SYNOPSIS: AMNIOTIC FLUID EMBOLISM MEDICAL

MALPRACTICE CASE

Patient Mrs. Theresa F. Bondoc (hereinafter referred to as the
Patient) was admitted as a service patient at the Emergency Room of
the FEU Hospital on 30 April 1995 at approximately 1:50 p.m. At the
time of her admission, she was complaining of hypogastric and
lumbosacral pain (labor pains) of approximately seven (7) hours prior
thereto, for which she sought consultation at the FEU Hospital.

Due to her imminent delivery, patient was immediately brought to the
delivery room upon admission. The patient was given a physical
examination and was found to have the following maternal vital signs,
to wit: blood pressure (BP) at 120/70 mmHg; pulse rate (PR) at
70/minute; respiratory rate (RR) at 19/minute; and weight at 138 lbs.
On the other hand, fetal heart tones were recorded at 140 bpm.

Soon after, the patient was given an internal examination, which
showed that the cervix was 8-9 cms. dilated, almost fully effaced,
cephalic presentation and station 0. Inasmuch as the patient was
already in active labor, at 1:55 p.m., amniotomy (artificial rupture of the
bag of water) was done in accordance with the accepted and usual
obstetrical practice in order to hasten delivery and lessen the
discomfort of both patient and fetus during active labor. Uterine
contractions occurred every 2-3 minutes, and each contraction being
approximately 40-60 seconds in duration with strong intensity.

At approximately 2:00 p.m. of 30 April 1995, or about ten minutes
since her admission, the patient complained of difficulty of
breathing. Oxygen inhalation was given; and the patient was
immediately referred to the Department of Anaesthesia, Medicine and
Pediatrics, who at once responded to the call.

At that point, the patient was already restless and in cardio-
respiratory distress, and presently hooked to a cardiac monitor and
pulse oximeter. The patients vital signs were as follows:

Blood pressure (BP) was recorded at 180/110 mmHg;
heart rate (HR) recorded at 180 per minute; and
respiratory rate (RR) recorded at 35 per minute; and
There were crackles all over the lung fields, indicating
fluid congestion in the patients lungs.

In view thereof, an immediate request for different laboratory
examinations was made pertinent to the case, such as chest x-ray,
ECG, ABG, BUN, creatinine, and Na+, K+ determinations. Patient
was likewise diuresed with Furousemide 40 mg slow IV push to
relieve her of her congestion. (Please see Doctors Orders, Annex
2; See also: Nurses Remark Sheet, Annex 3) Digitalization
with lanoxin 0.25 mg slow IV push was also given to control her
trachycardia (increased heart rate). (Please see Doctors Orders, Annex
2; See also: Nurses Remark Sheet, Annex 3) At this point, a
pediatric team was ready with their gadgets and medications for the
neonatal resuscitation.

At approximately 2:30 p.m., or within thirty (30) minutes after she
complained of difficulty of breathing, patient Ma. Theresa F.
Bondoc had a cardio-pulmonary arrest. The doctors then
immediately instituted a cardio-pulmonary resuscitation.

At this point, no fetal heart tones could be appreciated by
the electronic fetal monitor immediately after the arrest of
the mother, patient Mrs. Ma. Theresa F. Bondoc.

Team efforts were exerted to revive the patient Mrs.
Bondoc.

After the patient Mrs. Ma. Theresa F. Bondoc was resuscitated, an
indicated outlet forceps delivery was done by the OB-Gyne team at
approximately 2:57 p.m., delivering a cyanotic (dark bluish to purplish
discoloration of the skin due to deficient oxygenation in the blood) and limp baby
boy, who was immediately received by the pediatric team. (Please
refer to Nurses Remark Sheet, Annex 3-A).

Since no fetal heart tones could be appreciated, the
pediatric team immediately instituted
cardiopulmonary resuscitation. Secretions blocking
the airways were immediately removed and readily
secured by endotracheal intubation.

One hundred percent (100%) oxygen was delivered
to the baby through ambu-bagging, while the rest of
the team inserted umbilical canula for venous
access. Epinephrine (a noted sympathomimtic drug),
continuous ambu-bagging and cardiac massage
were performed on the baby.

Inspite of these measures, no signs of life were
appreciated. Knowing the futility of the procedures,
the pediatric team stopped the resuscitation at
exactly 3:17 p.m. of 30 April 1996, and labelled the
newborn as stillbirth.

In the meantime, patient Mrs. Bondoc while resuscitated, remained
comatose and hooked to a mechanical ventilator. At approximately
3:40 p.m., an order was made to transfer the patient to the Intensive
Care Unit. At approximately 4:00 p.m., the patient was brought to
the Intensive Care Unit where she was observed to have generalized
seizure (convulsions). She was thereafter managed adequately with
anticonvulsant therapy.

During her sixteen (16) day stay in said ICU, the following procedures
were undertaken as shown by the Doctors Orders Sheets and
Nurses Remark Sheets, attached herewith and made integral parts
hereof as Annexes 5 to 5-HH, and Annexes 6 to 6-QQ,
respectively, to wit:

Patient was hooked to a mechanical ventilator to allow
her to breathe artificially.

Medications were given to the patient, both to raise her
blood pressure and to relieve her of cerebral edema
that could result from hypoxic encepalopathy
secondary to cardio-respiratory arrest.

The patient was given all adequate supportive
measures, but she unfortunately never regained
consciousness since her cardio-respiratory arrest in
the delivery room.

From her second hospital day, the patient Mrs. Bondoc
had bouts of fever given the fact that so many invasive
procedures had to be done during the course of her
medical management. Appropriate management for
the fever was likewise instituted by the medical team at
the ICU.


On the sixteenth day of her stay at the intensive care unit and
despite all measures taken to rehabilitate her condition, patient Ma.
Theresa F. Bondocs vital signs deteriorated and subsequently, she
was pronounced dead at 9:15 a.m. of 16 May 1995.


A MEDICAL MALPRACTICE CASE WAS FILED AGAINST THE
HOSPITAL, AS WELL AS THE RESPONDENT DOCTORS WHO
ARE EITHER RESIDENTS OR CONSULTANTS OF THE
HOSPITAL.

TO DO: MAKE A FRAMEWORK OF ANALYSIS FOR THE
DEFENSE OF THE HOSPITAL REGARDING THE ALLEGED
MEDICAL MALPRACTICE ISSUE. DISCUSS ALL POSSIBLE
ISSUES, AND POSSIBLE COUNTER-CLAIMS, WITH
SUPPORTING RESEARCHES.