Surgical Confusion Leads To Malpractice At West Sacramento Hospital, Part 7 of 11

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the proceedings.)

Nursing notes picked up again in the OR. The first reference after 10:52 am was at 11:05, with Ms. Cruz in the OR. The anesthesia record of Dr. X. referred to fetal distress. Thus far, no one has testified to what occurred between 10:52 and 11:05 am. Dr. U. testified that he was present when Ms. Cruz arrived in the OR and that he left the breech patient to Dr. V. to sew up the initial skin incision. The surgery schedule indicated that the surgery stop time for the breech case was not until 11:15 am. The anesthesia record and Dr. X. testified that his spinal anesthesia began at 11:08 am. At 11:09 a.m., the fetal heart rate could not detected on Ms. Cruz’ baby. The spinal was said to have taken effect by 11:10 am – the time of the start of surgery for Ms. Cruz. At 11:10 am, a nursing progress note indicated that the spinal was completed and that the FHR (by hand-held doppler) on Martha was absent. In his operative report, Dr. U. reported that the surgery was rushed with a single shot of spinal analgesia, that there was massive intra-uterine bleeding” (estimated at 1800 cc), that a nuchal cord was present and 1200 cc of clots were found. Martha was delivered at 11:15 am.; she was born clinically dead with no signs of life. Dr. W. testified that he believed that the child probably had been dead for at least 8 minutes, from the time that nursing noted the absence of a heart rate at 11:10 am, until 3 minutes following the birth, when the first signs of life appeared. The placenta was sent to pathology and found to be normal.

Dr. W. was present for the delivery. The child was suctioned immediately and intubated by Dr. X.. An NICU team from The Medical Center was called and arrived within 25 minutes of birth. A cord blood gas was not taken; the initial arterial blood gas taken at 30 minutes of life demonstrated a PH of 6.53, PCO2 of 85, PO2 of 113, a base excess of -36 and an oxygen saturation of only 73%. Dr. W. testified that these values were indicative of severe respiratory and metabolic acidosis which he associated to anoxia due to placental abruption. (See Part 8 of 11.)

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