What is Fetal Bradycardia?
Certain heart rate changes in an unborn baby are critical indicators of the baby’s health condition. The general consensus in the medical community is that a fetal heart rate (FHR) in the range of 120-160 beats per minute (bpm) is considered normal. Anything exceeding this range should be recognized as a fast heart rate (“tachycardia”), and anything below this range should be recognized as a slow heart rate (“bradycardia”). Too slow or too fast heart rates in unborn babies may pose a serious health risk.
Fetal Heart Rate Strips
Normal Fetal Heart Rate Strip
Tachycardia Fetal Heart Rate Strip
Bradycardia Fetal Heart Rate Strip
Bradycardia is the medical term to describe an abnormally low heart rate. Clinically, an unborn baby’s sustained baseline heart rate below 120 bpm is called fetal bradycardia. Fetal bradycardia is a type of arrhythmia (slow and irregular heart rhythm), which could affect the health of the fetus during pregnancy and is one of the most common indicators that the baby is suffering from fetal distress. The lower the baby’s heart rate during pregnancy, the higher the risk of a birth injury including hypoxic-ischemic encephalopathy (HIE).
In modern day medicine the baby’s heart rate prior to delivery can be monitored using an electronic fetal monitor that will show the number of beats per minute (bpm) of the baby’s heart. From the strips and screen of the monitor, obstetricians and nurses can determine if a baby is suffering from bradycardia.
Degrees of Severity in Fetal Bradycardia
- Heart rate 100 to 120 bpm: Bradycardia in this range with normal variability is commonly seen in post-term pregnancy (lasting more than 42 weeks) as well as in fetuses with transverse (baby is positioned horizontally instead of vertically across the uterus) or occiput posterior (baby is head down but facing the abdomen) presentations.
- Heart rate 90 to 100 bpm: A fetus with this degree of bradycardia has a much higher risk of suffering from hypoxia and ischemia that can lead to a birth injury. This non-reassuring pattern of bradycardia is usually seen in fetuses with myocardial conduction defects (inherited heart rhythm disturbance) or other congenital heart abnormalities or that are suffering from prolonged hypoxia.
- Heart rate 80 to 90 bpm or lower: The chances of miscarriage are very high in babies with a heart rate of less than 90 bpm. Bradycardia of less than 80 bpm which prolongs for at least three minutes is an indication of severe hypoxia and is likely to result in a severe hypoxic ischemic injury.
Causes of Fetal Bradycardia
A variety of conditions may cause fetal bradycardia. One of the causes is certain types of medications that may have been administered to the mother. Research shows that beta-blockers to treat heart conditions in pregnant women may lead to fetal bradycardia. The use of labor inducing drugs such as Cytotec and Pitocin may also contribute to this condition in the fetus. Other causes of fetal bradycardia may include:
- Uterine rupture: This condition usually occurs at the site of a previous caesarian section, when there is a tear in the wall of the uterus
- Fetal Distress: Is the general term used when baby is suffering from any ailment causing reduced or lack of oxygen (hypoxia or anoxia)
- Placental abruption: This occurs when the placenta gets separated from the uterine wall
- Umbilical cord complications: These include conditions when the umbilical cord is wrapped around the neck of the baby, when it is compressed, and when it precedes the fetus through the birth canal
- Prolonged Labor: when this occurs a baby’s fetal oxygen reserves may be depleted
- Excessively large or long contractions (“Tachysystole”) that adversely affect the baby’s oxygen levels
- Uteroplacental insufficiency: This condition occurs when the blood flow to the placenta is inadequate
- Oligohydramnios: When the amniotic fluid is too little
- Polyhydramnios: When the amniotic fluid is in excess
- Breech position: When instead of head-down, the baby is in a buttocks-first or foot-first position
- Size of the baby: When the baby’s weight is more than 9 lbs. or when the baby’s head is excessively large and may not go through the pelvis
- Maternal connective tissue disorder: Connective tissue disorders, such as systemic lupus erythematosus (SLE) in the mother may be associated with fetal bradycardia
It is critical that all babies be monitored during the labor and delivery process with electronic fetal monitoring equipment to detect whether or not bradycardia is occurring. When the cause of fetal bradycardia cannot be determined or reversed or it persists, immediate delivery is usually recommended including by emergency c-section.
Potential Consequences of Bradycardia in Babies
Fetal bradycardia that is not diagnosed or corrected well in time may lead to serious long-term effects for the baby. The fetal or neonatal outcomes may include nerve damage, brain damage, hypoxia or anoxia, paralysis, cerebral palsy, and in some instances even death.
The consequences will depend on factors such as delay in clinical diagnosis and treatment, congenital heart defects, and the baby’s gestational age. Children who survive prolonged bradycardia may still be at the risk of living with a pacemaker immediately after birth or at some later stage in life.
Failure of medical providers to perform continuous fetal heart rate monitoring, failure to notice abnormalities in heart rate, incorrect installation of the FHR monitoring device, misreading of the fetal heart rate strips, and incorrect or delayed treatment when fetal distress is detected are some of the preventable factors that could make a critical difference to the baby’s health status and survival.
Types of Fetal Bradycardia
Fetal bradycardia is clinically classified into several types, including sinus bradycardia, blocked premature atrial contractions, and atrioventricular heart block. The medical team can diagnose the specific fetal bradycardia based on the echocardiogram (ECHO) measurements and atrioventricular (AV) conduction patterns.
“Atria” are the heart’s upper chambers and “ventricles” are the lower chambers. When electrical signals that produce heartbeat do not travel normally from the upper to the lower heart chambers, the condition is known as a heart block.
Sinus Bradycardia
- Transient Sinus Bradycardia: Brief bradycardia episodes lasting one to two minutes that are often physiologic and occur because of increased vagus nerve stimulation (VNS) are termed as transient sinus bradycardia. (Vagus nerve in the nervous system controls the heartbeat.) This condition is typically observed in second trimester when the fetal nervous system is relatively immature.
- New-onset Sinus Bradycardia: This condition may indicate urgent delivery because of severe hypoxia and fetal distress. New-onset sinus bradycardia may occur as a result of uterine rupture, placental abruption, umbilical cord prolapse, and fetal hemorrhage.
- Sinus Node Dysfunction: Sinus node is located in the right upper heart chamber, and it controls the heart rhythm. Sinus node dysfunction may occur because of a mal-positioned sinus node which functions at a slow rate (generally between 80 to 120 bpm). This condition is typically seen in babies with structural heart disease, which may disturb the node location.
Blocked Premature Atrial Contractions
When ectopic beats (skipped or extra heartbeats) prematurely arise from a location other than the sinus node, the fetal heart arrhythmia may be described as blocked premature atrial contractions. The “missed” heartbeats occurring from this condition could manifest as fetal bradycardia.
The diagnosis may become complex when the ectopic heartbeats occur at a regular rate, resulting in a “regularly irregular” heart rhythm. The medical providers should carefully differentiate these blocked premature atrial heartbeats from AV heart block condition because of the prognosis and treatment will change according to the diagnosis.
Atrioventricular (AV) Heart Block
Congenital heart block (CHB) or AV heart block is one of the commonly occurring forms of fetal bradycardia. This condition can lead to developmental delays or even intrauterine death. Up to 70% of the babies with this condition will require a pacemaker after birth, while the fetal death rate associated with AV heart block is 19%.
Fetal CHB is generally diagnosed during pregnancy at around 18 to 24 gestational weeks using fetal echocardiogram (ECHO) techniques. It’s noteworthy that congenital heart block condition is usually dynamic. Some babies may exhibit a normal or first-degree atrioventricular interval (gap between heartbeats) during initial pregnancy screening, which may later develop into second-degree or complete heart block.
Babies with severe CHB will show a substantially lower heart rate of 50 to 70 bpm. In these cases, the risk of intrauterine death, fetal heart failure, abortion, premature delivery, and edema is high. According to the available clinical evidence, this form of fetal bradycardia is associated with the placental transfer of maternal antibodies (Ro and La antibodies), which causes heart tissue damage.
Diagnosing Fetal Bradycardia
Early diagnosis as well as differential diagnosis (differentiating between two conditions with similar symptoms) is vital to plan for treatment strategies or immediate delivery.
Internal Fetal Monitoring (IFM)
Internal fetal heart monitoring may be used during labor when the cervix is open and the amniotic sac has broken. The medical team will put a thin electrode on the baby’s scalp through the cervix. One end of the electrode is connected to a monitor.
Readings obtained with this method are more reliable, and may prove useful when the external monitoring fails to provide a concrete measurement. Medical providers should monitor the baby’s heart rate and the mother’s uterine contractions together and compare the results for a more accurate diagnosis.
It should be noted though that external fetal monitoring should be instituted as soon as an expectant mother is admitted with labor. This type of electronic fetal monitoring will provide important information about the fetal heart rate during the early stages of labor.
Fetal Echocardiogram
Fetal echocardiogram (fetal echo) can establish the fetal bradycardia diagnosis. It is performed to evaluate the fetal heart structure and diagnose potential structural defects. To identify the specific form of fetal bradycardia, the medical team should assess the cardiac conduction pattern. (The heart conduction system includes conducting fibers and cardiac muscle cells that initiate impulses and conduct them rapidly through the baby’s heart).
Fetal echocardiography is quite similar to an ultrasound test. It helps the medical providers see the heart’s structure and function in the unborn baby. This exam is usually done between 18 and 24 gestational weeks (in the second trimester). The test utilizes sound waves, which produce an “echo” off the fetal heart structures.
An analysis of the echocardiogram images can provide useful information about how the fetal heart was formed and how it is functioning. A detailed look at the fetal echo images will also help the medical team identify any abnormalities in the blood flow through the fetus’s heart (which may cause abnormal heartbeat).
Fetal Ultrasound
A Doppler ultrasonography is a non-invasive test used in the diagnosis of fetal bradycardia. Unlike the standard ultrasound test, which cannot show the blood flow, a Doppler ultrasound can estimate the blood flow through the baby’s blood vessels. It bounces ultrasound waves (high-frequency sound waves) off the circulating RBCs (red blood cells) to indicate congenital heart disease, heart valve defects, and fetal bradycardia.
Diagnosing fetal bradycardia is of paramount importance because it may reveal fetal distress and the need for immediate delivery in order to prevent fetal mortality. Abnormal ultrasound findings (a low fetal heart rate of less than 100-120 bpm) could be an early indicator of potential miscarriage.
Laboratory Studies
Lab tests are essential to diagnose congenital AV heart block type of fetal bradycardia. Two antibody tests in this regard are anti-Ro (SSA) and anti-La (SSB) tests. These tests identify the presence of maternal anti-Ro and anti-La antibodies, which are associated with the third-degree AV block (congenital heart block or CHB), which is a potentially fatal condition for the fetus.
When the mother has a maternal connective tissue disorder, the fetus is a higher risk of developing CHB. Nine out of 10 mothers with fetuses with CHB will test positive for anti-Ro and anti-La antibodies.
Management of Fetal Bradycardia
Antepartum Management
Antepartum (before birth) management should focus on the specific form of fetal bradycardia that has been diagnosed.
- Fetal Sinus Bradycardia: If the condition results from hypoxia or fetal distress, urgent delivery is recommended. If the sinus bradycardia continues after birth (pediatric sick sinus syndrome), use of defibrillators and/or pacemakers, and beta blockers are potential treatments for children.
- Congenital Heart Block (CHB): When a fetal structural heart condition is diagnosed, it is not possible to treat it in-utero. However, certain therapeutic strategies may be used, such as intravenous immunoglobulin (IVIG 400 mg/kg), fluorinated steroids (dexamethasone 4 mg per day), beta blockers (to improve fetal heart rate in cases of CHB), and in recent years, hydroxychloroquine.
Intrapartum Management
When fetal bradycardia occurs, nurses and doctors must immediately take actions to correct the bradycardia. During the period from the onset of labor through the delivery of placenta, if diagnostic tests reveal that the fetal sinus bradycardia has occurred because of fetal distress or hypoxia, then urgent delivery may be clinically indicated.
Intrapartum fetal monitoring is critical to identify bradycardia events that could lead to hypoxic ischemic encephalopathy (HIE), cerebral palsy, brain injury, fetal distress or, even fetal mortality. Continuous electronic fetal monitoring (EFM) and intermittent auscultation (IA, a technique to listen and count the fetal heart rate) can help the medical team decide on an emergent cesarean delivery or an instrumental vaginal delivery. Timely action may reduce the risk of neonatal seizures, cerebral palsy, and neonatal death.
Interpreting the FHR Strips
One of the challenges with continuous EFM is the absence of standardized methods of interpreting fetal heart rate (FHR) tracings or patterns. The following approach should be considered for more accurate interpretation and effective intrapartum management in case of fetal bradycardia:
- Risk Determination: Determine the clinical risk status of the fetus along with the interpretation of the EFM readings. If the risk status of the baby increases during labor (for instance, a bacterial infection such as chorioamnionitis is diagnosed), the fetal heart monitoring should be changed from intermittent auscultation (IA) to continuous EFM.
- Uterine Contractions: The intrauterine pressure tracing should be reviewed prior to evaluating the fetal tracing in order to correctly interpret decelerations (drop in fetal heart rate). External fetal monitoring may not be adequate to accurately measure the strength of contractions, so an intrauterine pressure catheter should be used to measure the frequency and amplitude of contractions.
- Baseline Rate: The normal FHR baseline rate is considered to be 110 to 160 bpm. If a change in this range continues for at least 10 minutes, a change in baseline rate is said to occur. A baseline of 100 to 110 bpm (mild bradycardia) is associated with post-term babies and with occipitoposterior position (back of the baby’s skull is in the back of the mother’s pelvis). Rates below 100 bpm may be observed in babies with congenital heart defects. A baseline above 160 bpm is called tachycardia.
- Variability: The fetal heart rate will usually show variability of 6 to 25 bpm from the baseline rate. This variation is related to the baby’s central nervous system (CNS), which makes it is a critical indicator to determine the overall fetal status. Variability must be appropriately classified according to the Fetal Heart Rate strips amplitude as: absent, minimal, moderate, or marked variability.
A normal reduction in FHR variability may occur during sleep cycles of 20 to 40 minutes. Certain medications, such as anesthetics, analgesics, or barbiturates may also reduce variability. Variable or late decelerations accompanied by loss of variability will increase the risk of fetal acidosis, if left untreated.
Decelerations
Periodic fluctuations in fetal heart rate, as they correlated to contractions, are called decelerations. If in a 20-minute period, the decelerations occur with at least 50 percent of uterine contractions, they are classified as recurrent. When they occur with lower than 50 percent of uterine contractions, they are classified as intermittent. The reduction in FHR is estimated from the onset to the lowest point of the deceleration.
Management of Abnormal FHR Tracings
When the fetal heart rate measurements are interpreted as abnormal, the medical team should consider urgent interventions, such as change of position, maternal oxygenation, and IV fluid administration. If the continuous electronic fetal monitoring readings are indeterminate, a fetal scalp stimulation test may be used to determine the potential existence of fetal acidosis.
In the event of persistently abnormal FHR tracings, an urgent operative vaginal or cesarean delivery may be recommended. Umbilical cord blood analysis should be performed after such delivery (resulting from abnormal FHR interpretation). This is because the presence of fetal acidosis is one of the key criteria to determine an intrapartum hypoxic-ischemic encephalopathy (HIE) event, which may lead to cerebral palsy.
Summary of Intrapartum Interventions
In the event of abnormal electronic fetal monitoring tracings, the following interventions are recommended:
- Change the maternal position
- Evaluate maternal vital signs (pulse, blood pressure and temperature)
- Discontinue Pitocin (Oxytocin) infusion, if any
- Initiate oxygenation at 6 to 10 LPM (liters per minute)
- Carry out a vaginal examination (to determine umbilical cord prolapsed, vaginal bleeding indicative of placental abruption, or rapid descent of the fetal head)
- Administer IV fluids, if not given already
- Perform fetal scalp stimulation test
- Administer amnioinfusion (instilling of fluid into amniotic cavity) in case of variable and recurrent decelerations
- Assess the need for urgent cesarean or operative vaginal delivery
Postpartum Management
In the postpartum phase (after the delivery) any medical therapy that was started to treat the fetus must be discontinued. If the mother is diagnosed with maternal connective tissue disorder (which may have caused fetal bradycardia) she should be advised to follow up with a rheumatologist or her primary care physician in the postpartum phase for medical care.
Is Your Child’s Fetal Bradycardia the Result of Medical Malpractice?
Parents whose children suffer from cerebral palsy, developmental delays or hypoxic-ischemic encephalopathy caused by fetal bradycardia related complications deserve an answer to how their child developed this condition and whether the complications resulting from it were preventable. Was there evidence on the electronic fetal monitoring strips that the doctors and nurses failed to recognize or respond to? Was there a prolonged bradycardia that required an emergency c-section that was not performed or unreasonably delayed? Our dedicated birth injury lawyers want to help you find those answers and obtain monies necessary to purchase devices that can help improve the quality of your child’s life.
Fetal bradycardia may be an indication of fetal distress or hypoxic-ischemic-encephalopathy (HIE), which is a brain injury resulting from birth asphyxia or oxygen deprivation to the brain. HIE is the leading cause of cerebral palsy.
If your child has been diagnosed with fetal bradycardia related injury, and you suspect this may have been caused in part by medical mistakes, Miller Weisbrod Olesky will thoroughly investigate the facts and hold responsible medical providers accountable by pursuing medical malpractice claims against them. The compensation our clients receive helps them pay for their child’s current and future medical treatment and devices such as defibrillators and/or pacemakers to help child adjust to living with a heart condition, and to be able to pay for these cutting-edge devices.
Sometimes families are hesitant to reach out to a medical malpractice attorney or law firm. Other parents feel overwhelmed by their circumstances and worried that they will not be able to help out in a lawsuit involving their child’s birth injury.
Miller Weisbrod Olesky is different from most law firms.
We provide help NOW.
Many attorneys focus only on pursuing their client’s legal case. At Miller Weisbrod Olesky, we know your child needs help today – not just when your birth injury lawsuit is settled. We have a team focused on helping our clients NOW when they need it most.
We know that children with birth injuries like hypoxic-ischemic encephalopathy (HIE) and cerebral palsy often require intense therapy, specialized medical treatment, and assistive care. The stress of providing for a birth injured child’s needs can be both emotionally and financially draining.
But just ‘knowing’ this is not enough. We act on this knowledge by providing exceptional services to birth-injured children and their families.
While Miller Weisbrod Olesky’s birth injury attorneys aggressively prepare each legal case, another department goes into action to help the families of children we represent. Led by a nurse-attorney, this department acts as a medical case manager for our birth injury clients by:
- Regularly monitoring the child’s medical treatment status,
- Helping facilitate medical treatment and therapy, and
- Arranging transportation and services.
Where necessary, we also help families locate local medical providers specializing in the care and treatment of children who have suffered a birth injury. With Miller Weisbrod Olesky, you’re not just a ‘case’. And that’s important when you’re looking for a lawyer who can help you cope with your child’s needs today.
Please call or email our birth injury attorneys today to get started.
Registered Nurses and Nurse-Attorneys Are a Vital Part of Our Birth Injury Team … and Yours
Most national birth injury law firms will employ one or two nurses to assist the review of cases and medical research. But Miller Weisbrod Olesky offers an unmatched number of nurses and nurse-attorney employees support to both the birth injury attorneys and our clients.
Our team of registered nursing staff and nurse-attorneys bring a deep level of medical and personal insight to every client’s case. Our nursing team includes both an experienced labor and delivery nurse as well as an ICU nurse. Working closely with the rest of the team, they investigate the reasons behind a birth injury and how medical professionals breached their standard of care.
Meet our Legal Nursing Team
Linda Chalk
As a registered nurse, Linda practiced ICU nursing for 44 years while caring for a wide range of patient conditions. She has worked closely with founding partner Les Weisbrod for over 30 years, investigating and pursuing birth injury cases.
Along with DJ Weisbrod, Linda heads up the firm’s birth injury intake, screening, and medical literature research team. She personally screens all potential cases to ensure that medical issues have been addressed before we file lawsuits on behalf of birth-injured children and their families.
DJ Weisbrod
Before joining Miller Weisbrod, DJ practiced as a surgical nurse in various hospital and operative settings. She has been with the firm over 30 years.
DJ directs Miller Weisbrod’s birth injury intake and medical screening team. She has also served as firm founder Les Weisbrod’s trial nurse for all cases involving medical negligence and birth injury.
Linda Cuaderes
Linda Cuaderes is both a registered nurse and a licensed lawyer. Linda works exclusively in Miller Weisbrod’s Birth Injury and Medical Malpractice section. Linda acts as the firm’s patient advocate and liaison with our young clients and their parents.
Linda combines her legal and nursing experience along with her exceptional organizational talent and attention to detail to make sure each child we represent is provided the highest level of medical care and attendant care during the pendency of their case. Linda communicates with our parent clients regularly to monitor their birth injured child’s treatment, provide guidance as to additional care and therapies and when necessary assist them in obtaining specialized medical providers.
Linda was raised in Bartlesville, Oklahoma and completed her Bachelor of Science in Nursing with Honors at the University of Oklahoma. She started as an Oncology Nurse at Presbyterian Hospital in Oklahoma City, quickly becoming the Assistant Head Nurse of the Outpatient Endoscopy Unit. Linda then entered the University of Oklahoma College of Law.
Following graduation, Linda joined Les Weisbrod in the Medical Malpractice Section. After taking time off to raise her three lovely children, Linda returned to Miller Weisbrod and her passion of holding healthcare providers accountable for preventable errors. Linda is active in the American Association for Justice, Texas Trial Lawyers Association, Dallas Trial Lawyers Association, and the Texas Bar Association. Linda is an active member of the Birth Trauma Litigation Group and Medical Negligence Section of the American Association for Justice.
She is admitted to practice before the Texas Supreme Court and routinely works on cases pending throughout the United States. Linda has worked with child victims of birth injury, their parents and other victims of medical malpractice in Texas, New Mexico, Oklahoma, Arkansas, Louisiana, Iowa, Ohio, New York, Alabama, Georgia, Arizona, Utah and Missouri.
Education
- University of Oklahoma - School of Law, 1990, J.D. - Norman, Oklahoma
- University of Oklahoma - School of Nursing, 1985 - Norman, Oklahoma
Areas of Practice
- Birth Injury/Birth Trauma
- Medical Malpractice
Associations & Memberships
- Texas Bar Association
- American Association of Justice
- Texas Trial Lawyers Association
- Dallas Trial Lawyers Association
Kristin Jones
Kristin combines her medical and legal training to provide invaluable, passionate service to parents struggling to care for their birth-injured children.
Families often have questions as they go through the birth injury lawsuit process. Kristin diligently identifies and investigates all medical issues so the birth injury attorneys at Miller Weisbrod can answer those questions Kristin ensures that our birth injured children’s medical records are thoroughly reviewed and organized. Miller Weisbrod’s birth trauma litigation attorneys and medical experts retained by the firm need her services while pursuing justice for our clients.
Kelly Kunkel
Kelly Kunkel was born and raised in Dallas, Texas. She has 15 years’ experience in hospital based High Risk Obstetrics and Labor and Delivery bedside nursing care. Kelly graduated with an Associate’s Degree in Nursing from El Centro College in December of 1990 and received her Bachelor’s Degree in Nursing from West Texas A & M University in 2008; graduating with honors.
In addition, Kelly has over 25 years’ experience in medical malpractice case management and litigation and has worked with David Olesky for over 22 years. After many years of assisting in defending healthcare providers and hospital systems in medical malpractice cases involving complex litigation matters related to birth injury, catastrophic injury and death, Kelly has proudly joined David Olesky in the national birth injury and medical negligence practice at Miller Weisbrod Olesky.
Why Should You Talk with the Knowledgeable Attorneys at Miller Weisbrod Olesky?
The only way to find out if you have a birth injury case is to talk to an attorney who understands birth injuries leading to a delay or failure in developmental milestones including birth injuries that cause cerebral palsy. Many times fetal bradycardia is a preventable birth injury, but it takes a detailed expert review of the facts and circumstances of your child’s birth to determine the birth injury was the result of medical malpractice.
At Miller Weisbrod Olesky, a team of committed attorneys, nurses and paraprofessionals uses our detailed medical negligence case review process to assess your potential birth injury case. We start by learning more about you and your child and the status of meeting/missing developmental milestones. Then we gather medical records to determine what happened before, during, and after your delivery. We call in skilled medical experts who review your records and let us know if they think medical errors could have caused your child’s injuries.
If we feel medical negligence caused or contributed to your child’s injuries, we meet with you to discuss how you can receive compensation from the medical professionals who made the errors.
At no point in our legal intake process will we ask you to pay anything. The medical review of your case and the consultation are free. We only receive payment when you do.
Contact Our National Birth Injury Lawyers
Our Birth Injury Attorneys
Les Weisbrod
Les Weisbrod has been on the cutting edge of the national birth injury litigation scene for almost 40 years.
As a national birth injury attorney, Les has settled over 204 medical negligence cases for more than $1,000,000. He also obtained settlements in 75 birth injury cases for over $1,000,000 each.
His $31 million verdict against Baylor University Medical Center in Dallas was one of the top 100 verdicts in the United States that given year.
Les is recognized nationally and internationally as one of the top plaintiff’s medical malpractice trial lawyers in the United States. But the recoveries for the clients and the differences made in the lives of the children and families Les has represented tell only part of the story.
Les has worked with his law partner Clay Miller for years to build a one-of-a-kind law firm.
Miller Weisbrod Olesky provides unique and unparalleled services to families of birth-injured and brain-injured children from the moment the firm decides to take the case.
The registered nurses and registered nurse-attorneys on staff are valuable team members who assist Miller Weisbrod birth-injury clients. Les has designed a system where each birth injured child is assigned a nurse-attorney liaison to guide them through the process of medical treatment/evaluation, therapies, home assistance, and quality of life improvement.
Miller Weisbrod’s unmatched service allows families to better cope with the immediate challenges facing our young clients.
Birth-injured children and their families are Les and Miller Weisbrod’s priority.
Les and the attorneys at Miller Weisbrod fight for the justice their clients are entitled to under our nation’s system of justice.
This fighting spirit has taken Les across the United States to represent clients in birth injury and medical negligence cases. In fact, he has personally handled cases not only in Texas but also in Arkansas, Arizona, Colorado, Oklahoma, Louisiana, Utah, Iowa, Ohio, Oregon, Montana, Alabama, Georgia, Florida, and New York.
Les and Miller Weisbrod continue to expand their reach of helping brain-injured children to new states each year as we strive to bring a sense of justice to each affected family. And Les is not the only one who notices he fights for his clients.
Michael Rustad, a Professor of Law at Suffolk University Law School in Boston who has done extensive research on punitive damage awards, says,
“Les Weisbrod has obtained more medical malpractice punitive damage jury verdicts for his clients than any other attorney in the United States.”
Also, a well-known defense medical malpractice attorney dubbed Les Weisbrod the “pitbull” of the Texas medical malpractice bar in a media profile of Les published by a major newspaper.
Les shares his experience and knowledge to improve the representation of all birth-injured children and their families.
In the early 1990s, Les recognized that a more focused effort needed to be made to educate attorneys who handle birth injury cases. As a result, Les was the founding Co-Chair of the American Association for Justice (AAJ) Birth Trauma Litigation Group in 1991. He also was a founding Co-Chair of AAJ’s Medical Negligence Litigation Group in 1999 and served as Chair of AAJ’s Professional Negligence Section in 1996.
Combined, these groups have put on more than a hundred continuing education seminars across the United States. helping to educate other attorneys by bringing in world-renowned experts in the fields of:
- labor and delivery
- neonatal care
- the care and treatment of birth-injured children, including those suffering from cerebral palsy and hypoxic-ischemic encephalopathy (HIE)
Education and professional experiences back up his dedication to helping children and families harmed by medical malpractice.
Les received his B.A. magna cum laude in 1975 from Claremont Men’s College and his J.D. in 1978 from Southern Methodist University Law School.
He is Board Certified by the Texas Board of Legal Specialization in Personal Injury Trial Law and Civil Trial Law.
Les was a past president of the Dallas Trial Lawyers Association in 1993. He has been a member of the Texas Trial Lawyers Association Board of Directors since 1990.
His work with the American Association for Justice (AAJ) (formerly ATLA) includes serving as President, President-Elect, Vice President, Secretary, Treasurer, and Parliamentarian. Mr. Weisbrod has also served on the AAJ Board of Governors since 1998 and the 17-member Executive Committee of AAJ since 2001. In 1990, he was chosen as a Rising Star of the ATLA and presented a paper entitled “Dirt and Greed: A New Look at Medical Malpractice Cases.”
Les has written and lectured extensively on birth injury litigation, medical malpractice, and medical product topics.
Les is a contributing author to the 1996 text Operative Obstetrics published by Williams & Wilkins. He also co-authored the “Drugs & Medical Devices” chapter in AAJ’s Litigating Tort Cases.
He also has lectured to lawyer groups across the U.S., Canada, England, and Australia.
Education
- Southern Methodist University - School of Law, J.D. - Dallas, Texas, 1978
- Claremont Men's College - B.A. - Claremont, California, 1975
Areas of Practice
- Medical Malpractice
- Birth Injury/Birth Trauma
- Products Liability
- Personal Injury
Associations & Memberships
- State Bar of Texas
- National Association Of Distinguished Counsel
- Million Dollar Advocates Forum
- Multi-Million Dollar Advocates Forum
- American Association for Justice
- Texas Trial Lawyers Association
- Dallas Trial Lawyers Association
- Pan-European Organization of Personal Injury Lawyers
- American Society of Law and Medicine
- Consumer Attorneys of California
- Arkansas Trial Lawyers Association
- Louisiana Trial Lawyers Association
- Dallas and American Bar Associations
- ABOTA (American Board of Trial Advocates)
Clay Miller
Clay is Board Certified in Personal Injury Trial Law by the Texas Board of Legal Specialization. Clay has practiced solely in the field of catastrophic injury and wrongful death since graduating from law school. His practice has been limited to the representation of victims. Over the past twenty-four years, Clay has successfully settled or tried to verdict cases in the areas of vehicular negligence, medical malpractice, construction site accidents, workplace injury, premises liability, and commercial trucking and a nationwide business loss case (suits filed in a dozen different states) involving defective truck engines sold to trucking companies.
Clay represented dozens of trucking companies in lost profit and diminished value claims against Caterpillar in 2010 through 2012. These cases were filed in over a dozen states with the bellwhether trial set in Federal Court in Davenport, Iowa. After intense litigation and trial preparation, a global confidential settlement was reached for all the clients.
Clay's most recent 2017 victories are a $30,800,000 jury verdict in Tennessee arising from fraud claims in the sale of heavy-duty truck engines and a $26,500,000 jury verdict in a construction accident, obtained within 60 days of each other.
Clay was raised in Lewisville, Texas and completed his undergraduate degree in Finance at
Texas A & M University. Following graduation from Southern Methodist University School of law, Clay worked for two Dallas firms representing victims. In 1998, Clay began his own practice before forming his current partnership. In addition to his law practice, Clay has lectured at seminars and published in the areas of construction accidents, jury selection techniques, medical negligence, trucking accidents and settlement tactics.
He is active in local and statewide trial lawyers' associations including serving as the Chair of the Advocates for the Texas Trial Lawyers' Association in 2002 and remains on the Board of Directors. Clay served as President of the Dallas Trial Lawyers Association from 2008-2009. He has also been a member of the American Board of Trial Advocates (ABOTA) since 2014.
Education
- Southern Methodist University School of Law - Dallas, Texas
- Texas A&M University - Finance - College Station, Texas
Areas of Practice
Associations & Memberships
- State Bar of Texas
- State Bar of New Mexico
- State Bar of Colorado
- American Board of Trial Advocates (ABOTA)
- Texas Trial Lawyers Association
- Dallas Trial Lawyers’ Association
- American Association of Justice
David Olesky
David Olesky is Vice Chair of the Health Care Professional Liability practice. David is a trial lawyer focusing his practice on complex litigation matters that involve defending and protecting clients in all types of cases related to catastrophic injuries or death, but with a special focus on birth injury cases. David regularly advises his health care clients on the issues and challenges that they face on a daily basis. Clients repeatedly look to him for guidance to handle such high stakes cases and matters in Texas and jurisdictions outside of Texas.
David has earned the trust and reliance of clients he has worked with by consistently getting the results that matter most to them, whether that is a win at trial or a favorable outcome through alternative dispute resolution outside the courthouse. Through his representation, David demonstrates a true loyalty and hardworking commitment to the clients that he serves.
David believes the foundation of any client relationship is to act as a trusted advisor instead of simply as a litigator. Clients value his earnest representation of their business interests, accompanied by a devotion to understanding their businesses, prompt attention to their immediate needs and the challenges they face in their individual roles.
Education
- Southern Methodist University Dedman School of Law, J.D., 1992 - Dallas, Texas
- University of Texas, B.B.A, 1989 - Austin, Texas
Areas of Practice
Associations & Memberships
- American Bar Association
- Dallas Bar Association
- Dallas Bar Foundation Fellow
- Texas Bar Association
Alexandra V. Boone
Alexandra Boone is a partner in Miller Weisbrod. She concentrates her legal practice in the area of birth injury, medical malpractice and mass tort products liability. Alex currently works directly with firm partner Les Weisbrod in managing the birth injury docket and working with the firm’s highly qualified expert witnesses in the review of potential cases. Alex also litigates her own docket of medical negligence cases.
Over the course of her 17 years with the firm, Alex has focused on the administration and prosecution of mass tort litigation, originally focusing on occupational toxins, but more recently in the area of pharmaceuticals and medical devices. In the past, she has actively pursed cases involving hormone therapy medications. Alex was also instrumental in our firm successfully resolving thousands of cases transvaginal mesh, hip prosthetics, and blood thinner medications. She is actively prosecuting over 1,000 cases.
In addition to being a member of the Texas bar, she is also licensed in Oklahoma and is a member of the American Association of Justice, Texas Trial Lawyers Association, Oklahoma Association of Justice and the Dallas Trial Lawyers Association.
Education
- Baylor University - School of Law, 1996, J.D. - Waco, Texas
Areas of Practice
- Products Liability
- Mass Tort
Associations & Memberships
- State Bar of Texas
- American Association of Justice
- Texas Trial Lawyers Association
- Oklahoma Association of Justice
- Dallas Trial Lawyers Association
Pro Bono Activities
- East Texas Legal Services/Nix Law Firm Pro Bono Project, 1996 - 1997
Robert Wolf
Robert E. Wolf was born in Dallas, Texas and graduated Magna Cum Laude as a proud horned frog from Texas Christian University in 1997, with Bachelor of Science degree in Political Science and was inducted into Phi Beta Kappa and Mortar Board. He obtained his law degree from Southern Methodist University in 2000 while serving as an Articles Editor for the International Law Review and winning awards at Mock Trial and Appellate competitions.
Robert has been named a Thomson Reuters | Texas Super Lawyers Rising Star (less than 2.5% of attorneys in Texas receive this distinction) in 2011, 2012, 2013, 2014, and 2015. Further, Robert was recognized as a National Trial Lawyers Top 40 Under 40 attorney for Texas in 2012 (no more than 40 attorneys in Texas are eligible for this award annually).
Robert brought his passion for and over 14 years of experience of representing seriously injured individuals and their families to Miller Weisbrod in January 2015, and has concentrated his legal practice in the area of medical malpractice, products liability, and pharmaceutical/mass tort litigation. He is a member of the State Bar of Texas, American Association for Justice, Texas Trial Lawyers Association, and Dallas Trial Lawyers Association.
In addition to many successful jury verdicts and settlements across Texas, Oklahoma, Iowa, Wisconsin, and Idaho, Robert’s role as an attorney representing victims and their families has led to numerous changes to key safety practices and policies and procedures at corporations and medical facilities.
Robert and his wife Suzy also get plenty of exercise trying to keep up with their precious and very active daughter.
Education
- Southern Methodist University - Dedman School of Law, J.D. - 2000 - Dallas, Texas
- Texas Christian University - B.S. Political Science - 1997 - Fort Worth, Texas
Areas of Practice
- Medical Malpractice
- Personal Injury
- Products Liability
Associations & Memberships
- State Bar of Texas
- American Association of Justice
- Texas Trial Lawyers Association
- Dallas Trial Lawyers Association
Carrie Vine
Carrie Lynn Vine has over 15 years of experience in medical malpractice litigation, with a particular focus in representing children and families who have suffered birth injuries as a result of the negligence of either doctors, nurses or hospitals.
She is a passionate advocate for her clients and has handled hundreds of birth injury and birth trauma cases throughout the United States. As part of Carrie’s national birth injury legal practice, she has handled cases in Texas, Arkansas, California, Nevada, Kentucky, Georgia, Illinois, Wisconsin, Ohio, Pennsylvania, North Carolina, South Carolina, Florida, and North Dakota. She is determined to seek justice and works to obtain fair compensation for the children and families she represents.
Carrie earned her law degree from Northern Illinois University where she tutored other law students. Prior to law school, she received her undergraduate degree from the University of Notre Dame in Biomedical and Biological Science, and earned both a Master’s Degree and a Ph.D. from The Pennsylvania State University in Anthropological Genetics. She then conducted post-doctoral research at the University of Michigan Medical School before deciding to attend law school. She applies an academic mindset and love of science and medicine to mastering the medical principles and literature relevant to the cases she pursues.
Carrie is an active member of the American Association of Justice as well as the Birth Trauma Litigation Group (BLTG).
Education
- Northern Illinois University:
Law School
- University of Notre Dame:
Biomedical Science
- Pennsylvania State University:
Anthropological Genetics
Areas of Practice
- Birth Injury/Birth Trauma
- Medical Malpractice
Associations & Memberships
- American Association of Justice:
Member
- Birth Trauma Litigation Group:
Member
Larry Lassiter
Lawrence R. Lassiter is an AV-rated attorney with more than twenty years of experience in appellate and trial advocacy. He has been consulted by attorneys across the country to conduct research, evaluate cases, prepare appellate and trial briefs, and formulate litigation strategy. He has prepared hundreds of appellate briefs in federal and state appellate courts, including the highest courts of Texas, West Virginia, Georgia, Oklahoma, Ohio, Nebraska and Tennessee, and he is member of the Bar of the United States Supreme Court. Larry has a national appellate and legal briefing practice. Larry has filed extensive briefs and/or argued before either state or federal courts in 30 out of 50 states in his career.
Larry assists the Birth Injury team in all aspects of legal briefing. Unlike many other birth injury firms across the United States, Miller Weisbrod has an attorney dedicated to handling legal briefing on behalf of our clients across the country. Larry has handled extensive briefing in birth injury and other medical malpractice cases in Texas, New Mexico, Arkansas, Oklahoma, Iowa, Ohio, Alabama, Georgia, New York, Utah, Arizona, Louisiana and West Virginia.
Since joining Miller Weisbrod in 2010, Larry has won a number of important victories vindicating the rights of our clients in both state and federal appellate courts, including Vitacost.com, Inc. v. McCants, 210 So.3d 761 (Fla. Ct. App. 2017); TTHR Ltd. Partnership v. Moreno, 401 S.W.3d 41 (Tex. 2013); In re E.B., 729 S.E.2d 271 (W. Va. 2012); Mid-Continent Cas. Co. v. Davis, 683 F.3d 651 (5th Cir. 2012); Rouhani v. Morgan, 2017 WL 3526719 (Tex. App. – Houston [1st Dist.] 2017, no pet.); Mid-Continent Cas. Co. v. Andregg Contracting, Inc., 391 S.W.3d 573 (Tex. App. – Dallas 2012).
He was as a judicial clerk for the Honorable Harlington Wood Jr., Circuit Judge, United States Court of Appeals for the Seventh Circuit. Larry was a University of Iowa Presidential Scholar and served as Editor in Chief of the Iowa Law Review.
Larry is an active member of the American Association for Justice. He is a member of AAJ’s Birth Injury Litigation Group and Medical Negligence Sections.
Education
- University of Iowa - Political Science & History - B.A. - Iowa City, Iowa
- University of Iowa - School of Law - J.D. - Iowa City, Iowa
Areas of Practice
- Appellate Advocacy
- Medical Malpractice
- Pharmaceuticals & Medical Devices
- Products Liability
- Personal Injury
Associations & Memberships
- State Bar of Texas
- American Association of Justice
- Texas Trial Lawyers Association
- Dallas Trial Lawyers Association
Laurie Pierce
Laurie draws upon extensive experience in state and federal courts with a focus on complex claims involving medical malpractice cases. After many years of defending health care providers and hospital systems in medical malpractice cases, Laurie joined David Olesky in the national birth injury and medical negligence practice at Miller Weisbrod Olesky.
Laurie’s focus is to understand not only the facts and circumstances of the matter at hand, but to understand the specific needs and goals of the client and their unique business considerations. Her extensive background in commercial litigation provides a foundation that enhances her health care litigation practice. She works with clients that require more than a strong trial lawyer; they expect an attorney who understands the relationship between law and their specific business and who will work tirelessly to protect their rights, interests and bottom line.
Education
- Southern Methodist University:
Dedman School of Law - 1992
- Order of the Coif:
Journal of Air Law and Commerce, J.D. - 1992
- Miami University-Oxford, Ohio
B.S. Education - 1982
Areas of Practice
- Birth Injury/Birth Trauma
- Health Care Industry
- Health Care Litigation
- Litigation and Dispute Resolution
- Medical Malpractice
Associations & Memberships
- American Association for Justice
- American Bar Association
- Dallas Bar Association
- Dallas Bar Foundation Fellow
- Texas Bar Association
Distinctions
- Admitted to Pro Bono College of State Bar of Texas in 2019 for outstanding delivery of legal services to low-income Texans
Court Admissions
- United States Supreme Court
- U.S. District Court, Eastern District of Texas
- U.S. District Court, Northern District of Texas
- U.S. District Court, Southern District of Texas
- U.S. District Court, Western District of Texas
Linda Cuaderes
Linda Cuaderes is both a registered nurse and a licensed lawyer. Linda works exclusively in Miller Weisbrod’s Birth Injury and Medical Malpractice section. Linda acts as the firm’s patient advocate and liaison with our young clients and their parents.
Linda combines her legal and nursing experience along with her exceptional organizational talent and attention to detail to make sure each child we represent is provided the highest level of medical care and attendant care during the pendency of their case. Linda communicates with our parent clients regularly to monitor their birth injured child’s treatment, provide guidance as to additional care and therapies and when necessary assist them in obtaining specialized medical providers.
Linda was raised in Bartlesville, Oklahoma and completed her Bachelor of Science in Nursing with Honors at the University of Oklahoma. She started as an Oncology Nurse at Presbyterian Hospital in Oklahoma City, quickly becoming the Assistant Head Nurse of the Outpatient Endoscopy Unit. Linda then entered the University of Oklahoma College of Law.
Following graduation, Linda joined Les Weisbrod in the Medical Malpractice Section. After taking time off to raise her three lovely children, Linda returned to Miller Weisbrod and her passion of holding healthcare providers accountable for preventable errors. Linda is active in the American Association for Justice, Texas Trial Lawyers Association, Dallas Trial Lawyers Association, and the Texas Bar Association. Linda is an active member of the Birth Trauma Litigation Group and Medical Negligence Section of the American Association for Justice.
She is admitted to practice before the Texas Supreme Court and routinely works on cases pending throughout the United States. Linda has worked with child victims of birth injury, their parents and other victims of medical malpractice in Texas, New Mexico, Oklahoma, Arkansas, Louisiana, Iowa, Ohio, New York, Alabama, Georgia, Arizona, Utah and Missouri.
Education
- University of Oklahoma - School of Law, 1990, J.D. - Norman, Oklahoma
- University of Oklahoma - School of Nursing, 1985 - Norman, Oklahoma
Areas of Practice
- Medical Malpractice
- Birth Injury/Birth Trauma
Associations & Memberships
- Texas Bar Association
- American Association of Justice
- Texas Trial Lawyers Association
- Dallas Trial Lawyers Association
Kristin Jones
Kristin combines her medical and legal training to provide invaluable, passionate service to parents struggling to care for their birth-injured children. Families often have questions as they go through the birth injury lawsuit process. Kristin diligently identifies and investigates all medical issues so the birth injury attorneys at Miller Weisbrod can answer those questions. Kristin ensures that our birth injured children’s medical records are thoroughly reviewed and organized. Miller Weisbrod’s birth trauma litigation attorneys and medical experts retained by the firm need her services while pursuing justice for our clients.
Education
- SMU Dedman School of Law - Dallas, Texas
- University of Texas at Arlington - Arlington, Texas
Areas of Practice
- Medical Malpractice
- Birth Injury/Birth Trauma
Associations & Memberships
- State Bar of Texas
- American Association of Justice
- Texas Trial Lawyers Association
Matt Adair
Matt Adair is an attorney specializing in medical malpractice, products liability, and pharmaceutical litigation. He received his bachelor’s degree in Philosophy from the University of Notre Dame. During his time there, he studied abroad at the New College at Oxford University in Oxford, England.
Matt is a member of the State Bar of Texas, American Association for Justice, Texas Trial Lawyers Association, and Dallas Trial Lawyers Association.
Education
- University of Notre Dame - Philosophy, B.A. 2012 - Notre Dame, Indiana
- Baylor University - School of Law J.D. 2015 - Waco, Texas
Areas of Practice
- Medical Malpractice
- Products Liability
- Pharmaceutical Litigation
Associations & Memberships
- State Bar of Texas
- American Association of Justice
- Texas Trial Lawyers Association
- Dallas Trial Lawyers Association
Garrett Stanford
Garrett Stanford was born in Dallas, Texas and graduated from Southern Methodist University in 2017 with a B.A. in Political Science. After graduation, he attended Baylor University School of Law. During his time at Baylor, he was a member of the Order of the Barristers and he won the Judge W.C. Davis Endowed Criminal Practice Professional Track Award. He obtained his law degree and license to practice law in 2020.
Garrett joined Miller Weisbrod in August 2021. His legal practice is concentrated in the area of birth injury and medical malpractice. Garret is actively involved in handling birth injury and medical malpractice cases in Texas, Ohio, Utah, Arkansas and Oklahoma.
Education
- Southern Methodist University - Political Science, B.S. - Dallas, Texas
- University of Baylor - School of Law, J.D. - Waco, Texas
Areas of Practice
- Medical Malpractice
- Birth Injury/Birth Trauma
Associations & Memberships
- State Bar of Texas