Blockbuster Birth Injury Verdict Holds Lessons
November 1, 2025 13 minutes read
By Gregory Freeman
A Utah hospital has been hit with a verdict of nearly $1 billion after a baby experienced birth injuries that will lead to lifelong disabilities. The case holds lessons for management of both obstetrics and malpractice litigation.
Wyoming resident Anyssa Zancanella was 39 weeks pregnant in 2019 when her water broke while on vacation in Utah. She went to the nearest hospital, where she and the father allege that inexperienced nurses failed to react to signs that her baby was in distress and gave her excessive doses of Pitocin. Their lawsuit alleged that, although an on-call physician was asleep just 30 seconds away from Zancanella, staff did not intervene and perform a cesarean delivery for more than a day.
The baby was deprived of oxygen so long that she is brain-damaged and will be disabled for life, according to the medical malpractice lawsuit. Third District Judge Patrick Corum, JD, found the hospital liable and was blunt in awarding the family $951 million, thought to be one of the largest in the state’s history. He said Zancanella “would have been better off delivering this baby at the bathroom of a gas station or in a hut somewhere in Africa than in this hospital. Literally, this was the most dangerous place on the planet for her to have given birth.”
The judge went on to say that he might have awarded even more to the family if the hospital had participated fully in the trial. The hospital stopped communicating with its attorneys and withdrew from participating in court proceedings, Corum explained, forcing him to proceed without the hospital and enter a judgment by default. “Had the defendant been here,” he said, “I think the testimony would have been lengthier and even more compelling, if that’s possible.”
The health system that operated the hospital at the time was the largest physician-owned system in the United States before filing for bankruptcy in 2024.
Unlikely to Collect
The bankruptcy of the hospital entity, along with non-economic damage caps under Utah law, likely will make it difficult to collect on the overall amount, “denying this family their full measure of justice,” says Emily Thomas, JD, a birth injury malpractice attorney in Royal Oak, MI.
The large amount of the verdict is attributable to the hospital entity failing to defend the case entirely, she says. The defense attorneys for the hospital withdrew as counsel because they were not being paid by the hospital entity, Thomas says, and this led to a default judgment being entered against the defendant hospital for their failure to participate in court proceedings.
“It should be noted, too, that this was a bench verdict from Utah Judge Patrick Corum following entry of a default judgment for the hospital’s failure to defend the case,” she says. “It was not a runaway jury of peers situation.”
Thomas explains this is the breakdown of the verdict:
- $475 million in punitive damages;
- $65+ million in medical and economic damages;
- $200 million in non-economic damages to the injured child;
- $110 million in non-economic damages to Anyssa; and
- $100 million in non-economic damages to the father, Danny.
“Punitive damages are just what they sound like. They are to punish a party for outrageous conduct. Here, the punitive damages stem not only from the subpar medical care that injured the baby, yet also from the defendant hospital entity’s failure to defend the case,” Thomas says. “Not all states have punitive damages in medical malpractice cases. If a similar case were to be brought in Michigan, for example, the line item for punitive damages would be eliminated.”
Medical and economic damages are clear costs that can be identified in the market that occurred as a result of the malpractice that caused injuries, she says. For example, these include lost earnings/income, attendant care, medical care, equipment, and assistance with and supervision of all activities of daily living. These are, dollar for dollar, collectible in every medical malpractice action, Thomas says.
Non-economic damages are those that cannot be quantified with a dollar amount in the market, and that must be valued by the trier of fact based on the evidence in the case, she says. The judge or jury is tasked with deciding the dollar value of pain, suffering, mental anguish, disability, disfigurement, and other claims. “The rub with non-economic damages is that most state legislatures passed laws capping the amount of non-economic damages. Utah has such a cap. Therefore, it is possible that all the non-economic damages awarded are reduced to $450,000 under Utah law. So, the total of $410 million awarded in in non-economic damages may be collectively reduced to $450,000,” Thomas explains. “Plaintiff’s attorneys, however, are arguing that the $450,000 cap should not apply because of the default judgment. They should argue this point, because such a reduction wipes out nearly half of the judge’s verdict if the cap applies.”
Many states have non-economic damage caps, which deny true justice by invading the province of the jury or judge to put the number they, in their evaluation of the facts, find just for pain, suffering, disfigurement, and related issues, she says. Other states have found non-economic damage caps to be unconstitutional. “Lastly, as a birth injury attorney, the plaintiff’s attorneys likely spent significant costs in pursuing this case, which would be subtracted from any recovery as well. These costs were not made public; however, I would expect them to be significant,” Thomas says.
That cost likely runs into the hundreds of thousands of dollars based on the medical experts necessary to file and pursue birth injury cases, she says. “So, while this sounds on its face like a huge win for the family of this injured child that will require lifelong care, it keeps me up at night that the true amount of the recovery will not be anywhere near the amount necessary to provide lifetime care for the child,” Thomas says. “This is due to the bankruptcy, the non-economic damages cap, the cost of litigation, among other factors.”
Even though the family may never recover anything near the total amount, the huge award garnered attention in the medical community, and Thomas hopes that can make a difference.
“One has to step back and say how effective was this $951 million verdict really?” she says. “I hope it serves as a deterrent and betters care for future mothers and babies, rather than a story of how to get away with murder.”
Cascade of Failures
The key issues in this case revolved around a cascade of preventable errors, including the administration of excessive doses of Pitocin by inexperienced nurses who still were in orientation, failure to adequately monitor fetal heart rate strips indicating distress, and the on-call obstetrician’s unresponsiveness as he slept nearby despite being alerted to concerning signs (e.g., rising fetal blood pressure and maternal fever), says Greg J. Marchand, MD, FACS, FACOG, FICS, a surgeon with the Marchand Institute for Minimally Invasive Surgery in Mesa, AZ.
“These lapses delayed a necessary cesarean section for over 24 hours after admission, resulting in prolonged oxygen deprivation to the baby, Azaylee, causing severe hypoxic-ischemic encephalopathy and lifelong brain damage manifesting as seizures, cognitive impairments, and the need for constant care,” he says. “The hospital’s systemic shortcomings, such as undertrained staff and the lack of intervention from a charge nurse, compounded the tragedy, turning what should have been a routine induction into a never event that experts describe as a total breakdown in patient safety protocols.”
This case stands out from other birth malpractice cases because of the hospital system’s complete withdrawal from the litigation process, leading to a default judgment that bypassed typical jury trials and allowed unopposed presentation of devastating evidence, resulting in an extraordinarily high punitive component without the usual defenses or settlements that cap awards in contested matters, Marchand says. Unlike many birth injury suits, where issues stem from isolated errors (shoulder dystocia or improper forceps use), this involved a prolonged series of systemic failures — inexperienced staffing, ignored monitoring data, and physician abandonment. The injury was framed as a never event preventable with basic protocols, evoking stronger judicial outrage, he says.
“Additionally, the stark contrast between the mother’s joyful pregnancy and the catastrophic outcome, coupled with the health system’s bankruptcy complicating collection (potentially halving the award via creditor priorities), differentiates it by highlighting corporate irresponsibility over individual clinician fault,” Marchand says. “That is a rarer emphasis in an era, where most verdicts focus on direct provider negligence rather than institutional collapse.”
For other hospitals and risk managers, the primary takeaway is the critical need for robust staffing protocols in obstetrics, ensuring that labor and delivery units are never reliant on novice personnel without immediate supervision from experienced charge nurses or physicians, since undertraining directly contributed to this tragedy and exposes facilities to massive liability, Marchand says. Risk managers should prioritize simulation-based training for high-risk scenarios, such as inductions and fetal monitoring interpretation, while implementing strict electronic oversight for medication dosing, such as for Pitocin, to prevent overrides or errors, he says.
“Equally important is fostering a culture of proactive communication and escalation, where on-call providers are readily accessible and team huddles address early warning signs, avoiding the isolation that allowed distress to go unchecked here,” Marchand says. “It also is crucial to maintain active engagement in legal proceedings, even amid financial distress, preventing default judgments that can balloon awards, and to underscore the value of comprehensive insurance and crisis management plans to mitigate both clinical and reputational risks in maternity care.”
From a clinical standpoint, Marchand says this injury could have been prevented by adhering to evidence-based guidelines for labor induction, starting with conservative Pitocin dosing — typically initiating at 0.5 milliunitsto 2 milliunits per minute and titrating slowly while continuously monitoring uterine contractions and fetal heart rate to avoid hyperstimulation that restricts placental blood flow and oxygen delivery, which he says was flagrantly ignored here, with excessive administration over hours despite decelerations.
Timely recognition of fetal distress via accurate interpretation of monitoring strips should have prompted immediate cessation of augmentation and preparation for cesarean delivery within 30 minutes, rather than delaying for more than a day, a standard that could have preserved Azaylee’s brain function, Marchand says.
“Part of this problem could have been academic OB/GYNs who sometimes become so fixated on having a vaginal delivery that they let unsafe situations occur,” Marchand says. “I have seen this ‘vaginal delivery at all costs’ mentality in academic centers myself over the course of my career, where institutional pressures to minimize (cesarean delivery) rates lead to overlooking risks, emphasizing the need for a patient-centered approach prioritizing maternal-fetal well-being over delivery mode preferences.”
Could Have Been Avoided
From a legal standpoint, this high-dollar resolution could have been avoided through early settlement negotiations by the health system, leveraging their insurance coverage to resolve the claim pre-trial for a fraction of the verdict — potentially in the $10 to $50 million range typical for severe birth injuries — rather than withdrawing representation and inviting a default judgment that removed any opportunity to challenge evidence or mitigate damages, he says.
Proactive participation in discovery and trial preparation, including appointing new counsel after the initial attorneys’ exit, would have allowed presentation of defenses like the hospital’s sale to another health system or arguments on causation, potentially capping non-economic damages under Utah’s laws while negotiating punitive elements down, he says. Additionally, maintaining detailed contemporaneous documentation of clinical decisions and staffing ratios could have bolstered a defense against negligence claims. Implementing a robust enterprise risk management program to identify and address systemic issues early might have prevented the lawsuit altogether, highlighting how corporate financial maneuvers during bankruptcy often exacerbate rather than resolve liability in malpractice arenas, Marchand says.
To avoid a similar result, other hospitals should invest in comprehensive obstetric risk management programs, including mandatory multidisciplinary simulations for induction protocols and emergency cesarean delivery drills, ensuring all staff — from nurses to physicians — demonstrate competency in fetal monitoring and escalation before independent practice, he says. Establishing clear policies for on-call availability, such as requiring physical presence or telepresence within minutes for labor concerns, prevents the abandonment seen here, while adopting electronic health record alerts for high-risk medications, such as Pitocin, can enforce safe dosing limits, he says.
“Hospitals must also prioritize adequate staffing ratios, avoiding over-reliance on trainees during peak hours, and conduct regular audits of maternity outcomes to identify patterns of delay or error,” Marchand says. “Legally, maintaining solvent insurance pools and dedicated legal teams for ongoing claims management ensures active defense participation, while culturally shifting away from metrics that penalize (cesarean deliveries) toward outcomes-focused care, reduces fixation on vaginal births. Ultimately, transparent communication with families post-incident can de-escalate conflicts and foster trust, minimizing litigation escalation.”
Inexperienced, Untrained Nurses
This case contained not a single mistake but a series of cascading failures by the hospital staff, says Laurence Huttman, JD, an attorney with the Farah & Farah law firm in Jacksonville, FL.
“Here, we had inexperienced, untrained, unsupervised nurses, who failed to recognize and react to signs of fetal distress, the excessive and prolonged administration of Pitocin, and an on-call doctor who was not engaged and effectively abandoned the patient,” he says. “The hospital’s failure to maintain a safe, well-functioning environment for patient care was at the heart of the matter.”
The verdict was so large because of the profound and total harm caused to the child, which the judge himself described, Huttman says. The harm was not temporary. It resulted in a lifetime of severe disabilities, requiring constant care, medication, and a total loss of future potential. The damages awarded were an attempt to compensate for this irreversible loss, including future medical costs and a lost quality of life, he says.
The defendant’s default and subsequent failure to participate in the legal proceedings also likely contributed, since it allowed the judge to hear only the compelling evidence from the family’s side, Huttman says.
“This case stands out due to the systemic breakdown of care rather than a single act of negligence. The lawsuit documented a chain of errors involving multiple staff members and a disregard for established medical protocols,” he says. “The judge’s strong language, calling the hospital the ‘most dangerous place on the planet’ for the birth, highlights the severity and complete failure of the care provided, which is an exceptionally rare and damning legal conclusion.”
The primary lessons for hospitals and risk managers are to invest in proper staff training and supervision, especially for new employees, Huttman says. They also must strictly enforce established medical protocols to prevent events like this. A commitment to patient safety must be the top priority, and any failure to do so can result in devastating legal consequences, he says.
“From a legal standpoint, the most effective way for the hospital to have avoided this outcome was to take immediate responsibility and engage in good-faith settlement negotiations. By failing to communicate with their own attorneys and withdrawing from the case, the hospital essentially forced a default judgment,” Huttman explains. “Had they acknowledged their liability and worked toward a fair resolution, or participated in their defense if they had one, they could have avoided any media scrutiny that resulted from a public, billion-dollar verdict.”
Unusual Circumstances
Such a huge verdict demands attention from healthcare risk managers, but the circumstances of this case were unusual in several ways, says Timothy J. Sheehan, JD, partner with the Wilson Elser law firm in White Plains, NY. The involved hospital had declared bankruptcy, and the trial judge allowed its attorneys to withdraw because of nonpayment of bills just three months before trial. The hospital did not obey the judge’s instruction to retain new lawyers, and so the plaintiff’s attorneys tried the case without opposition.
“Normally, birth injury cases are tried before juries, but for reasons unknown, this one was a bench trial, one decided by a judge who was aware that the hospital was in bankruptcy and had disrespected the court by not hiring new counsel to put on a defense,” he says. “The plaintiff’s attorneys told media outlets their version of the delivery events and the extent of damages that they submitted to the judge, but there was never a defense side presented on these issues that was reported to the press or submitted to the judge.”
The trial judge made factual findings, sharply disparaged the hospital’s care, and awarded $265 million in medical and economic claims after hearing only one side of the dispute, so in that sense, it was not too surprising that the award was so high, Sheehan says.
However, that same judge also awarded $400 million in pain and suffering to the child and her parents, notwithstanding that Utah has a $450,000 per plaintiff cap on pain and suffering awards, he says. Finally, the judge awarded $475 million for punitive damages, awards that in some states are prohibited, limited, or involve a higher standard of proof, and, in Utah, half of such awards are diverted back to the state, he says.
“But no leaders in solvent hospitals will take any solace in any of the above explanations,” Sheehan says. “This award — or even a much lower one — will continue to remind hospitals that they must ensure that their labor units are adequately staffed, that their obstetrical nurses are properly trained and supervised, that their attending obstetricians are experienced and on site at all times, and that maternal-fetal medicine specialists are both available and are liberally consulted during the labor process when difficulties arise.”
This verdict is truly exceptional because of the public rage at a breakdown that was avoidable and severe, says Nick Bach, PsyD, a psychologist in Louisville, KY.
“The amount was never intended just for damages; it was a proclamation that trust in clinical judgment and hospital safety had collapsed,” he says. “In what I have read, the hospital was highly negligent by failing to act upon the risks that were known and by not monitoring fetal distress.”
Bach says he has learned from his practice that families who experience birth trauma carry emotional scarring, probably for decades.
“This case is different from others, as there were several missed opportunities, which also contributed to the perception of disregard, including the delay in involving an obstetrician,” he says. “Had the clinical staff escalated their concerns earlier or at least adhered to clear guidelines, this injury could have been prevented.”
From a legal perspective, earlier settlement discussion or open disclosure could have improved the result for the hospital, he says.
“Training pathways for rapid escalation must be enhanced within hospitals, along with fostering aggressive nursing cultures. Accountability also remains important where red flags are raised,” Bach says. “Hospital risk managers should thus treat communication breakdowns with the same seriousness as they would any surgical error.”
Greg Freeman has worked with Clinican.com and its predecessor companies since 1989, moving from assistant staff writer to executive editor before becoming a freelance writer. He has been the editor of Healthcare Risk Management since 1992 and provides research and content for other Clinician.com products. In addition to his work with Clinician.com, Greg provides other freelance writing services and is the author of seven narrative nonfiction books on wartime experiences and other historical events.
Sources
- Nick Bach, PsyD, Louisville, KY. Email: [email protected].
- Laurence Huttman, JD, Jacksonville, FL. Telephone: (904) 549-6434. Email: [email protected].
- Greg J. Marchand, MD, FACS, FACOG, FICS, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ. Telephone: (480) 999-0905. Email: [email protected].
- Timothy J. Sheehan, JD, Partner, Wilson Elser, White Plains, NY. Telephone: (914) 872-7457. Email: [email protected].
- Emily Thomas, JD, Royal Oak, MI. Telephone: (313) 230-5115. Email: [email protected].
A Utah hospital has been hit with a verdict of nearly $1 billion after a baby experienced birth injuries that will lead to lifelong disabilities. The case holds lessons for management of both obstetrics and malpractice litigation.
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