IN THE SUPREME COURT OF BRITISH COLUMBIA
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Citation: |
Strachan v. Reynolds et al., |
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2004 BCSC 915 |
Date: 20040709
Docket: C994119
Registry: Vancouver
Between:
Travis Michael Strachan,
an infant
by his mother and Guardian Ad Litem,
Karen Anne Strachan
and the said, Karen Anne Strachan
Plaintiffs
Dr. Margaret L. Reynolds,
Dr. Owen I. Yoshida and
Kelowna General Hospital
Defendants
Before: The Honourable Mr. Justice Hood
Reasons for Judgment
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Counsel for the Plaintiffs |
N.H. Smith, Q.C. |
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Counsel for Dr. Reynolds and Dr. Yoshida
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G. Khanna R. Samtani
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Counsel for Kelowna General Hospital:
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R. Harper |
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Dates and Place of Trial: |
8-12, 15-19, 22-25, and |
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Vancouver, B.C. |
TABLE OF CONTENTS
Page
NATURE OF THE PROCEEDINGS............................................... 2
BACKGROUND LEADING TO THE FIRST ADMISSION TO HOSPITAL................... 4
SIGNS AND SYMPTOMS OF UTERINE RUPTURE.................................. 11
EVIDENCE............................................................... 12
THE EVIDENCE OF KAREN ANNE STRACHAN.................................... 12
Cross-Examination By Ms. Khanna.................................. 16
Rupturing Of The Membrane........................................ 19
Cross-Examination By Ms. Harper.................................. 20
THE EVIDENCE OF MICAHEL STRACHAN....................................... 23
Cross-Examination by Ms. Harper.................................. 26
THE EVIDENCE OF DR. M. REYNOLDS........................................ 28
Direct Evidence.................................................. 28
Cross-Examination By Ms. Harper.................................. 45
Cross-Examination By Mr. Smith................................... 54
Rupturing Of The Membrane........................................ 81
THE EVIDENCE OF NURSE ALICE KINASH..................................... 94
Direct Examination............................................... 94
Cross-Examination By Mr. Smith.................................. 103
Re-Examination By Ms. Harper.................................... 110
Cross-Examination By Mr. Samtani................................ 111
THE EVIDENCE OF DR. G. DOERSAM........................................ 111
Direct Evidence................................................. 111
Cross-Examination By Ms. Khanna................................. 116
EVIDENCE OF DR. G. FEINSTADT.......................................... 127
Cross-Examination By Mr. Samtani................................ 133
THE EVIDENCE OF NURSE MARY RADMONOVIC................................. 146
Cross-Examination By Ms. Harper................................. 148
THE EVIDENCE OF DR. D.W.R. MCTAGGART.................................. 153
Cross-Examination By Mr. Smith.................................. 165
THE EVIDENCE OF DR. J. COOPER......................................... 175
Cross-Examination By Ms. Harper................................. 181
Cross-Examination By Mr. Smith.................................. 181
THE EVIDENCE OF DR. K. WILLIAMS....................................... 188
Cross-Examination By Mr. Smith.................................. 195
THE EVIDENCE OF DR. S.P. HUDSON....................................... 196
Cross-Examination By Ms. Khanna................................. 199
Cross-Examination By Mr. Smith.................................. 201
THE EVIDENCE OF NURSE SUSAN GRIXTI.................................... 205
Cross-Examination By Mr. Smith.................................. 209
ARGUMENT.............................................................. 210
THE SUBMISSION OF MR. SMITH - COUNSEL FOR THE PLAINTIFF............... 211
Standard of Care - Appropriate Witnesses........................ 211
Complaint of Constant Abdominal Pain............................ 214
Other Symptoms of Uterine Rupture............................... 216
The Monitor Strips........................................ 216
The Change of The Contraction Patterns.......................... 219
Negligence Of Dr. Reynolds - The Telephone Call
At 5:10 A.M..................................................... 224
The Consequences Of Dr. Reynolds' Failure To Think
About Uterine Rupture, Or A Developing Uterine Rupture
At 5:10 a.m..................................................... 226
The Negligence Of Nurse Kinash - The Telephone Call
Of 5:10 A.M..................................................... 231
Dr. Reynolds' Attendance At 5:30 a.m............................ 234
The Settling Of The Pain.................................. 235
The Artificial Rupture Of The Membrane.................... 237
Conclusion On Standard of Care.................................. 239
Causation....................................................... 240
THE SUBMISSION OF MS. KHANNA - COUNSEL FOR DR. REYNOLDS............... 241
Negligence...................................................... 243
The Evidence.................................................... 244
Dr. Reynolds.............................................. 244
Failure To Contact An Obstetrician At 5:10 a.m.................. 245
Failure To Contact An Obstetrician At 5:35 a.m.................. 250
The ARM......................................................... 253
Conclusion...................................................... 254
Causation....................................................... 257
The Law................................................... 257
THE SUBMISSION OF MS. HARPER - COUNSEL FOR KELOWNA GENERAL HOSPITAL... 262
Liability....................................................... 262
Factual Background........................................ 262
Legal Principles Applicable To Hospitals and
Nursing Staff............................................. 264
Analysis........................................................ 268
The
Expert Evidence....................................... 268
The Timing Of The Call To Dr. Reynolds..........................
269
The Contraction Pattern......................................... 275
Failure To Have The Toco On After Rupture Of
The Membrane.................................................... 277
The Fetal Heart Strips.......................................... 278
SUMMARY AND DISPOSITION............................................... 280
Nurse Kinash.................................................... 281
Dr. Reynolds.................................................... 282
DAMAGES .......................................................... 284
Non-Pecuniary Damages........................................... 286
Cost of Future Care............................................. 288
NATURE OF THE PROCEEDINGS
[1] This is a medical negligence case. The infant plaintiff, Travis Strachan, who is now five and a half years old, suffered catastrophic injuries during his birth on January 23, 1999. They are the result of a brain injury, brought on by lack of oxygen, as a result of uterine rupture occurring shortly before he was born in the Kelowna General Hospital (the "Hospital"). He will never be able to sit up, stand, walk or crawl. He cannot speak. His level of awareness, at best, is minimal. He must be fed through a tube into his stomach and he is profoundly disabled. He requires, and will continue to require, constant care. It is inevitable that his condition will deteriorate over his shortened life span, which was agreed to be ten years.
[2] Travis and his mother, Karen Anne Strachan, seek damages for injuries they suffered from the defendants, Dr. Reynolds and the Hospital, whose care they were under at the time the injuries occurred. They say that the known risks of uterine rupture at the site of a previous caesarean section scar were known to Dr. Reynolds, and to the Hospital's Nurse-In-Charge, Nurse Kinash, and that there were clear warnings of the possibility that it might occur when Mrs. Strachan went into labour, which they negligently failed to recognize and respond to. They were negligent in the provision of care, treatment and professional service.
[3] Dr. Reynolds and the Hospital say that the care and treatment provided to Mrs. Strachan and Travis was appropriate in the circumstances, and met the respective standards of care which they owed to Mrs. Strachan and Travis.
[4] Dr. Yoshida was called as an adverse witness during the plaintiffs' case. The action against him was dismissed on an unopposed No-Evidence Motion, following the close of the plaintiffs' case. The liability of Dr. Reynolds, and of the Hospital for the conduct of Nurse Kinash, remain at issue.
[5] The case was hard fought. It took 26 days. Much medical evidence and expert opinion, written and oral, was presented which was conflicting, and at times technical. Counsels' submissions, both oral and in writing, were lengthy, wide-ranging and very detailed.
[6] Counsel for the plaintiffs complained that the submissions of the defendants have attempted to confuse and complicate the case with a mass of irrelevant or marginally relevant detail. Indeed, I have before me a great deal of seemingly irrelevant or marginally relevant evidence, and very detailed submissions, to which all counsel contributed to some degree, and which I have had to consider at great length following the suit of counsel.
[7] While I have carefully considered the evidence and opinions of the various doctors (all of whom were found to be experts in their discipline) contained in the trial transcripts and in their reports, I will try not to deal with the evidence of each doctor in great detail, which is easier said than done, particularly the defence doctors. Generally speaking their evidence was, of course, somewhat the same, if not perhaps repetitive. There is little that has been said by the plaintiffs' doctors with which they agree.
[8] I do propose to review some of the expert opinion evidence of the "lead" physicians on each side, especially that of Dr. Feinstadt and Dr. Doersam who were called on behalf of the plaintiffs. It will be seen that I prefer the evidence of Dr. Feinstadt and Dr. Doersam over the evidence of the defendants' expert doctors where there is a conflict.
[9] I also propose to deal in more detail with what I consider to be the primary evidence, that of Mrs. Strachan, Mr. Strachan, Dr. Reynolds and Nurse Kinash. Dr. Reynolds and Nurse Kinash were the primary care providers to Mrs. Strachan and Travis at the material time.
BACKGROUND LEADING TO THE FIRST ADMISSION TO HOSPITAL
[10] Travis is the second child of Mr. and Mrs. Strachan. Their first child, Callum, was born by caesarean section in 1997. He was a "frank breach" baby. That is, in a position which would have made it extremely difficult to deliver, if not impossible. Dr. Yoshida advised Mrs. Strachan at that time to have a caesarean section, and she accepted his advice.
[11] When she was pregnant with Travis she was under the care of Dr. Reynolds and Dr. Yoshida. At the time that she became pregnant with Travis it was her understanding that once a woman had a caesarean section delivery, all subsequent deliveries also had to be by caesarean section. However, she was told by Dr. Reynolds that "we could try a VBAC" and this was acceptable to her. She was also told that if the vaginal labour was not successful, caesarean section could be performed. This was also acceptable to her.
[12] It is common ground that when it was decided that Mrs. Strachan would have her second child by vaginal birth she became a VBAC (Vaginal Birth After Caesarean) patient. I will refer generally to Mr. Smith's Opening, and the commencement of his written submissions regarding VBAC labour, and the dangers or risks associated with it, as mainly background which is not in contention and which, in any event, I find to be the case.
[13] At one time, as recently as the 1970s, the general rule in obstetrics was that once a woman had a caesarean section delivery, all subsequent deliveries had to be by caesarean section. It was subsequently recognized that many women who previous had a caesarean section could safely deliver a subsequent child by vaginal delivery, and it became common for such women to be offered a "trial of labour".
[14] The terminology "trial of labour" recognizes the fact that for a variety of reasons the VBAC labour may not be successful. The patient is monitored (lets wait and see what happens) and if any problems are observed it would then become necessary to perform a second caesarean section.
[15] I also observe that Dr. Yoshida said the following on this point:
Q.: The trial ... the use of the word "trial" implies that you are prepared to move to a c-section if necessary?
A.: I'm unsure who originated the term and what they meant by "trial". I would assume with any pregnancy, any labour, we would be prepared to move to intervene if there was a problem.
Q.: But there is a higher likelihood of intervention in a VBAC patient?
A.: Yes.
(Emphasis added).
[16] Dr. Williams, a leading defence expert, agreed at trial that every VBAC labour begins with the recognition that it may, in fact, turn into a repeat caesarean section for various reasons.
[17] The most serious risk associated with the trial of labour in a VBAC patient is the risk of uterine rupture. The uterus is the abdominal organ containing the baby, the placenta and the umbilical cord, which connects the baby to the placenta. In a woman who has had a previous caesarean section, an external scar is left on her abdomen. She will also have an internal scar left on her uterus, which, of course, cannot be seen. It is the internal uterine scar that is at risk of coming apart in varying degrees, and of rupturing during labour.
[18] The process of the uterine scar coming apart is referred to as "dehiscence". Dehiscence can progress to a complete rupture of the uterine scar after which the baby may be expelled or "extruded" from the uterus into the abdominal cavity. This can cut off the supply of blood and, with the blood, oxygen to the baby. At times I may refer to the earlier stages of the rupture, up to the time that the baby is about to be extruded, as a developing uterine rupture.
[19] I am satisfied that uterine rupture and extrusion occurred in this case. As the baby was extruded or expelled from the uterus, the umbilical cord was pulled which detached the placenta from the wall of the uterus. When the placenta was detached, or partially detached, the flow of blood to the baby was reduced or cut off, leading to brain damage. Having said this, I must observe that I have not foreclosed the possibility that the rupturing of the amniotic membrane by Dr. Reynolds did not at least speed up the final stages of the rupturing and detachment of the placenta.
[20] A uterine rupture is a life threatening complication to both the mother and baby. In my view, although the risk is statistically small, the seriousness of the consequences make it a very significant risk that doctors and nurses caring for a VBAC patient must be aware of and on the watch for.
[21] I will pause to note at this point that neither Nurse Kinash, nor Dr. Reynolds, kept any sort of "watch for" the possibility of uterine rupture. In fact they never directed their minds to that possibility at any time. Rather, they treated Mrs. Strachan as a normal low risk patient, like any other non-VBAC patient. In my view, this approach was a mistake, in that it probably channelled in the wrong direction their views of, and approach to, Mrs. Strachan's problems, and in particular, to the constant abdominal pain which she experienced for some 40 minutes prior to the concrete evidence of uterine rupture appearing.
[22] At trial Dr. Yoshida put it this way:
Q.: If you have a VBAC patient, uterine rupture is the worst thing that can happen?
A.: I would say so, yes.
Q.: And the risk of uterine rupture, although it is statistically small, is well known to exist with VBAC patients; correct?
A.: I'm sorry. Could you say that again.
Q.: The risk of VBAC ... I'm sorry - the risk of uterine rupture is generally known as a risk with a VBAC patient?
A.: Yes.
Q.: Alright. And, doctor, because the consequences of a uterine rupture are so potentially catastrophic, it is important to identify and respond to any signs of possible uterine rupture as quickly as possible?
A.: Correct.
(Emphasis added).
[23] Dr. Reynolds, had this to say on the subject matter when cross-examined:
Q.: And you knew that with any VBAC patient, there was a risk of uterine rupture?
A.: Yes.
Q.: And you knew that that would be the worst thing that could happen in that setting; right?
A.: In that setting, yes. There are other bad things that can happen in labour.
Q.: Well, I understand. But when you have --- when you have a VBAC patient, you know that the specific risk thats associated with that patient is a life-threatening catastrophe known as a uterine ... as a uterine rupture?
A.: Yes.
Q.: And you knew that was something that could cause severe brain damage to the baby if its not dealt with promptly?
A.: Yes.
(Emphasis added).
[24] Dr. Cooper, an Obstetrician called by Dr. Reynolds, also said that "although the risk of uterine rupture is statistically small, the potentially tragic consequences mean it must be regarded as a significant risk". (Emphasis added).
[25] Finally, on this point, for the moment, it is provided in the leading textbook on obstetrics, Williams Obstetrics, both the 19th and 20th editions, with which Dr. Reynolds was familiar:
Thus, a trial of labour following a previous caesarean section, especially of the low transverse variety, indeed would appear to be a safe option for the woman, however, we agree with Pitkin, (1991) who warns that "safety is relative" and these women are neither normal nor low risk. (Emphasis added).
[26] It is seen that notwithstanding this statement in the leading textbook, both Dr. Reynolds and Nurse Kinash said that it was the practice at the Hospital to treat VBAC patients as normal low risk patients; and the evidence is that they in fact did so. Counsel referred me to the decision of Madam Justice Boyd in Guerineau v. Dr. Seger et al, 2001 BCSC 291 at para. 16, wherein Her Ladyship said that a hospital's similar policy of characterizing VBAC patients as normal labouring patients, "created an atmosphere of risk". I agree with Her Ladyship's conclusion, which is a matter of common sense, and which is probably demonstrated in the case at Bar.
SIGNS AND SYMPTOMS OF UTERINE RUPTURE
[27] The signs and symptoms of uterine rupture, or an impending rupture, are set out in Guidelines published by the British Columbia Reproductive Care Program, which is Exhibit 13 (the "Guidelines"). These Guidelines form part of a manual that was kept in the labour and delivery area of the Hospital. They were adopted by the Hospital as its own Guidelines for managing VBAC labours, and constituted the source of Dr. Reynolds' knowledge of the signs and symptoms of uterine rupture.
[28] I will return to the subject matter, and to the source in a moment. At this point I will simply observe that one of the signs referred to in the Guidelines, and which I am satisfied is a most important and telling one, is "unusual abdominal/uterine pain", the essential feature and novelty of which are its occurrence between contractions. This was the evidence of Dr. Doersam, called for the plaintiffs, who said that while abdominal pain in labour is intermittent, in the context of a trial of labour, constant abdominal pain must be taken as a sign of womb separation.
[29] I turn now to the evidence.
THE EVIDENCE OF KAREN ANNE STRACHAN
[30] Mrs. Strachan was asked on direct whether she was told what would happen if the attempt at VBAC was not successful. She said that Dr. Reynolds informed her that "if it was not successful - if need be - we could do a caesarean section". This was agreeable to her. She was also asked whether she was given any information about the risks of uterine rupture at the time and she said "no".
[31] I pause here to note that I am satisfied that both Dr. Reynolds and Dr. Yoshida, in effect, told Mrs. Strachan that as a VBAC patient she would be monitored, and if any problems arose they would do a second caesarean section. It will be seen, in my opinion, that Mrs. Strachan was not properly monitored at the crucial time, and problems arose which should have been recognized and dealt with immediately by way of caesarean section.
[32] I note also that there is some evidence that Dr. Yoshida did inform Mrs. Strachan about the risks of uterine rupture, although it is unclear exactly what she was told, and it was probably said in the context of her being a low risk patient. In any event, as I understand it, failure to inform is not an issue; and I agree.
[33] Mrs. Strachan said that she started contractions early on the morning of January 22, 1999. She recalled Dr. Reynolds saying to her that with the onset of contractions she should go to the hospital immediately, as it was possible that her second child could also go into a breach position. She went to the Hospital, was examined by Dr. Yoshida, told that she was in the early stages of labour, and sent home.
[34] She returned to the Hospital on the evening of January 22, because at that time she was having stronger and more frequent contractions. They started to get uncomfortable and painful and so she thought it was time for her to go back in. Between contractions she felt uneasy and restless. She did not experience pain between her contractions on that evening.
[35] On that occasion she was assessed by one of the admitting nurses, who felt that she was still not in the full on-set of labour. The nurse gave her some sleeping pills and indicated to her to use them if she felt tired and needed to sleep. She asked the nurse when she would know the right time to come back, and she was told, when the contractions were two minutes apart and the pain so severe that she could not stand it. She was told "go home and cuddle with your husband".
[36] Mrs. Strachan testified that she used the sleeping pills which made her feel very groggy and out of sorts. She believes that she was still groggy when she returned to the Hospital for the final time, because she was having a hard time distinguishing time and events.
[37] The Hospital Records show that she returned to the Hospital in the early hours of January 23, 1999, at around 4:00 a.m. She thought that it was around 3:00 a.m. She went back to the Hospital because she was having severe pains. She was asked whether the pain was different in any way from the contraction pain she had been feeling earlier. She said that to the best of her recollection it was severe pain and "it was long and I don't even remember having contractions".
[38] She was asked whether the pain was continuous as far as she could recall. She said: "As far as I can recall it seemed like endless pain", when she arrived at the Hospital. At the time she could not walk and her husband had to wheel her into the Hospital in a wheelchair.
[39] According to the Hospital Records, the fetal heart rate was monitored electronically at 3:50 a.m. The first nurse's note was made at 4:00 a.m. It was then pointed out by counsel that the Records suggest that she had been in the Hospital for 45 minutes before the nurse recorded her constant abdominal pain.
[40] She was asked if the pain got worse after she arrived at the Hospital and she said that she did not recall.
[41] She was asked whether she was able to specifically say where the pain was. She said that she knows that it was abdominal pain, and that at some point in time, she does not know when, it was lower abdominal pain on her right side. She recalls later being more relaxed after she was given Demerol. Demerol is a "pain killer" which is given to women in labour to take the "edge" off the pain being experienced. She is not sure of the state of her pain when Dr. Reynolds arrived. She was asked if she told Dr. Reynolds that the pain had gone away completely. She could not recall if the pain had subsided or whether it had just become relaxed because of the medication.
[42] She was asked whether, when she was in the Hospital on January 23, she ever felt distinct contractions and she said "no". She could not recall anything she told Dr. Reynolds about the pain. When asked what Dr. Reynolds did when she arrived, she said that from what she could recall she believes that Dr. Reynolds did an internal examination. She recalled as well that Dr. Reynolds ruptured the amniotic membrane and that she has a "slight recollection of her holding the cord or baby in and taking me to the OR".
[43] She recalls getting out of the bed to go to the bathroom after Dr. Reynolds ruptured the membrane. She thought that at the time she was standing up and in, or coming out of, the bathroom "when I remembered saying I felt the baby turn or move - like a big swooping feeling".
[44] She was asked if she had any recollection from the time she felt the baby move to the time she was taken to the OR. She said that the next thing she could recall was Dr. Reynolds trying to place an internal monitor on the baby and "I know she - that this time she realized something was wrong". She was asked how she knew this and she said she did not recall exactly what happened, or what was said, but that they did have her turn over with her "chest to the table" and her "buttocks up in the air". It was her husband who told her to do it, and she actually thought that he was a doctor yelling at her. She did not know that it was him. She said, referring to Dr. Reynolds, "I just remember she was holding it in", referring to Travis.
[45] She was asked about her state of alertness on the morning of Travis' birth, given that she had taken some sleeping pills and had been given Demerol at the Hospital. She said "I just felt I didn't know what was happening around me. I could not recall a lot". And "I felt almost like I was in a drunken stupor".
Cross-Examination By Ms. Khanna
[46] Mrs. Strachan agreed that in December 1998, Dr. Reynolds referred her to Dr. Yoshida to determine if she could have a VBAC. She wanted to have a vaginal birth if possible. She felt that a caesarean section was major surgery and wanted to avoid it if possible. She agreed that another reason for wanting the vaginal delivery was that she had an 18-month-old child at home, and it was difficult to recover from such surgery with a small baby at home.
[47] She could not recall anything about her first appointment with Dr. Yoshida. She recalled a discussion with him, at some point, when he went through the trial of labour and advised her that if it was not progressing "we could look at going to a CS". She agreed that she was quite keen on the trial of labour.
[48] At one point it was suggested to her that if she had been aware of the small risk of uterine rupture prior to delivery, she would still have opted for vaginal delivery. Her response was that she would have opted for a vaginal delivery, but she believes that if she had been made aware of the signs and symptoms of uterine rupture, she would have stopped the trial of labour and demanded to have a caesarean section.
[49] It was suggested to Mrs. Strachan that when they drove to the Hospital on the final occasion her contractions were strong, but there was a break between them. She said that she could not "actually recall contractions - just remembered the pain - I don't recall contractions".
[50] Her evidence at discovery had been:
Q.: Alright. And how long is it from your home to the Hospital?
A.: About a 20 minute drive.
Q.: And you were still having regular contractions with a break between them, but they were strong?
A.: I just know they were strong. I don't know about ... I believe there were some form of break in between.
(Emphasis added).
[51] She agreed with the answers given and she then added "My Lord, I feel that over the years I think about this almost every day, and I felt just that I had constant pain and I don't recall having contractions in between". She was asked: "Are you suggesting that your memory is better now than at August 2000?" And she said: "in some areas, yes".
[52] She agreed that she was driven to the Hospital about one and a half hours after she had taken the Serax medication which made her feel quite groggy. It was then put to her that she did not have a good recollection about the pain she felt before she went to the Hospital and she said "correct". She has little recollection of her admission to the Hospital, and she cannot recall whether the Nursing Admission Record information is accurate.
[53] It was put to her that she could not say when the constant abdominal pain started and she said "thats correct". It was put to her also that she could not say where the pain was located "other than in your abdomen" and she said "yes". She added that she could recall that at one point in time it was in her lower right abdomen.
[54] It was put to her that by the time Dr. Reynolds attended the pain had settled, and she said "I was more relaxed, yes". She had been given Demerol about 45 minutes earlier. It was put to her that she was able to speak easily with the doctor, that she was not rolling around on the bed in pain, and that she could recall the doctor actually putting her hand on her abdomen and seeing if the pain was ongoing. Her answer to all of these assertions was that she could not recall.
[55] It was put to Mrs. Strachan that Dr. Reynolds did not tell her that she would rupture the membrane to alleviate her pain; rather that it was to enable her to look at the fluid. She said that she did not recall that. She just remembered that it was a way to alleviate pain. She did not recall Dr. Reynolds saying that she was pleased that the fluid was clean. She was asked if she recalled that ten minutes after the rupture she wanted to get up and go to the bathroom. She said that may very well have been the case since she was up to the bathroom many times. She was able to walk to the bathroom, which was not very far.
[56] It was pointed out that after she returned to bed the nurse had difficulty finding the baby's heart rate. She did not personally recall this; she recalled hearing this from other people.
[57] She was asked if she knew that when she returned to the bed the nurse did get a fetal heart rate, she then felt the baby move, and then there was no heart rate. She said that she was coming back from the bathroom when she felt the baby move. She was asked if she recalled that it was after she got back to bed that Dr. Reynolds came back to the room. She could not recall. She was asked if it was fair to say that her recollection of what happened throughout that five to ten minute period was not very clear and she said "correct, the span of the whole evening is not very clear".
Cross-Examination By Ms. Harper
[58] Counsel asked Mrs. Strachan if she took the sleeping medication given to her by the nurse when she went home. She believes that she took it around 12:30 or 1:00 a.m. but it did not help her sleep; it just made her groggy "every time I stood up because I wasn't comfortable in bed so I was walking around". She was able to cope with the contractions, but they were getting a lot stronger. This was her evidence at discovery.
[59] She believes that they, she and her husband, were timing her contractions at that time. They were not two minutes apart as yet, "but I was getting to the point of not being able to stand the pain". She believes that they got to the Hospital at 3:00 a.m. Because of the pain she could not walk and her husband had to wheel her in a wheelchair. She reiterated her discovery evidence that she thought she was given "pain killers" as soon as she got to the Hospital.
[60] The following questions and answers given at discovery were also put to her:
Q.583: Alright. And then what happened?
A.: I was having a lot of severe pain that were non-stop.
Q.584: When did that start?
A.: I don't know an exact time of when it actually started. I know they did give me, I believe, a shot of Demerol or something. Then I do recall I sat in a chair there and tried to get comfortable.
Q.585: Where was the non-stop pain? Was it in a particular location?
A.: Just somewhere in my abdomen. I don't know exactly where it was, whether it was in one spot or not.
Q.586: Thats something -
A.: I seem to recall it was but -
Q.587: I take it your recollection, given that you were in a fair bit of pain, is somewhat vague?
A.: Yes it is. I do recall things but I don't know the time of them or exactly what happened at that time.
Q.588: So your memory for exact sequence and details is not particularly good?
A.: Its a little bit off, yes.
(Emphasis added).
[61] Finally, she was referred to the following discovery questions and answers:
Q.596: The severe pain that you began to experience, was that constant pain?
A.: Yes.
Q.597: Did it ever go away?
A.: I can't recall if it actually had any breaks.
Q.598: Do you recall whether it seemed to get better at one point?
A.: No. I don't recall when it got better or if it was getting better at any point.
(Emphasis added).