A baby and her family have recovered $5.2 million dollars in damages from a Toronto area hospital which followed virtually no correct protocol surrounding the birth of twins, despite the clear risks twin pregnancies present.
The Toronto mother arrived to deliver twins after her membranes ruptured spontaneously. The obstetrician and nurses were aware that with twins labour can progress very rapidly, and they expected this particular delivery would be imminent. There were specific protocols for the delivery of twins, including requiring it to take place in a delivery room where a Caesarian section (C-section) could be performed immediately, having an IV inserted and monitoring the fetal heart rate (FHR) continuously with one monitor for each twin. In this case, none of this was done. Only one monitor was attached, and it recorded with such poor quality that the nurse could not continuously monitor the FHR of the twins. The paper on the fetal heart monitor ran out and was never replaced. An IV was not inserted nor was a blood type and screen test ever done. Additionally, the labour room was not prepared for an immediate C-section, as the anaesthetist and pediatrician were not readily available. Hospital protocol demanded the urgent attendance of an anaesthetist to start an epidural if needed. Unlike normal pregnancies, where an epidural is available on request, the delivery of the second twin necessitates one all the more, since delivery by forceps or C-section is extremely likely. The regional analgesia requires an IV prior to starting the epidural in order to avoid hypotension.
The pediatrician was not paged until 7 minutes before the delivery of the first twin. The back-up pediatrician did not respond for about 1 hour and 30 minutes, despite being requested to respond within 30 minutes. The anaesthetist on call was not paged until 40 minutes after the doctor ordered her to be paged. The back-up anaesthetist arrived in the delivery room 4 minutes after the delivery of the second baby.
The doctor did not wait for spontaneous delivery; instead, he ruptured Mom’s membranes for the second twin despite there being no emergency, since the first twin was delivered uneventfully. The second twin’s head was unengaged, which the doctor knew from a vaginal examination. Immediately following the rupture, the umbilical cord prolapsed, or fell out, which most commonly occurs when the head is not engaged in the pelvis. The doctor pushed the baby’s head up to relieve pressure on the cord. He then unsuccessfully attempted Kjelland forceps. On the second attempt, as the baby was emerging feet first, forceps were applied again, and the second twin was born not breathing and with no heart rate.
Had the anaesthetist been present for the delivery, an immediate C-section would have been performed. This would likely have avoided the intracerebral haemorrhages and subdural haematoma, sustained from the trauma of the forceps delivery, along with the accompanying asphyxia. Had the labour room been properly prepared with an ultrasound machine, the uterus could have been scanned to show the position of the second baby and to do a general assessment.
The baby has cerebral palsy with accompanying seizures, and is totally dependent in all areas of self-care. He requires constant supervision.
Sommers Roth & Elmaleh Professional Corporation has over 40 years of experience in medical malpractice litigation in the Greater Toronto Area (GTA), Ontario, and across Canada.
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