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OBSTETRIC MALPRACTICE

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					                Defending the Delivery Team:
              OBSTETRIC MALPRACTICE
Lessons Learned in the Defense of Perinatal Brain Injury Cases

              San Francisco, California
   Tuesday, April 28 and Wednesday, April 29, 2009

                     Tuesday, April 28, 2009

7:30   Registration and Coffee

8:30   Co-Chairs’ Opening Remarks

       David R. Lucchese
       GALLOWAY, LUCCHESE, EVERSON & PICCHI (Walnut Creek, CA)

       Kathleen L. Nastri
       KOSKOFF, KOSKOFF & BIEDER (Bridgeport, CT)


8:45 The Key to the Perinatal Brain Injury Case: Understanding the Differences
     Between a Normal Infant Brain and and an Injured Fetal and Neonatal
     Brain

       Bruce G. Fagel, M.D., J.D.
       BRUCE G. FAGEL & ASSOCIATES (Beverly Hills, CA)

       Dr. James Byrne
       Chief of Obstetrics
       Santa Clara Valley Medical Center
       Associate Clinical Professor
       STANFORD SCHOOL OF MEDICINE (Stanford, CA)

       No attorney, whether plaintiff or defendant, can properly represent a client in an
       obstetrical malpractice case without gaining a clear understanding of the
       differences between a normal infant brain and an injured one. In this must-attend
       presentation, a leading obstetrical specialist and California’s most prominent
       plaintiff medical malpractice attorney, who is also a physician, will discuss the
       development of the fetal and neonatal brain, exploring the physiological processes
       which cause maldevelopment and injury during the prenatal, intrapartum and
       neonatal periods. They will cover:

          •   How a normal infant brain develops in the initial three months
          •     What ultrasound and MRI results will reveal about the developing brain—
                and what to look for in the fetal and neonatal brain scans
          •     How infection impacts the infant brain while it is a fetus
          •     How to distinguish different types of brain damage from the imaging
                results
          •     Hypoxic ischemic injury
          •     The appropriate diagnosis and treatment of infection, metabolic and blood
                disorders as potential causes of brain damage
          •     How to assess the cause and define the standard of care in neonatal
                infection and metabolic disorders of the infant brain
          •     Causes of brain injury
                --neonatal infection
                --metabolic disorders
                --fetal asphyxia
                --genetic disorders
          •     Exploring causes of brain injury not caused by the delivery team—what
                are they and how do they arise?

10:30   Morning Networking Break

11:00   The Latest Tools and Science to Determine the Origin and Timing of
        Irreversible Brain Damage

        Moderator

        Kathleen L. Nastri
        KOSKOFF, KOSKOFF & BIEDER (Bridgeport, CT)


        Panel

        Dr. Richard Davis
        Professor Emeritus, Pathology
        UCSF SCHOOL OF MEDICINE (San Francisco, CA)

         Dr. Roy A. Filly
         Professor Emeritus, Radiology
         Co-Founder, Fetal Treatment Center
         UCSF SCHOOL OF MEDICINE (San Francisco, CA)

         Two of the best tools to determine the origin of irreversible brain damage—
         something that every attorney requires—are neuroimaging and placental
         pathology. Neuroimaging involves ultrasound, CT scan and MRI. One of
         America’s leading neuroradiologists will explain how neuroimaging can be used
         to determine the timing and origin of the injury. As well, placental pathology is
         an important tool for the events that led to injuries sustained by the fetus. Find
          out from a leading American specialist how this unique tool can be used to
          ascertain when injuries sustained by the fetus occurred. This is an important
          session for understanding how to determine the origin of brain damage and is
          required learning for any physician and lawyer in the field.

                 •   Understanding which work best: ultrasound, CT scans or MRIs?
                 •   Markers of asphyxial brain damage
                 •   Signs of traumatic brain injury
                 •   Acute, profound v. prolonged patial asphyxia
                 •   Dealing with the other causes of brain injury
                 •   The role of placental pathology in determining the cause and timing of
                     the events leading to brain injury
                 •   The importance of examining the placenta
                 •   Using the tools for success in a legal case

12:15   Networking Luncheon for Speakers and Delegates

                     Keynote Luncheon Address

                  Lawrence E. Smarr
                     President
            PHYSICIANS’ INSURERS ASSOCIATION OF AMERICA


 1:45   The Critical Role of Cerebral Palsy in a Brain Injury Case

         Moderator

        Kathleen L. Nastri
        KOSKOFF, KOSKOFF & BIEDER (Bridgeport, CT)

         Panel

         Dr. Larry Rand
         Director of Perinatal Service
         Fetal Treatment Center Perinatal Team
         UCSF SCHOOL OF MEDICINE (San Francisco, CA)

         Dr. Julian T. Parer
         Professor
         UCSF SCHOOL OF MEDICINE (San Francisco, CA)

          Many babies with cerebral palsy have a congenital malformation of the brain,
          meaning that the malformation existed at birth and was not caused by the
          birthing process. And this is important information in the defence of the
          delivery team when a brain-damaged infant is born. New lessons from the
        research laboratory have come up with other causes of cerebral palsy and a
        thorough understanding of the problems is essential. In this in-depth
        presentation, moderated by a prominent obstetric plaintiff attorney, you will
        learn:

             •   What is cerebral palsy?
             •   Causes of cerebral palsy
             •   Neonatal infection and brain damage
             •   What every attorney needs to know about cerebral palsy and
                 negligence and how to separate causation
             •   How cerebral palsy comes about from the birthing process
             •   How a diagnosis of cerebral palsy is made
             •   The different types of cerebral palsy
             •   How aggressive should the treatment for cerebral palsy be?
             •   Realistic goals for a child with cerebral palsy
             •   The criteria for implicating intrapartum care to cerebral palsy
             •   Understanding fetal heart rate evaluation, infection, trauma and
                 prematurity in the development of CP


2:30   Afternoon Networking Break

3:00   Effectively Using the Medicine to Defend the Delivery Team in a
       Neonatal Brain Injury Case

       Moderator

        David R. Lucchese
        Senior Partner
        GALLOWAY, LUCCHESE, EVERSON & PICCHI (Walnut Creek, CA)

        Panel

        David J. O’Keefe
        President, Managing Shareholder
        BONNE BRIDGES (Los Angeles, CA)

        Marshall Silberberg
        Partner
        LAW OFFICE OF MARSHALL SILBERBERG (Newport Beach, CA)

        Not every brain injury caused to an infant is birth-related. And that is why
        every medical issue must be analyzed objectively and critically. By thoroughly
        understanding the medical aspects of a case, defense lawyers can gain enormous
        information about the prenatal and perinatal causes of neurological dysfunction.
       The human brain is susceptible to a wide variety of genetic, developmental and
       acquired abnormalties that may have nothing to do with obstetric malpractice.

        In this dynamic presentation, hear of one America’s finest defense counsel
        describe how he has had several spectacular results over the last two decades
        by properly utilizing medical evidence in a brain damaged infant case. He will
        reveal the secrets of his success, including:

            •   How to win a case by “examining the brain first” approach
            •   Using films of the brain and other diagnostic studies to determine the
                cause of injury
            •   How to use laboratory and other clinical “time-markers” to defend a
                case
            •   Deploying medical information about nucleated red blood cells to
                negate negligence
            •   How viral illnesses during pregnancy can be proven as a defense
            •   Effective causation defenses that can disprove liability—and how to
                deal with them

          After Mr. Lucchese’s presentation, he will join the outstanding panel of two
          prominent obstetric malpractice attorneys—one plaintiff and one defense--
          who will engage in a spirited and stimulating discussion of the issues faced
          by every obstetrician, physician, hospital or nurse in the country. This is a
          rare opportunity to see three of the nation’s best lawyers in action.

5:00   Conference Adjourns

                    Wednesday, April 29 , 2009

8:00   Registration and Coffee

8:45    Opening Remarks from the Co-Chairs

9:00   The Absolute Key to an Effective Defense: Using the Right Expert to Meet
       the Standard of Care for the Delivery Team

       Moderator

       James R. Bostwick
       BOSTWICK, PETERSON & MITCHELL LLP (San Francisco, CA)

       Panel

       Leo H. Schuering, Jr.
       Senior Partner
        SCHUERING ZIMMERMAN SCULLY TWEEDY & DOYLE
        (Sacramento, CA)

        Stephen H. Mackauf
        Partner
        GAIR, GAIR, CONASON, STEIGMAN & MACKAUF (New York, NY)

        There is nothing more important to the successful defense of a baby brain
        injury case than the assistance and testimony of the expert medical experts.
        While oral testimony from witnesses in a case must state facts and not opinions,
        the expert is allowed to state opinions and is therefore held to a different
        standard from other witnesses. But proper preparation means finding multiple
        expert witnesses in multiple different disciplines. In this presentation,
        moderated by a prominent national plaintiff malpractice attorney,, hear a
        California malpractice defense lawyer and a well-known New York plaintiff’s
        lawyer discuss the key to an effective case:

             •   What specific types of experts to retain for evaluation of the issues of
                 the standard of care
             •   Why specific experts must be used for the issues of causation
             •   The experts required on the issues of damages
             •   How to assess and discredit experts in the case
             •   Effectively using the ACOG standards in expert evidence
             •   Unethical expert witness testimony
             •   Assessing credibility of the opposition experts

10:30   Morning Networking Break

11:00   What All Defendants and their Insurers Must Know About Protecting the
        Delivery Team—The Perspective of Two Prominent Plaintiff Attorneys

        For the Plaintiff

        Bruce G. Fagel, M.D., J.D.
        BRUCE G. FAGEL & ASSOCIATES (Beverly Hills, CA)

        Susan E. Loggans
        SUSAN E. LOGGANS & ASSOCIATES P.C. (Chicago, IL)

        For the Defense

        Elizabeth Cornacchio
        Partner
        HEIDELL, PITTONI, MURPHY & BACH (New York)
        Perhaps the most interesting perspective on protecting the delivery team can
        come from plaintiff lawyers themselves. In this remarkable presentation, hear
        two of America’s finest obstetric malpractice plaintiff attorneys describe how
        they view the defense of brain-damaged infant cases. Using real-life examples,
        California’s most prominent plaintiff attorney, Bruce Fagel, and Chicago lawyer
        Susan Loggans, a long-time veteran of many obstetric malpractice battles, will
        explore:

             •   Which cases the defense should try—and which ones they should settle
             •   How the plaintiffs view the strengths and weaknesses in a defense case—
                 and how they deal with them
             •   The most common mistakes made by defendants and their insurers—and
                 how to avoid them
             •   Valuable lessons that insurers an learn on how to save money
             •   The plaintiff view of the strengths and weaknesses in the defense of a
                 delivery team—and what they can do better
             •   Plaintiff suggestions for curbing negligence on the part of obsteticians,
                 nurses and hospitals
             •   The curves that a good defense team can throw up against plaintiff
                 counsel—and what to do about them
             •   Real-life examples of good—and bad—delivery team behavior

        After his presentation, they will engage in a spirited discussion with Ms.
        Cornacchio, an experienced medical malpractice defense lawyer who has won
        several defense verdicts on behalf of obstetricians and hospitals. She will
        challenge their theories. This session will provide both plaintiffs and defendants
        with valuable information with which to litigate their cases.


12:30    Networking Lunch

                       Luncheon Speaker

                           J. Ric Gass
                  GASS WEBER MULLINS LLC (Milwaukee, WI))
                   “Handling Catastrophic Injury Cases”

         Mr. Gass is an award winning speaker and acclaimed trial defense lawyer. He
         will talk about using the right words to tell the story of causation and damages in
         an obstetrical case involving a brain-damaged infant. He will demonstrate how
         to lay the groundwork for attacking damages and make a persuasive case before
         a jury on behalf of the defense. This is a compelling demonstration that cannot
         be missed!


2:00    Proven Strategies to Improve Outcomes and Reduce Obstetric
        Claims against the Delivery Team
      Moderator

      Michael A. O’Flaherty
      Of Counsel
      FONDA & FRASER LLP (Los Angeles, CA)

      Panel

      SUSAN PENNEY
      Director of Risk Management
      UCSF MEDICAL CENTER (San Francisco, CA)

      Theresa Kielhorn
      Manager of Professional Liability Program
      UNIVERSITY OF CALIFORNIA HOSPITALS (Oakland, CA)

       The defense of obstetrical cases—especially those involving brain damaged
       infants--can be devastating, so it is essential that every delivery team prepare
       and minimize its risk. In this session, moderated by a prominent Los Angelese
       defense lawyer, s leading obstetrical malpractice defense lawyer who was
       formerly a general counsel for a major hospital and two leading risk
       management specialists will recommend innovative strategies to pre-empt
       litigation. This session will give you valuable insights into:

       •   Avoiding litigation before it begins
       •   What successful hospitals have done to prevent obstetric claims
       •   How strategic decisions in the early stages can have dramatic consequences
       •   Effective decision-making
       •   The value of cross-functional teams
       •   How to set up an internal risk management systems to avoid litigation
       •   When to use drills as a preventative measure
       •   Allocating responsibilities on the delivery team
       •   Which risk management systems are most effective and which are not?
       •    Using internal investigations and audits to mitigate obstetrical malpractice
       •   Identify risks in documenting adverse outcome discussions with patients
       •   Charting and documentation procedures
           --what should be charted and who should do it?
           --establishing a common system of charting for the entire perinatal team
           --how to deal with unexplained gaps in charting
           --avoiding the pitfalls in both charting and fetal monitoring
           --appropriate guidelines for late entries

     Afternoon networking break from 3:15-3:45

4:30 Conference Concludes
              Conference Workshop

             Tuesday, April 28, 2009
                   5:30 p.m. – 8:00 p.m.

How to Effectively Handle an Infant Brain Injury Case:
Plaintiff and Defense Lessons from the Finest

It is difficult to litigate an infant brain injury case. It requires the utmost skill
and knowledge in all areas of personal injury law. Nothing, however, is more
important than an understanding of the medicine itself—and knowing what to do
with it. Since not every brain injury case is the result of negligence on the part
of the delivery team, any attorney who handles such a case must become an
expert in obstetrics and gynecology. And, in cases where the damages can now
exceed $100 million, you can never have enough knowledge. In this workshop,
led by two of the nation’s leading medical malpractice lawyers—you will learn
how to conduct an infant brain injury case from start to finish.

How you will benefit:

   •    Learn how to conduct an infant brain injury case from the very
        beginning to the finish
   •    Find out how to mesh the medicine with the legal aspects
   •    Discover which experts can help—and hurt—your case
   •    Understand what to look for in pretrial depositions
   •    Find out how to frame your case
   •    Understand exactly what is required to ascertain liability, causation and
        damage issues
   •    Discover exactly what defenses work—and which do not—and how to
        successfully deploy them

What we will cover:

    •   How to ascertain liability before the case starts
    •   How to deal with the medical information effectively
    •   Effective tactics for defeating the plaintiff’s claims
    •   The experts that should be used—and the ones that should not
    •   How to conduct pre-trail depositions—and what questions to ask
    •   Effective strategies for litigation
    •   When to take the case to trial—and effective techniques once you get
        there

David R. Lucchese
Senior Partner
GALLOWAY, LUCCHESE, EVERSON & PICCHI
Walnut Creek, CA

Kathleen L. Nastri
Partner
KOSKOFF KOSKOFF & BIEDER, P.C.
(Bridgeport, CT)

				
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