$48.1 Million Verdict After Mother Pushed for 12 Hours, Leaving Infant With Permanent Brain Damage

On May 3, 2020, Sarah Anyan, a 35-year-old cardiac nurse, was admitted to Mercy Hospital East Communities in St. Louis for the delivery of her first child. Her pregnancy had been uncomplicated. She received an epidural late that evening and reached full dilation by around 3:50 a.m. the next morning.

What followed was the center of the case. By 6 a.m., nursing staff documented difficult fetal positioning and minimal progress after two hours of pushing. Dr. Daniel McNeive, the obstetrician on duty, noted fetal heart rate patterns consistent with oxygen deprivation but directed the nursing staff to continue pushing. He then did not return to Anyan's bedside for another six hours. The infant was delivered by natural delivery at 4:24 p.m. after more than 12 hours in the pushing stage. He arrived limp, without a cry, and in acute distress. Seizures began approximately six hours later, and the infant spent 46 days in the neonatal intensive unit.

The diagnosis was global hypoxic ischemic encephalopathy, a form of brain injury caused by prolonged oxygen deprivation during birth. The condition produced cerebral palsy that is permanent. Now five years old, the child uses a gait trainer to walk and an eye-tracking device to communicate. His cognitive function is reported to be intact, but his physical condition requires ongoing care.

Plaintiff attorneys argued at trial that allowing a laboring patient to push beyond three to four hours carries well-documented risks, and that Dr. McNeive's six-hour absence from the bedside in the face of documented fetal distress fell below the standard of care. The case also alleged failures by Mercy nursing staff to escalate. The defense contested liability throughout a three-week trial before Judge Ellen Ribaudo.

On March 25, 2025, the jury deliberated four hours before returning a verdict of $48.1 million, composed of $28.1 million in compensatory damages and $20 million in punitive damages. Fault was apportioned 75 percent to Dr. McNeive and Mercy Clinic East Communities and 25 percent to Mercy Hospital's nursing staff. Missouri Lawyers Media reported the result as the largest medical malpractice verdict on record in the state.

The case was styled R.A., a minor, by Next Friends Sarah Anyan and Blake Anyan v. Mercy Hospital East Communities, Mercy Clinic East Communities, and Daniel McNeive, M.D., No. 21SL-CC03944. Elizabeth S. Lenivy of The Simon Law Firm served as co-counsel for the plaintiff alongside Amy C. Gunn and Erica Slater of Gunn | Slater. The $48.1 million figure reflects the jury's award, not the family's guaranteed recovery: while the jury deliberated, the parties reached a high-low agreement setting a floor and a cap on what the defense would pay regardless of the verdict. The amount actually collectible is now the subject of post-trial motions and an appeal before the Missouri Court of Appeals, Eastern District (No. ED114232), which will decide whether that agreement controls over the jury number.