A newborn baby now has cerebral palsy after a midwife failed to appropriately care for the vulnerable infant after he was born.
Deputy Health and Disability Commissioner Rose Wall said both Birthcare Auckland Limited and a registered midwife didn't deliver services with reasonable care and skill to the baby following his birth. There were "serious shortcomings" in Birthcare's subsequent management of the event and in their response to the parents' complaint.
As a result, both Birthcare and a registered midwife were found in breach of the Code of Health & Disability Services Consumers' Rights. They have also been referred to the Director of Proceedings to decide whether proceedings should be taken.
According to a report from the Health and Disability Commission, the infant was born healthy at Birthcare. But in the 24 to 48 hours after his birth, he slowly declined as he developed hypoglycaemia (low levels of sugar in the blood).
A delay in identifying and treating the hypoglycaemia meant the baby went into respiratory and cardiac arrest and he needed resuscitation during an ambulance transfer to the public hospital's neonatal intensive care unit (NICU).
The infant now has cerebral palsy with significant developmental delays and the family faces ongoing uncertainty around the extent of harm and the impact it will have on his future development, the report said.
Wall found that several Birthcare midwives showed shortcomings in the provision of care, however, the midwife caring for the infant over the critical period should have recognised and responded appropriately to the troubling clinical picture as it was emerging.
Careful consideration of all of the infant's symptoms should have alerted the midwife to the seriousness of the situation and led her to investigate further by way of a full assessment and then intervention. Although Wall said this didn't happen. The midwife showed "inadequate independent clinical decision-making at key points".
Birthcare and the registered midwife were found in breach of Right 4(1) of the Code, which states every consumer has the right to services provided with reasonable care and skill.
The midwife was found to have not appropriately managed the infant's hypoglycaemia or taken appropriate actions in recording vital signs prior to the ambulance transfer or administering oxygen during the ambulance transfer, the report said.
"The registered midwife did not follow the correct basic life support protocols required in an emergency situation such as this. The infant was in respiratory and cardiac arrest. Chest compressions should have been initiated promptly," Wall said.
In the context of treating hypoglycaemia, Wall said Birthcare's policy on neonatal hypoglycaemia was not consistently well understood by staff.
Wall said while hypoglycaemia and its management are within a midwife's scope of practice, it is incumbent on providers, like Birthcare, to ensure its staff are aware of the particular requirements of its own policies to maintain a consistent standard of care.
The Deputy Health and Disability Commissioner further noted that because no one at Birthcare administered the infant dextrose gel when he was hypoglycaemic, there was a fundamental failure to deliver services to a vulnerable infant with care and skill.
Birthcare was found to have breached Right 10 of the Code for their poor handling and management of the adverse event and the parents' subsequent complaint, Wall found. Right 10 gives consumers the right to complain about a provider in any form appropriate to them and the provider must facilitate a fair, simple, speedy and efficient resolution of complaints.
Additionally, Wall also found Birthcare in breach of Right 5(2) of the Code for failing to communicate openly, honestly and effectively with the parents about the complaint, and Right 6(1) of the Code for failing to openly disclose that the adverse event was being reviewed.
Wall made a number of recommendations, including:
- That Birthcare and the midwife provide written apologies to the infant and his parents for the deficiencies identified in the report
- That Birthcare provides HDC with evidence of staff training in documentation of handover and escalation, emergency skills, and roles and responsibilities during ambulance transfers
- That Birthcare update its Reportable Events Policy to include consumer participation as a key principle, and implement this as a meaningful part of its reportable events process
- That two of the midwives involved in the adverse event and complaint management each provide a personal letter of apology to the parents for their unprofessional communications, and that current Birthcare senior staff upskill in complaint management.
The infant's parents shared an impact statement after reviewing the findings, speaking of how this event impacted their baby's life.
"We feel that this tragic, preventable event has robbed him of his basic rights and joys of being a little human being - being able to walk, jump, run independently and explore the world, to be able to sing for fun, to talk and express his needs and wants, be able to have a sense of self-determination and independence, and most of all achieve his true potential in life," they said.
"We have been unnecessarily thrown into a lifelong situation where we feel powerless and out of control in all aspects of our lives."
Responding to the report, Birthcare said it continues to feel for the parents and their baby around what happened. It noted that since these events, Birthcare's ownership has changed and it is confident that a situation like this will not occur again.
"Birthcare advised that it fully accepts that the handling of the complaint by Mr and Mrs A [the parents] was unacceptable, and that the actions and omissions of its former employee, RM B, fell below expectations," the report said of Birthcare's response.
