Plain-English guide for Kentucky families about the medical records and other evidence used to investigate birth injury claims.
Updated August 2026
A single bad outcome does not prove medical negligence.
Neither does one abnormal fetal-monitor strip, a low Apgar score, an emergency C-section, a diagnosis of HIE, or a NICU admission.
In a Kentucky birth injury case, the strongest evidence is often a minute-by-minute reconstruction of what happened:
What did the medical team know?
When did they know it?
What did they do in response?
Did the baby’s condition improve or worsen?
If delivery or another intervention became necessary, how quickly did the team act?
What medical evidence connects the alleged mistake to the child’s injury?
Medical records supply much of that evidence.
But records do not “prove negligence” by themselves. In most Kentucky medical-negligence cases, qualified medical experts must use those records to evaluate the applicable standard of care, whether it was breached, and whether that breach caused the injury.
Kentucky’s certificate-of-merit statute generally requires consultation with a qualified expert before a covered medical-malpractice action is filed, subject to limited exceptions. In June 2026, the Kentucky Supreme Court again emphasized the importance of appropriate expert testimony in medical-negligence actions.
What Must Be Proven in a Kentucky Birth Injury Case?
A medical-negligence claim generally involves several separate questions:
- Duty: Did the healthcare provider owe a professional duty to the patient?
- Standard of care and breach: What should a reasonably competent provider have done under the circumstances, and was the care below that standard?
- Causation: Did the alleged breach actually cause or substantially contribute to the injury?
- Damages: What injury and losses resulted?
The fact that something went wrong answers none of those questions automatically.
Kentucky’s KRS 411.167 generally requires a medical-malpractice claimant to consult an expert qualified to give testimony concerning the standard of care or negligence before filing a covered action. Kentucky Rule of Evidence 702 separately governs the reliability and admissibility of expert testimony.
That means the medical record usually provides the facts, while qualified experts explain what those facts mean medically.
The Three Jobs Birth Injury Records Perform
Medical records generally help answer three different questions.
1. What Happened?
The records create the timeline.
Examples include:
- Fetal-heart-rate changes
- Contractions
- Oxytocin administration
- Provider notifications
- Bedside evaluations
- Emergency C-section timing
- Vacuum or forceps attempts
- Newborn resuscitation
- NICU treatment
- Transfers
2. What Caused the Injury?
This is often the most medically complex part of a birth injury case.
Evidence relevant to causation can include:
- Fetal monitoring
- Cord blood gases
- Placental pathology
- Apgar scores
- Resuscitation records
- Neurological examinations
- EEG
- MRI
- Infection studies
- Genetic or metabolic testing
- Long-term developmental findings
3. What Harm Resulted?
Medical records also document the extent of injury and future needs.
Those records may include:
- NICU course
- Diagnoses
- Neurology visits
- Developmental evaluations
- Therapy
- Feeding treatment
- Mobility equipment
- Seizure treatment
- Pediatric rehabilitation
- School or early-intervention services
- Future-care recommendations
A strong case therefore usually requires much more than the delivery note.
1. Complete Electronic Fetal-Monitoring Records
For cases involving possible fetal compromise during labor, the electronic fetal-monitoring record may be one of the most important pieces of evidence.
The tracing records:
- Fetal-heart-rate baseline
- Variability
- Accelerations
- Early decelerations
- Variable decelerations
- Late decelerations
- Prolonged decelerations
- Bradycardia
- Uterine contractions
- Tachysystole
ACOG’s current fetal-heart-rate guideline, published in October 2025, uses the Category I, II, and III framework and provides an evidence-based approach to evaluating and managing fetal-heart-rate abnormalities.
What the tracing can help establish
Experts may evaluate:
- When the pattern first became concerning
- Whether abnormalities were intermittent or recurrent
- Whether variability remained reassuring
- Whether the tracing deteriorated over time
- Whether uterine tachysystole was present
- Whether the fetus responded to interventions
- When escalation may have become appropriate
What to request
Ask for:
- Complete fetal-heart-rate tracing for the relevant labor period
- Uterine-contraction tracing
- Bedside annotations
- Event markers
- Associated nursing documentation
- Any available archived waveform export
Avoid describing “native-format EFM strips” as though Kentucky law automatically guarantees one particular technical file format.
The more accurate request is for the complete tracing and any available electronic waveform/export maintained by the facility.
Kentucky’s certificate-of-merit statute specifically includes fetal heart monitor strips within its definition of medical records for purposes of its record-production provision.
2. Nursing Notes and Labor Flowsheets
The fetal strip does not tell you everything happening in the room.
Nursing documentation may show:
- Fetal-monitor assessments
- Maternal vital signs
- Contraction frequency
- Oxytocin doses
- Position changes
- IV fluids
- Tachysystole
- Provider notification
- Provider response
- Bedside examinations
- Orders received
- Preparation for operative delivery
- Communication with anesthesia
- Neonatal-team activation
Nurses often document events at short intervals during labor, making these records useful for building a timeline.
But keep one important limitation in mind:
The time a note was electronically signed is not necessarily the time the documented event occurred.
Review the event time, documentation time, flowsheet time, medication administration time, and other records together.
3. Oxytocin/Pitocin Orders and Medication Administration Records
Oxytocin can be an important part of induction and augmentation of labor.
It can also contribute to uterine tachysystole when contractions become too frequent.
AHRQ identifies oxytocin as a high-alert medication and recommends standardized protocols for:
- Appropriate use
- Maternal and fetal monitoring
- Provider notification
- Recognition of tachysystole
- Reduction or discontinuation when appropriate
- Reassessment before restarting the medication
AHRQ defines tachysystole as more than five contractions in a 10-minute window averaged over 30 minutes.
Records that matter
Ask for:
- Oxytocin order
- Medication administration record, or MAR
- Start time
- Dose increases
- Dose reductions
- Stop time
- Restart time
- Nursing documentation
- Fetal-heart-rate assessments around dose changes
- Contraction assessments
What about pump logs?
You can ask whether separately retained infusion-pump data are available.
But a standalone pump log should not be described as though:
- Every hospital maintains one indefinitely
- It is always part of the patient’s ordinary medical record
- KRS 422.317 automatically requires its release
An attorney investigating a case can determine whether separately retained device information should be preserved or sought through another process.
4. Provider Notification and Response Records
One of the central questions in some birth injury cases is not whether a nurse recognized a problem, but what happened after the problem was recognized.
Relevant documentation may show:
- When the obstetrician was notified
- How the notification occurred
- What information was communicated
- Whether the physician came to the bedside
- What orders were given
- Whether the physician reviewed the tracing remotely
- Whether another physician was called
- Whether a chain of command was used
- When escalation occurred
Possible sources include:
- Nursing notes
- Physician notes
- Orders
- Call records
- Communication logs
- EHR messages
Some communication data may exist outside the standard patient chart.
5. Emergency C-Section Timeline
When an emergency cesarean occurred, collect records showing more than simply the “decision time.”
Important timestamps can include:
- First significant fetal or maternal concern
- Provider notification
- Provider arrival
- Decision for cesarean
- Anesthesia notification
- Operating-room notification
- Patient leaves labor room
- Arrival in operating room
- Anesthesia start
- Skin incision
- Uterine incision
- Delivery
There is no universal rule that every emergency cesarean must occur within one fixed number of minutes.
ACOG’s current fetal-monitoring guidance emphasizes that timing and mode of delivery depend on the maternal-fetal condition and what is clinically feasible.
That makes the entire sequence important.
Ask for
- Labor notes
- Cesarean decision documentation
- Anesthesia record
- Operating-room record
- Operative report
- Delivery record
- Nursing flowsheets
- Relevant orders
Do not focus only on decision-to-incision.
Experts may also evaluate what happened before the official decision was entered.
6. Vacuum and Forceps Delivery Records
If vacuum or forceps were used, the records may help determine whether operative vaginal birth was appropriately selected and performed.
ACOG’s operative vaginal birth guidance, reaffirmed in 2025, emphasizes proper patient selection, clinician skill, and knowledge of the risks associated with forceps and vacuum extraction.
Important documentation can include:
- Reason assisted delivery was recommended
- Cervical dilation
- Membrane status
- Fetal presentation
- Fetal position
- Fetal station
- Whether the head was engaged
- Instrument used
- Vacuum cup type
- Number of pulls
- Progress with traction
- Number of cup detachments or “pop-offs”
- Duration of attempt
- Reason the attempt was abandoned
- Sequential vacuum/forceps use
- Decision for cesarean
- Fetal-heart-rate status during the attempt
The record can help experts evaluate:
selection → technique → progress → abandonment → backup plan
A neonatal injury after vacuum or forceps delivery does not itself prove the instrument was misused.
7. Shoulder Dystocia Documentation
When shoulder dystocia occurred, the delivery record can be particularly important.
Look for:
- Time shoulder dystocia was recognized
- Personnel called
- Maneuvers attempted
- Sequence of maneuvers
- Delivery time
- Traction documentation
- Newborn condition
- Arm movement after birth
- Clavicle or humerus findings
- Neurologic evaluations
The medical record may identify maneuvers such as:
- McRoberts positioning
- Suprapubic pressure
- Delivery of the posterior arm
- Rotational maneuvers
- Other techniques
If a child later has a brachial plexus injury, the delivery record should be evaluated alongside pediatric, neurological, orthopedic, and rehabilitation records.
8. Umbilical Cord Blood Gases
Cord gases can provide information about the baby’s acid-base condition around the time of birth.
When available, request:
- Umbilical arterial pH
- Umbilical venous pH
- PCO2
- PO2
- Bicarbonate
- Base deficit or base excess
- Collection time
Cord arterial and venous gases provide different information.
A low pH can be medically significant, but it does not by itself prove negligence, HIE, or the timing of a brain injury.
The value should be interpreted alongside the fetal tracing, labor events, resuscitation, neurological examination, placental findings, and newborn course.
9. Apgar Scores
Apgar scores are typically documented at:
- 1 minute
- 5 minutes
- 10 minutes when continued assessment is necessary
- Later intervals in some resuscitations
They describe aspects of the baby’s condition after birth.
A low Apgar score can help establish that a newborn required significant assistance.
It does not independently prove:
- Why the baby was depressed
- When an injury occurred
- Whether HIE was present
- Whether malpractice occurred
Use Apgar scores as one part of the timeline.
10. Newborn Resuscitation Record
For a baby who required significant assistance at delivery, the resuscitation documentation can be crucial.
The 2025 AHA/AAP neonatal resuscitation guidelines emphasize preparation, effective ventilation, timely progression through resuscitation steps, and close monitoring after advanced resuscitation.
Ask for records showing:
- Initial heart rate
- Respiratory effort
- Stimulation
- Positive-pressure ventilation
- Oxygen concentrations
- Pulse-oximetry readings
- Intubation or alternative airway
- Chest compressions
- Epinephrine
- Volume administration
- Response to each intervention
- NICU admission
- Post-resuscitation monitoring
These records can help establish exactly what the baby required immediately after delivery.
11. HIE and Therapeutic-Hypothermia Records
When HIE is suspected, the first hours of life can be particularly important.
The AAP’s 2026 therapeutic-hypothermia clinical report continues to emphasize early recognition and cooling within six hours for eligible newborns, while providing updated guidance on delayed cooling, late-preterm infants, EEG, transport, and MRI.
Request:
- Cord gases
- Early newborn blood gases
- Neurologic examinations
- Sarnat staging or equivalent assessment
- Neonatology consultation
- Cooling eligibility documentation
- Cooling-center consultation
- Cooling start time
- Temperature records
- Cooling duration
- Rewarming record
- EEG
- MRI
- Seizure treatment
If the baby was transferred, combine these records with the transport timeline.
The question may be:
When did the baby first meet cooling criteria—not merely when did the baby finally reach the tertiary NICU?
12. EEG and Seizure Records
Neonatal seizures are not always visible at the bedside.
Continuous EEG can identify electrographic seizures that have few or no obvious physical signs.
The American Clinical Neurophysiology Society published updated guidance in 2025 addressing continuous EEG monitoring for newborns with suspected seizures, confirmed seizures, or increased seizure risk.
Ask for:
- EEG order
- EEG start time
- EEG stop time
- Continuous video EEG report
- aEEG records when used
- Documented seizure events
- Anti-seizure medications
- Medication administration times
- Neurology consultations
A final one-page EEG report may summarize days of monitoring.
When available and relevant, the underlying digital EEG study can contain additional information for specialist review.
13. Brain Imaging
Imaging can help experts investigate both the type and potential timing of neurological injury.
Possible studies include:
- Head ultrasound
- MRI
- MR spectroscopy
- CT in selected circumstances
Request both:
- Radiology reports
- Actual imaging files when available
The images may later be reviewed independently by pediatric neuroradiology or other appropriate specialists.
An imaging report alone may not answer every causation question.
14. Placental Pathology
If the placenta was sent to pathology, request the report.
Placental pathology can provide evidence concerning:
- Infection
- Inflammation
- Placental abruption
- Thrombosis
- Vascular abnormalities
- Infarction
- Other placental conditions
Those findings can be important because neurological or newborn injury may have causes unrelated—or partly unrelated—to the care provided during labor.
Placental evidence can therefore support or undermine a proposed theory of causation.
That is exactly why it matters.
15. Bilirubin and Jaundice Records
For cases involving severe neonatal jaundice or kernicterus, the most important evidence is often a trend, not a single bilirubin value.
The AAP’s current hyperbilirubinemia guideline applies to newborns at least 35 weeks’ gestation and uses treatment thresholds based on factors including:
- Gestational age
- Baby’s age in hours
- Bilirubin level
- Neurotoxicity risk factors
Request:
- Total serum bilirubin values
- Direct bilirubin when tested
- Collection times
- Transcutaneous bilirubin measurements
- Phototherapy start time
- Phototherapy stop time
- Repeat measurements
- Discharge bilirubin
- Follow-up recommendations
- Follow-up laboratory results
- Readmission records
- Exchange-transfusion documentation if performed
The timeline may reveal whether:
- Jaundice was recognized
- Testing occurred when appropriate
- Follow-up was arranged
- Phototherapy was timely
- Worsening bilirubin was recognized
Again, the guideline itself does not automatically establish the legal standard of care in a particular case.
16. Infection Records
Some newborn neurological injuries or complications can be related to infection.
Relevant records may include:
- Maternal temperature
- Group B strep status
- Duration of ruptured membranes
- Chorioamnionitis or intra-amniotic infection documentation
- Maternal antibiotics
- Newborn blood cultures
- CBC
- CRP or other markers
- Lumbar puncture
- Antibiotic administration
- Culture results
These records may be important both for identifying negligence and for evaluating alternative explanations for the baby’s condition.
A credible case review tests both.
17. Interfacility Transport Records
If the baby was transferred from the delivery hospital to a higher-level NICU, the transport record creates another timeline.
Kentucky families may encounter Kentucky Kids Crew, which provides 24/7 neonatal and pediatric critical-care transport to Golisano Children’s at UK, or Norton Children’s “Just for Kids” Transport Team, which provides specialized neonatal and pediatric transport.
Look for:
- Referral call
- Receiving physician
- Acceptance time
- Transport request
- Team activation
- Dispatch
- Team arrival
- Baby’s condition at bedside
- Treatments before departure
- Cooling or thermoregulation measures
- Departure
- Treatments during transport
- Arrival
- Receiving-team handoff
Transport records are particularly useful in cases involving:
- HIE
- Cooling therapy
- Seizures
- Respiratory failure
- Prematurity
- Surgical emergencies
- Severe jaundice
18. Long-Term Pediatric and Therapy Records
Proving that negligence occurred is only part of a case.
The injury and its consequences must also be documented.
Long-term records may include:
- Pediatric neurology
- Developmental pediatrics
- Physical therapy
- Occupational therapy
- Speech therapy
- Feeding therapy
- Orthopedics
- Rehabilitation medicine
- Audiology
- Vision care
- Seizure treatment
- Behavioral or neuropsychological testing
- Early intervention
- School evaluations
- Individualized education programs
- Equipment and mobility needs
These records may help qualified experts evaluate:
- Permanence of injury
- Future medical treatment
- Therapy needs
- Assistance with daily activities
- Equipment
- Educational needs
- Future-care costs
What About Hospital Policies and Protocols?
Hospital policies can sometimes be relevant to understanding the system in place at the time.
Examples include:
- Fetal-monitoring policy
- Oxytocin protocol
- Emergency C-section procedure
- Chain-of-command policy
- Vacuum/forceps policy
- Neonatal resuscitation policy
- HIE/cooling pathway
- Hyperbilirubinemia protocol
- Transfer policy
But there is an important legal distinction:
Hospital policies are not necessarily part of the patient’s medical record.
KRS 422.317 gives patients a right to a copy of their medical record upon written request. It should not be read as guaranteeing pre-suit access to every internal policy, procedure, administrative document, or operational record a hospital possesses.
Additional materials may sometimes be requested voluntarily, preserved, or obtained through formal litigation procedures.
What About Staffing Records?
Staffing can matter when an alleged delay involved:
- No obstetrician immediately available
- Anesthesia coverage
- Operating-room personnel
- Nursing assignments
- NICU staffing
- Simultaneous emergencies
Potential records can include:
- Staffing rosters
- Assignment sheets
- On-call schedules
- Time records
These are not necessarily part of a routine patient medical-record release.
An attorney can determine when staffing information is relevant and how it should be obtained.
What About Text Messages, Pages, and Secure Chats?
Modern hospital communication may occur through:
- Pagers
- Secure messaging
- EHR messaging
- Hospital phones
- Call systems
- Other clinical communication platforms
Those records can sometimes help determine:
- Who was contacted
- When the communication occurred
- How urgent the message was
- Whether a response was delayed
But not every communication is preserved, and not every preserved communication is part of the patient’s designated medical record.
Do not assume a routine medical-record request will automatically produce them.
What Is an EHR Audit Trail?
An electronic-health-record audit trail is system-generated information concerning activity within the EHR.
Depending on the system, it may show events such as:
- User access
- Entry creation
- Modifications
- Viewing
- Signing
- Other system activity
Audit-trail evidence can sometimes clarify when documentation was entered or changed.
But it must be interpreted carefully.
An audit timestamp does not necessarily establish when the underlying bedside event actually occurred.
Audit trails also should not be described as records automatically obtainable through an ordinary KRS 422.317 request.
If one may be important, an attorney can evaluate whether preservation or formal production should be pursued.
What About Medical-Device Data?
Medical devices can contain electronic information separate from the main EHR.
Potential examples include:
- Infusion pumps
- Fetal monitors
- Ventilators
- Cooling devices
- Physiologic monitors
Whether information remains retrievable depends on:
- Device
- Hospital system
- Storage architecture
- Retention settings
- Integration with the EHR
- Passage of time
For that reason, asking early whether separately retained data exist can be useful.
But again, do not promise families that “pump logs” or raw device exports will always exist or automatically be released.
Kentucky Medical-Record Rights
Kentucky law provides important record-access rights.
KRS 422.317
Under KRS 422.317, upon a patient’s written request, a covered hospital or healthcare provider must provide the patient a copy of the medical record without charge.
The statute permits a charge of up to $1 per page for a second copy.
That is an important correction to older summaries suggesting that ordinary copying fees necessarily apply to the patient’s first requested copy.
Parents’ Access to a Child’s Records
Kentucky enacted KRS 422.355, effective July 15, 2024.
It provides that the parent or qualifying personal representative of a patient under age 18 has the right to access the child’s health information maintained in the medical record, subject to applicable federal and state-law exceptions.
That can be particularly useful in birth injury investigations because the mother’s and baby’s records are usually separate.
Consider requesting:
- Mother’s labor-and-delivery record
- Baby’s newborn/NICU record
Do not assume requesting one automatically produces the other.
Kentucky’s Certificate-of-Merit Law Makes Records Especially Important
KRS 411.167 generally requires a certificate of merit when commencing a covered Kentucky medical-malpractice action.
The statute ordinarily requires the claimant to review the facts and consult at least one appropriately qualified expert who concludes there is a reasonable basis for filing the action.
The statute contains an especially relevant records provision.
If the claimant has requested records of treatment from the defendants and those records have not been produced, subsection (5) generally provides that the certificate of merit is not required until 90 days after the records have been produced.
For this provision, the statute expressly says “records” include, but are not limited to:
- Paper or electronic records
- Dictations
- Video recordings
- Fetal heart monitor strips
- Imaging studies
That language is particularly relevant to birth injury investigations.
The provision should not be treated as permission to ignore a statute of limitations. Filing deadlines and certificate-of-merit rules are separate issues that require individualized analysis.
How to Turn the Records Into a Birth Injury Timeline
Once the records are collected, organize them around six questions.
1. Recognition
What was the first sign of a problem?
Examples:
- Category II fetal-heart-rate pattern
- Category III tracing
- Prolonged deceleration
- Persistent bradycardia
- Tachysystole
- Maternal hypotension
- Fever
- Failure of descent
- Shoulder dystocia
- Newborn depression
- Rising bilirubin
- Seizure activity
2. Communication
Who knew about the problem?
Document:
- Nurse recognition
- Physician notification
- Time notified
- Physician response
- Chain of command
- Consultations
- Transfer calls
3. Response
What did staff actually do?
Examples:
- Maternal repositioning
- Oxytocin reduction or discontinuation
- Treatment of hypotension
- Amnioinfusion
- Treatment of tachysystole
- Operative vaginal delivery
- Emergency cesarean
- Newborn ventilation
- Intubation
- Cooling
- Phototherapy
- Antibiotics
- Seizure treatment
4. Reassessment
Did the intervention work?
This is often critical.
A treatment that promptly resolves an abnormality creates a different clinical picture from repeated measures that fail while the patient continues to deteriorate.
5. Escalation
When the problem did not improve, what happened next?
Look for:
- Senior physician involvement
- Anesthesia
- Operating-room activation
- NICU team
- Emergency delivery
- Tertiary-center consultation
- Transport activation
6. Causation and Outcome
Finally, compare the timeline with:
- Cord gases
- Apgars
- Resuscitation
- HIE examinations
- EEG
- MRI
- Placental pathology
- Bilirubin
- Infection studies
- Long-term diagnoses
This is where qualified medical experts assess whether the proposed negligence actually caused the injury.
A Simple Example of Why the Whole Timeline Matters
Suppose the chart shows:
1:42 p.m. — recurrent late decelerations begin
1:48 p.m. — nurse repositions mother
1:52 p.m. — oxytocin stopped
1:56 p.m. — obstetrician notified
2:04 p.m. — tracing deteriorates further
2:12 p.m. — physician at bedside
2:18 p.m. — cesarean decision documented
2:25 p.m. — anesthesia notified
2:38 p.m. — patient enters OR
2:47 p.m. — incision
2:51 p.m. — delivery
Looking only at:
Decision 2:18 → incision 2:47 = 29 minutes
would miss everything that happened before the official decision time.
An expert review may need to ask:
What did the tracing show at 1:42?
When should the physician have been involved?
Did the tracing respond to interventions?
Was the decision appropriately timed?
That is why a medical-malpractice case is rarely proven by one isolated number.
What Records Do NOT Automatically Prove Negligence?
None of the following establishes negligence by itself:
- Category II tracing
- Category III tracing
- Emergency C-section
- C-section longer than 30 minutes after decision
- Vacuum delivery
- Multiple vacuum pop-offs
- Shoulder dystocia
- Low Apgar score
- Low cord pH
- NICU admission
- Seizures
- HIE diagnosis
- Cooling therapy
- Cerebral palsy
- High bilirubin
- Kernicterus
- Transfer to another hospital
- Bad outcome
Each may be important evidence.
None substitutes for a complete standard-of-care and causation analysis.
Can Missing Documentation Prove Negligence?
Not automatically.
A missing record may raise questions, but there can be many reasons an item is not present in the initial production.
For example:
- It may be maintained in another system
- A different department may control it
- It may require a separate request
- It may not have been retained
- The hospital may not have produced the complete chart
Do not assume that a missing record was intentionally destroyed.
If preservation or spoliation becomes an issue, that is a separate legal analysis based on the facts.
Do Hospital Guidelines Prove the Standard of Care?
Not by themselves.
Organizations such as:
- ACOG
- AAP
- AHA
- AHRQ
- ACNS
publish clinical guidelines and patient-safety resources.
These can help experts understand recognized clinical approaches.
But a professional guideline, safety bundle, hospital policy, or checklist should not automatically be equated with the legal standard of care in one individual case.
Kentucky Rule of Evidence 702 requires reliable expert testimony based on sufficient facts or data and reliable methods when specialized expert evidence is offered.
Can a Kentucky Birth Injury Case Be Proven Without Experts?
There are limited circumstances in which expert testimony may not be required.
KRS 411.167 recognizes causes of action such as certain res ipsa loquitur and informed-consent claims for which expert testimony may not be necessary.
But birth injury cases involving fetal monitoring, obstetric decision-making, neonatal treatment, HIE, causation, and neurological injury ordinarily involve complex medical questions.
The Kentucky Supreme Court’s June 2026 decision in Diagnostic X-Ray Physicians, PSC v. Lloyd again addressed the general requirement for appropriate expert testimony concerning the standard of care in medical-negligence litigation.
Families should not expect a chart to “speak for itself” in a complex birth injury case.
Kentucky Deadlines: Records Are Important, but So Is Timing
Do not wait indefinitely to collect every possible document before having legal deadlines evaluated.
Private Medical-Malpractice Claims
The current version of KRS 413.140, effective July 15, 2026, generally provides a one-year limitations period for covered negligence or malpractice claims against physicians and licensed hospitals.
For the covered medical-malpractice claims, the statute provides that accrual occurs when the injury was discovered or reasonably should have been discovered and contains a five-year outside provision from the alleged negligent act or omission.
Claims Belonging to a Child
KRS 413.170 contains an infancy-tolling provision for qualifying claims belonging to a person who was a minor when the cause of action accrued.
In June 2026, the Kentucky Supreme Court reaffirmed the significance of this provision in Mercy Regional Emergency Medical System, LLC v. Estate of Fuson, holding that the minor children’s claims in that case remained protected by KRS 413.170.
That does not mean every claim connected with an injured child can wait until adulthood.
A parent’s individual claim, estate claim, wrongful-death claim, or other claim may involve different deadlines.
State-Related Claims Can Be Different
Claims that fall within the jurisdiction of Kentucky’s Board of Claims have different timing rules.
KRS 49.120 generally requires claims to be filed with the Board within one year after accrual and contains separate provisions for medical malpractice.
Importantly, the statute expressly says infancy or another legal disability does not extend its filing period under KRS 413.170.
That is another reason not to rely on a general “the child is a minor, so we have time” assumption.
Wrongful Death Is Different Too
If a child dies as a result of alleged negligence, KRS 411.130 provides that the wrongful-death action is prosecuted by the deceased person’s personal representative.
Do not assume that rules protecting a living child’s personal injury claim automatically apply to an estate or wrongful-death claim.
Kentucky Medical-Records Request Template
Use this as a starting point.
To: Health Information Management / Medical Records
Hospital: [Hospital Name]Maternal Patient: [Name]
DOB: [MM/DD/YYYY]
MRN: [if known]Child: [Name]
DOB: [MM/DD/YYYY]
MRN: [if known]Pursuant to applicable Kentucky and federal law, including KRS 422.317 and, for my minor child’s records, KRS 422.355, please provide an electronic copy of the complete available medical record.
For the maternal labor-and-delivery record, please include:
- Triage and admission records
- Labor-and-delivery flowsheets
- Complete fetal-heart-rate and uterine-contraction tracings
- Fetal-monitor annotations and event markers
- Any available archived electronic waveform/export associated with the tracing
- Nursing notes
- Physician, resident, midwife, and consultant notes
- Orders
- Complete medication administration record
- Oxytocin/Pitocin administration history and documented rate changes
- Intrauterine pressure catheter records, if used
- Laboratory results
- Anesthesia record
- Operating-room record
- Delivery note
- Operative report
- Vacuum/forceps delivery documentation, if applicable
- Placental pathology, if performed
- Postpartum and discharge records
For the child’s newborn/NICU record, please include:
- Delivery-room resuscitation record
- Apgar scores
- Umbilical cord arterial and venous gases
- Early newborn blood gases
- Newborn and NICU nursing records
- Physician records
- Medication administration record
- Laboratory results
- Bilirubin results
- Phototherapy documentation
- Neurological examinations
- Therapeutic-hypothermia records
- EEG/aEEG reports
- Neuroimaging reports
- Consultation records
- Infection workup
- Transport documentation maintained in the medical record
- Discharge records
- Follow-up referrals
If any patient-specific fetal-monitor waveform, infusion-pump, cooling-device, or other separately retained electronic data associated with this admission are available for patient release but maintained outside the ordinary medical record, please advise how those materials may be requested.
Please provide the records electronically through a secure portal or other available secure electronic method.
Name: ______________________________
Address: ____________________________
Phone: ______________________________
Email: ______________________________
Signature: ___________________________
Date: _______________________________
Remember: policies, staffing records, audit trails, internal messages, and some separately maintained device data may require a different request or legal process.
What Should You Save Yourself?
Families can also preserve information that may never appear in the hospital chart.
Save:
- Discharge instructions
- Patient-portal records
- Portal messages
- Appointment summaries
- Photos showing visible injuries
- Therapy records
- Medical bills
- Insurance explanations of benefits
- Specialist referrals
- Early-intervention records
- Developmental evaluations
- A symptom and therapy journal
If you made contemporaneous notes during the hospitalization, preserve the original.
If you later remember something else, make a new dated entry rather than rewriting the original note.
Frequently Asked Questions
What is the single most important record in a birth injury case?
There usually isn’t one.
For a fetal-monitoring case, the EFM tracing may be central.
For HIE, cord gases, neurological examinations, cooling records, EEG, and MRI may be especially important.
For kernicterus, the bilirubin timeline and follow-up records may matter most.
The appropriate records depend on the injury theory.
Do fetal-monitor strips prove malpractice?
No.
They show fetal-heart-rate and contraction patterns over time.
Qualified experts must evaluate the tracing in the clinical context and determine whether the response was appropriate.
Can Pitocin records prove negligence?
They can help establish:
- Dose
- Timing
- Tachysystole
- Fetal response
- Whether oxytocin was reduced or stopped
But an oxytocin infusion alone does not establish negligence.
Do cord gases prove when brain damage occurred?
Not by themselves.
Cord gases provide important information about the baby’s acid-base status around delivery, but neurological causation usually requires consideration of the complete pregnancy, labor, neonatal, imaging, EEG, and clinical evidence.
Is an abnormal MRI proof that the obstetrician caused the injury?
No.
MRI can help characterize the pattern and timing of neurological injury.
Determining why that injury occurred requires broader medical analysis.
Are EHR audit trails part of my normal medical-record request?
Not necessarily.
They are system data rather than ordinary clinical chart documents in many healthcare systems.
Whether an audit trail should be requested or produced is a separate question.
Can I request hospital policies?
You can ask.
But KRS 422.317’s right to a patient’s medical record should not be described as an automatic right to every internal hospital policy.
Policies may be obtained separately depending on the circumstances.
What if the hospital does not produce the fetal-monitor strips?
Follow up in writing and specifically identify what appears to be missing.
KRS 411.167 expressly includes fetal heart monitor strips within its definition of records for its certificate-of-merit production provision.
If a potential case is involved, legal counsel can determine what additional steps are appropriate.
Should I wait until I have every record before contacting an attorney?
No.
Some records can take time to obtain, and different legal deadlines may apply to different claims.
Start with what you have.
Additional records can be identified during the investigation.
Questions About Birth Injury Records in Kentucky?
If your child suffered a serious complication during labor, delivery, or the newborn period, Morrin Law Office can help identify which records may be important to understanding what happened.
A birth injury review may involve reconstructing:
recognition → communication → response → reassessment → escalation → delivery → newborn care → outcome
The goal is not to find one dramatic document.
The goal is to assemble the complete medical story and determine what qualified experts believe the evidence shows.
Call Morrin Law Office for a free consultation
859-358-0300
214 W Main St., Richmond, KY 40475
Sources and Public Resources
- Kentucky Revised Statutes — KRS 422.317: Copy of Patient’s Medical Record. Requires covered hospitals and healthcare providers to provide a patient’s first requested copy of the medical record without charge upon written request.
Kentucky Legislature — KRS 422.317 - Kentucky Revised Statutes — KRS 422.355: Access to a Minor’s Medical Record. Provides parents and qualifying personal representatives access to health information in the medical record of a patient under 18, subject to applicable exceptions.
Kentucky Legislature — KRS 422.355 - Kentucky Revised Statutes — KRS 411.167: Certificate of Merit for Medical Malpractice Actions. Generally requires expert consultation for covered malpractice actions and expressly includes fetal heart monitor strips among medical records addressed by its record-production provision.
Kentucky Legislature — KRS 411.167 - Kentucky Revised Statutes — KRS 413.140: Actions to Be Brought Within One Year. Current statute governing the general limitations period and discovery provision for covered medical-malpractice actions; current version effective July 15, 2026.
Kentucky Legislature — KRS 413.140 - Kentucky Revised Statutes — KRS 413.170: Infancy and Other Disability Tolling. Addresses tolling for qualifying causes of action belonging to persons who were minors or otherwise legally disabled when the claim accrued.
Kentucky Legislature — KRS 413.170 - Kentucky Revised Statutes — KRS 49.120: Board of Claims Deadlines. Contains separate limitation rules for qualifying claims within Kentucky’s Board of Claims jurisdiction and states that infancy does not extend those deadlines through KRS 413.170.
Kentucky Legislature — KRS 49.120 - Kentucky Revised Statutes — KRS 411.130: Wrongful Death. Provides that Kentucky wrongful-death actions are prosecuted by the deceased person’s personal representative.
Kentucky Legislature — KRS 411.130 - Kentucky Supreme Court — Diagnostic X-Ray Physicians, PSC v. Lloyd (June 25, 2026). Published Kentucky Supreme Court decision addressing the requirement for expert testimony to establish the standard of care in medical-negligence litigation and the limited res ipsa loquitur exceptions.
Read the 2026 Lloyd decision - Kentucky Supreme Court — Mercy Regional Emergency Medical System, LLC v. Estate of Fuson (June 25, 2026). Published decision addressing KRS 413.170 and minority tolling.
Read the 2026 Fuson decision - Kentucky Supreme Court Order 2024-19 — KRE 702. Amended Kentucky’s expert-testimony rule effective July 1, 2024, requiring reliable expert evidence based on sufficient facts or data and reliable methods applied reliably to the case.
Kentucky Court of Justice — Supreme Court Order 2024-19 - ACOG — Intrapartum Fetal Heart Rate Monitoring: Interpretation and Management, Clinical Practice Guideline No. 10 (2025). Current ACOG evidence-based framework for evaluating and managing fetal-heart-rate tracings during labor.
ACOG — Intrapartum Fetal Heart Rate Monitoring - AHRQ — Safe Medication Administration: Oxytocin. Perinatal patient-safety resource addressing standardized oxytocin administration, fetal and maternal monitoring, tachysystole, notification, and medication reduction/discontinuation.
AHRQ — Safe Medication Administration: Oxytocin - ACOG — Practice Bulletin No. 219: Operative Vaginal Birth (2020; reaffirmed 2025). Current ACOG guidance concerning forceps and vacuum-assisted delivery, including risks, benefits, proper use, and clinician competency.
ACOG — Operative Vaginal Birth - AHA/AAP — 2025 Neonatal Resuscitation Guidelines. Current guidance on preparation, ventilation, advanced newborn resuscitation, post-resuscitation care, and therapeutic hypothermia.
AAP — 2025 AHA/AAP Neonatal Resuscitation Guidelines - AAP — Therapeutic Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy (2026). Current AAP clinical report on HIE evaluation, cooling eligibility and timing, EEG monitoring, MRI, transport, and long-term follow-up.
AAP — Therapeutic Hypothermia for HIE - AAP — Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation (2022). Current AAP framework for bilirubin surveillance, treatment thresholds, phototherapy, escalation, and follow-up.
AAP — Hyperbilirubinemia Guideline - American Clinical Neurophysiology Society — Neonatal Continuous EEG Guideline (2025). Evidence-based guideline addressing continuous EEG use for neonates with suspected seizures, confirmed seizures, and other high-risk conditions.
PubMed — ACNS Neonatal Continuous EEG Guideline - UK HealthCare — Kentucky Kids Crew. 24/7 neonatal and pediatric hospital-to-hospital critical-care transport service.
UK HealthCare — Kentucky Kids Crew - Norton Children’s — “Just for Kids” Transport Team. 24/7 neonatal and pediatric specialized transport by ground and air.
Norton Children’s — Just for Kids Transport Team
Disclaimer
This page provides general educational information about records commonly reviewed in Kentucky birth injury investigations. It is not medical advice and is not a substitute for advice from qualified healthcare professionals.
It is also not individualized legal advice. A particular medical record, fetal-monitor pattern, lab result, diagnosis, delay, or poor outcome does not by itself prove medical negligence or causation. Kentucky claims can involve different parties, legal forums, filing requirements, and deadlines.
Reading this page or making an initial inquiry does not by itself create an attorney-client relationship. If you have questions about a potential claim or filing deadline, obtain individualized legal advice promptly.
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