Midwives opinion disregarded by doctor

Trust to pay millions after brain damaged boy's 'mismanaged birth'
This story was reported in The Independent UK, it is a sad story of a mother’s (Kristi Riches) labour & subsequent birth in 2001 that went wrong and resulted in her child (Oscar) being born with catastrophic cerebral palsy, severe cognitive deficit, impaired vision, epilepsy and painful muscle spasms. The midwives involved in the care of Kristi were very troubled and tried to influence the doctor’s course of action, to no avail.

Oscar Riches would have been unharmed and grown up to live a normal life if he had been born swiftly by emergency Caesarean, Mr Justice Holroyde heard at London's High Court.
But the delay at Eastbourne District General Hospital had left the now seven-year-old with catastrophic cerebral palsy.
Oscar's counsel, James Badenoch QC, said that East Sussex Hospitals NHS Trust had admitted liability because of the behaviour of the locum obstetric registrar - an overseas doctor who has now left the UK - who "grossly mismanaged" his birth. Mr Badenoch said that before Oscar's birth, the heart-rate trace showed that he was in great jeopardy but not yet damaged.
But the locum "inexplicably" insisted that Mrs Riches should continue in labour and then failed in a ventouse delivery. Eventually extracted by forceps, Oscar was severely asphyxiated with the umbilical cord tightly around his neck and did not breathe spontaneously for 20 minutes.

"It was effectively an admission of negligence against the doctor - it was not a system failure... and we are happy to acknowledge that the midwives were very concerned and did seek to influence the doctor to take prompt and effective action."

Mr Badenoch said that the locum refused to speak to the midwives, hummed and whistled while attending to Mrs Riches after the birth and wrongly recorded the amount of blood lost when she suffered a potentially dangerous haemorrhage.

"It was effectively an admission of negligence against the doctor - it was not a system failure... and we are happy to acknowledge that the midwives were very concerned and did seek to influence the doctor to take prompt and effective action."
Mr Badenoch said that the locum refused to speak to the midwives, hummed and whistled while attending to Mrs Riches after the birth and wrongly recorded the amount of blood lost when she suffered a potentially dangerous haemorrhage.
It was also reported that as a result of the trauma of Oscars’ birth in December 2001, Kristi (mother) suffered stress and anxiety that she could not contemplate having any more children.
It was not believed that he had worked again in this country but his present whereabouts were unknown.
Oscar is totally helpless and would require constant care long as he lived, which was likely to be into his 20s, funded by an agreed lump sum payment of £1.118m plus annual payments.

Mrs Riches who, with her husband Clive, cares devotedly for Oscar at their home in Glenleigh Park Road, Bexhill-on-Sea, East Sussex, has reached a further undisclosed settlement with the authority for her psychiatric injury.

It is interesting to see the CTG submitted as evidence relating to the fetus’ well being; however there was no mention of any fetal scalp sampling or cord bloods. Also the midwives documentation and concern were duly noted, it would be good to examine this case further to see what other options the midwives may of had in relation to the doctors who were leading this case.


Reference:Posted by The Independent
Friday, 30 January 2009 at 06:54 pm
Published: 2009-01-30 14:18:38
Author: By Jan Colley, Press Association

Cyber Talk and Midwives

Tonight I presented a lecture about Cyber talk: The presentation was a brief introduction to the Internet, focusing mainly on blogging. The aim of the presentation was to raise the awareness of midwives about the internet, who blogs and why, also to highlight the legal and professional responsibility of cyber mediums such as Facebook, MySpace, Skype, YouTube, Twitter and blogging. Currently there are approximately 22million blogs online. Blogs are becoming one of the fastest growing mediums for discussions relating to marketing, legal issues, health, political activism and social change.1


So, what is a blog? It’s a journal, reflection, diary, newsreel or a newsletter. However you describe it, it is something you write that is personal and informal for the world to read. Blogs are designed for the public forum – they can be updated daily, weekly, monthly or whenever the writer chooses. Blogs are very easy to set up – any of the major search engines will direct you to a site of your choice and you simply follow the instructions. 2

Major legal issues surrounding publishing on the Internet relate to: defamation, copyright, trademarks, moral rights and confidentiality. I am sure there are more but for now I will concentrate on these relating to midwifery.

All Midwives be they; community, independant, hospital based are bound by legislation such as the Nurses and Midwives Act. Within this framework we are regulated by the ANMC Code of Conduct (2008),

Code of Ethics(2008) &

The Competency Standards for the Registered Midwife (2006). If midwives fail to meet the required standards of these Codes, then they can face disciplinary action as stated within the legislation. Therefore midwives need to know and understand what the Codes mean and how they work. It is important to remember when you are blogging to be professional at all times, being mindful not to bring our profession into disrepute. Once something is published on the web it is very hard to delete, it is passed around the cyber world like lightening creating lots of threads and being saved in different places.

There are many health professionals blogging, sharing stories, practices, education and reflecting care given. This increases the risk of breaking patient/client confidentiality due to the blogger or authors sharing too much information, such as subspecialties, names, places and content.

The Journal of General Internal Medicine published an article titled “STUDY HIGHLIGHTS RISK OF BREAKING CONFIDENTIALITY IN BLOGS” this was a study that examined 271 medical blogs and found that 56% of the blogs contained enough information to reveal the author’s identity. 3 The study found that blogging was a great way to reach both patients and health professionals so long as people were responsible about it. However “blogging does pose serious concerns about confidentiality and bringing the profession into disrepute. 3”

Defamation occurs when one person communicates material that damages the reputation of another. This can be verbal, written or pictures and the publication must reach someone else other than the person being defamed. However there are several defences to defamation such as: is it a ‘fair comment’ on a matter of public interest or was it simply an opinion, was it an honest opinion of the author 3.

ANMC Professional conduct refers to the manner in which a person behaves while acting in a professional capacity. It is generally accepted that when performing their duties and conducting their affairs professionals will uphold exemplary standards of conduct, commonly taken to mean standards not generally expected of lay people or the ‘ordinary person in the street’.

The moral from this evening's presentation is to know your ANMC Codes inside out, they provide you with a tremendous framework. As for my presentation, I must remember to have my cheat sheet with me, because once I start talking lots of new ideas come through and I forget the ones I was going to focus on. This is such a massive topic that I really just tipped the iceberg.

Happy Blogging - 'have blog will travel'



References:
1. Sylvia Mercado-Kierkegaard, Blogs, lies and the doocing: The next hotbed of litigation? Science Direct.
2.http://www.artslaw.com.au/legalinformation/LegalIssuesForBloggers.asp
3. BMJ 2008;337:a1043; Study highlights risk of breaking patient confidentiality in blogs.