Waikato District Health Board (DHB) (now Te Whatu Ora Waikato) breached the Code of Health and Disability Services Consumers’ Rights (the Code) for not providing services with reasonable care and skill to a pregnant woman.
While she was 12 weeks pregnant with twins, the woman first presented to the hospital’s emergency department with headaches and nausea. She required acute management of early onset hypertension.
At the time there, was no effective plan in place to monitor the woman’s pregnancy in the community on an ongoing basis. The woman was later admitted to hospital with intrauterine growth restriction, as one of the twins had an abnormal heart rate. The woman remained in hospital until the delivery of her babies.
It was subsequently confirmed that only one foetal heartbeat was present, and the woman was told that one of her babies had passed in utero. That same day the twins were delivered by emergency caesarean section. While attempts to resuscitate one of the twins were unsuccessful, the other baby was born in good condition.
The woman stated that when she learned one of her babies had died, she told medical staff she needed to ensure they had whānau to care for them while she was unable to. Whānau were not notified, nor was a cultural support person sourced to be with the woman (who is Māori) while she worked through the immediate aftermath of losing her baby.
Rose Wall, Deputy Health and Disability Commissioner, found Waikato DHB breached Right 4(1) of the Code, which gives consumers the right to have services provided with reasonable care and skill.
Ms Wall accepted the circumstances were challenging, but the cumulative deficiencies in the care provided amounted to the breach.
She was critical of Waikato DHB’s care following the first ED review when an effective plan was not put in place to closely monitor the woman’s condition in the community. She was also critical that medical input was not sought when two separate heartbeats could not be identified clearly, and of the decision over whether to deliver the babies early.
Ms Wall recommended Te Whatu Ora Waikato provide a written apology, train staff on the management and monitoring of hypertension and pre-eclampsia in twin pregnancies, and provide HDC with a copy of its cultural/kaupapa training framework, outlining how the practice of tikanga with patients and their whānau is developed with all hospital staff.