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A Doctor's Duty of Care - Important for Mothers and Their Unborn Children

Victor Lewin - Monday, July 16, 2012

All doctors have a duty of care to their patients. In short, this duty is to treat their patients in a manner that reasonably prevents harm. Because the potential for severe injury is so significant, the importance of meeting their duty of care is especially important in obstetrical care. Doctors and nurses owe a duty of care to two patients simultaneously: the mother and the fetus.

Doctors monitoring pregnancies or delivering babies have many duties. For example, they have (a) the duty to conduct proper examination, (b) the duty to monitor, (c) the duty to utilize appropriate diagnostic testing, (d) the duty to respond in a timely manner to symptoms of acute fetal distress, and (e) the duty to communicate with each other.

Doctors in charge of obstetrical care must respond in a timely and often urgent manner. In the field of obstetrics wasted minutes can have tragic consequences. Doctors in the field have a duty not to waste minutes.

Beyond responding in a timely manner to urgent problems, obstetrical doctors must also take reasonable steps to anticipate those problems and plan accordingly.

Doctors and nurses owed a duty to their patienst to attend on a regular and timely basis, and, as required by their patient's condition, respond in a timely or urgent manner to potential harm.

The following case are examples of where Courts found doctors in the field of obstetrics to have breached their duty of care by provide an urgent response to critical problems:

The mother in McGlone (Guardian ad litem of) v. Kelly had an uneventful pregnancy. During labour, the child's heart rate fell periodically but recovered quickly each time. She was being treated by a family doctor with a practice in obstetrics. The doctor did not seek timely attendance of obstetrician and did not perform an urgent delivery. The child was born with severe cerebral palsy.

The Court found the doctor to have been negligent. He had a duty to recognize and respond to the significant accelerations in the fetal heart beat. The doctor had a duty to observe and consider information available from fetal heart monitoring independent of nursing advice. It was held that his failure to realize that the child was in distress fell below the standard of care. The doctor's failure to recognize and respond in the timely manner was found to be the material cause of the injury.

As a result of the breach of the duty of care, the Court awarded the injured baby and her family the large sum of compensation required to help cover the care needs associated with the injury.

Strachan (Guardian ad litem of) v. Reynolds dealt with a similar matter. After an uneventful pregnancy, the mother was treated as normal low risk patient. The fetal heart tracings commenced at 3a.m. The Court accepted evidence that, at 5 a.m., the tracings became non-reassuring. The non-reassuring tracings were combined with the mother's complaint of abdominal pain. Nonetheless, the doctor permitted the labour to continue until vaginal birth at 6 a.m. Doctors have a duty to recognize and respond urgently to signs of fetal distress. It was found to have been negligent for the doctor to not have performed an emergency c-section at 5:30.

A high financial damage award was provided to the baby and his family to compensate for such things like loss of enjoyment of life, cost of care, loss of earning capacity and housing costs.

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