ACL recently settled a claim brought on behalf of our client against a large maternity hospital arising out of an alleged substandard epidural infusion during her labour. This was our client’s first pregnancy and having been admitted with a spontaneous rupture of membranes and being transferred to the labour ward, the Consultant Anaesthetist was contacted, and the Senior Registrar attended for the purposes of administering an epidural. Consent for the epidural was obtained and that potential risks including post-dural puncture headache were discussed. Our client was placed into a sitting position and that the epidural was sited using an 18-gauge needle inserted between the 3rd and 4th lumbar vertebrae at the first attempt without dural tap. The epidural space was located at a depth of 7cm, and 4 cm of catheter threaded easily. The anaesthetist recorded no paraesthesia and no blood or cerebral spinal fluid on aspiration. The records note an administering initial dose comprising of 3ml of 0.5% bupivacaine. Blood pressure was noted to be 95/65 mmHg. A second dose is recorded five minutes later of 10 ml of 0.25% levobupivacaine. The anaesthetist ticked the box as confirming the loading dose as tolerated. A retrospective note then appears recorded by the midwife that following the epidural siting our client was in the left lateral position and feeling very weak. The doctor was noted to be still in attendance and the foetal heartrate was noted to be 110 beats per minute. The epidural block was noted to be very high, and our client was only able to feel ice on her face and unable to move her arms, legs or head. She was placed in an upright position and noted to be pale in colour. Oxygen was administered by face mask and help was summoned. The doctor prescribed ephedrine to our client and the Consultant Anaesthetist attended at which point our client collapsed and an emergency call was put out. She was resuscitated and a decision was taken to deliver by way of emergency caesarean section and using general anaesthesia. At the end of the procedure, our client was sedated and ventilated until the epidural block had begun to wear off and was successfully extubated. She had no recollection of events, but her baby was delivered in good condition.
Our client was never given any explanation as to what occurred on the day in question, and she had no recollection of the events herself. She eventually sought her medical records and was invited to the Birth Reflections Clinic where she met with the Consultant Anaesthetist who had attended her following her collapse. There was a full debrief of the records and it was noted that our client remained traumatised about the lack of communication from the hospital at the time of epidural and the subsequent events.
Augustus Cullen Law were instructed to ascertain if there was negligence on the part of the anaesthetist during the course of the epidural administration. An expert opinion was obtained from a Consultant Anaesthetist in which he has expressed the opinion that our client undoubtedly suffered a total spinal block arising from the epidural medication entering the spinal space. He believed this was due to an unrecognised dural puncture caused by senior registrar and while our expert did not believe that the failure to recognise the dural puncture equates to negligence, his opinion was that the registrar failed in his duty of care to our client by failing to take into account the impact of the epidural test dose prior to administering a loading dose of local anaesthetic and that this was responsible for her collapse, the need for active resuscitation including positive ventilation of the lungs, foetal compromise and an emergency caesarean section. On this basis proceedings were issued against the hospital.
A full Defence was delivered on the behalf of the hospital not only denying the allegations of negligence but also claiming that the proceedings were statute barred on the basis that the incident occurred in 2012 and proceedings were issued in 2020. A trial date was fixed and shortly before it was due to commence a settlement meeting took place and damages were agreed to be paid to our client representing approximately 80% of the full value of the case to take into account the issues on liability and the issue regarding the statute of limitations. The Defendant also agreed to pay the Plaintiff’s full legal costs.
For more information please contact Jamie Hart, Partner Augustus Cullen Law.