Rates of emergency cesarean-sections rose more than 30 per cent in recent years at a New Brunswick hospital that is under scrutiny after the firing of a nurse who allegedly misused labour-inducing drugs during at least two deliveries.
The number of emergency C-sections surged from about 11 out of 100 births at The Moncton Hospital in 2013-14 to nearly double that – 19 out of 100 births – in 2015-16, according to a Globe analysis of New Brunswick hospital delivery data obtained from the Canadian Institute for Health Information.
While the number decreased slightly the next year, emergency C-sections at the hospital rose once again in 2017-2018 despite little change in the provincial average.
It’s not known if the spike is related in any way to the nurse’s conduct. The hospital has refused to say if it believes other women may have been victims or whether the administrators took any measures to explore why the surgical rate was increasing so dramatically.
The Moncton Hospital dismissed labour and delivery nurse Nicole Ruest and her nursing licence was suspended in April after the hospital said an internal investigation determined a nurse had administered unauthorized oxytocin to two women. Ms. Ruest had been employed by the hospital for 14 years. The condition of the mothers and babies deteriorated so rapidly that emergency C-sections were required. Oxytocin is a high-risk medication that must be carefully monitored when used.
The hospital, operated by Horizon Health Network, referred its findings to the RCMP. The police investigation has since broadened beyond those two cases.
“We have a number of investigators involved who are pursuing a variety of avenues to determine the scope of the allegations,” said Corporal Jullie Rogers-Marsh, an RCMP spokesperson. “I can’t speak about how many potential victims as it’s part of the ongoing investigation,” she said.
Administrators at the hospital have remained silent on when increases in the rate of emergency C-sections were first detected.
Lynn Meahan-Carson, director of strategic communications for Horizon, said she was unable to respond to The Globe’s request for comment before deadline. The health authority is expected to file a response to the allegations against it within the next week.
Lawyers for several women who had emergency C-sections at the hospital allege the institution had “For years … known that it has a suspiciously high rate of emergency C-sections” and “failed to investigate” the reasons. The allegations are in an application for a class-action lawsuit filed last month in Moncton. The lawsuit names Ms. Ruest as the nurse who was fired. The allegations in the lawsuit have not been tested in court.
The Globe’s analysis shows emergency C-sections at the hospital spiked 50 per cent over the three-year period between the fiscal years 2013-2014 to 2015-2016, to 238 from 158. The increase occurred over a period in which the total number of deliveries at the Moncton Hospital was decreasing.
The provincial rate of emergency C-sections during that time (Moncton hospital numbers excluded) fluctuated by less than one percentage point.
While sometimes lifesaving, C-sections increase risks for both mother and baby. And unplanned or emergency C-sections have been associated with the increased likelihood for mothers to experience postpartum depression.
Over the five-year period in which Moncton’s disproportionate 33-per-cent spike occurred, the hospital’s total number of deliveries decreased by more than 10 per cent, from 1,359 to 1,214, a figure experts say raises red flags.
“That sounds like something you should be paying attention to,” said Jennifer Blake, chief executive officer of the Society of Obstetricians and Gynaecologists of Canada.
However, she pointed out that getting timely access to data in hospitals – including the sort that expose trends – can be a challenge, particularly in smaller centres that have limited financial resources.
“Typically, a lot of water will have gone under the bridge before you’re presented with that data, so you could hardly make a timely assessment that there’s a problem,” she said, adding: “In most places, we have had to develop our own early-warning sense that there is something amiss and respond to that.”
Those early warnings often come, for example, as anecdotal observations from hospital staff at monthly meetings, she said.
In Moncton, it is not clear when or how suspicions about Ms. Ruest’s alleged activities came to light.
Jayde Scott, the lead plaintiff in the class action, which names both Ms. Ruest and Horizon Health as respondents, said hospital doctors met with her after her emergency C-section to tell her that Ms. Ruest injected her with unauthorized oxytocin intravenously.
In less than five minutes, she began “to experience very strong contractions that would not stop,” according to her court filing. “Almost immediately, the fetal heart monitor showed a dangerous drop in the fetal heart rates. Jayde was also experiencing adverse effects.”
John McKiggan, a Halifax-based lawyer representing Ms. Scott, alleges “the hospital knew or should have known what was going on.”
“We’re going to be able to explore what did the hospital know, how did they let this go on for so long, why did they not take action sooner,” he said last month after filing the lawsuit.
“The civil process will enable us to access information that wouldn’t come out any other way,” he said.
Efforts to reach Ms. Ruest for comment this week were unsuccessful. She is also expected to file a response in court to the allegations made against her within the next week.