In addition to the advertising fraud that led to a $16 million verdict against Brookwood Medical Center in Birmingham, AL, the physical interaction by the nurse is troubling, says Kathleen Juniper, JD, an attorney with the law firm of Buchalter Nemer in Los Angeles.

“You could call it obstetrical violence,” Juniper says. “The facts of the case are pretty horrendous.”

The rough handling by the nurse might have been avoided with a better handoff between the first nurse, whom the patient saw as respectful, and the second nurse, says Damian D. Capozzola, JD, an attorney in Los Angeles. The first nurse should have reviewed the patient’s stated preferences at the handoff, and if the second nurse did not want to comply with them, she should have addressed that issue then.

“Ideally this takes place at the bedside so that the off-going nurse can introduce the patient to the oncoming nurse. At the same time, the plan of care is discussed between the patient and both nurses,” Capozzola says. “Had this occurred, the oncoming nurse would have had the opportunity to discuss her concerns with her charge nurse or supervisor, and her patient assignment could have been changed.”

The behavior of the nurse in this case was abnormal, especially considering the “Well, your doctor isn’t on call tonight” comment, says Jamie Terrence, RN, president and founder of Healthcare Risk Services in Los Angeles. Terrence previously was the director of risk management at California Hospital Medical Center in Los Angeles. The nurse may have had some objection to the mother’s choices, but her behavior demonstrates the need for effective internal communication, Terrence says.

“If the mother’s first doctor had adequately communicated the mother’s desire to have a natural birth, then the experience would have been better all around. Perhaps the nurse could have opted out if she so desired,” Terrence says. “The bottom line is that there needed to be better internal mechanisms supporting both mothers who wish to give birth naturally and staff members, regardless of whether they advocate for natural births or not.”

Terrence notes that regardless of hospital policies, patients have the right to make decisions about their care. This patient’s rights were violated on many levels, she says.

“Patients are not prisoners without freedom of choice. If their choices are dangerous to them or to their unborn child, the hospital has the responsibility to educate the patient about any danger their choices may involve,” Terrence says. “Caregivers may also refuse to participate in that care. But resorting to physical mishandling can be viewed as assault and, in certain circumstances, can even give rise to criminal charges.”