Two real-world scenarios illustrate the case for compassionate care – to the
tune of $13 million.
I’ve practiced family and emergency medicine in both rural and urban centers. Over
the past ten years, I’ve also been the in-house medical consultant at a well-known
personal injury firm, reviewing cases and advising attorneys. The following parallel
real-world scenarios illustrate the case for compassionate care – to the tune
of $13 million.
Cindy wakes with a start, her sheets soaked. She is pregnant, at full-term, with
no contractions. It’s 3 am.
She calls her obstetrician’s office and the on-call OB tells her to go to the hospital.
She arrives half an hour later, goes through the ED to L&D, and is hooked up to
a fetal heart monitor (FHM). Cindy is a large woman, so it’s hard for the nurse
to get an adequate fetal monitor strip. The on-call OB, whom Cindy has never met,
is paged and arrives in five minutes. The strip reveals a good fetal heart rate
(FHR) – in the 140s – as it had been for the past few prenatal visits. After the
exam, Cindy is told her membranes have ruptured and she will have to stay until
This is Cindy’s first baby. She and her husband have gone to all the prenatal classes.
During her pregnancy, she has seen four of the eight docs in a busy Ob/Gyn practice,
but has no real connection with any of them.
By 11 am, Cindy still has no contractions, and the new on-call doc is paged. He
is in clinic and orders a Pitocin drip over the phone. Contractions start and became
regular and painful. The on-call doc sees Cindy after his clinic hours. Because
her contractions are still regular and painful, she asks for and gets an epidural.
Due to her large size, the FHM isn’t working consistently. When it does, the FHR
is in the 140s. The nurse accepts this less-than-adequate monitoring.
That night, L&D is busy, with several other women in labor and delivering. The OB
isn’t paged by Cindy’s nurse, so he doesn’t visit her again, until her baby crashes
just after 2 am and is delivered by emergency Caesarian Section. The cause: uterine
tachysystole – contractions too often. The result: hypoxic-ischemic encephalopathy
(HIE) and a baby with CP.
Cindy and her husband were understandably upset. Because they had no real relationship
with either OB on call, they were also furious and vengeful. In court, the jury
awarded $13,000,000. The insurance company settled after trial for $7,500,000.
Amanda, also pregnant and full-term, has a similar story.
She is awoken at 2 am by a contraction and calls her OB. She’s told to stay home
and call back when the contractions are regular and strong. By late afternoon, Amanda’s
ready, calls her OB, and goes straight to L&D.
Like Cindy, Amanda is a large woman and it’s hard to get the FHM to work consistently.
The nurse struggles to get an adequate strip. The on-call OB is paged and arrives
in five minutes. After a few minutes, she is able to get a good monitor strip, revealing
a FHR in the 130s, as it had been for the past few prenatal visits. After the exam,
Amanda is told she is in active labor.
Amanda had been referred to a four-doc OB/Gyn practice, all of whom she had seen
at least once. This is her first baby, and she and her husband had attended all
the prenatal classes.
Late that night, Amanda’s labor subsides, and the on-call doc is paged. She examines
Amanda and takes her time to explain the pros and cons of a Pitocin drip. Amanda
agrees and, after a few minutes, Amanda’s contractions become regular again. Amanda
asks for and gets an epidural.
An hour later, the FHM isn’t working consistently but still reveals an FHR in the
130s. The on-call doc is paged, arriving a few minutes later. The OB spends some
time adjusting the FHM until it works. Thirty minutes later, it stops working, so
the nurse chooses to use the fetoscope, instead.
Overnight, L&D is busy. The OB isn’t paged by Amanda’s nurse, so she doesn’t visit
Amanda again, until the baby crashes at 7 am. The cause: uterine tachysystole. The
result: hypoxic-ischemic encephalopathy (HIE) and a baby with CP.
Amanda and her husband were extremely upset. But because they had a real relationship
with the OB on call, they wanted to believe that she had done everything that was
appropriate – and were reluctant to sue.