Date of Incident: July 1, 2004
Injuries: Asphyxia in utero resulting in death.
Settlement: $450,000.00 (paid by the hospital)
Comment: The mother and father were young, Hispanic-Americans who had a second child almost immediately. The net proceeds were used to buy a home, pay off bills, and to purchase a 20-year annuity.
Report Submitted By: Ron Perey
Facts:
This medical malpractice case arose from the birth injury to Baby Joan Doe that resulted in her death. Plaintiff mother, Jane Doe, was 19 years old in late 2003 when she became pregnant with her first child. She and long time boyfriend, John Doe (whom she later married subsequent to this incident), were very happy about this planned pregnancy. She sought prenatal care from Dr. X, a family practice physician. An ultrasound on December 12, 2003, revealed a 10-week fetus, giving her a due date of July 8, 2004. The prenatal course was uneventful.
On Thursday, July 1, 2004, at 8:15 a.m. Jane Doe presented to the defendant Hospital Y’s Labor and Delivery Unit with regular contractions every 2 minutes. She was 3 cm dilated, 75% effaced and baby was vertex (head down) at -2 station. A fetal monitor tracing was obtained and the labor nurse noted a baseline fetal heart rate of 130s, with “no variability” (the expected variation in heart rate expected in a normal, unstressed fetus) written in the assessment section. At 8:30 a.m. firm uterine contractions were noted every 2 minutes, lasting 60 seconds duration. The nurse called Dr. X to inform him of his patient’s presence at the hospital, but he was not summoned to the hospital. IV fluids were given around 9:50 a.m. and the nurse noted fetal heart tones of 132-140 and firm uterine contractions every 2 minutes lasting 70-80 seconds with a coupling pattern (irregular pattern of two contractions close together followed by a slight pause; often seen with a placental abruption). At 10:30 a.m. the nurse again noted a coupling pattern to the contractions. Jane Doe’s position was changed and IV fluids were given, both forms of nursing intervention to assist the fetus. The fetal heart tones were documented as 130-136. At 11:47 a.m. the nurse noted “uterine contraction palpates firm,” with contractions lasting 70-80 seconds; fetal heart tones 122-126; maternal blood pressure 136/68 with pulse of 89.
Jane Doe, while laboring, was then apparently left unattended by any staff at Hospital Y, for a minimum of 30 minutes. In this time, the fetal monitor strip because progressively ominous with an abnormal drop in baby’s baseline heart rate. The father, John Doe, was concerned and went to get a nurse. The next nurse entry, at 12:36 p.m., stated that “father of baby came to Nurse’s Station requesting RN to bedside for decreased fetal heart rate.” The fetal heart rate was then hovering at 80 beats per minute [normal is 120-160 beats per minute]. Upon entering the room, the nurse realized there was a problem. She attempted maternal position changes and repositioning of the external heart monitor. She called for nursing assistance and provided supplemental oxygen to the mother. A vaginal exam revealed the cervix to be 4 cm dilated, baby at -2 station and no cord felt. The nursing supervisor then arrived, repositioned the mother to knee-chest position, gave an IV fluid bolus and stat paged the physician, Dr. X at 12:45 p.m. At 12:50 p.m. Dr. X had not arrived and another obstetrician, was paged stat.
Dr. X arrived at 12:52 p.m. and noted profound fetal bradycardia with heart rate at 30-40 beats per minute. On his exam, the cervix was 6-7 cm dilated, 80% effaced with baby at -3 station with bulging bag of waters noted. An AROM (artificial rupture of membranes) was performed with thick meconium found. A fetal scalp electrode was placed with continuation of fetal heart rate in the 30s – 40s. A second OB/Gyn, arrived at that time (around 12:55 p.m.) and the decision was made to perform an emergency C-section.
Calls in anticipation of a C-section had already been made by the second OB/Gyn as he was en route to the hospital. In the OR, anesthesia arrived at 1:05 p.m., and performed general anesthesia on Jane Doe. A vertical skin and uterine incision were made at 1:06 p.m. Baby Joan Doe was delivered at 1:09 p.m., floppy and without respiratory efforts or heart rate. Cord blood was obtained but intentionally discarded, so no cord blood gas results are available. Pooled and clotted blood was noted behind the placenta, indicating evidence of a placental abruption.
A pediatrician was present at delivery to care for the baby. He intubated Baby Doe two times, noted meconium staining in the posterior pharynx, and began bagging. No pulse was felt. Cardiac compressions were done and epinephrine was given by endotracheal tube without response. Resuscitative efforts were continued for 15 minutes, but discontinued when the baby remained unresponsive. Baby Joan Doe was declared to have been stillborn.
Liability was contested by defendants, but they agreed to a pre-suit mediation. At mediation, plaintiffs' lawyers argued that Hospital Y was solely and completely responsible for the death of Baby Doe because of the substandard care its staff provided to Jane Doe and her baby. They failed to monitor the mother and the baby appropriately in Labor and Delivery Unit and failed to summon the physician before the baby was critically injured and could not survive. The nurses at Hospital Y should have been suspicious of a possible evolving placental abruption due to the unusual contraction pattern of coupling, as well as the very firm feel of the contractions in early labor. The lack of variability with baby’s heart rate and the repetitive late decelerations, should have been conveyed to the physician. More appallingly, the Labor and Delivery nurse, whose only function at the Hospital is to provide one-on-one nursing care to laboring mothers, left Jane Doe effectively unmonitored by leaving the delivery room and having no one watch the fetal monitor tracing. The purpose of the fetal heart rate monitoring was to warn of abnormalities that might reflect jeopardy of the baby, but no one from Hospital Y was in the room to read and interpret this monitor tracing. Only after summoned by the concerned father, who couldn’t really “read” the fetal monitor strip, but knew it seemed different from before, did the Hospital nurses attend to the mother and realize the urgency of the situation.
The physicians summoned around 12:45 and 12:50 p.m., responded promptly with the obstetrician prudently setting up for an operative emergency C-section before even arriving at the hospital. Baby Doe was quickly delivered, but the delay from that morning had caused catastrophic hypoxic damage to her brain and she could not be resuscitated. Had the physicians been summoned earlier, Baby Doe would have been born healthy.
County: Yakima County, Washington
Trial Judge: N/A (pre-suit settlement)
Plaintiffs: Baby Joan Doe, Minor, John Doe and Jane Doe, parents.
(Confidential Settlement)
Defendants: Hospital Y (Confidential Settlement).
Trial date: N/A (pre-suit settlement).
Date of Settlement: October 21, 2005
Plaintiffs’ Attorneys: Ron Perey
Perey~Harris, Seattle, Washington
Defendants’ Attorneys: Confidential.
Plaintiffs’ Experts: Not disclosed..
Defendants’ Experts: Not disclosed.
Mediators: Gary Bloom, Esq. (mediation 10/21/05).
Date of Incident: July 1, 2004.
Admitted Liability: No. Liability contested.
Summary Judgment: N/A
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