Prenatal Stress Test: Nurses Negligent For Failing To Detect Late Decelerations

Prenatal Stress Test: Nurses Negligent For Failing To Detect Late Decelerations

Legal Eagle Eye Newsletter for the Nursing Profession

December 1995

Quick Summary: The nurses were supposed to monitor the effect of the oxytocin challenge on the fetal heart rate. Instead of waiting for possible signs of late deceleration, the nurses disconnected the fetal monitor too soon, and sent the mother home. Four days later, the same thing happened, and the nurses again sent the mother home.

Three separate causes combined to produce mental and motor abnormalities in a newborn, which, by the time of a court trial at age eight, were the cause of significant mental retardation and motor delays in the child. At 40 weeks, a physician did a non-stress test. It showed delayed deceleration of the fetal heart rate which should have prompted an immediate cesarean birth, according to the medical testimony accepted by the court. Rather than proceeding with delivery of the child, the physician ordered a follow-up oxytocin stress test, in which nurses employed by the hospital were to monitor the effect of the oxytocin challenge upon the fetal heart rate. Instead of waiting for possible signs of late deceleration, the nurses disconnected the fetal monitor too soon, and sent the mother home. Four days later, the same thing happened, and the nurses again sent the mother home.

The California Court of Appeal accepted testimony from an obstetric physician, that it is below the standard of care for nursing to fail to detect and/or to appreciate the significance of fetal heart rate deceleration during a stress test.

The California Court of Appeal overturned the lower court’s ruling on the issue of causation. The lower court had ruled improperly that, whether or not the hospital prenatal nursing staff had been negligent, there was no cause-and-effect relationship between their negligence and the harm which resulted to the child due to apparently inadequate intra-uterine oxygen perfusion. To establish legal liability for negligence, it is not necessary to prove that a departure from the standard of care by a healthcare professional was the only cause of harm. It is sufficient to show that a departure from accepted standards of practice was a cause of harm, to hold a healthcare provider liable for negligence in a civil case. Espinosa vs. Hospital, 37 Cal. Rptr. 2d 541 (Cal. App., 1995).