Arizona Supreme Court Rules Expert Testimony Remains Critical in Birth Injury Cases

Around 75,000 babies are born in Arizona every year. Most of those deliveries go smoothly. But when something goes wrong during pregnancy, labor, or delivery, the fallout can follow a child for life. We're talking about conditions like cerebral palsy, brain damage, nerve injuries, and other serious impairments that change the trajectory of a family.

In August 2024, the Arizona Supreme Court handed down a ruling that clarified how medical negligence gets proven in state courts. The case, Francisco v. Affiliated Urologists, reinforced something that's been part of Arizona law but needed reaffirming: medical malpractice claims require qualified medical expert testimony. An FDA warning label on its own? Not enough. The Court made clear that documents like that can't stand in for an expert's analysis of what proper medical care actually looks like.

The Francisco case wasn't about a birth injury. But because the ruling applies to all medical malpractice claims in Arizona, it directly affects families pursuing cases over labor and delivery complications. It sets the bar for what you need to prove if you believe your child was harmed by a medical error.

Understanding the Supreme Court Ruling in Francisco v. Affiliated Urologists

On August 16, 2024, the Arizona Supreme Court decided Francisco v. Affiliated Urologists (CV-23-0152-PR). The central question: could an FDA "black box" warning, by itself, establish the standard of care in a malpractice case?

No. That was the Court's answer, and it wasn't ambiguous.

Here's the part most people don't realize about warning labels. They flag potential risks, sure. But they don't tell a doctor exactly what to do with a specific patient in a specific situation at a specific moment. Medicine doesn't work that way. There are too many variables, too many patient-specific factors, for a printed label to substitute for professional judgment.

Arizona law requires malpractice plaintiffs to bring in a qualified medical expert who can establish three things: what the standard of care was, how the defendant fell short of it, and how that failure caused the patient's injuries. You can't build a case on "common sense" alone, no matter how obvious the error might seem to a non-medical person.

That framework applies across the board. Birth injury cases included. And while it raises the bar, it doesn't block legitimate claims. If you have the right expert support, your case moves forward.

Why Expert Testimony Matters in Birth Injury Cases

If you're wondering why courts insist on expert testimony in these cases, think about what actually happens in a delivery room. You've got an obstetrician, labor and delivery nurses, possibly an anesthesiologist, maybe a maternal-fetal medicine specialist or a neonatologist. Multiple professionals making time-sensitive decisions simultaneously.

Nobody without medical training can look at that situation and reliably say what went wrong.

Take fetal heart monitoring. The machine produces a continuous tracing, and those lines contain subtle indicators of whether a baby is tolerating labor or showing signs of distress. To an untrained eye, the strip might look unremarkable. A specialist reviewing those same tracings might spot a pattern that should have triggered immediate action.

Timing is where these cases get complicated fast. An expert evaluates whether the care team caught warning signs quickly enough and responded the right way. When should they have called for a cesarean section? That depends on the specific heart rate patterns, how long concerning signs lasted, what other risk factors were present, and where the mother was in her labor.

And the standard of care isn't one-size-fits-all. A mother with preeclampsia needs different monitoring than a low-risk patient. Someone with gestational diabetes presents different challenges. The expert reviews every page of the medical records, line by line, and then explains what should have happened and where the care fell short.

This requirement keeps the process honest. Cases get decided on medical science and professional standards, not emotion. That protects families with real claims just as much as it protects providers from baseless ones.

Common Birth Injury Scenarios Requiring Expert Analysis

Different types of birth injuries call for different kinds of expert review. Some of the most common scenarios give a clearer picture of why qualified medical analysis can't be skipped.

Oxygen deprivation is probably the most serious. When a baby's brain doesn't get enough oxygen during labor and delivery (doctors call it hypoxia or asphyxia), the consequences can include cerebral palsy or hypoxic-ischemic encephalopathy. An expert has to go through the fetal monitoring strips and pinpoint when signs of distress showed up, whether the medical team recognized them, and whether they acted fast enough. There's a lot riding on minutes and sometimes seconds.

Delayed cesarean sections come up frequently. When monitoring data or clinical signs suggest a baby isn't tolerating labor, the decision to move to surgical delivery has to happen within a certain window. A qualified OB reviewing the case can establish what the data showed, when a reasonable physician would have made the call, and whether any delay caused harm.

Failure to respond to fetal distress overlaps with the above but has its own nuances. Was monitoring continuous when it should have been? Did someone actually look at the tracings and recognize what they were seeing? These questions need someone with real clinical experience to answer.

Pitocin-related complications require a different kind of analysis. Pitocin strengthens or induces contractions, and dosing has to follow specific protocols. An expert evaluates whether the medication was administered properly and whether the team reacted appropriately when problems developed.

High-risk pregnancies involving conditions like gestational diabetes, placental complications, or umbilical cord issues need experts who can assess whether the medical team identified the risks early enough and planned accordingly. Sometimes the error isn't what happened during delivery. It's what didn't happen in the weeks before.

Improper use of forceps or vacuum extractors rounds out the list, though these cases tend to be more straightforward to evaluate (at least compared to oxygen deprivation claims).

Real cases in Arizona illustrate all of this. In 2023, a Maricopa County jury returned a $31,550,825 verdict in a case involving oxygen deprivation during delivery, the largest medical malpractice verdict in Arizona history. A 2025 case involves allegations that a medical team failed to prepare for a high-risk delivery with gestational diabetes complications. In both, the medical expert's testimony was the backbone of the case.

Who Qualifies as a Medical Expert?

Not just any doctor can walk into a courtroom and offer an opinion on a birth injury case. Arizona law sets specific requirements for expert witnesses in malpractice cases, and those requirements exist for good reason.

The big one is specialty matching. The expert has to practice in the same or a similar specialty as the doctor being sued. So in a birth injury case, an obstetrician testifies about the physician's care. A labor and delivery nurse testifies about nursing standards. You can't bring in a cardiologist, no matter how brilliant, to opine on obstetric decision-making.

Board certification adds weight. It's not always legally required, but it matters to juries. A board-certified OB/GYN or maternal-fetal medicine specialist has completed specialized training and passed rigorous exams. That credibility counts.

Active clinical practice is another factor courts look at. An expert who's still seeing patients (or recently retired) stays current on how medicine is actually practiced today. Someone who left clinical work fifteen years ago may not understand how protocols have evolved.

And the expert needs to understand the setting where the care happened. A large academic medical center has different capabilities than a small community hospital. The specialist reviewing your records has to account for those differences when evaluating whether the care met professional standards.

Birth complication lawyers coordinate with these experts throughout the entire case. That means reviewing hundreds of pages of medical documentation, drafting detailed written opinions, sitting for depositions, and ultimately translating complex medical concepts into language a jury can follow. Both sides retain their own experts, and the jury weighs competing opinions alongside all the other evidence before reaching a verdict.

What This Means for Labor and Delivery Care in Arizona

The Francisco ruling doesn't change how doctors and nurses practice day to day. What it does is sharpen the legal framework that applies when something goes wrong. Healthcare providers still need to follow established protocols and document their decisions carefully.

For expecting parents, the takeaway is reassuring in its own way. Most births go well. And when they don't, Arizona's legal system provides a path forward, as long as the claim is backed by real medical evidence. The expert testimony requirement filters out cases that don't have medical support while making sure the ones that do get a fair hearing.

That distinction matters.

If your family is dealing with a birth injury and you're trying to figure out whether you have a case, the first step is talking to an attorney who works with qualified medical experts in obstetrics. They can review what happened, get the right specialist looking at your records, and give you an honest assessment. Not a sales pitch. An answer.