Iowa reverses major $97M malpractice case, what happened?

This November, the Iowa Supreme Court overturned the largest medical malpractice award in the state’s history.^[] In 2022, a jury awarded $97.4 million to a family in a medical malpractice lawsuit against the doctor who delivered their baby and her affiliated hospital.

According to the original lawsuit, the baby was injured during childbirth and experienced a head injury that caused several serious and potentially life-long medical complications. The family sued for negligence, alleging the doctor’s actions led to their baby’s injuries.

At the time, the burden of the payment was to be split between the doctor’s office and the hospital and would go toward the child’s lifetime medical expenses. A breakdown of the prescribed payout was as follows: 

• $42,203,818 for “future medical and/or custodial care expenses” 

• $11,698,731 for “loss of future earning capacity”

• $1,050,000 for “past loss of function of the mind and/or body” 

• $20,700,000 for “future loss of function of the mind and/or body” 

• $1,050,000 for “past pain and suffering” 

• $20,700,000 for “future pain and suffering”

How did we get here? Looking back at Iowa’s most expensive medical malpractice suit.

After giving birth to a baby with head and brain damage, a family sued doctor Jill Goodman, MD for alleged negligence in the steps she took to deliver their child. 

According to reports, Goodman led the family through a vaginal birth, used forceps to assist the birth, and then used a vacuum extractor.^[] 

Among other claims, the plaintiff argued that the use of the vacuum extractor was a key example of negligence—and arguments about the vacuum helped the plaintiff win the 2022 trial. But two years later, the same arguments influenced the court’s decision on appeal to overturn the decision.

Where are we now? Understanding how Iowa’s most expensive medical malpractice suit was overturned. 

Following the 2022 verdict, the doctor’s clinic appealed the decision. They argued that various parts of the trial had been improper and that the verdict should be reconsidered. The court agreed due to one key player: the vacuum. Here’s why it mattered.

The vacuum verdict

In 2022, the plaintiff and defendant both called on medical experts to testify whether or not the doctor had been negligent—which generally depends on whether the doctor’s actions were ‘reasonable’ in the circumstances. On many points, their experts presented two sides of the same argument—for instance, while one of the plaintiff’s experts said that the doctor's use of the forceps and vacuum was negligent, one of the defendant’s experts said that the use “was appropriate.”

When it came to arguments around the vacuum, however, the plaintiff had more than experts on their side: they also had a “package insert” from the vacuum manufacturer.

This insert contained statements like a list of “contraindications,” pertaining to various conditions in which not to initiate the vacuum—such as after a “failed vacuum or forceps attempt”—and a list of “adverse events,” pertaining to possible fetal injuries that could result from use—like “head trauma.”^[] The plaintiff framed these statements as truth and used them in their closing arguments.

Back in the 1980s, courts ruled that warnings on drug labels were similarly considered hearsay, and were inadmissible in court.

As such, the inclusion of the insert “deprived the clinic of a fair trial,” the court said. So, the first verdict was overturned and a new trial was ordered.

A few more problems

While the vacuum’s package insert played a large role in getting the case re-heard, it was not the only problem that influenced the court to overturn the decision. In addition, they said there were flaws in the “specifications of negligence” submitted to the jury, that the plaintiff’s counsel “engaged in repeated and deliberate misconduct,” and that the verdict was “flagrantly excessive” under Iowa law.