An exceptional case in the Vilnius court: a young woman claims that she gave birth to a dead baby because of doctors

The doctor who supervised the pregnant woman did not comply with the “standard of maximum care and diligence,” the Patient Health Injury Commission, which examined her complaint, stated that its representatives had decided that the Antakalnis Polyclinic should pay the victim 10 one thousand. Compensation in euros.

At that time, the State Health Activities Accreditation Service had a different opinion and stated in its report that the services provided to the patient in the polyclinic were provided in an adequate manner.

This position was also supported by the Vilnius Regional Court, which determined that the doctor working at the Antakalnis Polyclinic had not committed any violations and performed his duties correctly. However, the higher court disagreed with this position: the Lithuanian Court of Appeal confirmed the victim’s complaint and ordered the lower court to re-examine it.

This case was brought to court by the Antakalnis Polyclinic – the management of the medical institution did not agree with the conclusions of the Commission for the Determination of Damage to the Health of Patients and instructed the woman who lost her baby to pay compensation for moral damage. .

According to the data of the case, it was established that in the Antakalnis polyclinic since 2018. From May 2 to November 20, 2018 the pregnant woman received medical care services: care during pregnancy.

“The data from the patient’s file confirm that the uterine height of the patient was measured from 26 weeks of gestation: 22 cm of height of the uterine base was measured at 26 weeks of gestation (September 13), 25 cm height of the uterine base at 30 weeks of gestation (October 10)., At week 36 (November 19), the height of the uterine floor was 26 cm, and the court revealed the merits of the case . – At 36 weeks’ gestation, the height of the fundus of the patient did not meet the lower limit of the growth curve of the uterine fundus in the pregnant card, and an ultrasound was performed on November 20, when doctors questioned fetal heart tone. stillborn male. “

In the case before that court, the question arose as to whether the obstetrician-gynecologist who worked in the outpatient clinic had acted illegally when he was not in charge since 2016. The measurement curve of the height of the uterine fundus and the methodology of “ Fetal growth retardation ”(VAS) approved by the Lithuanian Society of Obstetricians and Gynecologists and the Lithuanian Association of Obstetricians are used worldwide.

The Court of First Instance ruled that the doctor had not acted illegally, followed the growth curve of the uterine fundus approved by order of the Minister of Health and carried out an assessment of the curve of the uterine fundus (diagnosis of fetal growth retardation) with based on the EVA methodology.

According to the judges who hear the case, the primary duty of the doctor is to provide qualified and diligent medical care, and when deciding whether the health provider acted as a diligent and qualified professional in his field, it is verified in particular that the doctor complied with the legislation governing the service., provisions.

According to the court, doctors must complete a maternity card showing the growth curve of the uterine floor by weeks of gestation, distinguishing between the upper limit of the curve, the mean and the lower limit.

“During the period relevant to the dispute, the VAS methodology was approved by the decision of the Lithuanian Association of Obstetricians and Gynecologists and the Lithuanian Association of Midwives, which was published on the website of the Ministry of Health,” the court said. . – The methodology discusses, among other aspects, the diagnosis of insufficient fetal growth. The methodology establishes that the diagnosis of fetal growth retardation is made on the basis of the following methods: precise determination of the duration of pregnancy and elucidation of risk factors; measurement of the height of the uterine fundus; ultrasound fetomerism and search for possible developmental defects; If VAS is suspected, the fetus is reexamined by ultrasound. In this methodology, it was found that between 20 and 34 weeks of gestation, the height of the uterine floor in centimeters corresponds to the gestational age in weeks; When the lining of the uterus is less than 3 cm above the mean height of the lining of the uterus during the relevant week of pregnancy, the fetus is suspected to be weedy. The diagnosis of VAS must be confirmed by ultrasound. “

According to the judges, the standard of conduct of the most caring, caring, and qualified medical professional is met by completing the uterine height growth curve on the pregnant woman’s card and also taking into account the evaluation of uterine height ( fetal growth retardation) prepared. by medical associations. diagnostics) methodology.

“The file data confirm that, during the controversy period, the uterine floor height rate for the relevant week of pregnancy, approved by order of the Minister of Health, did not coincide with the uterine floor height rate for the corresponding week of pregnancy “, the appeal Agnė Tikniūtė, President of the Chamber of Judges of the Court of First Instance.

According to the court, the patient was measured at a height of 22 cm from the fundus at week 26 of gestation, which was within the limits of the curve approved by the Minister of Health, but the height of the fundus was lower 26 cm using the EVA. method and the deviation of the EVA method, on the other hand, the obstetrician-gynecologist did not follow the EVA methodology developed by the professional association of doctors, did not pay attention to the fact that the deviation of the height of the uterine floor of the patient from the VAS methodology was significant and based on VAS did not perform an ultrasound examination “.

In addition, according to the judges, the height of the uterine floor of the patient of 25 cm was measured at 30 weeks of gestation, and the doctor did not violate the order of the minister, but did not take into account the EVA diagnostic methodology, which required that the patient have an ultrasound.

According to the judges, although the doctor at the Antakalnis Polyclinic did not violate the procedure established by the Minister, “the conduct of an extremely attentive, attentive, qualified and qualified professional requires that the doctor evaluate not only the mandatory forms approved by the Minister of Health , but also take into account recommendations from professional medical associations, methodologies to diagnose specific diseases and evaluate all these data together “.

“The fact that the growth curve of the uterine fundus has been approved by order of the Minister does not relieve the physician of the obligation to use diagnostic methods approved by professional associations, especially in cases where the professional association describes in more detail and precision in the diagnosis of a specific disease, the form to be filled out has been approved ”, said the panel of judges headed by A. Tikniūtė.

According to the doctors who advised the court, the patient had to undergo an ultrasound both at week 26 and at week 30 of gestation, so “the doctor did not follow the VAS methodology when providing care during pregnancy to the patient and for thus violated the standard of utmost care, care, and qualification.

The Court of First Instance had noted that there was no unequivocal evidence in the record that, even with a prior diagnosis of fetal growth retardation, fetal death could be medically prevented.

“It should be noted that if a medical violation is discovered at the causal stage, it must be determined what is the probability that the patient will not be harmed by the physician’s violation, that is, if the damage could have been avoided. fetal growth would be diagnosed in a timely manner and used to assess whether the physician’s actions were sufficient to cause harm to the patient, the court noted. “If it is established that fetal growth retardation could have been prevented with sufficient probability if the growth retardation If the fetus had been diagnosed in time, there must be a causal link between the doctor’s irregularities and the patient’s harm. “

According to the panel of judges, such an evaluation requires special knowledge, but the evaluations of the obstetricians and gynecologists in the case do not answer the question of whether a proper diagnosis of VAS could have prevented fetal death and harm to the patient.

In addition, according to the court, the guilt of the medical institution (doctor) is presumed, so this presumption must be refuted by the Antakalnis polyclinic, and since the woman who lost her child did not agree with the sentence of 10 one thousand. In the present case, the amount of damage suffered by the patient must also be reassessed.

The Antakalnis Polyclinic did not agree with the decision of the Patient Health Injury Commission, which determined that the doctor did not provide adequate medical care services to the patient. According to the medical institution, the growth curve of the pregnant uterine floor is approved by a normative legal act: by order of the Ministry of Health, it is mandatory for all health care institutions that provide care during pregnancy and all health professionals who work on them. .

“At 26 and 30 weeks of pregnancy, the patient’s uterine height determined the mean growth curve of uterine height, so no additional ultrasound adjustment was required,” the clinic also noted. It is unreasonable because the methodology does not provide a uterine floor height growth curve to determine the uterine floor height index.

“The methodology followed by the doctor was followed correctly,” said the representatives of the medical institution.

The woman, who lost her son at the time, pointed out that the incident was being investigated by the police and that the doctor was still in 2018. On November 19 during the visit, when the fetus had already died, she heard the heart tones of the fetus: “This raises reasonable doubts about the quality of the tests done by the doctor so far and the evaluation of their results.”