Mother Brain-Damaged After Missed Chiari Malformation at Andrews AFB

Ruth Lawson became pregnant with her second child in March 2000 and received her prenatal care at Malcolm Grow Medical Center, the military hospital at Andrews Air Force Base in Maryland. Over the following months she reported severe nausea and vomiting, dizziness when she lay down, back pain that eventually required narcotic medication and, by late summer, a left foot drop. According to the court's findings, no provider performed a neurological examination or referred her to a neurologist at any point in the pregnancy.

She delivered her son vaginally on November 24, 2000. Her symptoms did not ease. The day after delivery she developed involuntary eye movements (nystagmus), and in the weeks that followed she described a room spinning around her, an inability to lie flat, and a heavy left leg. A neurologist did not see her until January 17, 2001, and an MRI of the head and spine on April 1, 2001 showed a Chiari Type I malformation, a condition in which the lower brain protrudes into the spinal canal, along with a large fluid-filled cavity (a syrinx) running through the cervical spinal cord. She had decompression surgery on April 12, 2001.

Ruth Lawson sued the United States in March 2003 under the Federal Tort Claims Act. Judge Roger W. Titus of the U.S. District Court for the District of Maryland heard the case without a jury in Greenbelt from February 7 through February 17, 2006. Denis Charles Mitchell, Gerard E. Mitchell and Laurie Ann Amell of Stein Mitchell and Mezines represented her; lawyers from the U.S. Attorney's Office defended the government. The central questions were whether the standard of care required her providers to recognize an underlying neurological disorder being aggravated by pregnancy, and whether the failure to do so caused permanent harm.

The court answered yes to both. It found that her providers treated each visit in isolation, attributing a growing list of symptoms to pregnancy when their severity and duration called for specialist review. It accepted the testimony of her treating neurosurgeon and her neurology and radiology experts that earlier imaging would have revealed the malformation, and that a planned cesarean delivery followed by earlier surgery would likely have spared her serious neurological damage. It rejected the opinions of the defense experts, including one who testified that even years of delay would not have mattered.

Judge Titus described her present condition in detail. Her brain and spinal cord are permanently and severely damaged. She has serious problems with balance and coordination, falls frequently, and sometimes loses so much leg strength that she cannot walk on her own. She has persistent occipital headaches, constant involuntary eye movements that make reading difficult, memory and concentration problems, and depression. She will never live independently and needs help caring for her children and running her household. Before her injury she had worked as a records manager for the Air Force and ran and swam regularly.

The court issued its opinion and judgment order on September 28, 2006. The total was $5,264,657.01, made up of $3,724,423 for future care, $938,982 in lost net income after taxes, $11,252.01 in past medical expenses, and $590,000 for pain and suffering. The court valued her noneconomic loss at $1.8 million but reduced that portion to $590,000, the maximum Maryland law allowed for a cause of action arising after October 1, 2000. The government then asked the court either to offset the anticipated value of her future military health benefits or to hold the future-care award in a reversionary trust. After a hearing in January 2007, Judge Titus denied both motions on March 30, 2007, finding the future benefits speculative and a trust against her interests.