Facts

Jane Doe, 30, was a G3P2 (two prior c-sections) with an estimated due date of Dec. 8, 2008. Jane Doe had no problems during her prenatal care with her regular obstetrician, with her last regular visit on Nov. 10, 2008. This delivery was planned to be a scheduled c-section, not a VBAC (vaginal birth after c-section) but on the night of Nov. 13, 2008, at 36 and 6/7 weeks gestation, Jane Doe fainted at home after developing severe abdominal pain and diaphoresis.

She presented in labor to Roe Hospital with severe pain in the early morning of Nov. 14.

PLAINTIFF'S CONTENTIONS:
After her arrival in labor and delivery, Jane Doe was required to sit there for some time unattended until she was finally placed in a gown and evaluated at approximately 1:30 a.m. A vaginal examination showed her to be at 70 and -1 to -2.

Doe's regular obstetrician was also the private attending obstetrician. No VBAC consent was obtained or verified by the nurses. The labor and delivery nurses failed to get an adequate fetal monitoring strip for the first hour after admission since it was not until 2:24 a.m. that they had a strip that gave any useful information. This was below the standard of care. In the interim, SROM at 2:17 a.m. was bloody. Once the fetal monitor strip was assessed by the nurses, it showed decreased variability (a sign of fetal hypoxia) and very little in the way of contractions.

At 1:30 a.m., the nurses noted that Jane Doe had reported pain at a level of 8-9/10. At 1:55 a.m., the private attending obstetrician was notified by phone about her complaint of abdominal pain and the nurses' difficulty in assessing the fetal strip. There was no discussion with him about her previous c-section history or the plan for a c-section delivery. He ordered a narcotic analgesic for Jane Doe's complaint of pain but did not come in to assess her and the fetus nor did the labor and delivery nurses insist for him to come in. There was no discussion or nursing assessment of the cause for her severe pain despite her very mild contractions. Nor was there any discussion of the plan in case an emergency c-section needed to be done since this turned out to be a VBAC, despite no plan to do so. The OB/GYN should have been immediately available. He was not. It was the hospital's responsibility to assure that the delivery can be converted to a c-section immediately because of the increased risk of uterine rupture. Instead, the only physician in-house responsible for her care was the OB resident and she was not credentialed to perform a c-section.

The nurses recorded that Jane Doe's pain level remained at 8-9/10 at 2:10 a.m., 2:30 a.m. and 3 a.m. despite having received Stadol and Phenergan for pain and only mild contractions. The resident on-call testified that the nurses did not report Jane Doe's pain levels to her despite the fact that the level of pain was out of proportion to the contractions and she would not routinely have reviewed the nurses' notes herself. The nurses should have demanded that the private attending obstetrician come in to evaluate the patient.

However, the evidence bears out that the nurses were not critically thinking about Jane Doe, her previous c-section history, whether she was a VBAC section patient or not and the cause for her extreme pain. This was below the standard of care.

The OB resident was tied up with another patient until 2:41 a.m. The resident was still unlicensed as a physician in California. (She was not licensed until Jan. 28, 2009) Under this residency rotation, the residents would cover the private attending' patients at night. Because the OB resident had other patients to attend to, there was no physician evaluation of Jane Doe or her fetus between 1:55 a.m. and 3 a.m.

According to the OB resident, it was one of the busiest nights during her rotation at Roe Hospital. She had approximately 15 patients to care for. The labor and delivery nurses were also very busy and violated Title 22 when they staffed Jane Doe as a patient in a 3:1 ratio rather than 2:1 ration as required since she was in labor. The labor and delivery nurses failed to insist that the attending obstetrician come in and assess Jane Doe and her fetus. They also did not ask the in-house attending obstetrician to see the patient in the absence of the OB resident.

An epidural was placed at 2:17 a.m. At 2:40 a.m. a narcotic was given for abdominal pain and oxygen was administered to Jane Doe at this time as the strip showed signs of fetal distress including a three minutes deceleration down to 80 bpm. Again the labor and delivery nurses should have called the private attending obstetrician to come in immediately to assess the situation, but failed to do so. The nurses also failed to interpret the fetal monitoring strips correctly, which showed clear signs of fetal distress. At 3 a.m., the OB resident reviewed the strips for the first time. She did not know what the private attending obstetrician's original plan for delivery was and she felt that this was not supposed to be a VBAC although she had no idea when it was going to be performed. At 3:25 a.m., the nurse recorded that the OB resident performed a cervical examination and a plan was documented to recheck her in two hours after a discussion with the private attending obstetrician. At 3:30 a.m., variability was absent. At 3:40 a.m., there was a prolonged deceleration down to 90 bpm, but the OB resident was not called until seven minutes into it.

After her arrival at 3:47 a.m., it was only then that the OB resident called the private attending obstetrician at 3:49 a.m. when the fetal heart rate dropped from 90 to 70 and a stat c-section was ordered. Jane Doe was taken to the operating room at 4 a.m., anesthesia was started at 4:06 a.m., the incision was 4:10 a.m. and delivery was at 4:15 a.m., The in-house attending obstetrician performed the delivery in the absence of the private attending obstetrician, with the OB resident assisting.

At c-section, a lower segment rupture of the uterus at the site of the previous scar was noted with 2 liters of blood in Jane Doe's abdomen and placental bulging into the site of the rupture. As a result of the rupture, she had to have a hysterectomy.

Damages

John Doe claimed loss of consortium. Plaintiffs' life care plan estimated a present value of her medical needs in the range from $7.4 to $12.7 million. The present value of her loss of earning capacity is approximately $1 million. There is a Medi-cal lien of $115,000.

Injuries

Baby Doe suffers from static encephalopathy manifested by chorioathetoid cerebral palsy, microcephaly, seizure disorder, profound developmental delays. She is blind, she is unable to roll, she does not smile or laugh, she does not babble and has no demonstrable expressive or receptive language.

Result

Plaintiffs settled with Roe Hospital for $4.65 million.

Other Information

FILING DATE: March 26, 2010.