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The cerebral palsy cases fit that pattern. Mr. Edwards did accept the occasional case in which a baby died during delivery; The North Carolina Lawyers Weekly reported such cases as yielding settlements in the neighborhood of $500,000. But cases involving children who faced a lifetime of expensive care and emotional trauma could yield much more.
In 1985 he handled his first cerebral palsy case, for Jennifer Campbell, the girl whose voice he recreated at trial. In his book "Four Trials," Mr. Edwards described the case as an uphill battle. The doctor was esteemed and worked at a prestigious teaching hospital. Mr. Edwards's associate interviewed 41 obstetricians before finding one local doctor who would make a good witness.
It was clear which evidence would be crucial: "I had to become an overnight expert in fetal monitor readings," Mr. Edwards wrote.
In other cases, too, his colleagues say, the fetal monitor readings would constitute the key evidence.
"It's just like a black box in a car," said Douglas B. Abrams, Mr. Edwards's co-counsel in a cerebral palsy case settled for $1 million in 1995. "You know when a truck driver was driving too fast."
Doctors say that is an oversimplification.
"It seems to me that only trial lawyers are experienced at reading fetal monitor strips and are able to tell me exactly when infants became asphyxic," or deprived of oxygen, said Dr. William J. West Jr., an obstetrician and the president of First MSA Inc., which administers health care savings accounts.
In any event, Mr. Edwards's closing argument in the Campbell case still resonates in North Carolina.
"It would have been a very, very cold heart that was not reached by that, because Senator Edwards lived in that case," the judge who presided over the trial, Herbert O. Phillips, said in a recent interview. "That was Edwards, and Edwards was that case. He projected that oneness with his client and carried that to the jury, and he did it well."
The lawyer on the other side, Robert Clay, agreed.
"I was thinking that is really a bold thing to do," Mr. Clay said. "There is not really one lawyer in a thousand who could do that without having it turn against him because he is being hokey. It's just such a blatant appeal to emotions, like putting up a sign: `I'm appealing to your emotions.' But John could get away with it."
Not entirely. Five weeks after the verdict, Judge Phillips ruled it "excessive" and said it appeared "to have been given under the influence of passion and prejudice," adding that "the evidence was insufficient to support the verdict." He gave the Campbells a choice: They could accept half of the $6.5 million the jury awarded or face a new trial. They declined to take half, appealed the case and eventually settled for $4.25 million.
Next weekend, members of the Birth Trauma Injury Litigation Group of the Association of Trial Lawyers of America will gather in Atlanta for a two-day conference. On the agenda the first morning: "Electronic Fetal Monitoring: Understanding How the Strips Can Help or Hurt Your Case."
A Medical Advance Is Rethought
Electronic fetal heart monitoring was introduced in the 1960's to great fanfare. Advocates thought it would prevent most cerebral palsy by providing continuous immediate data on how babies were weathering labor and delivery.
But in the 1980's, scientists began to challenge the premise that medical care during delivery had much to do with cerebral palsy. Studies concluded that 10 percent or fewer of cases could be traced to an oxygen shortage at birth. The vast majority of children who developed cerebral palsy were damaged long before labor, the studies found.
Then a series of randomized trials challenged the notion that faster delivery could prevent cerebral palsy. Reviewing data from nine countries, two researchers reported last year that the rate of the disorder had remained stable despite a fivefold increase in Caesarean deliveries.
Dr. Karin B. Nelson, a child neurologist with the National Institutes of Health, says the notion that paying greater heed to electronic monitoring will prevent brain injuries remains just that, a notion. "Evidence of high medical quality contradicts the assumption that the use of electronic fetal monitoring during labor can prevent brain damage," Dr. Nelson said.
