Oxygen Deprivation at Birth (HIE): Malpractice, Delayed Cesarean and Compensation

Summary

Hypoxic-ischemic encephalopathy (HIE), which develops during or around the time of birth, can cause permanent neurological damage in a baby. However, a diagnosis of HIE, or a diagnosis of cerebral palsy made later, does not mean that the team managing the birth was necessarily at fault. Legal liability requires an overall assessment of the monitoring of foreseeable risks, the timely recognition of deterioration, the avoidance of delay in the correct intervention, the proper conduct of newborn care, and the causal link between any negligence and the harm. This guide explains which records families should request, under what conditions the doctor and the hospital can be held liable, and which legal routes are available in Türkiye.

My Baby Was Deprived of Oxygen at Birth and Is Now Disabled: Is This Malpractice?

Short answer: not always. A child's diagnosis of HIE after birth, or the development of cerebral palsy or epilepsy, does not by itself prove medical error. On the other hand, failure to take account of risks before delivery, failure to assess abnormal fetal heart rate patterns in time, delay in a necessary delivery intervention, or shortcomings in newborn treatment can justify a claim of medical malpractice.

A doctor is expected to deliver not a guaranteed outcome of a healthy child but care that meets the medical knowledge and standard of care applicable in the circumstances of the case. The hospital also has a duty to organize uninterrupted monitoring, on-duty staff, an emergency operating room and newborn care. In litigation, it is not only the baby's final condition that must be examined, but the chronology of all events from pregnancy follow-up to discharge.

What Is HIE, and Is It the Same Condition as Cerebral Palsy?

Hypoxic-ischemic encephalopathy is a newborn brain dysfunction that can develop when the oxygen and blood flow reaching the brain are insufficient. Neonatal encephalopathy is a broader clinical term; not every case of neonatal encephalopathy is caused by hypoxia. HIE may be linked to events before birth, during birth or immediately after birth. Cerebral palsy, by contrast, is a group of permanent disorders affecting movement and posture that result from damage to, or differences in, the developing brain. Not every case of HIE turns into cerebral palsy, and not every case of cerebral palsy results from oxygen deprivation during birth.

Other conditions that can cause a similar picture

Genetic and metabolic diseases, fetal or neonatal infections, placental circulation disorders, prematurity, developmental brain anomalies, neonatal stroke and certain bleeding disorders can cause similar findings. Unless these possibilities are properly examined and excluded, attributing a baby's neurological outcome solely to a single event at birth is not scientifically safe. The assessment approach of ACOG and the American Academy of Pediatrics (AAP) rests on a multidimensional clinical evaluation rather than a single sign. [1, 2]

Three separate questions to answer in a legal review

• Medical diagnosis: What is the child's neurological condition, and which specific findings is the HIE diagnosis based on?
• Timing and cause of the event: Did the brain damage develop during pregnancy, during birth or after birth, and are there other explanations?
• Liability: Is there any act or omission by the healthcare team that departed from the medical standard, and what effect did it have on the occurrence or worsening of the damage?

How Is a Complication Distinguished from a Medical Error?

Premature separation of the placenta (abruption), cord prolapse, uterine rupture or a severe drop in the fetal heart rate are, in some cases, rapid developments that cannot be predicted in advance. The occurrence of such an event is not conclusive proof of fault. But the complication itself and the medical response to the complication are separate subjects of review. Once the risk was identified, was the frequency of monitoring increased? Was emergency help called? When did the doctor personally see the patient? Were the operating room and the newborn team prepared? Was there a delay in resuscitation or referral after birth?

Concluding that a complication was unforeseeable does not mean that all healthcare provided from the moment the intervention began was automatically appropriate. Conversely, compensation cannot be awarded on the basis of the outcome alone for an unavoidable harm that developed despite monitoring and intervention in line with medical standards. Both possibilities need to be tested against the case file and expert opinion.

What Do NST and CTG Records Prove in an HIE Case?

NST (non-stress test) and CTG (cardiotocography) provide information on the fetal heart rate and uterine contractions. The purposes and interpretation conditions of a prenatal NST and of a CTG kept during labor are not the same. In particular, the baseline heart rate, variability, late or variable decelerations, prolonged deceleration and bradycardia are followed. An abnormal CTG is not conclusive proof of brain damage or of a doctor's fault; it is assessed together with the clinical condition of the mother and the baby, the gestational week, the medications used and the stage of labor. NICE's guideline, updated in March 2026, likewise does not accept heart rate monitoring as a diagnostic tool on its own. [3]

Why is the raw record more important than the discharge summary?

An epicrisis (discharge summary) that merely states "NST reactive" or "fetal distress" does not by itself show the time, the duration, the shape of the trace or which intervention was carried out. For this reason, wherever possible, the raw CTG/NST printouts, the device's digital records, the partogram, midwife monitoring charts and the physician's assessment notes should be obtained together. Even whether a heart rate recording during labor was confused with the mother's pulse can matter in a specific case.

The expert should determine the following time intervals separately: the first suspicious finding, reassessment, notification of the doctor, the doctor's examination, the measure taken, the point at which an indication for emergency delivery arose, the decision, entry into the operating room and the birth of the baby. In this way, it can be discussed not only whether the decision was made late, but at what moment the necessary decision should have been made.

If there is no NST, CTG or partogram record, is the case won automatically?

No. Records that were never kept, were not preserved, have become illegible or were drawn up inconsistently are a serious problem for proof; the court may need to consider ordering production of documents, preservation of evidence where necessary, and expert examination. However, causation between a missing record and neurological harm is not established automatically. In the Court of Cassation 3rd Civil Chamber decision of 22 September 2025, too, a judgment finding no fault was upheld on the ground that, although missing records were identified, no link to the harm could be established. [8]

When Can a Delayed Cesarean Give Rise to Liability?

In discussing an emergency cesarean, the starting point is not "how many minutes passed between the decision and the birth." First, it must be determined at what time the fetal or maternal risk made a decision for a cesarean or another emergency delivery method necessary. In a labor that has lasted a long time, the first examination, a labor that is not progressing, the mother's blood pressure and signs of infection, the use of oxytocin, meconium, the course of the fetal heart rate and the position of the baby in the birth canal are assessed together.

The source of the delay may be different people or stages

• The midwife/nurse may not have noticed a critical deterioration in the heart rate or may have notified the doctor late.
• The doctor, although informed, may have delayed assessing the patient or deciding on the appropriate intervention.
• The decision may have been made at the right time, but carrying it out may have been prolonged because of the organization of the operating room, anesthesia or the surgical team.
• If the baby has already advanced in the birth canal, choosing another method of delivery instead of a cesarean may be medically correct under the obstetric conditions at that moment.

The "30 minutes" expression used for emergency cesarean is not an absolute limit of fault or absence of fault that applies to all cases. The severity of the specific danger, the stage of labor, the medically possible intervention and the real effect of the delay are what matter. In determining the time, the operating room and anesthesia records, the operation note, the nurse observation form and the time of birth are examined together.

What Happens If Fetal Distress Is Not Recognized in Time?

Although the term "fetal distress" is used in practice, the objective findings that exist must be written down specifically. Some heart rate changes are transient; others suggest that fetal oxygenation is impaired and require urgent assessment. NICE addresses urgent obstetric assessment in the case of sudden bradycardia during labor or a single prolonged deceleration of three minutes or longer, and, if the findings persist, rapid delivery depending on the risk status. However, the durations and categories in the guideline cannot be applied retrospectively as an automatic fault standard to every event. [3]

The causation assessment here has two stages: Was there really a delay? If so, could this delay have caused the harm that occurred or aggravated the existing damage? A positive answer to the first question does not mean the second has also been proven.

HIE Diagnosis After Birth, Resuscitation and Cooling Treatment

It is a significant shortcoming for the legal review to end at the moment of birth. Whether the baby's spontaneous breathing began, the heart rate, the duration of resuscitation efforts, intubation, the first blood gas, seizures, admission to intensive care and referral records must also be assessed. A neurological examination by a neonatologist, appropriate EEG/aEEG monitoring and brain imaging may be needed.

Why are the first six hours important for therapeutic hypothermia?

According to the AAP clinical report of 26 January 2026, in cases of moderate to severe HIE that meet the appropriate criteria and in babies born at 36 weeks of gestation or later, therapeutic hypothermia, applied by lowering body temperature to about 33.5 °C, started within the first 6 hours and maintained for 72 hours, reduces the risk of death or moderate to severe neurodevelopmental impairment. This practice depends on specific clinical and biochemical conditions; it is not applied automatically to every baby with a low Apgar score. For births at 35 weeks, the benefits and risks are weighed case by case; it is not recommended as standard below 35 weeks. [4]

If the health facility has no capacity to provide this treatment, early recognition of possible HIE, consultation with a newborn center, and no delay in the referral and transfer plan are important. That hypothermia was applied is not conclusive proof of the cause of HIE; that it was not applied is not automatic evidence of malpractice either. The expert must assess, together with the medical standards applicable at that date and at that center, whether the baby actually met the conditions for treatment.

How Are Brain MRI, Apgar and Cord Blood Gas Interpreted in HIE Cases?

The Apgar score serves to describe the baby's clinical condition in the first minutes after birth. The Apgar score alone is neither a diagnosis of asphyxia nor an indication of its timing. Severe metabolic acidosis in the umbilical artery blood gas can increase the likelihood of intrapartum hypoxia, but alone it does not show at which minute it developed. A value within normal limits can reduce the likelihood of certain causes. MRI shows the pattern and extent of the damage; it is often not possible for it to determine at exactly which minute the damage occurred. [1, 2, 5]

The timing of the brain MRI, the diffusion sequences, the pattern of basal ganglia–thalamus or watershed injury, possible metabolic or vascular diseases, seizure records and placental pathology should be discussed together by specialists. When the presence or absence of a single marker is treated as the outcome, the legal assessment loses its scientific consistency.

The Responsibilities of the Doctor, Midwife, Newborn Team and Hospital Must Be Examined Separately

At the different stages of medical care, the powers of decision and execution differ. The obstetrician-gynecologist may be responsible for risk assessment and management of the birth; the midwife and nurse for monitoring within their own sphere of authority and for the necessary notifications; and the newborn team for post-birth assessment, resuscitation and appropriate treatment. Until it is established from the file who knew what information at what time and what they were obliged to do, the entire outcome cannot be attributed to a single person.

The hospital's organizational fault

Inadequate on-call arrangements, the lack of a system ensuring that critical CTG findings are communicated, the unavailability of a specialist doctor, the inability to prepare an emergency operating room, the absence of newborn resuscitation equipment, or delayed referral to an appropriate center may be discussed within the scope of the hospital's independent service/organizational fault. In a private hospital, the hospital operator's contractual liability and its liability for auxiliary persons; in a public hospital, the administration's service fault, are addressed on different legal bases.

As to informed consent, whether the mother was appropriately informed about the method of delivery and the significant risks may also be examined separately. A signed consent form does not automatically make every procedure carried out afterwards lawful; nor does a lack of information mean that the same lack was the cause of the whole neurological outcome. [6]

How Are Fault, Damage and the Causal Link Proven Together?

In an HIE file, the accuracy of the medical diagnosis, the conduct of healthcare personnel in breach of the duty of care, the child's concrete damage and an appropriate causal link are separate elements. In particular, the likelihood that timely intervention would have prevented the severe damage entirely or reduced its severity must be discussed scientifically together with alternative causes. The claims put forward must be tied to measurable findings in the file.

In defense, it is often said that the damage occurred before birth, that the event was sudden and unavoidable, that the CTG was not pathological, that an earlier cesarean would not have changed the outcome, or that the conditions for cooling treatment were not met. Merely saying "the baby was healthy" is not enough to answer these. The pregnancy records, the complete CTG series, the neurological assessment, the corresponding MRI pattern, post-birth treatment and possible alternative etiologies need to be examined by the same panel of experts.

Which Medical Documents Should Families Request?

Article 16 of the Patients' Rights Regulation (Hasta Hakları Yönetmeliği) provides that a patient may examine the files and records relating to their health condition, personally or through an authorized representative, and obtain copies. For a minor's records, the authority of legal representation and the confidentiality of health data are taken into account. [7] It is helpful to request from the institution not only the discharge summary but the following records, with dates, times and, where available, electronic record history.

If documents are missing, the request letter and the reply received should be kept; where possible, preservation of evidence or a request that the court order production of documents under the Code of Civil Procedure (HMK) should be considered. An estimated time should not be written in place of a missing record, and different system clocks should be reconciled.

A Method for Reconstructing the Birth Minute by Minute

For a sound claim or defense, the following sequence should be built in a single chart:

This table is not merely a procedural convenience; it ensures that the questions put to the expert focus on the real cause of the event. It is important to verify the same time interval against records from different personnel and institutions.

How Should the Expert Panel Be Formed and What Questions Should Be Asked?

Obstetrics-gynecology/perinatology, neonatology and pediatric neurology may need to be assessed together. Depending on the interpretation of the MRI, pediatric neuroradiology may be needed; depending on clear alternative causes, genetics or metabolism expertise; and depending on hospital organization, relevant service management and anesthesiology knowledge. What is decisive is not the titles of the panel but that the genuinely disputed issues are evaluated by the relevant fields of expertise.

The expert report should clearly answer the following questions:

1. What was the standard of monitoring on the date of the event, and are the concrete records consistent with it?
2. When did the first objective sign of fetal risk appear, and at what moment were appropriate assessment and notification required?
3. Under what conditions and at what time did the indication for a cesarean or other emergency delivery arise?
4. Was there any organizational deficiency with respect to staff, the operating room, anesthesia and the newborn team?
5. What are the findings regarding the possibilities of pregnancy-related, birth-related and post-birth causes of hypoxia and permanent neurological damage?
6. Could early intervention, proper resuscitation, referral or the application of hypothermia have prevented or reduced the outcome?
7. Which medical questions cannot be answered because of missing NST/CTG, partogram or other records?
8. After each claim, counter-opinion and alternative cause has been assessed, what is the scientific conclusion on fault and causation?

An unreasoned positive or negative answer to the question "is the doctor at fault?" alone is not sufficient for the medical and legal review of complex files of this kind.

How Do the Court of Cassation, the Council of State and the Constitutional Court Assess HIE Cases?

Council of State: Neglecting fetal heartbeat monitoring during birth can constitute service fault

Council of State 15th Chamber, 18 April 2016, E. 2013/3929, K. 2016/2660. In this case, it emerged that there was no record showing that the baby's heartbeat had been monitored regularly during a certain time interval, and that the expert assessment found the necessary monitoring had not been carried out; a connection was drawn between the delay in intervention and the oxygen deprivation at birth and the death that followed. The Council of State upheld important parts of the compensation judgment based on the administration's service fault; it reversed certain parts, such as the portion of non-pecuniary compensation for the mother, father and siblings that had been set too low, and the starting date of interest. This decision shows that liability for compensation may arise in cases in which a concrete monitoring deficiency and a finding of causation are present together. The account of 15–20 minutes of monitoring in the decision is the expert assessment in that case; it should not be relayed as a fixed general duration for every birth. [18]

Court of Cassation: Missing birth records and post-birth causes must be investigated

Court of Cassation 13th Civil Chamber, 22 December 2016, E. 2015/32770, K. 2016/24095. In this decision, concerning allegations of a late cesarean, oxygen deprivation and severe brain damage that developed later, it was found that the investigation report did not discuss the different possibilities before birth, during birth and after birth, that part of the relevant medical records was missing, and that the parties' objections had not been answered. The Court of Cassation reversed the dismissal judgment, on the ground that a new report capable of review should be obtained from the expert board. This decision does not mean that the fault of the hospital or doctor has been established. [9]

Court of Cassation: Conflicting scientific opinions on HIE must be resolved

Court of Cassation 13th Civil Chamber, 14 November 2019, E. 2016/18168, K. 2019/11331. In a file involving hypoxic brain damage in a newborn, some experts took the view that it was a complication, while the neonatology specialist took the view that fetal distress and delayed birth increased the risk of damage. The Court of Cassation found it incorrect to dismiss the case without resolving the material conflict between the reports, and stated that a new report should be obtained from another university panel including obstetrics and neonatology. [10]

Council of State: Post-birth intubation and delay in diagnosis must also be examined

Council of State 10th Chamber, 1 November 2021, E. 2019/6645, K. 2021/5213. In a decision concerning a baby born at a public university hospital who later developed severe disability, it was noted that the report did not adequately explain matters such as the timing of intubation after birth and the possibility of delay, the meaning of early tests, follow-up during pregnancy and the adequacy of diagnosis before discharge. The Council of State reversed the dismissal decision based on an incomplete expert examination. [11]

Contrary decisions: HIE and missing records do not give rise to compensation in every case

Council of State 10th Chamber, 16 November 2023, E. 2023/2397, K. 2023/7023. In a case involving HIE and cerebral palsy, the Council of State relied on reports that found no service fault or organizational error on the part of the doctor or the administration; it found it incorrect to award non-pecuniary compensation merely because of the severe disability and the family's suspicions, and reversed the judgment granting the claim. The decision was given by majority; there is a dissenting opinion. [12]

Court of Cassation 3rd Civil Chamber, 22 September 2025, E. 2024/4338, K. 2025/4192. Although it was discussed whether deficiencies in the NST/partogram and follow-up documents amounted to fault in record keeping, the dismissal of the case was upheld, because the expert reports could not establish that the deficiency caused the baby's current condition and because the procedures were assessed as complications. This decision does not diminish the importance of missing documents; it shows that a causal link with the damage is a separate matter of proof. [8]

Constitutional Court: A critical objection and an allegation of delay must be discussed with reasons

Constitutional Court, 24 May 2023, Application No. 2020/26359. This application concerns not HIE but brachial plexus injury at birth. It is nonetheless important for the standard of expert review and examination. The Constitutional Court held that the failure to adequately discuss at which stage the risk of birth arose, whether timely intervention by a specialist doctor would have changed the outcome, and the effect of the delay in diagnosis after birth was a violation of rights under Article 17 of the Constitution, and ordered a retrial. The Constitutional Court did not itself establish the doctor's fault here. [13]

What Compensation Can Be Claimed for HIE?

In files in which the child needs lifelong support, pecuniary damage is not limited to hospital bills paid up to now. Within the framework of TBK Article 54, necessary expenses proven with concrete evidence in connection with treatment, rehabilitation, medication, medical devices and special education, transport costs, continuous care and the need for a caregiver, loss of earning capacity and future economic loss may be assessed. Collecting the same expense more than once, and the effect on the calculation of any social security payments, are also examined separately. [14]

How are caregiver costs and future damage determined?

The degree of disability alone does not show all the elements of the need for care. The child's age, activities of daily living, need for supervision, how many hours the care lasts, the necessity of third-party assistance and the expected life expectancy may be subject to medical and actuarial assessment. That the family actually provides care does not mean that the legal value of care labor should not be investigated at all. The calculation of future damage should be made with uncertainties and concrete reports in mind.

The parents' right to non-pecuniary compensation

Where the physical harm is serious and the conditions are met, under TBK Article 56(2), an appropriate amount of non-pecuniary compensation may also be awarded to the relatives of a person who has suffered severe bodily harm. The child's own non-pecuniary damage and the parents' separate claims should not be confused with one another. The basis and scope of each claim must be set out separately. [14]

Is a Case Against a State Hospital Filed in the Same Place as One Against a Private Hospital?

No. For the acts and omissions of public hospitals in providing health services, a full remedy action before the administrative courts against the administration is, as a rule, the route. The administration's service fault and, where necessary, other grounds of liability under administrative law are examined in the specific case. İYUK Article 13 provides for a prior application to the administration within one year of learning of the administrative act and in any event within five years of the date of the act, followed by filing an action after rejection or implied rejection. If the application goes unanswered for 30 days, implied rejection is considered; the subsequent administrative action period is calculated separately. Matters such as damage that is understood much later, minors as parties and the starting point of the period in special cases require separate legal review. [15]

In the relationship with a private hospital and a private doctor, liability based on contract or tort may arise. Where the specific relationship has the nature of a consumer transaction, the competent court may be the consumer court; mediation as a condition precedent to litigation under Article 73/A of Law No. 6502, and its exceptions, should be considered before filing. The nature of the contract, the capacity of the defendants, the date of the event and the basis of the claim may change the outcome on jurisdiction and procedure. For university or foundation university hospitals, the judicial route should not be determined merely from the name of the institution. [16]

Why should compensation and filing periods be examined separately?

For tort claims in private law, TBK Article 72 generally provides two years from the date the damage and the liable person became known and ten years from the act; where the act requires a penalty and a longer criminal limitation period applies, a special rule is provided. For a contractual claim, the general ten-year period in TBK Article 146 is considered together with special provisions and the nature of the obligation. Generalizations in a medical damage file such as "ten years in every case" or "the period starts when the child turns 18" are dangerous. [14]

Do criminal and administrative complaint routes replace a compensation action?

Where the conditions are met, a report to the prosecutor's office, a complaint to the health institution or the Provincial Health Directorate (İl Sağlık Müdürlüğü), or processes relating to professional liability may be considered separately. Supplementary Article 18 of Law No. 3359 provides a special permission procedure for criminal investigations concerning acts of examination, diagnosis and treatment by healthcare professionals within the scope of their duties; the status of the personnel concerned and the exceptions must be checked separately. Filing a complaint does not automatically result in acceptance of compensation or suspension of the filing periods. [17]

Roadmap for Families: First Application and Preservation of Evidence

1. Secure the medical record. In addition to the pregnancy and birth file, request in writing the raw CTG/NST, the digital log, and the operating room and newborn documents.
2. Clarify the clinical diagnosis. Have the degree of HIE, the MRI pattern, seizures, cord gas and other possible causes assessed by an expert opinion.
3. Build a timeline. Compare the times in different documents and institutions; do not fill in missing ones with assumptions.
4. Determine the nature of the health facility. Distinguish the counterparty, the judicial route and the conditions for filing according to whether it is public, private, a university or a contracted structure.
5. Assess the application periods without delay. Bear in mind that waiting for the medical diagnosis or the disability report to become final may, in some files, result in loss of rights.
6. Put concrete questions to the expert. Instead of a one-sentence fault report, request a scientific assessment that discusses alternative causes and the effect of the delay.
7. Document the heads of damage. Record separately the actual expenses, the treatment plan, special education, care needs and expected future expenses.

Conclusion

The development of HIE because of oxygen deprivation at birth does not, by itself, prove that the doctor or the hospital was at fault; nor does labeling an event a "complication" place every stage of the process beyond judicial review. The decisive questions are at what moment the findings revealing the risk were present, when the team should have recognized them, how and within what time the appropriate intervention was carried out, whether the newborn's care was provided on time, and the effect of all these actions on the child's harm.

For this reason, in HIE disputes, the pregnancy file, the raw fetal monitoring records, the emergency birth chronology, the cord blood gas, resuscitation, hypothermia/intensive care and the MRI review should be placed at the center of the file before any disability report obtained later. The common practical value of the decisions of the Court of Cassation, the Council of State and the Constitutional Court is that fault and the causal link must be assessed with reasoning that addresses the critical allegations, rests on the relevant specialties and is capable of judicial review.

Related articles: Birth Injuries and Permanent Harm to a Newborn: Liability of the Doctor and the Hospital, Malpractice Case: Compensation, Proof and Routes of Application for Doctor and Hospital Errors, Doctor Error at a Public Hospital: Administrative Application and Full Remedy Action, Objecting to an Expert and Forensic Medicine Report in a Malpractice Case and How to Obtain a Patient File and Medical Records address the related topics separately.

Frequently Asked Questions

If my baby was diagnosed with HIE, will the hospital necessarily pay compensation?

No. Although an HIE diagnosis is important data on the damage, the other conditions of legal liability and the scope of the damage must also be determined separately for compensation.

Is a cesarean taking longer than 30 minutes automatically a doctor's error?

No. When the indication for emergency delivery arose, the reason for the delay between the decision and the procedure, and its effect on the baby are examined together. In some cases even a shorter delay can be critical.

Can a case be filed if there are no NST or CTG records?

The absence of records does not by itself decide the case, but it is an important matter for the production of evidence and expert examination. Other medical documents should be reviewed, and why the records are missing should be investigated.

Does a normal Apgar score definitively rule out oxygen deprivation at birth?

Not on its own. Apgar is one of the elements of clinical assessment. It should be assessed together with the cord blood gas, newborn findings, MRI and other causes.

If hypothermia treatment was not given, is there malpractice?

Not always. The suitability of treatment is determined by gestational week, the severity of HIE, neurological and blood gas findings, the time elapsed since birth and the medical criteria at that date. Whether there was a delay in the diagnosis, referral or treatment of a baby who met the criteria is also examined separately.

If permanent cerebral palsy develops, can the mother and father also claim non-pecuniary compensation?

In the case of severe bodily harm where the conditions are met, separate non-pecuniary compensation claims by relatives may arise under TBK Article 56(2). They are assessed without being confused with the child's claims.

Where should one apply first for a birth error at a state hospital?

For damage claims arising from an administrative act, the rule is that a timely application is made to the relevant administration under İYUK Article 13, and the full remedy action route is then considered. The date of learning and the exceptions must be examined in the specific file.

In an HIE case, is a report from an obstetrician-gynecologist alone sufficient?

Not in every file. In particular, where newborn resuscitation, hypothermia and the cause of brain damage are disputed, the expertise of neonatology, pediatric neurology and, where necessary, neuroradiology should also be considered; conflicts between the reports must be resolved.

Sources

1. ACOG, Neonatal Encephalopathy and Neurologic Outcome, Task Force Report, 2014 (reaffirmed in 2019).
2. American Academy of Pediatrics, Neonatal Encephalopathy and Neurologic Outcome, Second Edition, Pediatrics 2014;133(5):e1482.
3. NICE, Fetal monitoring in labour, NG229; 14.12.2022, last updated 25.03.2026.
4. Zanelli SA et al., Therapeutic Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy: Clinical Report, AAP, Pediatrics 2026;157(2):e2025073627, DOI: 10.1542/peds.2025-073627.
5. ACOG, The Apgar Score, Committee Opinion, 2015.
6. Vural T, Erbaş M, "Examination of the Views of the Court of Cassation and the Council of State on 'Informed Consent' in Compensation Actions Brought on Allegations of Medical Malpractice" (Tıbbi Malpraktis İddiası ile Açılan Tazminat Davalarında Yargıtay ve Danıştay’ın “Aydınlatılmış Onam (Rıza)” Hususundaki Görüşlerinin İncelenmesi), Adli Tıp Bülteni 2024;29(1):20–28, DOI: 10.17986/blm.1665.
7. Ministry of Health, Patients' Rights Regulation (Hasta Hakları Yönetmeliği), especially Art. 16.
8. Court of Cassation 3rd Civil Chamber, E. 2024/4338, K. 2025/4192, 22.09.2025.
9. Court of Cassation 13th Civil Chamber, E. 2015/32770, K. 2016/24095, 22.12.2016.
10. Court of Cassation 13th Civil Chamber, E. 2016/18168, K. 2019/11331, 14.11.2019.
11. Council of State 10th Chamber, E. 2019/6645, K. 2021/5213, 01.11.2021.
12. Council of State 10th Chamber, E. 2023/2397, K. 2023/7023, 16.11.2023.
13. Constitutional Court, Application No. 2020/26359, 24.05.2023.
14. Law No. 6098, Turkish Code of Obligations (Türk Borçlar Kanunu), Arts. 54, 56, 72, 112, 116 and 146; Ministry of Justice UYAP Legislation.
15. Law No. 2577 on Administrative Procedure (İdari Yargılama Usulü Kanunu), Arts. 2, 7 and 13; Ministry of Justice UYAP Legislation.
16. Law No. 6502 on Consumer Protection (Tüketicinin Korunması Hakkında Kanun), Arts. 73, 73/A; Ministry of Justice UYAP Legislation.
17. Law No. 3359 on Basic Health Services (Sağlık Hizmetleri Temel Kanunu), Supplementary Art. 18; Ministry of Health announcement of 17.07.2026.
18. Council of State 15th Chamber, E. 2013/3929, K. 2016/2660, 18.04.2016.