This is a trial decision of a shoulder dystocia birth injury case causing a brachial plexus injury that occurred at the Mississauga Hospital in Mississauga, Ontario.
ISSUES
The two liability issues decided in this trial were:
- Whether the defendant obstetrician fell below the standard of care in his management of a shoulder dystocia emergency during the delivery of the baby?
- If the doctor did fall below the standard of care, did this cause a permanent brachial plexus injury?
FACTS
Shoulder dystocia occurs where the anterior shoulder of the baby becomes stuck behind the bone of the mother’s pelvis.
Until the shoulder is released from this impaction, pulling on the baby’s head will just stretch the head away from the shoulder because the shoulder is fixed. The more downward an obstetrician or midwife pulls on the baby’s head, the greater the stretch becomes between the impacted shoulder and the head, and the more likely there is going to be an injury to the brachial plexus.
Downward traction (pulling the baby’s head towards the floor) is to be avoided during shoulder dystocia as it can increase the risk of injury. Lateral traction (away from the mother) has the same effect as downward traction.
At trial, it was the Plaintiffs’ position, through expert evidence, that the most probable cause for the baby’s brachial plexus injury was due to negligent excessive traction during shoulder dystocia.
The defence expert evidence on the other hand advanced a theory of liability that the baby’s brachial plexus injury was caused by non-negligent propulsive, in-utero forces without shoulder dystocia.
DECISION
After considering all of the evidence at trial, the judge found as a fact that the defendant obstetrician applied more than gentle downward traction after he identified the shoulder dystocia emergency which caused the brachial plexus injury. He applied downward traction either before, or in the course of putting the baby through the McRoberts manoeuvre to effect an axial delivery.
In making this finding, the trial judge observed (at para. 186):
This is not to say that Dr. Scheufler is not a skilled physician who has had a long and distinguished career. However, Dr. Scheufler had been on shift for over 15 hours of a 24 hour shift by the time he delivered [the baby]. In a normal shift where he would deliver an average of 10 to 12 babies, he completed five caesarian sections and delivered 14 babies that night. Dr. Scheufler was an obstetrician in a busy, urban hospital, where demand for care is high, and the volume of cases is great. I have no way of concluding with certainty if Dr. Scheufler unintentionally injured [the baby] when managing her birth, but the law does not require me to find facts on any degree of certainty.
EXPERT LIABILITY WITNESSES
Plaintiffs’ Experts
Dr. Timothy Draycott: Dr. Draycott was qualified as an expert to give opinion evidence on the standard of care of obstetricians in Canada in resolving shoulder dystocia during birth in 2009, and the causes and prevention of brachial plexus injuries.
Dr. George Arnold: Dr. Arnold was qualified to give opinion evidence on obstetrics, the management of shoulder dystocia and the causes of brachial plexus injuries.
Dr. Robert Allen: Dr. Allen was qualified as an expert to give opinion evidence in the field of biomedical engineering on what caused the injury to the baby, and when that injury took place.
Defence Experts
Dr. Robert Gratton: Dr. Gratton was qualified to provide opinion evidence on the standard of care expected of an obstetrician practicing in Canada in 2009.
Dr. Arthur Zaltz: Dr. Zaltz was qualified as an expert in obstetrics to give opinion evidence of the standard of care expected of an obstetrician practicing in Canada in 2009, and in particular the management of shoulder dystocia and on the cause of brachial plexus injuries.
Dr. Michele Grimm: Dr. Grimm was qualified as an expert in the field of bio-medical engineering to provide opinion evidence about the causation of birth related brachial plexus injuries and the cause of the baby’s brachial plexus injury in this case.
Decision Date: May 31, 2023
Jurisdiction: Ontario Superior Court of Justice
Citation: Rathan et al. v. Scheufler et al., 2023 ONSC 3232
