Confidential

Facts

The infant's mother was 19 years old and in her first pregnancy. The pregnancy was complicated by third trimester by maternal hypertension.

The mother was admitted to Roe hospital on Sept. 23, 1999 for induction of labor. Orders for Pitocin were given by the OB, up to 25 mu/hr. Pitocin was begun at 6:00 p.m. Contractions began three hours later.

The following day, Pitocin was taken as high as 28 mu/min. This was in the face of uterine contractions occurring every 1.5 minutes beginning at approximately 3 p.m. on Sept. 24. In addition, maternal blood pressure was borderline hypertensive throughout and a maternal fever developed late in the day.

At 7 p.m. on Sept. 24, nursing care was assumed by a Nurse Trainee. In the nursing flow sheet, she charts uterine contractions every 1.5 minutes over a several hour period of time. She also charted in the flow sheet a decrease in long term and short-term variability.

In two phone calls to the OB, she did not report uterine hyperstimulation or decreased long term and short-term variability.

On Sept. 25, at 1:30 a.m., the mother began to push. The OB was called, and arrived at 02:00. The baby was delivered at 3:14 a.m. with Apgars of one (at one minute) and three (at five minutes and four at 10 minutes). Cord blood was not drawn. The first blood gas showed significant metabolic acidosis with a ph of 7.16 and a base excess of -20.

Seizures were noted in the NICU later in the day of Sept. 25. The infant was discharged with severe spastic quadriplegic syndrome.

PLAINTIFFS' CONTENTIONS:
The plaintiffs contended that the hospital nurses violated the Pitocin order, and further violated the hospital's protocol by not appreciating that mother was experiencing uterine hyperstimulation. The hospital protocol required the discontinuation of Pitocin and notification of the physician in the face of uterine hyperstimulation.

The plaintiffs further contended that there was inadequate supervision of the nurse trainee on the evening of Sept. 24 and early morning of Sept. 25. The fetal monitoring strips were missing. The hospital custodian of records testified that they were last seen and accounted for the day following the birth.

The plaintiffs further contended that the hyperstimulation, coupled with maternal hypertension and maternal fever, caused fetal distress and hypoxic ishemic encephalopathy, which, in all likelihood, was reflected clearly on the fetal monitoring strips. This fetal distress should have been appreciated and the fetus should have been taken hours earlier by c-section.

DEFENDANT'S CONTENTIONS:
The defendant contended that the nursing care and treatment was, at all times, within accepted standards of care. It was discretionary to take the Pitocin up to 30 mu/min. There was never any convincing evidence of hyperstimulation or any evidence of fetal distress. The hospital could offer no explanation for the missing fetal monitoring strips.

Injuries

The infant was born with cerebral palsy. Life expectancy estimated at 45 years, with need for 16 hours per day of CNA care to age 18 and for the balance of her life. The defendant contended that the child's life expectancy is only to age 12-14.

Other Information

The case settled following two sessions of mediation with Jay Horton, Esq. at Judicate West. The defendant obstetrician received a dismissal with prejudice in return for a waiver of costs. The Roe hospital paid the entire settlement.