Email offers details of Moncton Hospital probe of alleged improper use of oxytocin by nurse

Moncton Hospital executives watched "hours" of security footage, including a live feed, while trying to get to the bottom of a spike in emergency cesarean sections before firing a nurse, a physician wrote in a 2019 email.

The email sent March 28 by Dr. David Dodge, the head of the hospital's anesthesiology department, says a nurse had been fired and RCMP were investigating.

The email's contents became the subject of a series of court hearings over recent months. Its contents can be reported after a judge lifted a publication ban this week.

A proposed class action lawsuit naming labour and delivery nurse Nicole Ruest and Horizon Health Network was filed in 2019 on behalf of mothers who believe they were improperly administered the drug oxytocin.

It alleges Ruest administered the drug to potentially "hundreds" of pregnant women at the Moncton Hospital without their consent.

Ruest denies any wrongdoing. Crown prosecutors opted not to charge her following an RCMP investigation. The allegations in the lawsuit have not been proven in court.

Court of Queen's Bench Justice Denise LeBlanc ruled in January that the information in Dodge's email would be inadmissible as part of the proposed class action certification process, a procedural step before the case can continue to trail. 

The certification hearing last fall came to a halt when a doctor who worked at the hospital contacted lawyers representing the mothers, claiming to have information about what the hospital knew and when. 

Dr. Arun Anand, who received Dodge's email, filed an affidavit in November and included the message.

In May, lawyers for Ruest and Horizon Health argued a publication ban on the information should continue, while lawyers for the mothers called for it to be lifted.

Ruest's lawyer Andrew Faith described the information at the time as "multi-level hearsay."

LeBlanc ruled this week there was no basis to continue the publication ban, citing the open court principle that makes court proceedings public by default.

Dodge wrote he was sending the email to a dozen colleagues who missed a March 28, 2019, meeting with the hospital's chief of staff. The email lays out a timeline of the hospital's internal investigation.

As they were unsure if this was just an inadvertent mistake as opposed to malicious intent they decided to stay alert to future cases that seemed to follow the same type of pattern.- David Dodge, head of anesthesiology

It says an unexplained "spike" in emergency cesarean sections had been noticed over the preceding two years, and discussed as early as November 2018.

Two weeks before the email, Dodge said a physician told Dr. Ken Gillespie, the chief of staff, that it seemed a patient had "inadvertently received oxytocin" which led to fetal bradycardia, an abnormally low fetal heart rate, prompting an emergency C-section. 

An IV bag used with that patient was tested at an "independent lab," Dodge wrote, which found oxytocin.

"As they were unsure if this was just an inadvertent mistake as opposed to malicious intent they decided to stay alert to future cases that seemed to follow the same type of pattern," Dodge wrote, saying it was unclear who was responsible.

Another emergency C-section on March 23, 2019, seemed to fit the pattern, Dodge wrote. An IV bag was tested and oxytocin found, the email states. 

Watching video

Gillespie and Christa Wheeler-Thorne, the hospital's executive director, examined hours of video surveillance of the obstetrics unit, according to Dodge's email.

All IV bags were removed and examined with a cover story about them being recalled. Two IV bags had small punctures and oxytocin was found. RCMP were called.

The email says the hospital was planning to install more surveillance cameras. However, the day before the email was sent, it says Gillespie was watching a live video feed and saw a nurse walk out of a room with two IV bags where the bags aren't normally stored.

The email says another emergency C-section occurred "shortly afterwards" and the attending physician saw the same nurse "casually throw" an empty vial of oxytocin into a sharps container.

Gillespie retrieved the IV bags and the email says the lab found it contained oxytocin. It says the vial was also collected for fingerprint analysis.

Dodge's email then says the nurse was fired. It doesn't name Ruest.

"I'm told she has not confessed nor given any motive for her actions," Dodge wrote. "I'm sure there will be a media shitstorm when the story comes out."

Faith said in a statement to CBC that the information in the email was "found by the court to be too unreliable to admit into evidence against either defendant."

"As to our client, her conduct was fully investigated by the RCMP and no charges were ever laid against her. She strongly denies the allegations against her in this lawsuit and looks forward to a fair opportunity to respond to them in court."

Virginia Gillmore, a lawyer representing the plaintiffs, said despite being ruled inadmissible for the certification hearing, they will seek to have the email admitted if the case goes to trial.

Lawyer John McKiggan, also representing the mothers, argued during a May hearing that much of the information was already broadly public because of a news conference by Horizon Health in 2019 and previous news stories.

The lifting of the publication ban is likely the last action LeBlanc will take in the case. She was appointed to the New Brunswick Court of Appeal in early June, so another judge will hear the case. 

On Monday, lawyers asked for that judge to start the certification hearing process from scratch when the case returns to court in late February 2023.