Nurse, midwife fail to expedite C-section

On July 18, 2003, the patient, who was expecting her first child, was admitted early in labor to the hospital with intact membranes. She came under the care of a certified nurse midwife and obstetrical nurse that evening.

For at least four hours prior to delivery, the baby demonstrated fetal heart rate patterns indicative of a worsening fetal oxygenation status, particularly in the final two hours. Neither the nurse nor the midwife monitored the readings or called a supervising physician. The nurse did not check the maternal pulse to assure that the fetal monitor strip was recording the fetal heart rate rather than the maternal heart rate.

Five hours into the mother’s stay, the nurse called the pediatrician, as she realized that she was recording the mother’s pulse instead of the baby’s heart rate for at least 40 minutes.

The baby was born limp and cyanotic with no respiratory effort. She was intubated and transferred to the level II nursery, where she suffered seizures before being transferred to another facility.

She was diagnosed with hypoxic ischemic encephalopathy and status epilepticus. She was transferred to another hospital and stayed there until November, when she was transferred to another facility. She was eventually sent home and remains under the care of her mother.

The parents’ experts were expected to testify that fetal hypoxia was present for a significant period of time prior to delivery and that there is no evidence of any alternative etiology for the HIE. The radiological findings indicate that the injury occurred before delivery.

The child, now six years old, suffers from spastic quadriplegia and significant cognitive, language, communication and motor delays. She will always be dependent on others for her daily activities, including personal hygiene, feeding, dressing and mobility.

The case settled for $4 million.

Type of action: Medical malpractice

Injuries alleged: Hypoxic ischemic encephalopathy, permanent brain injury

Date: November 2009

Submitted by: Philip J. Crowe and Florence Carey, Crowe & Mulvey, Boston