The ways in which the fetal heart rate is classified during pregnancy and labour has also changed over this time. Despite this evolution, the interpretation of fetal heart monitoring continues to be the source of much debate in birth injury cases. For example, in Medina v. Wong, 2018 BCSC 292, the Court was faced with expert opinion that provided two different interpretations of the fetal heart tracing. The infant plaintiff was born by caesarean section and suffered a brain injury around the time of birth. His mother went into labour and, following a period of monitoring by intermittent auscultation, nursing staff commenced monitoring the fetal heart rate by external fetal monitoring. All of the experts agreed that the SOGC Guidelines were the guidelines that they were expected to follow when interpreting external fetal monitoring. The experts for the defence described that the timing of the decision to expedite delivery by caesarean section was reasonable, based in part on the external fetal monitoring. However, the experts for the plaintiff opined that the timing was not reasonable, and that the defendant physician, Dr. Wong, failed “to summon obstetrical help in the face of an obvious abnormal fetal heart rate.”
Although the Court accepted that the SOGC Guidelines and the guidelines produced by the defendant hospital had “the common objective of standardizing interpretations and the actions that are required,” ultimately, “[g]uidelines are just that, guidelines” and they were not determinative in deciding whether the standard of care was met. Despite admitting that he did not follow the guidelines, Dr. Wong was found to have met the standard of care when he did not call for an obstetric consult but instead ordered an epidural when he was faced with a heart rate tracing that he himself described as having “some areas of concern.”
Even supportive expert opinion was not enough for the case to succeed. The Court, in describing the theory of “two schools of thought,” identified that where the trier of fact is convinced “that there is more than one viable approach,” medical practitioners, “acting reasonably, may reach opposite or different conclusions based on the same medical evidence.” Guidelines themselves can introduce uncertainty and the Court identified that the guidelines in question potentially did not accommodate an abnormal strip which then improves. Ultimately, the Court acknowledged that the experts for the defence and for the plaintiff differed on their interpretation of the fetal heart tracing. Finding for the defendants, Justice Abrioux described that the role of the court is “not to weigh the competing schools of thought and assess their relative merit.” Here, the Court found that it was not possible to conclude that Dr. Wong “improperly exercised” his judgement in his interpretations such that it was actionable.
So where does this leave a lawyer whose birth injury case relies upon the interpretation of the fetal heart rate tracing? Just as in Slater, the expert medical opinion is key. But so is understanding the wider circumstances of the case.
