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    OB ignores nursing supervisor, fractures infant’s skull


    The verdict

    A $10.2 million verdict was returned, which included $575 for funeral and burial expenses, $100,000 for past pain, $3 million for past loss of companionship, $3 million for future loss of companionship, and $4.1 million for past mental anguish.


    While the description of the obstetrician’s use of forceps in this case may indeed sound reckless, and may have been a contributing factor in the large jury award, the chain-of-command issue allowed the plaintiff to proceed against the hospital and nurses—and their “deep pockets”—as defendants. Most hospitals have a chain-of-command policy, and a good policy addresses the specific situations in which it is to be employed. Expert witnesses disagree about whether it should be employed when the doctor is at the bedside making decisions—the “captain of the ship” model. Others feel that nurses have an independent duty to go up the chain of command when there is significant disagreement in patient management that they believe may be detrimental to a patient’s well-being. The “captain of the ship” model, however, works only if it rescuses the hospital and nurses from any liability risk and holds the doctor solely responsible once at the bedside making management decisions. Since this is rarely the case, all caregivers should know what their chain-of-command policy requires.


    Delayed cesarean leads to cerebral palsy

    A 30-year-old Wisconsin woman who weighed 300 lb was admitted to the hospital at 40 weeks’ gestation for induction of labor. Oxytocin was started, and within 30 minutes the baseline FHR increased, accelerations ceased, and late decelerations were noted. The dose of oxytocin was steadily increased throughout the day. In the early afternoon the FHR showed the fetus was not tolerating the contractions, so the nurse discontinued the oxytocin. The attending obstetrician ordered the oxytocin be restarted after giving the fetus an opportunity to recover. The patient requested a cesarean delivery, but the obstetrician felt that the patient’s excessive weight and prior heart surgery would make a cesarean risky and that it was unnecessary. His shift ended and his partner took over care of the patient. Early the next day the nurse notified the new obstetrician that the patient had made no progress in labor and that the FHR showed tachycardia. The obstetrician ordered terbutaline but did not examine the patient. An hour later a prolonged deceleration of the FHR was seen and the obstetrician immediately performed an emergency cesarean. The infant was severely depressed. Magnetic resonance imaging performed at 23 days of life showed that she had distinct hypoxic-ischemic injury. She was diagnosed with cerebral palsy (CP), and is non-ambulatory with significantly impaired cognitive abilities.

    In the lawsuit that was filed following this delivery, the patient alleged she should have had a cesarean on the first day when she requested it. She faulted the nurses for not being more assertive in obtaining a cesarean for her. The expert pediatric neurologist opined that the infant’s injury occurred within 30 minutes of delivery, and that the injury could have been prevented had a cesarean been performed earlier.

    The verdict

    The parties settled during mediation for $8.4 million.



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