Deposition of Carl Coghill, MD: Defense Expert Witness in the 'Williams vs Onasanya Case

Defense Expert Witness Spotlight: Deposition of Carl H. Coghill III, M.D. Williams v. Onasanya | Fulton County State Court | Case No. 13EV016873A Who is Dr. Coghill? Dr. Carl H. Coghill III, M.D. is a Board-certified pediatrician and neonatologist, serving as Medical Director of the NICU at Children's of Alabama since 1998. The Case of Keyondria Williams brought this medical malpractice action following the death of her newborn son, Kayden Henderson, on November 16, 2011 — eight days after birth at South Fulton Medical Center, a six-bed community NICU. Kayden suffered from neonatal pneumonia that progressively worsened during his NICU stay, ultimately resulting in a 45-minute cardiac code, hypoxic-ischemic encephalopathy, and death. An MRI at Children's Healthcare of Atlanta confirmed severe, acute HIE. The plaintiff alleged that Dr. Onasanya , the sole neonatologist at South Fulton with no backup , failed to diagnose and treat Kayden's pneumonia, discontinued antibiotics despite worsening chest X-rays, misplaced umbilical catheters, failed to transfer the baby to a higher-level facility, and never disclosed to the mother that her son had coded for 45 minutes. Key Testimony 🔹 Antibiotic Discontinuation: A central issue in this case was Dr. Onasanya's decision to discontinue Ampicillin and Gentamicin on November 12, even as serial chest X-rays showed persistent and worsening lung infiltrates. Egleston's own admission records confirmed infiltrates had been present on every X-ray since birth and that the antibiotics were discontinued on November 12. Dr. Coghill defended this as within the standard of care, though the complaint characterized it as a critical departure from accepted neonatal practice. 🔹 The Code and Failed Intubation: Kayden's code began at approximately 12:50 a.m. on November 13 and lasted 45 minutes. The respiratory therapists at South Fulton were unable to successfully intubate and ventilate him. Dr. Coghill acknowledged the failure but declined to criticize the team. When pressed, if irreversible brain damage occurs within 18–20 minutes and the physician is 30 minutes away , Dr. Coghill largely agreed the physician's physical presence would be of limited help, but maintained a well-trained bedside team should have managed without him. 🔹 The One-Doctor NICU: The deposition's most candid exchange came when Potts asked whether a single neonatologist with no backup could realistically provide continuous Level 3 NICU coverage. Dr. Coghill's reply was telling: "I wouldn't want the job." 🔹 Catheter Misplacement: Dr. Coghill agreed the proper position for a UVC is not in the liver. Egleston records confirmed that upon transfer, the UVC placed by Dr. Onasanya was in the liver, and had been in the liver on every prior X-ray since insertion. Dr. Onasanya had documented it as "satisfactory position" on November 9. A UAC placed by Dr. Onasanya was also inserted too far and discontinued on November 9 due to cyanosis of Kayden's toes. 🔹 Transfer to Higher-Level Facility:Dr. Coghill declined to agree that Kayden would have been better served at a children's hospital, arguing transport risk must be weighed against benefit. However, he conceded that transfer is appropriate when a team lacks the skills to care for a patient, that guidelines recommend transfer when clinically indicated, and that transferring before the code would have been preferable to transferring during it. Kayden was transferred after the code with no incident and died three days later. 🔹 AAP Guidelines and Georgia Regulations Dr. Coghill was presented with AAP Guidelines for Perinatal Care, requiring Level 3 NICUs to have "continuously available" neonatologists, and Georgia regulations requiring a Board-certified neonatologist "on-call on a 24-hour basis" for intensive newborn services. He had not reviewed either document before the deposition. He acknowledged both but testified they did not change his opinions, arguing the word "available" does not necessarily mean physically present. The Bigger Picture This deposition is a study in contrasts. Dr. Coghill works in one of the most sophisticated NICUs in the country and was asked to defend care delivered in a six-bed unit by a solo physician with no backup, where the resuscitation team could not intubate a dying infant. His honest concessions , "I wouldn't want the job," the UVC was in the wrong place, transfer before the code would have been better, he destroyed his notes , give plaintiff's counsel powerful material for trial. Attorney James H. Potts II used a methodical, document-driven approach throughout: presenting guidelines, regulations, X-ray reports, lab values, and the code sheet to walk the witness through Kayden's clinical deterioration step by step. Rather than attacking the expert's credibility directly, Potts built a record of concessions and let the facts speak. This content is for educational and informational purposes only and does not constitute legal advice.