Language is Safety: “Available” Means Something Different For Different People
Labor and delivery. ObGyn. They save lives every day. They also harm patients in ways that are preventable, traceable, and fixable, if you know where to look. This series shows you exactly where to look, and by the time you finish it, you will be a more informed clinician, a more empowered patient, and a more effective advocate for the care that every woman deserves.
The Case Nobody Talked About
When I arrived as the new director of a major labor and delivery unit, there was an event that nobody liked to mention. It took me nearly a year to piece together what had actually happened. What I discovered when I finally did changed how I thought about clinical language for the rest of my career.
A patient arrived at term with a clear medical indication for induction. Her private attending physician came in, ordered oxytocin verbally, and left for an early morning gynecology case in the main operating room. He told the chief resident he was leaving. He told no one else. Not the nurses. Not another attending
Over the next several hours, the fetal heart rate tracing deteriorated. The nursing staff grew increasingly concerned. The chief resident was uncertain what to do. Nobody felt empowered to stop the oxytocin or escalate beyond the resident. The attending was in surgery. The protocol said he needed to be available. The nurses were not empowered to stop the pitocin.
He was available. He was in the building.
The fetal heart rate eventually became a sustained bradycardia. An emergency cesarean was performed. The baby was born with a low Apgar score and later developed cerebral palsy. A malpractice suit followed. The settlement ran into seven figures. The hospital paid over ninety percent of it.
The attending’s position was straightforward: he had not been there, therefore it was not his fault. He had performed the cesarean. He had responded when called.
He had also been available. The protocol said so.
The Word That Did This
The protocol governing oxytocin administration on that unit contained a sentence that exists, in some form, in obstetric guidelines across the country. It required that a physician be “available” during labor induction with oxytocin.
That sentence felt like a standard. It read like a standard. It was not a standard. It was a geography-free, time-free, accountability-free suggestion that could be satisfied by a physician in an operating room three floors away, unreachable for the duration of a major gynecologic case, while a fetal heart rate tracing told a story that nobody on the floor had the authority to act on.
“Available” is not a location. It is not a time. It is not a credentialing requirement. It is a word that means whatever the person using it needs it to mean, and in a deposition, it will mean whatever their attorney needs it to mean.
This is how a single word becomes a patient safety crisis.
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