(Please note: the names and locations of all parties have been changed to protect the confidentiality of the proceedings.)
According to the deposition testimony of nurses E. and F., the breech patient arrived after Ms. Cruz in L&D. Nurse E. did a physical examination and found the patient to be a term footling breech with bulging membranes and completely dilated. She considered her to be in need of an emergency Cesarean section, due to the threat of cord prolapse if her membranes ruptured spontaneously. She assigned the breech patient to L&D nurse, Nancy G.. At approximately 9:30 am, nurse G. called Dr. D. to advise him of his need to come in for his patient due to the breech emergency. Dr. D. informed nurse G. that he was out of town, two hours away, and asked whether there was another physician in-house who could deliver his patient. Nurse G. told him that Dr. U. was either coming in or already was in. She did not mention that he had an emergency patient of his own. There was no further contact with Dr. D.. According to charge nurse E., Dr. U. was made aware of the breech patient upon his arrival and that he agreed to deliver that patient. At 9:30 am, house supervisor Nurse F. called the members of the second-call OR crew as requested by Dr. U., and within 5 minutes, all team members had been contacted. Nurse F. then called L&D to confirm that the crew was on their way in. Sometime between 9:30 am and 10:00 am, the breech patient was taken down to the main OR on the orders of Dr. U., though the OR crew, called by Nurse F., had actually been initially requested for Ms. Cruz.
At 9:30 am, the systolic pressure on Ms. Cruz reached 150. Magnesium sulfate was started at 9:42 am. At 9:46 am, the FHR dipped to 110 beats per minute (bpm). At approximately 10:00 am, Dr. U. went to the basement to see about the status of the OR crew. At that time, Ms. Cruz’s systolic pressure rose to 164. There were no orders for anti-hypertensive medications. There is no documentation in the patient’s chart to indicate that Dr. U. was told about the rising systolic pressures.
Nurse E. testified that after the breech patient was taken to the OR, she returned to Ms. Cruz and called house supervisor nurse Olivia F. for an another OR crew for Ms. Cruz. At approximately 10:00 am, nurse F. received information from L&D and was aware that another OR crew was needed due to the need for a second Cesarean section in which the primary surgeon, Dr. D., was not available. She claims that she was never told the circumstances of this Cesarean section nor its urgency. Nurse F. knew that she did not have a third OR crew to call–the hospital had only two OR crews available on Saturdays. The nursing director of the OR, who was on-call 7 days a week but not on-site on weekends, was available to be contacted, but nurse F. never considered making that call in order to assemble a third crew. The idea of a third crew was dropped. Meanwhile, charge nurse E. contacted personnel in the main OR again and informed them of another Cesarean section that was critical. The nurse there reported that she was busy. Nurse E. knew nothing about the ongoing hysterectomy that morning and was never told that both OR crews were involved with separate patients.
Hospital nursing personnel requested that Dr. U. deliver the breech patient first. He accepted responsibility for the delivery of the breech patient and agreed that the risk in the breech case was probably greater than in the case of Ms. Cruz. The anesthesiologist on the second OR crew, Dr. Y., who had been called for Ms. Cruz, had been directed by hospital OR personnel to begin anesthesia on the breech patient. The entire second OR crew was diverted to the breech patient. By the time that Dr. U. arrived in the OR, spinal analgesia was already running on the breech patient. There was never any contact between Dr. U. and Dr. D.. Neither Dr. U. nor any hospital personnel informed Dr. Y. of an emergency fetal distress patient (Ms. Cruz) upstairs in the L&D unit. Pursuant to the deposition testimony of Dr. D., he was not told that Dr. U. had an emergency patient of his own. When Dr. U. began surgery on the breech patient, he had not announced any plan for the delivery of Ms. Cruz. (See Part 6 of 11.)
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