Medical Malpractice
Nurses play a critical role in the process of labor and delivery at modern hospitals. Women in labor often have more contact and interaction with the nurses than they do with the actual doctor(s). Maternity nurses today do more than just bring ice chips and check blood pressure.
Being a nurse in the labor and delivery department requires a high level of expert knowledge and training in the childbirth process. In addition to medical expertise, nurses need to be skilled communicators because teamwork between the nurse and doctor is essential. Keeping the doctors adequately informed and reporting accurate assessment data is critical.
Nurses are considered healthcare professionals and can be liable for medical malpractice when their care falls below the applicable nursing standard of care. In fact, nurses are frequently involved in birth injury and other medical malpractice lawsuits. Medical malpractice claims involving nurses are somewhat different than malpractice claims against doctors for a number of reasons. This page will look at the types of medical malpractice claims that are commonly brought against nurses in birth injury cases.
Common Labor and Delivery Nursing Errors
Many birth injury cases involving nurse-related errors or negligent nursing care arise during the first stage of labor: from the first contractions to when the cervix is fully dilated. Nursing malpractice can also occur during the second stage of labor and during the delivery itself.
The reason nursing care is so important during the initial stages of labor is simple. During early labor, the nurse is often the primary bedside healthcare provider. The doctor may periodically check in on how the patient’s labor is progressing, but unless something goes wrong, nurses usually provide most of the ongoing monitoring and assessment. When it comes time to actually deliver the baby and the doctor takes over, the nurse continues to have important responsibilities for monitoring, assessment, communication, documentation, and carrying out appropriate orders.
The most common types of negligent nursing care leading to adverse outcomes and medical malpractice claims are: (1) communication negligence; (2) failure to ensure adequate care from the doctor; (3) medication errors; (4) negligent assessment; and (5) negligent intervention.
1. Communication Negligence
Communication negligence primarily involves failing to adequately inform the physician of changes in maternal or fetal status or other complications or events arising during labor. Negligent communication is one of the most frequent types of nursing malpractice involved in birth injury cases. Many negligent communication cases against nurses involve some type of failure to notify the doctor of fetal distress indicators on electronic monitoring devices.
2. Failure to Ensure Adequate Doctor Care
Another common theory of nurse malpractice in birth injury cases involves nursing negligence in failing to obtain adequate care and attention from the attending physician. These are cases where the nurse reports warning signs or problems to the doctor but fails to ensure that the patient receives the necessary care and attention in response.
For instance, if the nurse reports signs of fetal distress but the doctor fails to respond because the doctor is busy, cannot be reached, or is not at the hospital, the nurse may have a duty to take appropriate action to ensure that the patient gets the required care. This may involve contacting another doctor, reporting to the nurse supervisor, using the hospital’s chain of command, or following other hospital protocol.
This is an important point in birth injury cases. Calling the obstetrician once does not necessarily end the nurse’s responsibility. If the fetal heart tracing continues to deteriorate and the doctor does not respond appropriately, the nurse may need to keep escalating the problem until someone does.
3. Medication Error
Medication administration negligence is another common type of nurse malpractice claim in birth injury cases.
The administration of medication when contraindicated is one type of drug-related error involving labor and delivery nurses. Many of these cases involve nurses who continue administration of the drug Pitocin despite fetal heart rate abnormalities, excessive uterine contractions, or other circumstances that may call for Pitocin to be reduced or stopped. Administering the wrong dose of a medication and giving the incorrect drug are other common forms of drug-related malpractice claims against nurses.
Medication Error Case Example: A woman is admitted to the hospital for labor with borderline signs of preeclampsia. Magnesium sulfate is administered by intravenous infusion. Two hours after the infusion is started, the woman displays classic signs and symptoms of magnesium sulfate toxicity.
The nurse decreases the infusion rate but provides no further care in terms of patient assessment. Thirty minutes later, the woman is found in full cardiopulmonary arrest. She is successfully resuscitated but suffers major brain damage, and the baby is delivered stillborn. A later investigation reveals that the nurse, working as a “floater,” negligently administered eight times the prescribed dosage of magnesium sulfate.
4. Negligent Assessment
Negligent nursing assessment is another common type of nurse malpractice in birth injury cases. Negligent assessment claims usually involve nurses who do not pay close enough attention to fetal monitor tracings and fail to notice warnings of fetal distress in a timely manner. This can involve nurses who do not adequately read the monitor tracings or who ignore warning signs. Failing to apply and properly set up the monitoring devices is another type of negligent nursing assessment.
5. Nursing Intervention Negligence
The final category of common birth injury malpractice claims against nurses involves negligent intervention. These cases involve nurses who perform one of their functions incorrectly or without adequate skill. Setting up fetal monitoring equipment is usually the responsibility of the attending nurse. One example of negligent nurse intervention is when nurses set up or use fetal monitoring equipment incorrectly.
What Does a Labor and Delivery Nurse Have to Do When the Fetal Heart Rate Is Abnormal?
A labor and delivery nurse does not diagnose the baby’s condition in the same way an obstetrician does, but the nurse is responsible for monitoring the fetal heart rate, recognizing concerning changes, taking appropriate nursing measures, and communicating those changes to the doctor.
The exact response depends on what the fetal monitoring shows and what else is happening with the mother and baby. Appropriate nursing care can include changing the mother’s position, evaluating uterine contractions, adjusting or stopping Pitocin when indicated, notifying the obstetrician, and continuing to monitor whether the fetal heart rate improves.
If the tracing remains concerning and the physician does not respond, the nurse cannot simply document that the doctor was called and move on. Depending on the circumstances and hospital policies, the nurse may need to use the chain of command and get additional medical help.
Can the Hospital Be Liable for a Labor and Delivery Nurse’s Negligence?
Yes. Labor and delivery nurses are usually hospital employees, so the hospital can often be held responsible when negligent nursing care causes a birth injury.
There may also be a separate claim against the hospital based on its own negligence. A hospital can create problems through inadequate staffing, poor training, communication failures, inadequate policies, or a chain-of-command system that does not adequately protect patients.
This is one reason a birth injury lawsuit may involve more than the obstetrician who actually delivered the baby. The fetal monitoring records and nursing notes may show that the warning signs appeared hours before the doctor entered the delivery room.
What Evidence Is Important in a Nursing Malpractice Birth Injury Case?
The medical records are critical because nursing malpractice cases often come down to timing. The question is not simply whether fetal distress eventually developed. The question is when the nurse first had information that should have triggered a response and what happened after that.
Important evidence can include:
- Fetal monitoring strips: These can show when fetal heart rate abnormalities first appeared and how long they continued.
- Nursing notes: The notes can show what the nurse observed, when the doctor was called, and what interventions were performed.
- Medication administration records: These records can show when Pitocin, magnesium sulfate, and other drugs were started, increased, decreased, or stopped.
- Hospital communication records: Phone records, electronic messages, and chart entries can help establish when the doctor was notified.
- Hospital policies and procedures: These can be important when the case involves fetal monitoring, medication administration, or a nurse’s obligation to use the chain of command.
Sometimes the nursing chart says the doctor was notified without telling you much more. That is when the timeline becomes particularly important. What did the fetal monitor show before the call? What did it show afterward? Was Pitocin still running? Did the nurse call again? Did anyone move up the chain of command? Those details can make or break a nursing negligence case.
Contact Miller & Zois About Nursing Negligence
If your child was born with a birth injury, negligent nursing care may have been involved. The birth injury attorneys at Miller & Zois can investigate your case and help you take appropriate action. Call us at 800-553-8082 or get an online case review.