A 19-year-old Florida woman brought a malpractice action following the delivery of her child by an obstetrician employed by a federally funded medical clinic. She claimed the obstetrician was negligent for failing to perform an emergency cesarean and continuing use of oxytocin despite ominous signs of fetal compromise. As a result, the child suffered a severe brain injury requiring 24-hour professional care for the rest of his life.
The obstetrician argued that the patient refused cesarean delivery multiple times, against the obstetrician’s medical advice, prior to the vaginal delivery. He noted the refusals in the medical records. He claimed he did not fall below the standard of care in administering oxytocin or using a vacuum for delivery because the patient refused the recommended cesarean delivery.
The verdict: The jury found in favorof the child, the patient, and the husband, including $20,965,144 for the child’s future economic damages and $7.625 million for his non-economic damages as well as $3.3 million for the patient and $1 million to the father.
Oxytocin is one of the most frequently used drugs during labor but it can also become a major issue in a malpractice case filed after a labor and delivery if there is an adverse outcome. If the drug is used during labor, all policies and protocols in effect at the time will be requested during discovery and will be compared to how the patient’s oxytocin dose was managed. Any deviation from the protocol will be pointed out as care falling below the standard, whether or not it had anything to do with the alleged injury. It is imperative that everyone administering oxytocin during labor is aware of what the protocol requires and documents any reason or thought process for deviating from that protocol.
Did aggressive use of oxytocin cause uterine rupture?
A Kansas woman presented to a hospital in labor at term. The on-call obstetrician ordered oxytocin augmentation. According to protocol, dosage of the drug was to be increased by 2 MU up to 30 MU or until adequate contraction pattern was observed. Over the next few hours, the nurses increased the infusion several times. When the patient began to push, a bloody discharge from the vagina was noted and the fetal heart rate (FHR) was temporarily lost. When the FHR was found, it was down to 50 beats per minute. After a few attempts to deliver the infant by vacuum and forceps, an emergency cesarean was performed. The patient had a ruptured uterus and the infant suffered permanent brain injury.
The patient sued those involved with the delivery, alleging the health care providers fell below the standard of care by negligently increasing and maintaining the oxytocin at unsafe levels, causing the uterine rupture. The result was a lack of oxygen to the fetus, which caused the subsequent brain injury. The patient’s expert obstetrician testified that the patient’s uterine contractions were adequate when the oxytocin dose reached 14 MU/minute, but the dose continued to be increased.
The verdict: The parties reached a$3.5 million settlement.
From the author - This will be my final column for Contemporary OB/GYN. I have had the privilege of writing for this magazine for many years and thank the editorial leadership and staff for that opportunity. And thanks to you, the readers, for all your comments and for making the Legally Speaking column a success. – Dawn Collins, JD