This case involves a female patient who was being seen by her family medicine physician for her prenatal and post-partum care. Her physician ordered an ultrasound due to the low growth of the baby in utero. An ultrasound was performed which revealed troubling signs of cardiac distress, and a follow-up ultrasound was ordered. The defect was noted on the patient’s records. Some time later, the patient was admitted to the hospital to have labor induced due to preeclampsia, however, during this time none of the patient’s doctors noted the earlier ultrasound findings. After the child was born, the mother’s doctor noted that the baby was failing to thrive, and several nurses had indicated concern over the baby’s condition. Nevertheless, the baby was discharged without further workup. It was later discovered that the child was suffering from a severe case of Erb’s Palsy and a serious cardiac issue that would have benefited greatly from earlier intervention.
Question(s) For Expert Witness
- 1. Do you serve as a hospital administrator at a facility with labor & delivery/neonatal units?
- 2. Have you ever published or lectured on this subject?
- 3. Have you ever reviewed a similar case in the past?
- 4. Have you ever been sued or arrested?
Expert Witness Response E-023880
I have extensive experience as a hospital administrator. The issues for me are bread and butter: A.) Know the patient for whom you are caring for, read the record and do the required follow-up. B.) With this prenatal history, was the baby ever referred to a maternal fetal medicine doctor? Why is a family medicine doctor providing care to this high-risk pregnancy? Did this hospital have pediatric cardiology and pediatric cardiothoracic surgery? The child should have been born at a facility that could have provided the necessary care. C.) I am just tongue-tied on what to say about the lack of attention by the staff to the baby’s condition at the time of discharge.
Expert Witness Response E-026526
It appears that the family medicine physicians providing prenatal care should have referred the patient to an MFM specialist (maternal fetal medicine-obstetrics and gynecology). Had this been done pre-term, I feel certain that the MFM specialist would have arranged for all necessary care post-partum. Hospital policies for neonatology coverage vary extensively based primarily on the size and complexity of the L&D unit and the presence or absence of a NICU. An MFM specialist would have referred the patient to a hospital with full NICU care facilities thus avoiding this unfortunate outcome.