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'Traumatic' birth results in $5.2M award for disabled teen

CBCCBC 2/06/2016 Jason Proctor

In considering whether the standard of medical care was met, the judge said the tragic outcome of the case could not drive her analysis. © Provided by CBC In considering whether the standard of medical care was met, the judge said the tragic outcome of the case could not drive her analysis. A B.C. judge has awarded a disabled 16-year-old more than $5.2 million ($5.8m NZD) in damages after finding her cerebral palsy was the result of the failures of a nurse and doctor involved in her delivery.

According to the B.C. Supreme Court judgment, Tianna Brodeur's brain damage was caused by the profound asphyxia she suffered when the scar from her mother's previous caesarean section ruptured during birth.

'It was a traumatic event'

Known as a 'uterine rupture', the condition is life-threatening for both mother and infant; the teen's family successfully argued that an attending nurse and doctor didn't act quickly enough to recognize the gravity of the situation.

"Amanda Brodeur gave birth to a baby girl on September 21, 1999," Justice Neena Sharma writes in the opening words of her 82-page decision.

"Instead of an occasion filled with joy and happiness, it was a traumatic event which left her daughter with life-long cognitive and physical disabilities."

The ruling details the history of a medical process called vaginal birth after caesarean section or VBAC.

Currently there are 97 expectant mothers on a waiting list for the services of a mid-wife.:    © CBC    Sharma notes that at one point, having a caesarean guaranteed all future births would be done the same way, But in the early 1980s, doctors started encouraging some women to consider VBAC.

"This was preferred in order to reduce the risks associated with caesarean section deliveries which included possible infection, a prolonged delivery interval, total operative time, blood loss, multiple epidural placement failures, postoperative endometritis and prolonged hospitalization," writes Sharma.

"In general, vaginal birth was viewed as less risky for the mother."

But VBAC also carries the slim possibility of uterine rupture: in the case of an obstruction, the scar from the previous caesarean might tear, causing the mother intense pain and forcing the fetus into the abdominal cavity.

In that case, the only solution is to conduct an emergency C-section.

Tragic outcome 'must not drive analysis'

Brodeur's family argued the child's mother was not adequately warned about the risks of VBAC, but Sharma found she was provided with "adequate and sufficient information".

The judge goes on to examine the actions of Dr. Dayna Freedman, then a resident in her fourth year of training for a specialty in obstetrics and gynecology, and Heidi Marsh, a nurse who was caring for the mother.

"A main issue in this case is whether medical staff ought to have recognized and responded sooner to the signs and symptoms of uterine rupture than they did," Sharma writes.

But the judge points out that the "tragic outcome in this case must not drive the analysis".

Sharma constructed a timeline of Tianna Brodeur's birth, beginning at 18:30, when Amanda Brodeur was nauseated and vomiting.

By 21:45 Brodeur was complaining of "constant left lower uterine pain" and retching. At 21:54, Sharma says the fetal heart rate had dropped radically and Nurse Marsh called for help.

The judge says Marsh claimed Freedman insisted on doing her own assessment of the fetal heart rate. Sharma writes that at some point between 21:58 and 22:06, Freedman called another doctor to say she couldn't find the fetal heart rate.

Sharma says the other doctor "started hyperventilating and told Dr. Freedman that it was most likely uterine rupture. She ran to Ms. Brodeur's room."

Failure to meet standard of care

The judge found that Nurse Marsh failed to meet the standard of care by "not immediately reporting to the physician at 21:45 Ms. Brodeur's report of constant pain between contractions."

Sharma said Freedman failed to meet the standard of care on two occasions: "by failing to immediately recognize the report of unusual pain as a possible sign of uterine rupture, and by not immediately calling" a senior doctor.

"I find that the plaintiffs have established on a balance of probabilities, but for the negligence, Tianna would not have suffered her injury," Sharma concluded.

The judge awarded damages based on a variety of factors, including Tianna Brodeur's past and future care.

The teenager has a mild intellectual disability, but is functionally literate. But Sharma notes that she "will never be able to live independently" and "is vulnerable to being taken advantage of financially, emotionally and physically, including sexually."

She will never be competitively employed, will always need help with personal care and has "only basic social communication skills".

Sharma wrote that both parents testified they "want Tianna to live with them until they are no longer able to care for her, at which time they agreed and understood Tianna would live" with her sister.

The judge assessed the cost of future care at $3.2 million. The total amount of damages is $5.2 million.

In a statement, the hospital said it's not yet in a position to comment on the decision.

"B.C. Women's Hospital recognizes that this is a tragic case and our sympathy is with the family. We are reviewing the Court's decision."

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