(Please note: the names and locations of all parties have been changed to protect the confidentiality of the proceedings.)
Regional Medical Center: Hospital nursing personnel fell below the standard of care in the following areas:
1) Regardless whether Ms. Cruz or the breech patient arrived at the hospital first, once the second of the two arrived, hospital nursing personnel had a duty to obtain a third OR crew, which would, at a minimum, have necessitated phone calls to obtain a third anesthesiologist STAT. Assuming that the second OR crew was called for Ms. Cruz, as was suggested by the timing of Dr. U.’s call to house supervisor Nurse F., an OR crew had not been called for the breech patient which, under the circumstances was below the standard of care. The hospital made no provision for two simultaneous Cesarean deliveries under circumstances in which a scheduled surgery had also been planned. There were three operating rooms in the main OR, but the hospital only had 2 OR crews. No calls were ever made to obtain a third anesthesiologist, who was then available.
2) Failure to transfer Ms. Cruz directly to the main OR with fetal monitor and L&D nursing personnel at 9:20 am, and to monitor the patient at that location until surgery could begin, thereby avoiding the delay of delivery which occurred between 10:52 am and 11:15 am.
Further, at 9:34 am, the FHR baseline was noticeably smoother than it was at 9:10 am, which failed to get the attention of L&D nursing personnel or to form an additional basis on which to prompt immediate transfer to the main OR. There is nothing in the chart indicating that Dr. U. was ever made aware of these changes of the FHR.
3) Given the status of Ms. Cruz on arrival at the hospital and the assumed inability of Dr. D. to arrive STAT for her own patient, rather than force Dr. U. into an untenable position relative to the breech patient, hospital nursing personnel had a duty to contact the OB/GYN on call in the ER to deliver either Ms. Cruz or the breech case STAT; alternatively, to make contact and enlist the assistance of Dr. Z. or Dr. C., or to speak with Dr. V., all of whom were OB/GYNs, all of whom were surgeons capable of delivering the breech or to deliver Ms. Cruz after Dr. U. began the breech case. L&D and OR nursing personnel had a responsibility, independent of Dr. U. and Dr. D., to insure the health and safety of these two patients regardless of inaction or the poor management decisions by these physicians. This responsibility was greater still when L&D nursing personnel were aware that the FHR on Ms. Cruz declined and a call made for a CRASH delivery at 10:20 am for Ms. Cruz. Yet, for the ensuing 45 minutes, there is no documented evidence that L&D nursing personnel, charge nurses, or house nurse supervisors did anything to facilitate the delivery of Ms. Cruz. And nothing was done until Dr. U. again became available following the delivery of the breech patient.
4) Failure of hospital nursing personnel, when Dr. U. was in surgery with the breech patient to access the chain of command to insure the health and safety of Ms. Cruz and her baby. Under these circumstances, regardless of Dr. U.’s intentions relative to Ms. Cruz (known or otherwise), nursing personnel had a responsibility to assume that Dr. U. was unavailable and had a responsibility to independently protect the health and safety of Ms. Cruz and her baby by all reasonable means, including necessary contacts with those in the chain of command to allow an earlier delivery of Ms. Cruz. Certainly, there were sufficient numbers of OB/GYNs in the OR unit, but none were asked to assist or respond to the growing deterioration of Ms. Cruz’ baby as shown by the fetal monitor. No attempts were made to contact Dr. X. or Dr. Y. to determine whether they could become involved with two patients simultaneously. There were several options that morning between 9:15 am and 11:05 am, but no one made an effort to protect Ms. Cruz or her un-born baby.
5) Failure to advise Dr. D. that Dr. U. had an emergency case of his own so that Dr. D., if she was not immediately available and no one else was available at the hospital, could contact her own back-up to do the breech case or, in the event that Dr. U. began the breech case, to deliver Ms. Cruz. (See part 9 of 11.)
For more information you are welcome to contact Sacramento personal injury lawyer, Moseley Collins.