In this respect, both the nurse and the obstetrician breached the standard of care: the nurse, “in failing to communicate regarding the plaintiff’s progress in terms of both her station and her position before pushing commenced, and after pushing efforts had been ongoing for an hour without descent”; and the obstetrician, “in failing to ensure that this communication occurred, and in the absence of that nursing assessment and communication, performing her own assessment of station and position before pushing started, and after one hour of pushing.”26 Gilmore can therefore be read as potentially ascribing doctors with a more stringent duty of communication than was previously understood, through the precedent set in cases like Briante: in some situations, the standard of care may require a physician to seek out additional, relevant information themselves if it is not disclosed by the team member responsible for ascertaining that information.
Doctor-Nurse-Patient Miscommunication
By 7:00 pm, the plaintiff’s mother finally began to feel the urge to push, and the obstetrician conducted an examination that revealed the fetus was OT and had not descended at all since the 2:30 pm examination. The obstetrician attempted to manually rotate the fetal head to OA position, without success. At this point, the plaintiff’s mother was given two options: continue to push for another 30 minutes or proceed with a C-section. She opted for the latter.
The court found that the obstetrician and the obstetrical nurses breached the standard of care once again in failing to caution the plaintiff’s mother that continuing to push after a C-section had been called could result in fetal head impaction. The court found that the plaintiff’s mother “did not understand, because she had not been told, the dangers of impacting the fetal head by pushing with contractions going into a caesarean section.”27 This is precisely what happened; by the time the plaintiff’s mother arrived at the operating room, the fetal head was “tightly, tightly wedged against the pubic bone”,28 creating the circumstances that led to the injury.
Doctor-Operating Room Team Miscommunication
Finally, the court found that the obstetrician’s standard of care included the duty to “decide upon an appropriate treatment plan and to communicate that plan with other staff involved in the care of the patient”.29 At the time of the C-section, the obstetrician failed to communicate with the operating room team in two significant ways: first, by failing to prepare them for the possibility that someone would need to try to dis-impact the fetal head from below (i.e., through the vaginal canal), and, second, by failing to prepare them for the possibility of needing to unstrap and reposition the mother’s legs into the semi-lithotomy (frog-leg) position, which would have facilitated the team’s efforts to disimpact the fetal head. The court found that the failure to communicate here was “a non-de minimis cause of [the infant plaintiff’s] injuries.”30
Conclusion
Due to the collaborative, team-based approach to healthcare delivery in Canada, communication between team members is critical to patient safety. Errors in communication may increase the risks that a patient is exposed to, and, depending on the degree of miscommunication, may even lead to patient injury or death.
