Legal Case Study: Medical Negligence during Delivery

Background and Case Facts

1. Please answer the questions in an organized and coherent way.

2. There is no set format for the assignment.

3. Please do not include an introduction and conclusion.

4. You are not required to use external sources.

5. Please note that collaboration or group work is forbidden.

6. You are required to refer to relevant legal tests, cases and legislation to support your arguments.

7. Be sure that you accurately cite and quote all sources used to avoid academic misconduct. This case arises out of a delivery at Main Street General Hospital on March 29, 2018. At that time Ms. Catherine Brown gave birth to a baby boy, Patrick Brown. It is known that Patrick Brown suffered a hypoxic ischemic event shortly before his birth which resulted in serious and permanent brain damage. Patrick Brown suffers from cerebral palsy. Ms. Brown previously gave birth to another son on January 20, 2016.

This child was macrosomic at birth (i.e. over 10 lbs). Delivery needed to be effected with the assistance of a vacuum extractor. Following delivery this child developed a pneumothorax and required ICU care. Dr. John Goodchild was Ms. Brown’s obstetrician at both the delivery in 2016 and in 2018. During the course of her pregnancy in 2017/18 Dr. Goodchild did not take any symphysis fundal height measurements to monitor the growth of the fetus. According to Ms. Brown she asked Dr. Goodchild on several occasions as to whether the size of the fetus was going to be a problem. She has stated that Dr. Goodchild told her not to worry and that he thought the child was about seven or eight pounds. Dr. Goodchild denies that he would have given an estimate of the fetal size to Ms. Brown as this is very difficult to predict.

 

He states that given the size of the earlier baby he would have been proceeding on the assumption that the fetus would have been as large as the earlier baby or possibly somewhat larger. He would not have been concerned, however, about whether Ms. Brown would be able to deliver the baby vaginally given her earlier history delivering a macrosomic baby with minimal assistance. It is recognized that pneumothorax can occur following delivery spontaneously and is usually not associated with the circumstances surrounding the delivery. In the latter stages of her pregnancy, Ms. Brown developed thrombo-phlebitis. In order to alleviate this condition Dr. Goodchild recommended that she undergo an induction for delivery. Dr. Goodchild did not have any discussions with Ms. Brown about the plan for the delivery or the possibility of an operative delivery due to macrosomia.

Details of the Delivery and Post-Natal Issues

 

He had her sign a general consent for delivery indicating that the risk s and benefits of the procedure had been explained to her. Ms. Brown was admitted to Main Street General Hospital on the afternoon of March 28, 2018. Dr. Goodchild administered a prostin gel induction which was effective in stimulating Ms. Brown’s labour. During the course of the labour, the patient’s progress was monitored by Nurse Barb Meanswell. Electronic fetal heart monitoring with an external transducer was initiated by Nurse Meanswell. This electronic monitoring was not strictly required under the terms of the hospital policy but allowed Nurse Meanswell to have a continuous monitoring of both the fetal heart rate and the mother’s contractions. At 03:10 hours on the morning of March 29th, Nurse Meanswell did a vaginal examination and recorded that Ms. Brown was eight centimetres dilated. She felt that the mother was close to delivery.

 

As a result she placed a call to Dr. Goodchild who attended in the labour room at 03:20 hours. Both Dr. Goodchild and Nurse Meanswell were with the patient and her husband up until the time of delivery. Upon his arrival in the labour room, Dr. Goodchild performed a further examination of Ms. Brown. He found that she was fully dilated and told the patient to start pushing. After the patient started to push there were gaps in the fetal heart tracing. This is not uncommon during the second stage of labour because of movement of the fetus through the birth canal. Nevertheless, it makes it more difficult for clinical staff to monitor the fetal heart rate. Nurse Meanswell also had some difficulty in monitoring the mother’s contractions. As a result she took off the electronic transducer and palpated the contractions by hand. Unfortunately, this means that there is no record of the contractions on the fetal heart strip after 03:30.

 

Nurse Meanswell has a recollection, however, that she was able to confirm a good fetal heart rate after each contraction, even though this is not specifically recorded in her not notes up to 03:40 hours. Variable decelerations during this second stage of labour are quite common and not a source of concern so long as they are not prolonged or deep and there is good recovery at the end of each contraction. At 03:40 hours she was not able to hear the fetal heart rate at the end of the contraction. She therefore reported to Dr. Goodchild that she was having difficulty picking up the fetal heart rate. Dr. Goodchild had the option at this point of applying an internal scalp electrode directly to the fetal head which would have given an uninterrupted recording of the fetal heart rate. This procedure is out of the scope of practice of a nurse. Dr. Goodchild instead decided to apply a vacuum in the labour room in order to expedite the delivery.

Allegations of Medical Negligence

 

He maintains the clinical indication for application of the vacuum was a series of fetal heart decelerations which were not recorded on the fetal heart strip. Dr. Goodchild states that these decelerations were quite deep and prolonged although it is not possible to determine this from the existing fetal heart strip because of the numerous gaps on the tracing. Dr. Goodchild did not make any note in the Chart of the clinical indications for the application of the vacuum. There is evidence, however, that the fetal monitor produces an audible sound with each beat of the fetal heart rate. This can sometimes be heard audibly before there is sufficient data to produce a read out on the printed strip. The Hospital policy allows for the application of a vacuum in a labour room. However, if there is any indication that neo-natal support will be required at the time of delivery the mother is to be transferred to an operative delivery room. Immediately after Dr. Goodchild applied the vacuum the fetal heart rate is shown on the strip to fall precipitously and a period of bradycardia ensues.

 

In retrospect it appears that the application of the vacuum has triggered an occult cord prolapsed which could not have been predicted. Dr. Goodchild applied the vacuum during the course of three contractions with a view to attempting a delivery. However, this is not successful and at 03:49 hours the vacuum is removed. Ms. Brown’s husband who was present throughout the events leading to the delivery has a specific recollection that immediately following the removal of the vacuum Dr. Goodchild asked Nurse Meanswell some questions about the monitoring of the baby’s heart rate. He recalls Nurse Meanswell turned to Dr. Goodchild and said, “But I thought you were paying attention to that”, and Dr. Goodchild said, “Oh but I thought you were paying attention to that”. Mr. Brown believes that neither Dr. Goodchild nor Nurse Meanswell had been paying attention to the fetal heart rate. After the vacuum was removed Dr. Goodchild performed a further vaginal examination and identified that there had been no significant descent of the fetus. In addition, he identified that the fetus was in the occiput posterior position which is an unfavourable position for the delivery of the fetus.

 

Dr. Goodchild then orders that the mother be transferred to an operative delivery room for a forceps rotation. Under the Hospital policy all forceps rotations must be conducted in an operative delivery suite. The mother arrives in the delivery suite by 03:55 hours. Dr. Goodchild proceeds to perform a forceps rotation and the delivers the infant weighing 10.5 lbs and 04:05 hours. At the time of the delivery some difficulty is encountered due to a shoulder dystocia which is related to the size of the baby and causes a further delay in the delivery of the child. The baby is born flat and requires immediate resuscitation.

 

Questions please do the following:

• Prepare your theory of the case, identify the Plaintiff(s). Specify the allegations which will be made in the action, explaining and supporting your allegations by referencing to and applying various tort claims covered in course material.

• Identify the witnesses you will need to prove your theory of the case and why you need these witnesses.

• Give an assessment about your prospects for success in the action Acting for the Defendant(s), please do the following:

• Please identify the Defendants, defences you will argue and prepare your theory of the case, explaining and supporting your allegations by referencing to and application of various tort claims covered in course material.

• Identify the witnesses you will need to prove your theory of the case and why you need these witnesses.

• Give an assessment about your prospects for success in the action.