The case of Elisha Woods published last Friday provides a valuable learning opportunity in CTG interpretation for junior CN lawyers and a useful refresher for those of us regularly involved in birth injury litigation.

The judgement of Mrs Justice Lambert followed a liability trial involving fetal heart/CTG monitoring and, as well as being fairly accessible at only 17 pages long, is a good illustration of the familiar issues involved, namely:

  • Fetal tachycardia on the first CTG trace during the first hospital admission on 28 September 1998 (paragraphs 5-8).
  • A second trace the same day identifying all the relevant features which was interpreted as reassuring, leading to the claimant’s mother being allowed home (paragraph 11).
  • The features of a CTG upon her readmission on 13/14 October 1998 which led to an emergency caesarean section (paragraphs 13-15).
  • The central issue of criticisms of the interpretation and classification of the second trace which mandated that the mother should not have been discharged (paragraphs 18-19) as supported by the obstetric expert John Hare on behalf of the claimant.
  • The Trust’s case as supported by its obstetric expert Derek Tufnell (paragraphs 22-23).
  • The questions which Mrs Justice Lambert identified for herself, to be judged “by reference to the standards of the day“.
  • A summary of the evidence and opinions on breach of duty of John Hare (paragraphs 30-43).
  • A summary of the evidence and competing opinions of Derek Tufnell (paragraphs 44-52).
  • Criticisms of Derek Tufnell which demonstrate that, as CN lawyers, we need to make sure that our experts have all the right material at the right time and have recently reviewed it before finalising their reports (paragraphs 63-64), and that we make sure that they have recorded and dealt with the clinical history accurately and with appropriate attention to detail (paragraph 65-66) and considered all the issues with care so as to appear measured and reasonable (paragraph 66).
  • The judge’s analysis of and findings upon the first trace (paragraphs 70-74).
  • Following on from that, her analysis of and findings upon the second trace as (in fact) non-reassuring – or at least not reassuring enough to permit discharge (paragraph 75) – and the breach of duty therefore represented by the decision to let mum go home on 28 September (paragraph 76).
  • The judge’s findings on the ‘but for’ management absent her findings of negligence (i.e. ‘factual causation’) in terms of further investigations and clinical decisions which would and/or should have followed (paragraphs 77-86), which include an interesting discussion of why, physiologically, the CTG traces showed what they did (paragraphs 81-86).

And, as an added bonus to our learning exercise, the claimant won!