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Morrell v. Finke11/3/2005
t 8:45 a.m. Dr. Finke's examination revealed that the fetus had progressed to a minus one station at 10:00 a.m. "Station" refers to the position of the baby's head as it descends in the birth canal, with reference to the ischial spines. Dr. Finke used a five-point system for measuring the station by centimeters, ranging from "minus five" centimeters above, to "plus five" below the ischial spines. The nurses' method for measuring stations was purportedly different from Dr. Finke's, and this difference would generate a factual dispute at trial.
At 11:00 a.m., Nurse Marianne Walker came on duty as the labor and delivery nurse assigned to Donna. By 11:15 a.m., the variable decelerations in Madeline's heartbeat started to widen out and deepen, meaning that it was taking her heart longer to return to baseline. At 12:05 p.m., Nurse Walker began administering Pitocin, as Donna was still not in active labor and dilation of her cervix was not progressing. By 12:40 p.m., Donna was dilated to two centimeters, and the baby was making some progress.
D. Afternoon
Dr. Finke next saw Donna at 2:00 p.m., performed a vaginal exam, and placed an intrauterine pressure cannula to better assist in evaluating the frequency and intensity of Donna's contractions. Donna had four to five contractions lasting fifty seconds in a ten-minute span. Dr. Finke ordered the Pitocin continued, and Nurse Walker increased the Pitocin dosage to nine milligrams. According to the hospital's records, Dr. Finke did not enter Donna's room again during the next five hours, until 7:00 p.m.
At approximately 3:10 p.m. and 3:13 p.m., the fetal heart monitor strip documents several late decels, one of them showing a sudden drop in Madeline's heart rate from 130 beats per minute down to 60 beats per minute. According to Nurse Corrine LaMont, Plaintiff's nursing expert, this portion of the strip indicates "a fetus that's having a hard time coping to get back up to the baseline. . . . It indicates that the baby is having a hard time and is losing its reserves and is being stressed more than it can tolerate." Additionally, Donna's uterus had become hyperstimulated by the Pitocin increase, and she experienced nine contractions in ten minutes. The nurses and doctors agreed that a hyperstimulated uterus decreases oxygen to the baby.
At 3:25 p.m., Nurse Walker turned off the Pitocin and gave Donna oxygen. She notified Dr. Finke of Donna's status at 3:30 p.m. From 3:30 p.m. to 4:30 p.m., the strip documents continued variable and late decels, with no accelerations or beat-to-beat variability. Nurse Walker restarted the Pitocin at a lower level at 4:10 p.m. At 4:20 p.m., an anesthesiologist began an epidural anesthesia. At 4:40 p.m., the strip shows a late decel lasting for over a minute. Nurse LaMont explained that the increasing length of time it was taking for Madeline's heart to return to baseline indicated that she was losing her ability to recover, that she was being stressed, and that she had suffered so many insults that "it taking longer and longer to fight back." Donna's uterus again became hyperstimulated by the Pitocin; she experienced seven contractions in ten minutes, ensuring a problem with Madeline's oxygenation. Following a deceleration, lasting over ninety seconds, Nurse Walker turned the Pitocin off again.
Dr. Finke's 4:50 p.m. progress note indicated that the baby was still at zero station and that moderate variable decels were occurring, some after contractions. But Donna's cervix was now dilated seven to eight centimeters, so Dr. Finke's plan at that time was to continue to monitor Donna and to discontinue the Pitocin because of Donna's increased contractions. Dr. Finke testifi
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