Labor/Delivery: Nurse Not Negligent, Kept Physician Informed of Late Decelerations
Legal Eagle Eye Newsletter for the Nursing Profession
April 1999
Quick Summary: One legal responsibility of a labor and delivery nurse is timely to inform the attending obstetrician of all late decelerations so that the obstetrician can make a judgment whether an emergency cesarean is necessary.
Any specialty nurse must possess the degree of knowledge and skill ordinarily possessed by other nurses in active practice in the specialty. COURT OF APPEAL OF LOUISIANA, 1998.
The mother came to the hospital in labor. She was admitted to the labor and delivery unit and an obstetrical nurse was assigned. Four hours later, at 3:48 a.m., the baby was delivered by cesarean. The baby had brain damage and died seven weeks later. According to the Court of Appeal of Louisiana, the cause of death was never determined.
The parents sued the hospital, the physician and the obstetrical nurse. The physician’s insurance company settled. Then the court ruled the nurse was not negligent, and dismissed the lawsuit against her and the hospital.
The parents’ lawsuit alleged the nurse was negligent for not calling the physician after a late deceleration seen on the fetal monitor at 3:03 a.m. If he were called, the suit alleged, the cesarean might have been done sooner, and the baby might have been born healthy.
However, the court looked at the whole record. The court ruled on the basis of the whole record that there was no nursing negligence.
The obstetrical nurse phoned the obstetrician at 12:10 a.m., 2:45 a.m. and 3:00 a.m., shortly after each late deceleration the nurse saw.
As of 2:45 a.m. the obstetrician was en route to the hospital. The nurse apparently spoke with the obstetrician on his car phone at 3:00 a.m. By then the obstetrical nurse had seen to it that the cesarean team was being called in, that is, a surgical assistant, nurse anesthetist, anesthesiologist and pediatrician were being assembled. She had also notified the emergency room doctor and the house nursing supervisor. The patient had been prepped and taken to the operating room and the surgical instruments were all there, according to the court record.
When the obstetrician had phoned the nurse at 1:25 a.m., she reported the sporadic decelerations that had been happening. The nurse also reported that the fetal heart rate had returned to baseline when she repositioned the mother on her side.
At 2:45 a.m. the nurse, according to the court, again repositioned the mother on her side and administered oxygen. Although the fetal heart rate returned to baseline there were indications of fetal distress on the monitor tracing. At this point the physician headed to the hospital, and the cesarean was called at this time.
The nurse’s actions, when considered in totality, did not infer liability on her part, as the court phrased it. Dumas v. Medical Center, 722 So. 2d 1210 (La. App., 1998).