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A Utah County judge has ruled that Intermountain Healthcare should be sanctioned for the misconduct of its lawyer in a medical malpractice case involving an infant who suffered brain damage.

In findings released this week, 4th District Judge Christine Johnson wrote that Intermountain's lawyer, JoAnn Bott, secretly pressured a doctor to change his medical opinions to make Intermountain seem less responsible for the 1995 brain injuries of infant Jared Wilson.

Jared is now 20 and lives in a care facility, according to his family's legal team. He was born prematurely, at 24 to 27 weeks' gestation, in Intermountain's Utah Valley Regional Medical Center after his mother suffered complications, according to court documents. Jared had bleeding on his brain, which his parents claim was caused by oxygen deprivation during his delivery. His parents, Jerome and Leilani Wilson, have argued that Leilani Wilson showed clear signs of infection, which wasn't properly treated and contributed to their son's extensive brain injuries. Those could have been avoided, the parents say, had Jared been delivered via C-section.

Intermountain claimed the hemorrhage occurred sometime after Jared's birth. One of Jared's doctors, Richard Boyer, testified in a 2008 trial that Jared's brain images show he suffers from congenital brain defects.

The jury found Intermountain was not negligent in Wilson's care. The Wilsons appealed to Utah's Supreme Court, which voided the jury's verdict and ordered a new trial in 2012. The high court found that Intermountain's lawyers prejudiced the jury by repeatedly ignoring court rules that forbade them from making mention of funds the Wilsons have received, such as insurance coverage and government assistance, to pay for Jared's care.

The court also found that Bott and Boyer unethically conferred about Boyer's medical findings without notifying the Wilsons or gaining their consent, which amounted to a breach of doctor-patient confidentiality. In its ruling, the high court asked Johnson, the new trial-court judge, to consider sanctioning Intermountain.

Johnson ruled on Wednesday that the contact between Bott and Boyer not only was unlawful and unethical, but that it "tainted" the process with "altered testimony and amended records" involving "two tragic cases involving babies born with devastating, life-altering complications."

In her ruling, Johnson found that Bott and Boyer met four times to discuss Wilson's case and a separate, similar case involving another infant who suffered brain injuries. Over the course of those meetings, Boyer amended his conclusions in both cases.

In his earlier reviews of Wilson's brain imaging, Boyer described a congenital defect as a "possibility," but he concluded that a later MRI suggested a brain injury related to obstructed blood flow around the time of delivery — which was consistent with the Wilsons' claims. He did not mention a congenital defect.

However, Bott then called a meeting with Boyer and Intermountain's risk manager to discuss a potential birth defect, and Boyer revised his findings to claim one was present.

"This court can conceive of no reason a risk manager would be invited to such a meeting, unless it is to signal the treating physician that a large damage award may turn upon his or her opinion," Johnson wrote. "This is a not-too-subtle attempt to influence, particularly where the physician receives 90 to 95 percent of his income from the hospital."

Johnson's characterization echoes the claim the Wilsons had hoped to present to jurors in 2008, that Intermountain's market share could protect them from damaging testimony in the malpractice suit. The judge would not allow the argument, ruling that the Wilsons' witness wasn't sufficiently expert to make claims about Intermountain's market.

In the case of the second infant, Kylie Butterfield, Boyer initially described her brain injuries as consistent with oxygen deprivation — which supported her parents' claims against Intermountain. But in a later document, Boyer retracted that finding and suggested Kylie suffered a stroke. In another addendum, after a meeting with Bott and an Intermountain risk manager, Boyer changed his finding again to state Kylie's brain injury occurred in the days before her birth, clearing Intermountain of any negligence.

In a January hearing, Allen Young, the Butterfields' attorney, described Boyer's shifting diagnoses as "the most unfair shot at justice I ever had."

Johnson refused the Wilsons' request to direct the jury to find damages on a verdict of negligence. However, in imposing sanctions, she forbade Boyer from testifying in the retrial and ruled that Intermountain will not be allowed to argue that Wilson suffered from the birth defect.

"The damage resulting from Ms. Bott's improper conduct is impossible to quantify," Johnson wrote. "One can only speculate about how events may have unfolded if the ... meetings [between Bott and Boyer] had not occurred.

"No party should walk out of the courtroom door with such a cloud hanging over their proceedings."