By Damian D. Capozzola, Esq., and Jamie Terrence, RN
News
In July 2025, an appellate court unanimously affirmed a record-breaking medical malpractice judgment of $207 million against a hospital for catastrophic birth injuries. The case involved a newborn who sustained severe brain damage leading to cerebral palsy and profound lifelong disabilities after a mishandled delivery at the hospital. A jury had awarded $183 million (later increased to $207 million with delay damages) for the child’s future care needs and pain and suffering. On appeal, the hospital argued that the verdict was exorbitant and unsupported, but the appellate court held that the award did not “shock the conscience” in light of the trial evidence. The court emphasized that juries may award substantial damages when justified by the record, and it refused to disturb the verdict or grant a remittitur. This high-profile decision illustrates that courts are often reluctant to overturn jury verdicts, so long as they are grounded in credible evidence.
Background
In early 2018, a 19-year-old woman near the end of her pregnancy was transported by ambulance to a hospital after her water broke. Within hours, she delivered her son by emergency cesarean delivery under general anesthesia. Upon waking, she was told that her child had experienced a severe brain injury during labor caused by prolonged oxygen deprivation. The newborn was later diagnosed with hypoxic-ischemic encephalopathy, resulting in moderate-to-severe cerebral palsy and a host of permanent impairments.
The child is unable to walk, speak, or eat normally. He requires feeding through a gastrostomy tube, experiences painful muscle spasticity, and depends entirely on caregivers for daily living. Expert testimony at trial confirmed that he will require round-the-clock support for life, including specialized medical equipment, therapies, medications, and surgeries.
The plaintiff filed a medical malpractice lawsuit against the hospital on the basis that its obstetrical team negligently delayed performing a necessary cesarean delivery. At trial, her attorneys argued that fetal heart monitoring showed clear signs of distress, particularly a prolonged deceleration of the baby’s heart rate, which required earlier surgical intervention. They argued that, if the delivery had occurred even 30 to 45 minutes sooner, the child would have been born healthy. Expert witnesses for the plaintiff ruled out other causes and pointed to meconium-stained amniotic fluid at delivery as further evidence of acute fetal distress.
The defense maintained that an infection, not delayed delivery, caused the injury. Hospital experts cited cord blood gas data and medical opinions suggesting the oxygen levels were within normal range at the time of birth. However, the jury found the plaintiff’s account more persuasive.
Following a multi-week trial, the jury returned a verdict in favor of the plaintiff. The hospital had stipulated that the physicians and nurses involved were acting within the scope of their employment, so no individual providers were held separately liable. The jury found the hospital negligent in its labor and delivery care and determined that its actions were a factual cause of the child’s injuries. The jury awarded approximately $183 million, including $101 million for future medical care and $80 million for pain and suffering. With the addition of delay damages allowed under state law, the total judgment rose to $207 million, which is the largest medical malpractice verdict in the state’s history.
The hospital filed post-trial motions seeking to overturn the verdict or reduce the damages, arguing that no individual caregiver was found negligent and that the damage awards were speculative and excessive. The trial judge rejected those arguments, finding the evidence sufficient and noting that the hospital had waived certain objections by failing to raise them during trial. The appellate court affirmed the judgment, finding no abuse of discretion and ruling that the verdict did not “shock the conscience.”
What This Means for You
Because obstetrical cases usually are the costliest for hospitals and physicians and the most devastating to parents, a multitude of programs and practice guidelines have been created over the years by professional organizations and adopted as expected standards of care both in hospitals and obstetrical care offices. Hospitals are licensed and accredited if surveyors find evidence of these standards of practice. A basic practice is an immediate response to a monitor indicating fetal distress where minutes matter and seconds count even more. “Decision to incision is 30 minutes” has been set by the American College of Obstetricians and Gynecologists (ACOG) for a reason. It takes teamwork to make that happen, especially in a busy labor and delivery environment. There must be an emergency plan in place that includes a responsive staff, the surgical suite, the surgical team, a waiting neonatal intensive care unit team, and the attending obstetrician. The plan must be available 24/7 and practice drills tested on a regular basis to maintain staff competencies.
That said, and more broadly, this case illustrates the legal principles that govern large medical malpractice verdicts and why they are so difficult to overturn. The appellate court’s ruling serves as a critical reminder for hospitals, insurers, and attorneys about how courts evaluate damages, liability, and appellate arguments in high-exposure cases. It also highlights the importance of trial strategy, record preservation, and expert preparation when facing catastrophic injury claims.
A key takeaway is that courts will not reduce a jury’s damages award unless it “shocks the conscience.” In this case, the defense argued that the $207 million judgment was excessive, particularly because it was based on a 70-year life expectancy. But the court emphasized that damages falling within the broad range of reasonableness will not be reduced absent clear signs of bias, passion, or mistake. Since the jury’s award was grounded in expert-supported evidence, including detailed life care plans and testimony regarding the child’s future needs, the court upheld it. The trial judge’s rejection of remittitur was affirmed, reinforcing how difficult it is to reduce a verdict once a jury has spoken. For defendants, this means that even extraordinary awards may stand so long as the plaintiff’s case is well-supported at trial.
The damages in this case included $101 million for future medical costs and $80 million for pain and suffering. The plaintiff’s life care planner presented several long-term care scenarios, including in-home and residential support extending to 75 years of age. Although no expert specifically testified that the child would live to 70 years of age, the jury was permitted to infer life expectancy based on standard government tables, which both sides agreed could be used. Testimony also established that being non-ambulatory could shorten life expectancy by five to 10 years, but the jury was not bound by defense estimates. Because the damages were calculated based on known needs, expert projections, and accepted statistical tools, the court found them justified.
The pain and suffering award was similarly upheld. Evidence presented at trial showed the extent of the child’s physical pain, frustration, and limitations in experiencing a meaningful life. Jurors saw the child in court, heard testimony from his mother and medical professionals, and were instructed on how to weigh noneconomic harm. Courts rarely disturb pain and suffering awards unless they are disconnected from the evidence. Here, the trial court concluded that the $80 million award was supported and not excessive. These findings make clear that substantial awards can survive appellate scrutiny if backed by clear, credible evidence.
A hospital generally can be held vicariously liable for its staff’s negligence even when the jury does not make individual findings against specific employees. The defendant argued that because the verdict did not name individual doctors or nurses, it should not be held responsible. But the court rejected that view. The hospital had stipulated that all relevant providers were acting within the scope of their employment. The jury was asked whether the hospital, “acting by and through” those clinicians, was negligent, and it answered yes. That was enough to impose institutional liability under principle of respondeat superior. The law generally does not require that jurors identify precisely which employee erred so long as the plaintiff proves that at least one employee was negligent. From a litigation strategy perspective, this reinforces that a hospital cannot shield itself from liability by demanding precise findings against each medical professional.
The appellate court also declined to reexamine witness credibility, expert assumptions, or the logic behind the jury’s damages calculations. Instead, it reiterated that reviewing courts will not substitute their own judgment for that of the jury when the verdict is supported by legally sufficient evidence. The defense had argued, for example, that the jury’s life expectancy assumptions were speculative and that certain closing argument comments inflamed the jury. But these issues were either deemed unsupported or procedurally waived because they were not properly objected to during trial. This underscores the critical importance of contemporaneous objections. Once a jury issues a verdict and the trial court affirms it, the appellate court’s role is limited.
The outcome also underscores the role of expert testimony in high-value cases. The plaintiff presented a cohesive set of experts across multiple specialties including obstetrics, neonatology, neurology, infectious disease, and economics. They collectively provided a consistent account of what went wrong, when the harm occurred, and what the future would require. Their testimony laid the foundation for the massive award. The defense, although it offered competing views, could not overcome the coordinated, well-documented nature of the plaintiff’s case. This highlights the importance of presenting not just expert opinions, but a unified and comprehensible expert narrative that can persuade a jury.
This case illustrates that massive awards will stand when supported by credible evidence and clean procedure. For hospitals, insurers, and litigators, the lesson is to invest in strong trial advocacy and ensure objections and evidence challenges are properly preserved. Once a jury renders its verdict and the trial court affirms, appellate relief is rare. The case also is a reminder that, when faced with compelling evidence of avoidable harm and a life altered forever, juries will not hesitate to impose extraordinary financial consequences.
Damian D. Capozzola, Esq., The Law Offices of Damian D. Capozzola, Los Angeles
Jamie Terrence, RN, President and Founder, Healthcare Risk Services, Former Director of Risk Management Services (2004-2013), California Hospital Medical Center, Los Angeles
Reference
- Decided on July 10, 2025, in the Superior Court of Pennsylvania, Case Nos. 536 EDA 2024 and 766 EDA 2024.
In July 2025, an appellate court unanimously affirmed a record-breaking medical malpractice judgment of $207 million against a hospital for catastrophic birth injuries. The case involved a newborn who sustained severe brain damage leading to cerebral palsy and profound lifelong disabilities after a mishandled delivery at the hospital. A jury had awarded $183 million (later increased to $207 million with delay damages) for the child’s future care needs and pain and suffering. On appeal, the hospital argued that the verdict was exorbitant and unsupported, but the appellate court held that the award did not “shock the conscience” in light of the trial evidence.
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