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External review to examine VGH newborn death

An independent, external review into case of a infant death during childbirth has been commissioned by the Vancouver Island Health Authority.

An independent, external review into case of a infant death during childbirth has been commissioned by the Vancouver Island Health Authority.

Unlike VIHA’s routine internal investigation, which concluded last week and was shared only with hospital staff and the patient involved, the external review will be made public.

VIHA acting-chief medical officer Dr. Martin Wale said the review was called to help restore public confidence in maternal care at Victoria General.

It will cover the events leading up to the death and make recommendations on how such a tragic outcome might be avoided in the future.

“It’s really tragic and we’re deeply sorry to the family for their loss,” Wale said. “We expect to be held accountable for what happened. If recommendations come back with things we could have done better, we’ll change our procedures.”

Details of the case were made public by an anesthetist at the hospital, Sue Ferreira, who said the mother required an emergency cesarian section but the procedure was delayed because the one general anesthetist in the hospital was busy with another surgery.

An anesthetist administers the epidural or spinal anesthetic before a C-section begins and monitors the mother’s pain throughout the procedure.

Wale said the national standard for how long it should take an anesthetist to reach a patient in an emergency is 30 minutes. He said in this case, from the time the doctor called for a C-section to when the back up anesthetist arrived at the hospital was 10 minutes and another 15 minutes elapsed before the procedure began.

During that time the child died inside its mother, and it was delivered as a stillborn.

Erna Turrie, the grandmother of the woman who lost her child, told media that she blames the doctors for not calling in the anesthetist sooner. Ferreira says if there had been a dedicated obstetrical anesthetist working in maternity the C-section could have started sooner.

VIHA tried to hire a second anesthetist in 2009 but none would work for the $348,000 salary offered, which is the maximum allowed rate set by the province and the B.C. medical association.

Wale said he’s confident that staff at Victoria General are providing the best maternal care they can under the circumstances.

“The vast majority of births have a positive outcome,” he said. “We’re not working with limitless resources, but if there’s a way we could be doing better with what we have, I expect this external review will shine a bright light on that.”

Wale could not say at press time who would undertake the review. VIHA was working with the Ministry of Health and the B.C. Patient Safety and Quality Council to find a suitable reviewer.

The review is expected to be completed by early September.

Wale said VIHA hasn’t been subject to an external review since 2006, but thought it was important to call for one in this case.

“This has become a public confidence issue that we need to address,” he said. “We want to reassure pregnant mothers that we take this very seriously.”

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