Failure to Recognize Signs of Fetal Distress

Filed under Birth Injury, Cerebral Palsy

The Kondas Case

By September 22, 1995, Mrs. Kondas was 42+ weeks gestation when she came to the hospital early in the morning. She was 1 cm dilated and fully effaced. Beginning at approximately 3:50 pm, the fetal monitor strip showed continual ominous fetal heart tones which went totally ignored. From 12:00 noon to 7:00 pm when a stat C-section was ordered, no physician bothered to see Mrs. Kondas.

Throughout this prolonged period of fetal distress, the obstetrical nurses attending to Mrs. Kondas either failed to recognize blatant fetal distress or failed to look at the monitor (Even up to the time of their depositions, the obstetrical nurses attending to Mrs. Kondas were unable to decipher rudimentary fetal heart patterns). The inadequate staffing at the hospital rose to an absurd level when Mr. Kondas was called upon to operate a hand-held fetal monitor. By the time mother and baby’s dire condition was finally recognized and appreciated, baby Kondas’s brain was permanently damaged from oxygen starvation. “This is as clear a case of perinatal asphyxia as I have ever seen,” said one pediatric neurologist who was consulted on the case.

Minor’s cerebral palsy was clearly preventable had there been rudimentary obstetrical care. The defendants in this case were grossly negligent. Their gross negligence was the legal cause of Minor Kondas’ tragic condition.

This is the testimony that was elicited during the discovery phase of the case:

An obstetrician definitely wants to be notified when his patient’s fetal monitor strip shows a late deceleration because a late deceleration can be a sign of fetal distress.

A late deceleration can be a sign that the fetus isn’t getting enough oxygen and a sign that the mother requires a cesarean section to save the baby.

Obstetrical nurses attending to patients should notify the OB of all instances of fetal bradycardia. They should not try to interpret the significance of fetal bradycardia or whether fetal bradycardia is isolated and therefore insignificant. That type of interpretation is the obstetrician’s responsibility, not the obstetrical nurse’s responsibility.

At 3:50 pm [strip #68674], Mrs. Kondas fetal monitor strip showed a late deceleration.

At 4:20 pm [strip #68685], Mrs. Kondas’ fetal monitor strip showed another late deceleration. Even if someone would interpret the earlier late deceleration as isolated (and therefore requiring no action) this one certainly could not be considered isolated because of the late deceleration at 3:50 pm. This is exactly the type of fetal activity that obstetricians rely upon obstetrical nurses to relay to them.

At 5:50 pm [strips #68714, #68715], there is a late or variable deceleration which in no way could be considered as isolated because of the previous abnormalities at 3:50 and 4:20. This is precisely the type of fetal activity which could signify that the fetus is not receiving sufficient oxygen.

Pitocin is contraindicated where a fetus isn’t receiving sufficient oxygen because Pitocin intensifies contractions and diminishes further the amount of oxygen going to the fetus. Pitocin intensifies fetal distress.

One of the Defendant Obstetricians

Pitocin was still being given by 5:50, 2 hours after continuous ominous fetal heart tones began.

At 5:50 pm [strip #68715], there were decelerations, the type of fetal heart tracing abnormality which would typically prompt obstetrical nurses at the hospital to discontinue Pitocin.

One of the Defendant Obstetrical Nurses

Moments after this latest fetal heart abnormality, at 6:00pm, the chart indicates that One of the Defendant doctors was telephonically notified. Incredibly, however, the Obstetrical nurse and the Obstetrician both maintained in the depositions that the OB was not told about any fetal abnormality, but instead told that Mrs. condition was fine. This had to have been either not truthful, or reflective of gros negligence in light of admitted ominous fetal heart irregularities at 3:50, 4:20 and 5:50. These errors were later compounded:

From 5:54 pm to 6:10 pm the obstetrical nurses who were supposed to be attending to Mrs. Kondas had no idea of the fetal status because the fetal monitor was absolutely unreadable!!!

At 6:12 pm there was a late deceleration; again, the type of fetal activity that OBs must be informed about (but, according to the defendant OBs, were not in this case).

One of the Defendant Obstetricians

At this point (6:30 pm), the chart indicates that telephone contact was again made with one of the defendant obstetricians by an obstetrical nurse, yet both maintained in their depositions that the doctor was not informed of any fetal abnormality.

Beginning at 6:35 [strip #55690], there is fetal bradycardia with a deceleration, the type of fetal heart abnormality which obligates obstetrical nurses at the hospital to notify the obstetrician.

One of the Defendant Nurses

Mrs. Kondas’ husband was then asked to assist in the use of a hand-held fetal monitor because there were not enough nurses around to adequately attend to Mrs. Konda.

One of the Defendant Obstetricians

One of the Defendant Obstetrician’s interpretation of the strip at this time is a series of decelerations which cannot be further interpreted because the obstetrical nurses were not monitoring Mrs. Kondas’ contractions. It was imperative, however, for the OB to know what type of decelerations were occurring.

The fetal heart monitor is absolutely unreadable after this point.

At 6:50 pm, One of the Defendant Obstetricians arrived at the hospital, went into Mrs. Kondas’ room, and exchanged pleasantries with the family. He conducted a physical examination, and then left the room without ever having looked at the fetal monitor. He did not believe he had any reason to be concerned about Mrs. Kondas or baby’s condition because the obstetrical nurses did not inform him about the fetal heart abnormalities.

Had one of the defendant obstetricians bothered to look at the fetal monitor strip when he came to Mrs. Kondas’ room the first time, he would have seen that there was not an interpretable heart tracing for at least the previous 20 minutes.

One of the Defendant Obstetricians

A stat C-section was finally ordered, but Minor Kondas was not delivered until 7:33 pm. At birth, he exhibited all of the classic signs of perinatal asphyxia:

  • profound neonatal depression
  • profound metabolic acidosis;
  • need for major resuscitation;
  • major organ shutdown, including brain, kidney, heart, lung, liver and blood;
  • evolving encephalopathy;
  • evolving EEg

By every medical criterion, the negligence of Minor Kondas’ providers prolonged unnecessarily the duration of Minor Kondas’ asphyxia. By every medical criterion, Minor Kondas incurred a brain injury shortly before his birth.

On the day a jury was to be selected and the case was to commence trial, a multi-million dollar settlement was achieved for Minor Kondas. The proceeds from that settlement were deposited into a Court-supervised Trust Fund, which will remain in tact for the entirety of Minor Kondas’ life. A new home was built for the Kondas family which is totally accessible. The Trust fund continually purchases need modalities for Minor Plaintiff’s mobility, such as high tech wheel chairs and lifts and a van. The Trust also oversees his therapies and overall healthcare, including his education and entertainment. He is taken care of as best as money is able, and with his loving family and doing well.

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Publisher: Harry S. Cohen and Associates, P.C.