Defense Questions Neonatal Nursing Expert’s Testimony on Obstetric Nursing

Court: United States District Court for the District of KansasJurisdiction: FederalCase Name: Holt v. Wesley Med. Ctr.Citation: 2004 U.S. Dist. LEXIS 13814

The nursing expert witness, retained by the plaintiff, opined on the standard of care in an obstetric nursing facility. The defendants argued the expert was unqualified.

Facts

The plaintiff’s mother went to the defendant hospital for elective labor induction. The mother delivered the plaintiff through an emergency cesarean section. The plaintiff was frail and weak without voluntary breathing. She sustained irreversible brain damage. The mother suffered a ruptured uterus and a badly lacerated reproductive tract.

The woman had signed an agreement with the defendants upon her hospital admission. It allowed residents to share in her care and treatment as part of their specialist training. Approximately three weeks after birth, the mother’s medical records were prepared to include three separate observations of poor urine production and bleeding urine. The addendum also contained a left-sided pain break chart, though block rates were similar.

The Plaintiff’s Nursing Expert Witness

The nursing expert witness was a registered nurse and nurse practitioner. She used to assign nursing duties as chief nurse, staff nurse, and charge nurse at a hospital. The expert made appointments at the defendant’s newborn intensive unit from 1979–1989. She has conducted leadership and strategy workshops, including nurse training talks.

The nursing expert witness prepared two reports. She checked patient records, fetal monitor strips, and doctor and nurse deposition to write the first paper. She compiled a second expert report after reviewing a letter from a doctor and a patient allocation list. The expert also reviewed a second patient’s nursing birth room records, the defendant’s nursing practices, and perinatal care guidelines.

The nursing expert witness concluded that the defendant had either understaffed nurses or inadequate health treatment during labor and childbirth. She based her decision on medical records. The records revealed that nurses were failing to capture and report vital signs as mandated by nursing policy. Patient assignment lists indicated that a nurse assigned to the mother was at the same time assigned to another patient. The records also revealed that there were frequent nurse changes. The expert testified that she was unaware of any testimony that a nurse not at the bedside of the mother interfered with the physician’s ability to administer treatment. However, she thought the absence of one-to-one caring clashed with the mother’s treatment. The nursing expert witness also opined that the defendant’s nurses “acted in a wanton manner.”

Arguments

The defendant hospital argued that the expert was not qualified to give an opinion on the quality of obstetric nursing. The nursing expert witness was a neonatal nurse. The defendants asserted that she had never served a single shift on a labor and childbirth floor. Furthermore, the defendants argued that she had never practiced obstetric nursing. The defendants claimed that even if the expert was qualified, her theories on understaffing were based entirely on assumptions. The defendant hospital argued that there was no basis for her testimony. Moreover, the defendant claimed the expert simply hypothesized that the nursing service given to the plaintiffs was below the level of treatment. The defendant also argued that the testimony of the expert was not founded on evidence.

Discussion

The court acknowledged that the expert served in the neonatal unit rather than the labor and childbirth floor. However, the court noted that this didn’t prohibit her from opining on the standard of care in an obstetric nursing facility. The supposed void in her qualifications went to the weight of her view. The court also noted that she had carefully examined a wide range of sources to shape her viewpoint. The opinions were not unfounded. The court noted that her testimony was reliable. The expert confirmed her assertion with concrete facts.

Ruling

The court denied the defendants’ motion to exclude the nursing expert witness testimony.

Key Takeaways for Expert

It’s important to align your expertise to what you’re testifying about. But it’s also crucial to base your opinions on facts, not conjecture. In this case, the expert relied on medical records to form her opinion on the standard of care. Your background and expertise should match what you’re opining on. Additionally, you should rely on medical records when testifying about medical malpractice cases.