What is Premature Rupture of Membranes (PROM)?
Premature rupture of membranes (PROM) is a medical condition that occurs after 37 weeks of gestation and before labor begins, when the amniotic sac holding the amniotic fluid and the baby ruptures. Commonly known as “water breaking,” rupture of membranes (ROM) usually prompts the onset of labor.
When PROM occurs before 37 weeks of pregnancy, it is termed as PPROM or preterm premature rupture of members. When ROM occurs along with or after the onset of labor prior to 37 weeks, it is termed as SPROM or spontaneous preterm rupture of membranes. When ROM at any stage persists for longer than 24 hours before the onset of labor, it is termed as prolonged ROM.
In most cases, PROM requires medical intervention and fetal heart rate monitoring. Loss of the protective amniotic sac layer puts the baby at an increased risk of birth complications, such as infections like Group B strep, umbilical cord compression/umbilical cord prolapse or breathing difficulties as a result of prematurity.
If these birth complications are not addressed and either prevented or timely treated, a baby could suffer a brain injury including hypoxic-ischemic encephalopathy (HIE) which can lead to cerebral palsy, neonatal encephalopathy (associated with multi-organ dysfunction), PVL or periventricular leukomalacia (white matter damage in the brain).
PROM occurs in approximately 8% of pregnancies. The earlier the water breaks, the greater are the health risks for the mother and the baby. An emergency cesarean section is usually advised in cases of PROM and PPROM.
What are the Causes and Risk Factors of PROM?
At full-term the water breaking (rupture of the membranes) is a normal part of labor and delivery. The science behind membrane rupture is as the mother labors or prepares to labor the activation of enzymes, programmed cell death and mechanical forces trigger the rupture of membranes. According to researchers, PROM probably occurs because of these same mechanisms and pathways, but with their premature activation. Risk factors of PROM may include:
- History of PROM in a previous pregnancy
- Placental abruption (separation of placenta from the inner uterine walls prior to birth)
- Intra-amniotic infection, such as chorioamnionitis
- Multiple pregnancy (twin pregnancy)
- Placenta previa, marked by antepartum vaginal bleeding
- Preterm labor
- Collagen vascular disorders
- Anemia
- Uterine septum or other uterus anomalies
- Excessive myometrial thinning (myometrium is the thick middle muscle layer of the fundus, which stretches in pregnancy to hold the growing baby)
- Cervical shortening (incompetent cervix) in the second trimester
- Advanced cervical dilation
- Polyhydramnios (excessive amniotic fluid)
- Oligohydramnios (insufficient amniotic fluid)
- Prior cervical conization (procedure to remove abnormal tissue from the cervix)
- Invasive uterine procedures (such as cervical cerclage, amniocentesis, or fetoscopy) during pregnancy, which may damage the membranes
- Chronic steroid therapy
- Multiple manual vaginal exams
- Nutritional deficiency (especially ascorbic acid and copper)
- Low BMI (body mass index)
- Substance use (such as cocaine)
- Cigarette smoking
- Direct abdominal trauma
How are Birth Injuries and Complications Associated with Premature Rupture of Membranes (PROM)?
Premature rupture of membranes (PROM) can cause fetal distress and other birth complications because the fetus is without the protective layer of amniotic fluid. Most of these birth complications may lead to cerebral palsy in babies if not diagnosed and treated appropriately. With vigilant fetal heart rate monitoring, ultrasound exams, blood tests, proactive administration of antibiotics and imaging tests, obstetricians and labor and delivery nurses can detect fetal distress early and perform a timely cesarean section to minimize the risk of complications.
Premature Birth
In the US, about 11% of all babies are born prematurely. PROM is the underlying cause of about 3 to 4% of these premature births. Preterm birth can contribute to various secondary birth complications, such as hypoxia or birth asphyxia, which may eventually lead to cerebral palsy.
When PROM occurs with a preterm baby (before 37 weeks) one of the main considerations of the medical team must be whether or not the baby’s lungs are adequately developed for a safe delivery. This will usually depend upon how premature the baby is when the premature rupture of the membranes occurs. Doctor and nurses have antenatal steroids, such as dexamethasone and betamethasone that can be given to the mother so her baby’s lungs develop more quickly when PROM occurs.
Prolapsed Umbilical Cord and Umbilical Cord Compression
PROM is one of the common causes of umbilical cord prolapse. In this condition, the cord slips into the birth canal before the baby’s descent. Umbilical cord compression can then occur if the baby gets trapped against the cord as they descend into the birth canal. This umbilical cord compression can reduce or even cut off the baby’s oxygen flow, posing the risk of hypoxic-ischemic encephalopathy (HIE), which may lead to cerebral palsy.
Maternal Infections
Infection is one of the most common complications associated with PROM for the baby and the mother. The amniotic fluid following PROM is exposed to any infection that the mother has because the protective barrier of the membranes has been lost. As a result the risk of infections, such as Group B Streptococcus, chorioamnionitis, bacterial vaginosis, urinary tract infection (UTI), and herpes simplex virus (HSV).
Obstetricians and nurses should almost always administer antibiotics when the premature rupture of the membranes occur to prevent any known or even unknown infection from occurring.
Malpresentation causing a Breech Delivery
PROM often results in a change of the fetal position and presentation. For instance, breech presentation can occur where the baby’s feet or buttocks or both move to so that they are positioned to come out first during birth. This may prompt the use of delivery assistance devices (such as forceps and vacuum extractors), increasing the baby’s risk of birth injury. When a breech baby is suspected after a PROM, the medical providers must be prepared to perform an emergency c-section if there is prolonged or arrested labor or if the electronic fetal monitoring strips show continuing fetal distress is occurring.
Respiratory Distress Syndrome
Following PPROM (preterm PROM), about 10 to 40% of the babies will develop respiratory distress syndrome (RDS). This acute morbidity occurs because the baby’s lungs are under-developed (pulmonary hypoplasia) and may not produce sufficient surfactant to keep them from collapsing. RDS can cause oxygen deprivation in the brain, increasing the baby’s risk of cardiac complications, HIE, and cerebral palsy.
Necrotizing Enterocolitis (NEC)
PROM is a risk factor for necrotizing enterocolitis (NEC), which is a severe gastrointestinal complication affecting many preterm babies. The intestinal tissue becomes inflamed in NEC and begins to die. Intestinal strictures (narrowing of the intestines) or abdominal infections due to perforations in the intestine are potentially life-threatening consequences of NEC.
Connection between PROM and Cerebral Palsy
Researchers conducted a retrospective cohort study of pregnancies complicated by PPROM (preterm PROM) and SPROM (spontaneous PROM) with delivery before 34 weeks of gestation. The study cohort consisted of 168 babies who underwent neurologic follow-up. The researchers identified 26 cases of cerebral palsy.
Factors related to cerebral palsy were identified as:
- Lower gestational age at PROM
- Longer latency (interval between PROM and labor)
- Chorioamnionitis related inflammation of the umbilical cord tissue
Researchers concluded that gestational age in PPROM and SPROM is significantly associated with cerebral palsy. The moment the rupture of membranes occurs in preterm PROM and spontaneous PROM, a process leading to brain damage may get triggered, which eventually causes cerebral palsy. As a result, doctors and nurses must be very aggressive in providing care and treatment to minimize the birth complications that can cause cerebral palsy following a preterm PROM.
How is a Diagnosis of Premature Rupture of the Membranes (PROM) made?
PROM and PPROM are primarily a clinical diagnosis. When an expectant mother reports watery vaginal discharge or leaking, the medical provider should confirm it with a sterile speculum exam (speculum is a device to look inside the vagina to observe the cervix). This minimally invasive diagnosis relies on the medical provider’s ability to determine three clinical signs on speculum examination:
- Fluid leakage from the cervical os (opening to the uterus) or visible pooling of fluid in the posterior fornix (larger recess behind the cervix)
- Nitrazine test (which is a lab test) to detect the alkaline pH balance of the cervico-vaginal discharge (confirmed if the fluid turns nitrazine paper from yellow to blue)
- Fern test to microscopically examine the cervico-vaginal discharge on drying to identify a “fern-like” pattern, indicative of PROM.
An ultrasound may also be used to detect evidence of oligohydramnios (low amniotic fluid volume). This alone will not confirm a PROM diagnosis, but may be used as supportive evidence to indicate it in a clinical setting.
What is the Significance of Early and Accurate PROM Diagnosis?
Accurate and timely preterm PROM diagnosis enables the medical team to make obstetric interventions appropriate to the gestational age of the baby. This can minimize the risk of severe complications, such as infections (neonatal sepsis or chorioamnionitis) and umbilical cord prolapse, while optimizing the perinatal outcomes.
How does Gestational Age matter once PROM has been diagnosed?
Doctors and nurses will manage the baby and expectant mother differently based upon the gestational age of the baby. This is primarily based upon the baby’s lung maturity at various stages of development. The closer to term, the more likely the baby’s lungs are going to be developed allowing a quicker delivery from time of PROM.
37 Weeks or Later
When PROM is diagnosed at 37 weeks of gestation or later, continuous fetal heart rate monitoring should be performed. Induction of labor methods (such as Pitocin infusion) should be commenced, or a cesarean section should be performed if it was planned. In case of Pitocin, the medical team should be prepared for a prolonged latent period of cervical dilation.
An emergency c-section should be performed if signs of fetal distress are detected during the monitoring. Antibiotic prophylaxis for Group B Streptococcus (GBS) should be administered when PROM lasts for more than 18 to 24 hours (regardless of the clinical GBS status).
34 to 36 Weeks
When a diagnosis of preterm PROM is made at 34 to 36 weeks of gestation, the medical team should be prepared to perform an emergency cesarean section or use labor induction methods (vaginal delivery is not contraindicated with preterm PROM).
The goal should be to avoid prolonging the pregnancy. Studies have shown that conservative PROM management at this stage increases the risk of complications. Corticosteroids for speeding up the maturity of the lungs are contraindicated at this stage, but the medical provider should prescribe antibiotics as a precaution (“prophylactically”) to eliminate the risk of maternal infections, such as Group B Streptococcus.
32 to 33 Weeks
When preterm PROM is diagnosed at 32 to 33 weeks of gestation, prolonging pregnancy should be avoided if the baby’s pulmonary maturity (lung development) is documented. Conservative management to prolong pregnancy in this situation unnecessarily increases the risk of umbilical cord compression, maternal amnionitis, and neonatal infection.
Medical providers should carefully weigh the risk of respiratory distress syndrome (RDS) associated with premature delivery against the risks of cord accidents and neonatal sepsis, which are associated with pregnancy prolongation in this condition. Antibiotics and corticosteroids should be administered and a cesarean section within 48 hours or at 34 weeks should be considered in consultation with a PPROM specialist and a neonatologist.
24 to 31 Weeks
At this stage, the goal of the medical provider should be to try and prolong the pregnancy up to 34 weeks. At the same time, the medical team should inform the patient and her caregivers that some patients may deliver within 7 days of preterm PROM.
Continuous fetal heart rate monitoring and other forms of fetal surveillance, such as biophysical profile and non-stress testing should be performed when preterm PROM is diagnosed before 32 weeks of gestation Delaying labor should be discontinued if non-reassuring fetal heart rate patterns (fetal distress) are observed in electronic fetal monitoring, or placental abruption, chorioamnionitis or other complications has occurred.
A Multi-Disciplinary Team Approach can Improve Outcomes
Immediate medical attention is vital when premature rupture of membranes occurs. Correct assessment of gestational age and accurate diagnosis are critical for appropriate patient management. The expectant mother should be carefully monitored for signs of infection. Continuous fetal heart rate monitoring should be performed to identify signs of fetal distress.
A team approach is always helpful and necessary to improve outcomes. The obstetrician should dictate patient management, a nurse should monitor the mother and the baby, and a pediatric team should be informed about the patient status so that they can prepare for the baby’s delivery. The anesthesia team should be informed in case obstetric anesthesia or a cesarean section is required.
Is Your Child’s PROM Related Birth Injury or Complication the Result of Medical Malpractice?
Parents whose children suffer from PROM related birth injury or complications want and deserve answers as to the cause of their child’s injury and whether mistakes by the doctors and nurses contributed to the injury.
- Were there signs of premature rupture of membranes during the pregnancy, or presence of risk factors such as a history of PROM, maternal infection, or vaginal bleeding which were either not recognized or properly treated?
- Did the medical team fail to provide precautionary antibiotics after premature rupture of the membranes occurred?
- Did an umbilical cord prolapse occur that was preventable or did the doctors and nurses fail to react to the prolapse in a timely manner?
- Was the decision to perform a cesarean delivery delayed despite the known birth complications due to PROM were occurring?
- During the labor and delivery, were there clear indications that the baby was suffering from fetal distress, but appropriate actions were not taken by the obstetrician or nurses?
- Did the neonatal resuscitation team delay in providing critical breathing support after birth?
- Were serious neonatal conditions like fetal hypoxia, hypoglycemia, or jaundice missed or treated incorrectly?
The experienced birth injury lawyers at Miller Weisbrod Olesky will help you determine if mistakes of the medical providers caused a birth injury to your child, including Hypoxic-Ischemic Encephalopathy (HIE) or cerebral palsy. Our hard working and successful birth injury attorneys have represented families all over the United States in their time of need after a birth injury. We use our experience and expertise to obtain for you and your child a medical malpractice settlement that will help provide specialized medical therapy in order to maximize the quality of life and independence of your child throughout their life.
Sometimes families are reluctant to contact a medical malpractice lawyer. It’s also not uncommon for parents to feel overwhelmed by the responsibilities they encounter in caring for their injured child and worried that they will not be able to help out in a lawsuit involving their child’s birth injury or complication. Our birth injury attorneys and nursing staff will address these hesitations and concerns, so you can focus on your child and maximizing their care.
Registered Nurses and Nurse-Attorneys Are a Vital Part of Our Birth Injury Team…and Yours
Most 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 a lawyer experienced in birth injury lawsuits. It’s not uncommon that a birth related complication results in a preventable birth injury, including cerebral palsy, but it takes a detailed expert review by a birth injury attorney of the medical records from your child’s birth to determine if the birth injury was the result of medical malpractice.
At Miller Weisbrod Olesky, a team of committed lawyers, nurses and paralegals uses our detailed medical negligence case review process to assess your child’s 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. Our birth injury attorneys have recovered millions of dollars in settlements for families of children that have suffered a birth injury.
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, Vioxx, Fosamax, and Reglan. Alex was also instrumental in our firm successfully resolving thousands of cases transvaginal mesh, hip prosthetics, and the blood thinner Xarelto. 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