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Fetal Strips "Missing": Did Nurses Monitor Patient?

CASE ON POINT: Velazquez v. Portadin, 2000 N.J. 0042244 A.2d - NJ (2000)

ISSUE: When key evidence in a case is "missing" judges and juries may be suspicious. Was that possible in this case?

CASE FACTS: On August 18, 1990 at approximately 2 a.m., Barbara Velazquez went to Newcomb Medical Center to deliver her first child. She was examined by Dr. Michelle Torchia, an obstetrician covering for Vineland Obstetrical Associates. The patient was placed on a fetal monitor. Dr. Ronald Portadin took over for Dr. Torchia at 8 a.m. Nurses Eileen Cinotti and Ann Spoltore had responsibility for monitoring the patient. Nurse Cinotti was the nurse who had primary responsibility for monitoring the patient during labor. Nurse Spoltore was designated to provide care for the newborn after delivery. At approximately 1:30 p.m., Dr. Portadin determined that Pitocin should be administered. Pitocin often causes contractions to occur too frequently or last too long. When hyperstimulation of the uterus is caused by Pitocin, the interval between contractions is significantly decreased and there may not be enough time for the fetus to obtain sufficient oxygen before the next contraction. Thus the need for constant monitoring. Shortly after 1:30 p.m., Nurse Cinotti began the intravenous infusion of Pitocin at a rate of two milliunits per minute. Soon the "readability" of the fetal monitor strip began to decrease. At approximately 2:24 p.m., Nurse Cinotti increased the Pitocin rate to four milliunits per minute. At that time, Nurse Cinotti was relieved by Nurse Spoltore. Nurse Cinotti proceeded to prepare the delivery room for the patient. Nurse Spoltore increased the Pitocin rate to six milliunits per minute. At 2:45 p.m., the patient was disconnected from the fetal monitor and transferred to the delivery room. Although it was claimed that the patient was monitored when she reached the delivery room, the monitor strips were "missing." At 3:02 p.m., the patient, while still receiving Pitocin, delivered a baby girl, Diana. Diana had no heartbeat. Following resuscitation she was diagnosed as having Cerebral Palsy (CP). The patient and her husband brought suit in the State Court of New Jersey against the physicians, nurses and hospital alleging malpractice. At the end of the trial the court gave the jury a model jury charge. The jury returned a verdict for all defendants. The plaintiffs appealed.

COURT'S OPINION: The Supreme Court of New Jersey reversed the judgment of the lower court and remanded the case for a new trial. The court held, inter alia, that the trial court failed to tailor its charge to the jury to the theories and facts. First the trial justice neglected to explain that it was the jury's duty to determine whether the defendants, in fact, monitored the patient at all times while she was on Pitocin. The court found that there was evidence from which the jury could have found that the defendants failed to monitor the patient and that the reason they did not take any action when the fetal monitor strips were "unreadable" was because they were "unaware" of it. The court further held that whether the strips were "readable" was not a judgment call by the jury. Experts for both the plaintiffs and defendants agreed as to the standards for "readability" of the fetal monitor strips. If the strips were "readable" the issue was whether they indicated fetal distress. If there was no fetal distress, no intervention was required. However, if there was fetal distress all experts agreed that the Pitocin should have been discontinued stat.

LEGAL COMMENTARY: The plaintiffs' expert witnesses testified that the baby's condition was due to birth asphyxia. They found no other explanation for her condition. They based their conclusions upon a plethora of evidence including the baby's blood acidity, her susceptibility to seizures and her breathing problems. The plaintiffs' experts concluded that the oxygen deprivation had occurred within the last one and one-half hours before birth, which was the exact time during which Pitocin was administered. The defendants' experts opined that the cause of CP is unknown and that the plaintiffs' contention is only a theory. However, all experts agreed that it was appropriate for Pitocin to be administered and that monitoring was "necessary." The focal point of the dispute between the experts was whether monitoring took place and whether the strips were sufficiently "readable" to allow the defendants to determine the patient's reaction to the Pitocin induced contractions. The fetal monitor strips were "missing." Were the monitor strips really "missing?" Would "readable" strips have indicated negligence? Would "unreadable" strips have indicated negligence if not reported?
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Article Details
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Author:Tammelleo, A. David
Publication:Nursing Law's Regan Report
Article Type:Brief Article
Geographic Code:1USA
Date:May 1, 2000
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