Mid-July brought a headline that traveled quickly through both sides of the medical malpractice bar. A Wake County jury returned a unanimous $18.2 million verdict in Naqah Lake v. WakeMed, No. 22 CVS 011664-910, tried in Wake County Superior Court before Judge Winston C. Gilchrist. The plaintiffs are the child, who sued through his guardian ad litem, Christopher Duggan, and his mother, Laurel Browne. Plaintiffs’ counsel described the award as the largest in the state for a brachial plexus injury, which damages the network of nerves that controls the shoulder, arm and hand.
For practitioners on either side of the caption, the verdict is less interesting as a number than as a case study in how obstetric causation gets tried, and in how North Carolina’s damages architecture converts a jury’s arithmetic into a judgment.
The record, and what the jury actually found
The delivery took place in September 2019 at WakeMed’s Raleigh Campus. Laurel Browne’s labor was complicated by shoulder dystocia, an obstetric emergency in which the baby’s shoulder becomes lodged behind the mother’s pubic bone after the head has delivered. Plaintiffs alleged that the resident, identified in the pleadings as Dr. Tara Brenner, responded with a fetal vertex rotation, turning the baby’s head while the shoulder remained impacted. Their expert testified that this technique should never be used in that situation.
The procedural sequence deserves attention. On July 2 the jury cleared two other physicians and a physician assistant, finding only that Brenner’s negligence caused the injury. The court dismissed Brenner after the liability phase closed, and WakeMed accepted vicarious liability for her conduct. Critically, the jury declined to find that Brenner was grossly negligent. A separate damages phase followed, producing $2.2 million in economic damages and $16 million in noneconomic damages.
That last distinction matters, and at least one trade outlet has reported it inaccurately by characterizing the $16 million as punitive damages. It was not. According to reporting drawn from the News & Observer, the award breaks down into roughly $2.2 million in economic loss and $16 million in noneconomic damages for pain, suffering and disfigurement. Of the total, $17.7 million was allocated to the child and $500,000 to the mother. Counsel citing the verdict in briefing or settlement negotiations should work from the verdict sheet rather than the trade press.
The cap is the second trial
North Carolina’s noneconomic damages cap is where this case now lives. N.C. Gen. Stat. § 90-21.19(a) limits noneconomic damages in a medical malpractice action to $500,000 against all defendants combined. That figure is adjusted every three years based on the Consumer Price Index, and the statute directs the trial court to modify any judgment that exceeds the limit. The Office of State Budget and Management has set the current figure at $712,847, effective January 1, 2026.
The escape hatch is conjunctive. Under subsection (b), the limit falls away only if the trier of fact makes two findings. First, the plaintiff must have suffered disfigurement, loss of use of part of the body, permanent injury or death. Second, the defendant’s conduct must have been committed in reckless disregard of the rights of others, or been grossly negligent, fraudulent, intentional or malicious.
Prong one is satisfied comfortably on these facts. Prong two is the problem, because the jury declined to find gross negligence. Unless the plaintiffs can locate a finding elsewhere in the verdict that supplies the requisite state of mind, the noneconomic component appears exposed to reduction. Local coverage flagged precisely this, noting the $712,847 cap could substantially shrink the award.
The lesson runs in both directions. Plaintiffs’ counsel in a permanent-injury case should treat the aggravating-conduct issue as a distinct trial objective with its own evidentiary theory, not as a rhetorical flourish added to the negligence case. Defense counsel should recognize that a favorable finding on gross negligence can be worth more in dollars than a marginal improvement on the negligence issue itself.
Causation is where these cases are won
The scientific record on neonatal brachial plexus palsy has moved considerably, and it does not line up neatly behind either side.
The defense theory here was timing. WakeMed argued that the injury occurred in utero. Plaintiffs’ counsel countered that the resident’s own contemporaneous documentation of the maneuver contradicted that position. Complicating the causation picture, the injury involved the posterior shoulder rather than the anterior one, which made causation harder to prove.
That is not an eccentric defense. The 2014 ACOG Task Force report on neonatal brachial plexus palsy (NBPP) found that maternal forces alone are an accepted cause of at least transient NBPP. It also noted that the literature documents cases occurring without clinically recognizable shoulder dystocia, including cases delivered by cesarean section. The report concluded that an NBPP diagnosis does not by itself indicate excessive exogenous force, and that the injury can occur even when intrapartum care met the standard. Commentators have emphasized that posterior arm involvement is the scenario least amenable to an exogenous-force explanation, because maternal forces can stretch the posterior brachial plexus against the sacral promontory.
So why did the defense lose? The most plausible answer is documentation. The same literature urging caution about causation stresses the importance of a detailed delivery note, particularly where posterior arm injury is involved. Here the note recorded the maneuver. Once a chart entry establishes that a specific rotational technique was applied at a specific moment, an in utero timing defense is arguing against the defendant’s own record. Defense counsel evaluating obstetric files should read the delivery note first and calibrate the timing defense to what it will support.
Plaintiffs’ counsel should draw the mirror-image lesson. The ACOG materials are a real obstacle, and the literature on sequential maneuvers is not uniformly favorable. Still, biomechanical modeling indicates that McRoberts positioning, suprapubic pressure, oblique positioning and posterior arm delivery each reduce brachial plexus stretch and clinician traction. That research supports a theory that the clinician failed to use the appropriate maneuvers. The viable case is one anchored in a documented departure from a recognized algorithm, not a res ipsa inference drawn from a bad outcome.
Threshold discipline still governs
None of this reaches a jury without compliance with the pleading rule. Rule 9(j) requires a medical malpractice complaint to assert that the medical care was reviewed by a qualified professional willing to testify that the conduct fell below the standard of care. The 2011 amendments tightened the rule to require prior review of both the care and all available medical records. A complaint lacking the certification when the limitations period expires shall be dismissed. Defense counsel should audit the certification early. Plaintiffs’ counsel should assume it will be tested.
What to take from it
Liability findings and damages findings now do different jobs in North Carolina. A jury can find negligence, causation and catastrophic permanent injury, yet the judgment can still be cut dramatically because a separate finding on the defendant’s state of mind went the other way. Whether that allocation is sound policy is a question for the legislature. As a practical matter, both sides should try the aggravating-conduct issue as if the difference between $712,847 and $16 million depends on it, because it does.
Sources
Health Exec, jury verdict report: https://healthexec.com/topics/healthcare-management/legal-news/jury-awards-family-182m-after-wakemed-never-maneuver-leaves-child-paralyzed-life
North Carolina Lawyers Weekly, verdict report and case number: https://nclawyersweekly.com/2026/07/16/never-maneuver-leads-to-lifelong-birth-injury-seven-figure-verdict/
Grant & Eisenhofer statement (via Lawdragon): https://www.lawdragon.com/press-releases/2026-07-15-grant-eisenhofer-wins-record-182m-jury-verdict-birth-injuries
Damages breakdown and cap coverage (reporting on the News & Observer): https://hoodline.com/2026/07/raleigh-jury-slaps-wakemed-with-18-2-million-in-baby-birth-injury-case/
Phased verdict and gross negligence finding: https://atlantablackstar.com/2026/07/24/jury-slams-hospital-with-18-2-million-verdict-after-doctors-never-maneuver-left-boy-unable-to-hug-his-mother-with-both-arms/
N.C. Gen. Stat. § 90-21.19 (text): https://www.ncleg.gov/EnactedLegislation/Statutes/HTML/BySection/Chapter_90/GS_90-21.19.html
N.C. Office of State Budget and Management, 2026 cap amount: https://www.osbm.nc.gov/facts-figures/economy/liability-limit-noneconomic-damages-medical-malpractice
ACOG Task Force on Neonatal Brachial Plexus Palsy, executive summary: https://journals.lww.com/greenjournal/fulltext/10.1097/01.aog.0000445582.43112.9a~executive-summary-neonatal-brachial-plexus-palsy
Commentary on NBPP causation and delivery documentation: https://www.contemporaryobgyn.net/view/neonatal-brachial-plexus-palsy-prevention-possible
Biomechanical modeling of shoulder dystocia maneuvers: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078281/
UNC School of Government, Rule 9(j) special pleading requirement: https://www.sog.unc.edu/sites/default/files/additional_files/Rule%209%28j%29%20Special%20pleadings%20rule%20in%20med%20mal%20actionsUSE.pdf
