Proving a hypoxic-ischemic encephalopathy (HIE) malpractice case generally involves three kinds of evidence:
- Complete medical records, especially the fetal monitoring strips, labor and delivery notes, cord blood gas results, placental pathology, and brain MRI images
- Testimony from qualified medical experts explaining the standard of care, how it was breached, and how that breach caused the brain injury
- Your child’s current and future needs, which proves damages
Of these, causation evidence showing when the injury happened is usually the deciding factor. Building that proof is at the heart of how we at the Killino Firm handle every HIE and hypoxia case.
What does your family have to prove?
In a civil malpractice case, your family must prove its claim “by a preponderance of the evidence,” meaning the claim is more likely true than not. The evidence must show that a provider owed a duty of care, breached the standard of care, and caused the injury, and that your child and family (in some instances) suffered real losses.
Each of those elements is proven with different evidence. A gap in any one of them can defeat an otherwise strong claim.
What are the medical records that matter most in an HIE case?
HIE cases are built on both the mother’s and the baby’s records.
The mother’s records must include:
- Prenatal records, showing risk factors, ultrasound findings, and how the pregnancy was managed
- Labor and delivery records, including nursing notes, physician notes, Pitocin records, and the timing of calls and orders
- Electronic fetal monitoring strips, the complete continuous tracing, not a summary; often the most important evidence in the case
- Electronic audit trails, the hidden data showing when each entry was created or changed; can reveal late entries or notes written after the outcome was known
- Operative reports, including the timing of any C-section or vacuum or forceps delivery
The baby’s records must include:
- Delivery room and resuscitation records, including Apgar scores
- Umbilical cord blood gases, which measure acid levels in your baby’s blood at birth
- Placental pathology, the lab analysis of the placenta, which can support or undercut arguments about infection or earlier injury
- Early lab results, which can show kidney, liver, heart, or clotting injury that often comes with oxygen loss around birth
- NICU records, including cooling logs, EEG seizure monitoring, and transport records
- Brain MRI images, the actual image files, not just the radiologist’s written report
Hospitals are generally required to keep medical records, but archiving practices for monitoring data vary significantly. That’s one reason we request and preserve the strips and audit trails as early as possible.
How do families get HIE medical records?
You can request both your own records and your baby’s directly from the hospital. Under federal privacy law, providers generally must respond within 30 calendar days, with one 30-day extension allowed if they explain the delay in writing. The US Department of Health and Human Services explains your HIPAA right of access in detail here.
When you ask for your records, be specific. Records departments often default to sending only a partial “standard” set, so request the complete fetal monitoring strips, the MRI image files, and all pathology reports by name.
When we take a case, our team handles the requests for you. We also send preservation letters asking the hospital to protect its electronic data, including monitoring archives and audit trails.
Why medical experts are essential
HIE cases can’t be proven with records alone. The law requires qualified experts to explain among other things what the records mean. A typical HIE case may involve:
- An obstetrician or maternal-fetal medicine specialist, on labor management and delivery timing
- A labor and delivery nursing expert, on fetal monitoring and when to escalate concerns
- A neonatologist, on resuscitation and cooling
- A pediatric neuroradiologist, on the MRI pattern and timing of the injury
- A pediatric neurologist, on diagnosis and long-term outlook
- A placental pathologist, on whether the placenta points to another cause
- A life care planner and an economist, on your child’s future needs and their costs
Many states require expert support before a case can move forward. For example, Pennsylvania requires a certificate of merit confirming that a licensed professional found a reasonable basis for the claim. Meanwhile, New Jersey requires an affidavit of merit from a qualified expert within 60 days after the defendant answers the complaint.
Retaining this many experts is expensive, and it’s one reason some firms turn down HIE cases. We cover these costs upfront, so your family never pays out of pocket.
How causation is proven in an HIE case
Causation evidence answers the question the defense will press hardest: Would the outcome have been different with proper care?
Our experts typically rebuild a minute-by-minute timeline, lining up the fetal heart rate tracing against what staff did and when. They then connect that timeline to objective markers, including cord gas acidosis, low Apgar scores, injury to other organs, and an MRI pattern consistent with injury around birth.
A tracing that was reassuring when the mother arrived and worsened during labor is especially powerful. These timing markers help show whether HIE was preventable or whether it happened before labor began.
What the hospital’s defense usually argues
Hospitals and their insurers may claim the injury happened before labor, came from infection or placental disease, stemmed from a genetic condition, or would have happened no matter when the baby was delivered.
A strong case answers these arguments before they’re raised. That involves placental pathology, infection workups, genetic testing when appropriate, and expert analysis that rules out other causes.
Evidence that proves your child’s lifelong needs
To build a strong damages case, your attorney will gather medical bills, therapy and equipment records, school and developmental evaluations, and testimony from your child’s treating doctors.
From there, a life care plan is developed to project your child’s needs over a lifetime. An economist then calculates the cost of that care and your child’s lost earning capacity. That analysis is what determines the value of an HIE case.
What can parents do now to protect the evidence?
- Write down what you remember about labor and delivery, including times and names
- Keep discharge papers, NICU summaries, and appointment records
- Save bills, receipts, and insurance statements
- Keep a simple journal of your child’s symptoms, therapies, and milestones
- Avoid discussing the delivery on social media
- Talk to a lawyer early, since evidence and HIE filing deadlines run side by side
Let our team build the evidence for you
You shouldn’t have to become a medical expert to get answers. When you work with us, a dedicated team of attorneys, paralegals, investigators, and medical professionals will gather and analyze the evidence on your behalf so you can focus on your child.
Our secure mobile app makes it easy to stay connected with your legal team from anywhere in the country. Upload documents, sign forms, and send messages all in one place. You can also review results we’ve achieved for other families before speaking with our HIE birth injury lawyers about your baby’s records.
Get your free, confidential case evaluation. Call 24/7 at 878-788-7718 or contact us online.
No upfront fees; client pays no legal fees unless a recovery is achieved.
The information provided on this site is not formal legal advice. Prior results do not guarantee a similar outcome. Confidential consultation is required.
