Editorial: Allegations of racism and poor medical care during childbirth

It appears a troubling series of events may have occurred at the University Hospital of Northern B.C. in Prince George.

A young Nisga’a woman, Kristy White, has alleged that while giving birth at the hospital, she was subjected to racist remarks by the nurse on station. White is a child and family services court co-ordinator with the Nisga’a Lisims Government.

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Specifically, White alleges the nurse made disparaging remarks about “Indians,” and about the way they harvest and preserve food.

More seriously, she also alleges that the nurse refused to follow the instructions of the attending physician.

White’s baby was in a transverse position, that is, sideways in her uterus rather than head down. White’s doctor ordered the drug oxytocin to be administered every 30 minutes as soon as the baby was in the correct position.

Oxytocin causes contractions, and is administered in increasing doses until the contractions bring about birth. White alleges the nurse refused to follow these instructions over a prolonged period, defied the doctor face to face, and on several occasions demanded she leave the room.

Eventually, after a 24-hour period of labour, White was exhausted and experiencing chest pains, so she requested a C-section. But by then her doctor feared that was not an option, and she decided instead to a use vacuum-assisted delivery.

In this procedure, a flat inflatable cup is inserted into the birth canal until it comes in contact with the baby’s head. The cup is then manually inflated to create a vacuum seal between the cup and the baby’s head. The baby can then be withdrawn. Unfortunately, the child suffered brain bleeds following the procedure, and is now developmentally delayed. After an MRI, the child’s neurologist said the brain bleeds were likely caused by the vacuum-assisted delivery.

Though these are all allegations, not proven facts, the Northern Health Authority has conceded that a disagreement did take place between the nurse and physician. It has also admitted that “the team did not function effectively.”

The authority denies, however, the charge of racism, stating that the nurse’s actions were due to her concern for the safety of mother and child.

So what should happen when a nurse and doctor disagree about the form of care to provide?

Normally, physicians’ orders take precedence in such a situation. Doctors are trained to a higher level of expertise than nurses.

It is certainly appropriate for a nurse to differ with a physician’s orders, and to discuss the matter. Two heads are often better than one.

But if a resolution is not reached in a timely way, and this was a childbirth in progress, time is of the essence.

The proper course of action is for the nurse to ask her supervisor to intervene. If White’s allegations are true, this did not happen.

While the nurse in question did eventually relent, and administered the oxytocin, valuable time had passed.

So what are the facts of the matter? Other than conceding that a disagreement took place and the team did not function effectively, Northern Health will not say.

The authority conducted an internal investigation, but when we asked what was found, we were told nothing could be said, for “privacy” reasons.

Medical staff bylaws empower health authorities to restrict or suspend privileges of a staff member if patient care has been placed at risk.

We asked if this was done. Again, the same answer: Privacy.

Now there is a point of difficulty here. B.C.’s privacy laws place limits on what a public body may or may not reveal in such circumstances.

Northern Health has said that it “strives to support a health care system that is culturally safe for Indigenous people … free from discrimination, bullying and harassment.” But White’s complaints go beyond the allegation of racism. She alleges the quality of care she received fell below the proper standard because of a dispute between staff members.

On that matter the authority still owes the public an assurance that all is in order.

Childbirth is a formidable enough experience at the best of times. Any pregnant woman about to deliver a child at the hospital in Prince George is entitled to know that steps have been taken to correct the imperfect teamwork that Kristy White endured.

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