Who was responsible for excessive oxytocin doses? $18.2M verdict

Who was responsible for excessive oxytocin doses? $18.2M verdict
Early in the morning, a woman at 40 weeks’ gestation presented to the hospital for induction of labor managed by her ObGyn. Labor was lengthy, and the mother was given increasing doses of 22, 24, and 26 mIU/min of oxytocin to stimulate labor. The baby was delivered in the evening. The child suffered a hypoxic birth injury and has cerebral palsy. 

Parents’ claim Excessive oxytocin was administered, causing uterine hyperstimulation and excessive contractions. Nurses failed to inform the ObGyn of an abnormal fetal heart rate during the afternoon.

Defendants’ defense The parties disputed the oxytocin orders. The ObGyn claimed she has a standing order against oxytocin doses over 20 mIU/min. The nurses claimed that the dosage was based on the ObGyn’s verbal orders, which the ObGyn denied. The ObGyn denied negligence and maintained that if she’d known of the oxytocin administration greater than 20 mIU/min and the abnormal fetal heart rate, she immediately would have called for cesarean delivery. The hospital denied negligence and maintained that the oxytocin was administered 10 hours before delivery and played no role in fetal distress.

Verdict At trial, the ObGyn did not call expert witnesses and, in closing arguments, the physician’s attorney asked for exoneration of the ObGyn and a finding of fault solely against the hospital. An $18.2 million Washington verdict was returned against the hospital.

What caused the child’s Erb’s palsy?
A mother presented to the hospital for induction of labor. Oxytocin was administered and the first stage of labor progressed normally. When the mother began pushing, the ObGyn noted a turtle sign at crowning and called for assistance. The ObGyn attempted to deliver the fetus with downward guidance of the fetal head but encountered shoulder dystocia and a nuchal cord. He unwrapped the cord and instructed the nursing staff to place the mother in the McRobert’s position to help dislodge the right shoulder. When  that did not work, the ObGyn performed a first-degree episiotomy and completed delivery. The child was found to have Erb’s palsy of the right arm. She underwent decompression and neurolysis of the brachial plexus using sural nerve grafts but still has reduced use of her right arm. 

Parents’ claim Shoulder dystocia was improperly managed, causing the brachial plexus injury.

Defendants’ defense The ObGyn and hospital system denied negligence. The child’s injury occurred in utero due to natural forces of the mother’s uterine contractions.

Verdict An Ohio defense verdict was returned.

Woman claims lack of proper consent
A 47-year-old woman underwent endometrial ablation performed by her ObGyn. During the procedure, the uterus was perforated and the ObGyn performed a hysterectomy. Six days later, the patient was found to have peritonitis and underwent bowel repair surgery. The patient developed untreatable bowel adhesions that cause chronic pain.

Patient’s claim There were less expensive and invasive alternatives to the ablation that the ObGyn did not offer. The patient claimed lack of informed consent for the ablation and hysterectomy and negligence in perforating the bowel. The ObGyn was also negligent in failing to recognize the perforation and to diagnose peritonitis in a timely manner. 

Texas state law requires consent for hysterectomies without documented evidence of immediate danger to life. Her husband did not have the authority to consent on her behalf. 

Physician’s defense The husband gave informed consent. Failure to recognize the perforation was not negligent; it is a known risk of the surgery. The patient’s care was transferred to another physician after the second postoperative day.

Verdict A $200,000 Texas settlement was reached. 

Bowel obstruction in pregnant woman
A 29-year-old woman at 27 weeks’ gestation had abdominal pain. She went to a community hospital where a hospitalist was assigned to her care. After a day, the patient was found to have a small bowel obstruction and necrosis of the bowel. The baby was delivered preterm. The mother underwent 12 operations; half of her intestines were resected. The mother is being treated for posttraumatic stress syndrome. The child is autistic.

Parents’ claim The hospitalist did not diagnose the mother’s intestinal blockage in a timely manner and did not obtain an obstetric consult or notify the patient’s ObGyn. The hospital staff did not follow protocol to notify the mother’s ObGyn. The child’s autism is a result of preterm delivery.

Defendants’ defense The hospital denied any duty to notify the ObGyn if the patient was admitted to the hospital for nonobstetric reasons. The case was settled during trial.

Verdict A $4.2 million Washington settlement was reached including $3 million from the hospital.