Baby dies after op delay
Hospital frees up more space for elective caesareans after tragedy
Ababy died during birth after the mother was bumped from her elective caesarean at least once because an emergency case took priority. The incident at Waikato Hospital happened in December last year, despite doctors previously warning managers of a life-threatening risk caused by elective and acute caesareans competing for the only theatre dedicated to deliveries.
It is not clear what the exact cause of death was but the district health board admitted yesterday that the mother’s scheduled caesarean had been delayed and changes had been put in place since.
The death sparked two reviews and has resulted in more theatre space opened up for planned C-sections.
In a damning letter to Waikato District Health Board chairman Bob Simcock, specialist anaesthetist Margot Rumball said the “safety of mothers and babies delivering at Wai- kato Hospital should be a no-brainer in a caring hospital”.
“The community should have confidence that they will be looked after when they attend our delivery suite, but there have been multiple nearmisses and some adverse outcomes,” the letter, dated September 7, reads.
Rumball said between two and four women continued to be at risk every month. “There are email trails going back years regarding this issue, with clinicians requesting a change in practice: for elective caesarean sections to be scheduled separate from acute caesarean sections, for the safety of both,” Rumball wrote.
“The inactivity on the part of management has been frustrating. Even with a death, they have lacked energy or competence to drive a business case through.”
A source close to the hospital told the Herald that senior doctors previously raised concerns that a death could happen and that it was a “significant risk” for patients and the DHB.
But DHB managers told the Herald yesterday that following the death of the baby, space was made available in the hospital’s main theatre, which is at least a 10-minute walk from the delivery suite, for elective caesareans.
Women’s and Children’s service director Michelle Sutherland said that if two emergency caesareans happened at the same time, a second theatre could be opened in the main operating theatre.
Sutherland said the gripe from doctors was now around a business
case for one dedicated theatre for elective caesareans within the main operating theatres, available on set days of the week.
“They’re looking for both the capacity and the reassurance that they don’t have to move to a different theatre on a daily or weekly basis.”
It was hoped this would be achieved by the end of the year.
Obstetrics and Gynaecology clinical unit leader Dr Narena Dudley said the board had become aware of safety risks before internal and external reviews into the baby’s death highlighted the need for greater capacity.
Dudley said increasing numbers of complicated pregnancies, repeat elective caesareans and increasing delays for planned caesareans meant a second theatre was needed to separate electives from emergencies.
Quality and patient safety clinical director Dr Doug Stephenson said the opening up of a main operating theatre for elective caesareans was only one of the recommendations
If you’re knee-deep in acutes, then electives don’t get a look in. Resident Doctors Association general secretary Deborah Powell
made in the external review, because theatre capacity was not the only issue.
He did not know of any other near misses in the delivery suite.
Resident Doctors Association general secretary Deborah Powell said it was common sense that emergencies took priority over electives, but that came with risks.
“If you’re knee-deep in acutes, then electives don’t get a look in. Someone looking for an elective C-section, eventually that baby is going to have to come out, so it will turn into acute.
“If the decision is they need to have an elective for whatever reason and suddenly they become acute, that is a failure of care for that person.”
The revelations are the latest in a series of incidents in which senior doctors have criticised senior managers for failing patients.
Last November a group of orthopaedic surgeons accused managers of stopping them from making follow-up checks on patients, so they could assess more new patients instead to meet national health targets.
One young woman’s elective surgery was postponed at least twice, allegedly putting her at risk of paralysis, according to a surgical services manager.
Chief executive Nigel Murray is currently on leave while his work expenses are investigated over unexplained spending.
Waikato Hospital has warned this week that it is bursting at the seams, with all elective non-emergency surgeries cancelled. On Tuesday hospital staff posted to Facebook that the emergency department was “in overload”.
Labour leader Jacinda Ardern’s 85-year-old grandfather was among those affected, with staff trying to discharge him at 11.30pm on Monday due to a bed shortage.