Delayed C-Section in double footling breach delivery spells disaster.

THERE ARE TIMES WHEN C-SECTIONS ARE A MUST! There are other situations, in which C-Sections may or may not be indicated. In many cases vaginal delivery is the patient's preference and a C-Section is performed only as a last resort. However, in this extraordinary case, when a physician encountered a two-legged footling breech presentation, there should have been no question whatsoever that a C-Section was indicated. However, the physician not only failed to perform the C-Section but directed the attending nurses to apply fondal pressure, which was counterproductive.

SHARON TAYLOR HAD BEEN UNDER THE CARE OF DR. RICHARD BARRY FOR PRENATAL SERVICES PRIOR TO THE BIRTH OF HER SON, CHARLES III. On October 29, 1994, the patient arrived in labor at Lake Charles Memorial Hospital (LCMH). Because Dr. Barry was unable to be at the hospital, Dr. Richard Clement was called to the hospital to attend Sharon. When Dr. Clement arrived, he saw that the feet and ankles of the unborn child were protruding from Sharon's vagina. Although a heart monitor was not in place upon Dr. Clement's arrival, a heart rate of between 110 and 138 was recorded after a nurse attending Sharon placed a fetal heart monitor on the baby. Dr. Clement maintained that such a heart rate in the unborn baby indicated the baby was "doing well." Dr. Clement performed a vaginal delivery of the baby at 1:53 a.m., on October 21, 1994. At one minute, the baby had an APGAR score of two and was not breathing. Efforts to resuscitate him were begun. At five minutes, the APGAR score increased to five. The attending nurse, Janean Henning, maintained that the two low scores indicated that the baby needed continued resuscitation. At ten minutes, the APGAR reached a level of nine, an acceptable score. On November 22, 1994, 24 days after birth, the baby died. The Taylors filed suit against Dr. Clement. The trial court returned a judgment in favor of the Taylors in an amount in excess of one-half million dollars. Dr. Clement appealed.

THE COURT OF APPEAL OF LOUISIANA AFFIRMED THE JUDGMENT OF THE LOWER COURT. The court held, inter alia, that in a medical malpractice suit against a physician, a plaintiff must establish a physician's deviation from the applicable standard of care exercised by others in the same field. Further, a plaintiff must show a causal relationship between the alleged negligence and the resulting injury. The court noted that the evidence in the case showed that Dr. Clement arrived to deliver the baby. Upon his arrival, the fetus was in a double footling breach position. Since in that position, a baby's head is at the top of the mother's uterus, there is (the court concluded from the testimony adduced at trial) a clear and compelling need that a C-Section be performed immediately. Further, the court found that the position of the child presented a clear danger. Within the course of delivering the child vaginally, the baby's head was subjected to substantial risk of being trapped in his mother's cervix. Accordingly, the court recognized that the baby was subjected to cord and neck compression which could likely cause a lack of oxygen to the brain.

THE COURT CONCLUDED THAT THERE WAS CLEAR AND CONVINCING EVIDENCE THAT A C-SECTION COULD HAVE BEEN PERFORMED IN A SHORT TIME USING GENERAL ANESTHESIA. The court noted that one expert testified that using "general anesthesia with the crush induction technique" Sharon would have been asleep within one to two minutes. The court further noted that because Dr. Clement perceived the difficulty in getting the baby out of the vaginal canal, he ordered the attending nurses to push on the mother's abdomen to facilitate the delivery. The court commented on the fact that the plaintiffs expert witness testified that Dr. Clement's order to the nurses to apply fundal pressure was inappropriate because when the nurses pushed on the patient's abdomen, they were, in turn, pushing on the baby's head, which could cause head trauma to a baby in a double footling breach position. The court noted that Dr. Clement was the only witness to testify that he was not liable for the suffering and death of the Taylors' baby. The court rejected Dr. Clement's primary contention that the baby was dead before he was delivered. The court found that the medical records and testimony of Nurse Henning revealed that there were two instances when the baby's heart rate was recorded at 110 and later at 138, both indications that the umbilical cord was not prolapsed and was within the normal range for a baby who is "doing well." Taylor v. Clement, 2002 WL 31697255 So.2d--LA

Meet the Editor & Publisher: A. David Tammelleo, JD, is a nationally recognized authority on health care law. Practicing law for nearly 40 years, he concentrates in health care law with the Rhode Island law firm of A. David Tammelleo & Associates. He has presented seminars on medical, nursing and hospital law throughout the United States. In addition to his writings as Editor of Medical Law's. Nursing Law's & Hospital Law's Reagan Reports. his legal articles have been published in the most prestigious health law journals. A prolific writer, his thousands of articles, as well as his achievements as all attorney and lecturer, have won him recognition in Martindale-Hubbell's Bar Register of Preeminent Lawyers and Marquis Who's Who in American Law.