as corrected. second corrected.: March 11, 1991.
Pekelis, J. Coleman and Forrest, JJ., concur.
Athena Garcia appeals several trial court orders and evidentiary rulings arising out of her medical malpractice suit against Providence Medical Center (Providence), the Seattle Indian Health Board (SIHB), and Jennifer Mayfield, M.D. (Dr. Mayfield). She contends that the trial court erred in (1) denying her motion in limine to exclude evidence of her prior abortions and a prior referral to Child Protective Services (CPS) following a report of child abuse, (2) granting a motion for a directed verdict in favor of Mayfield and the SIHB, and (3) admitting the testimony of respondents' expert witnesses and excluding the
deposition testimony of her expert witness, Dr. Peter Watson. She also assigns error to the court's refusal to give two of her proposed jury instructions and failure to impose CR 11 sanctions. We reverse the judgment against Providence and remand for a new trial. We affirm the judgment in favor of the remaining respondents.
Garcia's pregnancy was first diagnosed in November 1984. During the course of her pregnancy she visited the SIHB on eight occasions for prenatal care. At that time, the obstetrics team at the SIHB consisted of Doctors Jane Fellner, Peter Talbot, Jennifer Mayfield, and consultant Dr. Richard Agress. Dr. Fellner, a family practitioner, was an employee of the SIHB. Dr. Mayfield, also a family practitioner, was a fellow at the University of Washington volunteering at the SIHB. Dr. Talbot was a federal employee stationed at the SIHB. Dr. Agress was an obstetrician in private practice providing obstetrical/gynecological consultation services to the SIHB.
On June 13, 1985, Garcia was examined by Dr. Mayfield at the SIHB. Dr. Mayfield estimated that the gestational age of the fetus was approximately 38 weeks, or nearly term.
On June 20, 1985, Garcia was examined by Dr. Fellner. Garcia informed Dr. Fellner that she was not sure if the baby was moving as it usually had. Dr. Fellner noted this on Garcia's prenatal chart by writing "Question mark, arrow down, fetal movement." Dr. Fellner instructed Garcia to go home and count fetal movements.
On June 27, 1985, Garcia was seen by Dr. Mayfield for a second and last time. She told Dr. Mayfield that the baby was not moving or kicking as much as it had been. Dr. Mayfield explained to her that babies normally slow down prior to term. She listened to the heartbeat and informed Garcia that everything was fine.
On July 3, 1985, Garcia was examined again by Dr. Fellner. She complained of decreased fetal movement and also
reported that she was experiencing contractions. Dr. Fellner referred Garcia to the labor and delivery department at Providence for an evaluation of her early labor.
Garcia was admitted to Providence at approximately 1:45 in the afternoon by Elizabeth Berkey, R.N. Garcia informed Nurse Berkey that she had been feeling decreased fetal movement over the previous 24 hours. To help assess the status of the baby, Nurse Berkey placed an external fetal monitor on Garcia.
Electronic fetal heart rate monitoring is used to test fetal well-being. The mechanism produces a "fetal heart rate strip," which is analyzed to determine various parameters, including fetal heart rate variability, i.e., the moment to moment changes in the heart rate. The strip has two segments, the top part representing the fetal heart rate and the bottom segment representing uterine contractions. A drop in the fetal heart rate below the base line is termed a deceleration. A clear pattern of late decelerations is associated with fetal hypoxia, or a decrease in oxygen to the baby.
The first time Garcia was placed on a monitor, the fetal heart rate and beat to beat variability were in the low end of the normal range. Nurse Berkey called Dr. Fellner at 2:30 p.m., and told her the output of the strip. Dr. Fellner instructed Berkey to have Garcia walk around for half an hour to see if the baby would become more active. Garcia was put back on the monitor at 3:08 in a new labor and delivery unit. The base line on the strip indicated a mild decrease in beat to beat variability.
Nurse Berkey reported Garcia's status to Nurse Suzanne Hutchinson, whose shift started at 3 p.m. At 3:45, Nurse Hutchinson called Dr. Fellner again. She gave Garcia oxygen. Because the strip was worrisome, Dr. Fellner communicated her concerns to Dr. Talbot, who was to be on call that evening. Responsibility for Garcia's ...