Susan is a 39-year old female who presents to the ED with complaints of abdominal pain and cramping. She is 7 months pregnant and reports having received prenatal care in another state early
Susan is a 39-year old female who presents to the ED with complaints of abdominal pain and cramping. She is 7 months pregnant and reports having received prenatal care in another state early in her pregnancy but has not seen a physician for 4 months. She is admitted to L&D directly from the ED. A fetal heart monitor reveals a non-reassuring pattern but the patient states that she needs to speak with the father of the baby prior to making any decision. With fluids, oxygen and re-positioning the condition of the baby seems to improve slightly. Both the physicians and nurses explain to Susan the importance of an immediate C-Section to deliver the baby and both describe the possible sequelae associated with delay. The team (including anesthesia) is ready to take the mom into surgery for delivery but agree to hold off at her request. In the chaos which ensues, these discussions are not documented anywhere in the medical record. Monitoring continues with both physicians and nurses at the patient’s bedside. Two hours after the patient’s admission, the baby’s HR drops to 50 and attempts to improve it fail -a decision is made to deliver the baby by emergency C-section but an anesthesiologist is unavailable having just been called into another case. The baby is finally delivered after two additional hours. The baby is flaccid and cyanotic upon delivery with an Apgar of 1. A pediatrician is on site and begins attempts at resuscitation which are unsuccessful. The baby is pronounced dead after 35 minutes. The mom is returned to the postpartum unit. The baby’s father finally arrives angry that he was not located prior to the procedure and the mom immediately advises the hospital that she plans to contact her lawyer. The mom is told that her refusal to consent to surgery when it was initially recommended is the cause of the baby’s demise. A nurse who has been with the mom also intimates that the mom’s lack of prenatal care could have also contributed to the bad outcome.
For this case please imagine that you are either the general counsel or the VP of Quality.
What initial information would you try to gather in this case?
What are the legal problems (standard of care issues) that could challenge a successful defense?
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