Ruminations

Decidedly Sub-Par Hospital Treatment and Responsibility

"It tells me that hospitals can and will do everything in their power to avoid paying compensation. It tells us we need to be very, very careful and vigilant when a poor outcome results from a medical treatment."
"We can't rely on what was said by a health-care provider ... to find out what really happened."
Hilik Elmaliah, lawyer, Barrie, Ontario

"RVH [Royal Victoria Hospital] sincerely and unreservedly regrets the failings surrounding Sarah's birth."
"We recognize how difficult this has been for the Butler family and the challenges they face. The birth of a child is a joyous experience and we hope Sarah and her family receive the support they need."
Rachel Kean, chief quality and privacy officer, Royal Victoria Hospital

Google Maps Royal Victoria Regional Health Centre in Barrie, Ontario

The joy the Butler family felt was no doubt genuine on the birth of twins, tempered rather more than somewhat by the fact that one of those twins met, on her way to birth, a fractured future. Sarah Butler is now ten years of age, having been born in 2007 at the Royal Victoria Hospital in Barrie, Ontario, a little after her brother Luke was born without incident. Without incident, Luke was delivered normally and has developed normally. His twin sister, however, has lived sin e her decade of birth, a far more troublesome existence.

Sarah Butler will require personal support services for the rest of her life. She suffered brain damage at birth, leaving her with disabilities such as cerebral palsy and poor co-ordination, along with cognitive deficits and speech impairment; in short all the hallmarks of a normal child developing at normal milestones to produce an individual taking her normal place in normal society. It will be of little comfort to Sarah and her family to learn that the hospital claims to recognize its responsibility to perform a comprehensive quality review after the occurrence of an "incident".

But at the time that Sarah was born in 2007, no such quality review was even contemplated. Instead, a cover-up of malfeasance leading to the "incident" appeared to result. Nurses who were looking after Sarah's mother, Jaye Butler, while she was in labour and delivering her twins, made a decision to hasten the second twin's appearance, when the on-call obstetrician was nowhere to be seen in the hospital. The nurses decided they would rupture the amniotic sack to help the birth commence.

The unborn baby's weight, pressing on the umbilical cord as the amniotic fluid drained, deprived the baby's brain of oxygen, an "incident" that resulted in lasting damage. The nurses' decision to rupture the membrane and release the amniotic fluid was inappropriate in their experience and professional level, leading to a catastrophe for this little girl and her family. The morning of her birth medical charts were written up to reflect that a spontaneous rupture of membrane had occurred, rather than nurses deliberately rupturing the membrane.

Accordingly, the next day a "unusual incident report" was routinely issued which failed to mention the rupture. It took awhile for the family to absorb the burden that had been laid at their doorstep; a lifetime of worrying and caring for a child whose life would be anything but normal. But they did eventually launch a lawsuit against the hospital after raising the issue of their daughter's birth gone awry with hospital officials and coming away dissatisfied with the reaction of the hospital, and their obvious unwillingness to admit fault.

Last year, after the hospital at last came around to admitting culpability, hospital authorities still posed their argument in court that Sarah's problems were largely a result of attention-deficit and hyperactivity disorder [ADHD], a condition they contended she had genetically inherited, and not as a result of brain damage occasioned by her delivery at their hospital. To counter the lawsuit the hospital claimed that Sarah became "distressed" leading to her delivery by emergency Cesarean section, and their staff had "appropriately monitored and cared" for mother and child.

This was an argument that failed to resonate with the judge hearing the case. The hospital's argument was rejected since no evidence existed that she suffered from ADHD, let alone that the child's problems were in any manner genetic in origin.

Coincidentally a 2004 study concluded that about 70,000 preventable errors occur in hospitals in Canada on an annual basis, the result of which is 9,000 to 23,000 deaths as an outcome. Some provinces routinely publish adverse-event statistics, reliant for their figures on what is given them by health-care facilities, but it is understood in the medical community that what is reported represents a fraction of the actual number of such adverse events.

In the case of the Butler family and their daughter Sarah, Justice John McCarthy ruled last week that the hospital must now pay $5.2-million in damages to the family to cover for Sarah's loss of future income, the ongoing personal support required to allow her to live as well as possible under the circumstances, and allied issues. The issue of whether the nurses who wrote false data on the baby's chart in self-defense against the outcome of an unauthorized medical procedure were ever sanctioned, was not forthcoming.