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Richmond doctor cleared in premature birth lawsuit

Risks and extents of complications from premature birth could have been reduced if not for negligence, claimed mother and son.
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A mother accused a Richmond Hospital doctor of medical malpractice after her son was born prematurely and suffered medical complications.

A mother and son's claim that a Richmond doctor's negligence resulted in a premature birth with significant medical problems was struck down in court.

Li Qu filed a lawsuit in the B.C. Supreme Court against Dr. Loida Rebeca Rivera, an obstetrician and gynecologist at Richmond Hospital, back in 2016.

She claimed the risk or extent of complications experienced by her son, who was born at 25 weeks old, could have decreased if Qu received treatment one day earlier.

She also filed a claim on her son's behalf.

Rivera denied liability and argued the care she provided was "reasonable and consistent with the standard expected."

The Richmond News reported last year that the lawsuit against Richmond Hospital and other doctors, who were originally named as co-defendants, was dismissed on the first day of trial. The trial took place last October and spanned 10 days.

The court heard Qu had gone to Richmond Hospital on the morning of Nov. 30, 2014 after noticing two or three drops of blood.

She was seen by Rivera and underwent various tests, after which she went home. She later returned to Richmond Hospital the next morning after feeling pain in her lower abdomen on at least two occasions and reported more cramping and bleeding, according to hospital records.

Qu received the first dose of antenatal steroids shortly before noon and her son was born after 2 p.m. He was then transported to the NICU at BC Children's Hospital and spent six months there, going through six surgeries before he was discharged.

As a result of being born at 25 weeks old, Qu's son suffered "typical complications" of children born at that age and continues to suffer from gastrointestinal issues, wrote B.C. Supreme Court Justice Hugh William Veneestra in his decision issued Feb. 13, 2024.

"It is clear that (Qu's son's) life has been significantly affected by complications from his preterm delivery," wrote Veneestra, who added his parents' "resolve and dedication" to help him live a full life was "admirable."

Doctor 'would not have' done anything different

In the lawsuit, Qu claimed, had she been provided with antenatal steroids one day earlier, it would have decreased the risk or extent of the complications her son experienced.

Qu's son's gestational age was 25 weeks and one day at the time, but it was incorrectly noted as 23 weeks and five days in hospital records on Nov. 30.

According to the nurse who made the record, the incorrect estimate was based on the expected due date of March 24 provided by Qu, but Qu denied having spoken to the nurse about this. When she was cross-examined, Qu said she did not know the exact due date.

Rivera told the court she met with Qu during the Nov. 30 visit to tell Qu about the risk of preterm delivery and mentioned the use of steroids in case she wanted full and active resuscitation.

"Dr. Rivera recalled that when she asked Ms. Qu what her wishes would be, Ms. Qu was very resistant to that discussion," wrote Veneestra.

Rivera added Qu asked to be discharged and although Rivera suggested a stay in the hospital as the preferred option, it was "not unreasonable" to let Qu go home given she had no contractions and bleeding at the moment and lived nearby.

When Rivera was asked whether she would have done anything different had she known the actual gestational age was 25 weeks instead of 23, she said she would not.

She told the court if she had a full discussion with Qu about the chance of survival on Nov. 30, she would have said it was less than 50 per cent at 23 weeks and five days, and around 50 to 80 per cent if the gestational age was at 25 weeks and one day.

However, Rivera told the court she would also have told Qu it was a "very critical time" in the pregnancy and she might have to make decisions at any time.

"(Rivera) was clear that, if Ms. Qu had said that she wanted everything done to resuscitate her baby, then she would have said to start the betamethasone right then.

"However, Dr. Rivera said they simply did not get to that point in the discussion," wrote Veneestra.

No negligence on doctor's part, says B.C. Supreme Court justice

In Veneestra's decision, he noted there were "significant differences" between Qu, Rivera and the nurse's evidence.

For example, Rivera recalled Qu got "upset" during their conversation when Rivera mentioned Qu's risk of preterm delivery, and the conversation was "difficult" because Qu "was not really engaging in the discussion and simply wanted to go home."

However, Qu denied there was any discussion about medications and said she did not get upset. She told the court she recalled the entire conversation as about her bleeding.

"Neither party suggested that any of these fact witnesses was not 'credible' in the sense of their veracity. However, each suggested that the recollection of the other witnesses was less reliable given the time that has passed," he wrote, adding the trial took place "just short of nine years" after the events.

He also agreed with both parties that all key witnesses were "doing their best to accurately recount the events" of Nov. 30 and he would focus on reliability rather than credibility.

Relying on clinical records to resolve conflicting evidence, Veneestra found Rivera's evidence was more reliable.

Veneestra accepted Rivera's evidence that she had a discussion with Qu about the risk of preterm delivery and the need to decide whether active resuscitation was needed, referring to clinical notes, a consultation report and texts from Rivera to another doctor.

He also accepted Rivera would have made the same decision had she known the actual gestational age, and it was appropriate to discharge Qu despite offering in-patient admission as the preferred option when Qu first went to Richmond Hospital on Nov. 30.

He rejected the plaintiffs' submission that Rivera should have discussed the use of antenatal steroids with Qu at the beginning of Qu's visit on Nov. 30.

"Nothing in the expert reports suggests that Dr. Rivera should have proceeded to a discussion of the risks of preterm delivery before completing her investigation of those risks," wrote Veneestra.

He added Rivera's failure to recognize the revised gestational age when reviewing one of Qu's medical reports did not make any difference in the circumstances "given Ms. Qu’s refusal to engage in a discussion of the risk of preterm delivery and the options to be considered upon grappling with that risk."

He ultimately concluded the plaintiffs failed to prove Rivera breached the standard of care owed to Qu and dismissed the lawsuit.

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