When a jury ordered Johns Hopkins Hospital to pay $55 million to a Baltimore family whose newborn was brain-damaged, the case hinged on what doctors and nurses did in the two hours before birth.
But the jury never heard about the nurse midwife trying to deliver the baby at home during the half-day before the mother arrived by ambulance at the emergency room because of what court documents called "fetal distress."
Evelyn Muhlhan's license was suspended by the Maryland Board of Nursing for her alleged actions during that delivery and four other home deliveries over three years. In one of those cases the baby died, according to the board, which has not completed its investigation.
"The question of whether Ms. Muhlhan was negligent is absolutely irrelevant to determining whether Hopkins was negligent," lawyers representing the family successfully argued to keep information about the midwife from jurors, according to court records.
Information on the suspension would prejudice the jury, the lawyers said.
Rebecca Fielding and Enso Martinez sued Hopkins in February 2011 in Baltimore Circuit Court, alleging that their son Enzo, now 2, was deprived of oxygen to his brain as Fielding waited for a C-section at the hospital. The baby was diagnosed with hypoxic-ischemic encephalopathy, which causes permanent and severe cognitive delays. The $55 million judgment is one of the largest malpractice awards in state history, and if it stands, the family will receive $29.6 million after a state cap on damages is applied.
Whether the baby would have fared better in a hospital from the start is not known, though court records show that was Hopkins' contention. The hospital said it will appeal the award.
The nursing board will hold private hearings to determine whether to permanently revoke or to reinstate Muhlhan's license. The board did not respond to several inquiries, so the timing of a hearing could not be determined.
Muhlhan could not be reached for comment by phone or email or through a visit to her home. Her legal counsel also could not be reached.
Malpractice cases rarely go to trial, typically being dismissed or settled. The public details of this case provide fodder for both sides in a growing debate about when it's safe to deliver babies at home.
"There wasn't a shred of definitive evidence that showed anything that happened at home resulted in any injury to the child," said the family's attorney, Gary A. Wais, in a recent interview. The family did not sue Muhlhan and has taken the baby to see her since the birth in March 2010, he said.
Supporters say midwives are unfairly blamed and targeted in a state that has among the nation's most restrictive laws governing home births. Unlike many states, only certified nurse midwives, and not certified professional midwives with no nurse's training, are allowed to perform home births in Maryland.
Only three or four nurse midwives in Maryland currently deliver babies in homes, though about 220 are certified in the state and mainly deliver in hospitals, according to Jeremy Galvan, a Hagerstown paramedic and president of Maryland Families for Safe Birth, which works to expand the number of professionals able to perform home births.
Galvan said he supports peer review and punishment of midwives who make mistakes but is unsure that Muhlhan will get a fair appraisal by the nursing board. The board, as well as state health officials and the state's physicians' society, oppose loosening home birth rules, he noted.
"Doctors have this tendency, even if the midwife does exactly what she's supposed to do, to say if they need to go to the hospital there was failure somewhere," Galvan said.
When Kate Lynch hired Muhlhan to help her deliver at home five years ago, the midwife made sure Lynch understood that if there was something beyond her abilities that she would take the woman to the hospital near her Frederick home, but the delivery was easy. The experience was so positive that Lynch recommended Muhlhan to friends and became a doula so she could support other women who want home births. She has worked with Muhlhan several times, though not since the midwife's suspension, she said.
Muhlhan has been advertising her services as a doula since the suspension, able to assist home births with another midwife. She has attended 500 births in 26 years, according to her website.
Muhlhan's suspension has made the task of finding a legal midwife for home births in Maryland much harder, Lynch said. Some might be resorting to illegal midwives, she said, "which isn't good for anyone, the midwives, the mothers or the babies."
"People hire midwives and doulas because they feel like they have absolutely no control over their birth experiences," Lynch said. "Women don't feel like their doctors are on their side. They get pushed into doing things they really don't want to do. They're told they have no choice."