Human Rights Review Tribunal, [2019] NZHRRT 37, (1 August 2019)
The Director of Proceedings filed proceedings by consent against the defendant obstetrician, Dr Brooks, in the Human Rights Review Tribunal (“the Tribunal”) regarding his care of a young, first-time mother, Cerise Lawn.
Dr Brooks was an obstetrician and gynaecologist employed by Taranaki District Health Board and who also practised privately. He was Mrs Lawn’s lead maternity carer (LMC). Prior to 2.37am on 24 January 2012, when a hospital midwife called Dr Brooks to Taranaki Base Hospital, Dr Brooks had not been advised that Mrs Lawn had been admitted to hospital at noon the previous day. Dr Brooks had also not been notified of Mrs Lawn’s clinical presentation since 11pm on 23 January, including the presence of increasing maternal tachycardia (high pulse rate), meconium (fetal stool) in the amniotic fluid, an increasing fetal heart rate (FHR) baseline, episodes of fetal tachycardia, and raised maternal temperature (pyrexia). Dr Brooks arrived at 2.50am when Mrs Lawn had been in the second stage of labour (pushing) for 1 hour and 20 minutes and the fetal head was on view. Mrs Lawn’s temperature was high, and her pulse was tachycardic. The FHR was consistently tachycardic. Dr Brooks did not perform a vaginal examination (VE). He did not discuss with Mrs Lawn the significance of her pyrexia, her tachycardia, the fetal tachycardia or the meconium, the possibility of maternal infection, or the possibility of fetal compromise. Nor did Dr Brooks discuss instituting continuous electronic fetal monitoring (CTG) to assess the FHR. Despite Mrs Lawn's clinical presentation and indicators of fetal compromise and maternal infection, Dr Brooks did not administer IV antibiotics to Mrs Lawn, nor did he expedite delivery of the baby by instrumental delivery or Caesarean section. Dr Brooks also did not call the neonatal unit (NNU) to request its presence at the birth. Rather, Dr Brooks commenced an IV infusion of Syntocinon in order to augment labour, which was contraindicated in the circumstances. Despite marked fetal tachycardia, Dr Brooks did not institute CTG monitoring when administering the Syntocinon. When Mrs Lawn’s baby was born at 3.50am covered in meconium, pale and floppy, and in respiratory distress, Dr Brooks failed to call the NNU to assist with resuscitation. Dr Brooks finally consented to a third request to call NNU once his own attempts at resuscitation failed, seven minutes after delivery. Mrs Lawn’s baby suffered hypoxic ischaemic encephalopathy with seizures, and was diagnosed with Group B Streptococcus sepsis (GBS) and resulting GBS meningitis. She has experienced significant and complex health difficulties and developmental problems.
As a consequence of the actions and inactions of Dr Brooks, Mrs Lawn lost the benefit of receiving appropriate obstetric care and, in particular, the timely detection and appropriate response to maternal infection and fetal compromise; the benefit of making informed decisions about her delivery; and the benefit of receiving timely and appropriate resuscitation of her baby. As a result, Mrs Lawn has suffered significant and enduring emotional distress, grief and trauma, and injury to her feelings. Dr Brooks accepted that his actions amounted to a breach of the Code of Health and Disability Services Consumers’ Rights (the Code), and the matter proceeded by way of an agreed summary of facts. The Tribunal was satisfied that Dr Brooks failed to provide services to Mrs Lawn with reasonable care and skill, and issued a declaration that he breached Right 4(1) of the Code.
The Tribunal’s full decision can be found at http://www.nzlii.org/nz/cases/NZHRRT/2019/37.html