Legal Eagle Eye Newsletter for the Nursing Profession

October 1997 

  Quick Summary: An obstetrical nurse reading a fetal monitor must keep at the task of reporting important developments in the patient’s condition to the physician.

  Variable late decelerations continuing is an important development, for which repeated efforts must be made by the nurse to communicate with the physician.

  The standard of care for the nurse in this case was to keep phoning the physician to report that late decelerations were continuing, until the physician arrived at the hospital and took charge of the situation. This was necessary even after she had called once to get instructions to admit the patient and a second time to report late decelerations.

  However, before damages can be awarded to a patient for a nurse’s error or omission, there must be proof the nurse’s actions caused harm to the patient. There was no proof this physician would have arrived or called a cesarean sooner if the nurse had kept phoning. NEW YORK SUPREME COURT, APPELLATE DIVISION, 1997.

   The patient was pregnant with her fourth child. She called her physician’s office, said she was in labor, and was told to go to the hospital. On arrival at the hospital an obstetrical nurse on the labor and delivery unit did a vaginal exam and started a fetal monitor. The obstetrical nurse phoned the physician and was told to admit the patient.

   Twenty-five minutes later the nurse perceived from the monitor strips that the fetus was having variable late decelerations, indicative of fetal hypoxia. She phoned the physician and reported this.

   The decelerations continued, but the nurse did not call the physician back, as she should have according the the New York Supreme Court, Appellate Division.

   The physician did not arrive until an hour after the one and only phone call from the nurse which dealt directly with the issue of late decelerations. When he got there the physician did not think there was a problem. He did not call for a cesarean until an hour and twenty minutes after he arrived. The baby was born vaginally nineteen minutes after the cesarean was called, just as the cesarean procedure was to start.

   The baby had aspirated meconium into the lungs, but the problem was corrected without major complications. Nevertheless a jury awarded $328,000 in damages, 50% against the physician, and 50% against the hospital as the nurse’s employer.

   The court ruled the nurse departed from the standard of care for labor and delivery nursing for failing to try repeatedly to contact the physician about the variable late decelerations. Nevertheless, the court let the hospital out, as there was no proof, had the nurse phoned, that the physician would have arrived or called a cesarean sooner or that a cesarean would have prevented meconium aspiration. Rampe vs. Hospital, 660 N.Y.S. 2d 206 (N.Y. App., 1997).