OBGYNs Missed Thiamine Need in Severe Morning Sickness, Leaving 21-Year-Old With Permanent Brain Damage

In mid-June 2021, a 21-year-old woman in her first pregnancy went to her OBGYNs for prenatal care. She had already been vomiting for several weeks. Over the next two months her condition grew steadily worse: intractable vomiting, cascading electrolyte deficiencies, severe malnutrition, and a weight loss of roughly 40 pounds from her pre-pregnancy baseline. The diagnosis was hyperemesis gravidarum, the most severe form of pregnancy-related nausea and vomiting.

What the treating physicians did not do was administer thiamine. Vitamin B1 deficiency is a well-documented consequence of prolonged vomiting and caloric restriction, and the American College of Obstetricians and Gynecologists has long recommended empiric thiamine supplementation for patients with severe hyperemesis gravidarum. The cost of the vitamin is negligible. By early August 2021, without it, the patient developed Wernicke's encephalopathy, a neurological emergency caused by acute thiamine depletion.

The brain damage proved permanent. She was left with significant cognitive impairment, memory loss, and neuro-ophthalmologic deficits that affect her daily life. Her child was born into a household with a mother who cannot function as she did before the pregnancy.

Edward McNelis and Philip Marstiller of Emroch and Kilduff in Richmond took the case. Their experts testified that the warning signs in the medical record, persistent vomiting, documented electrolyte abnormalities, poor nutritional intake, and a dramatic weight curve, should have prompted thiamine supplementation well before the neurological crisis. The defendants did not act on those signs.

The case was mediated before retired Judge Joanna Fitzpatrick and settled on January 27, 2025, for $1.5 million. No reduction or remittitur applied to the settlement figure.