YOUNGSTOWN Doctor: Colleague said drug was given correctly

The doctor did not review information on the labor-inducing drug before administering it, he testified.
By JoANNE VIVIANO
VINDICATOR STAFF WRITER
YOUNGSTOWN -- An obstetrician accused of negligence in the stillbirth of an infant in 1999 testified that he was acting on the advice of another doctor when he ordered a drug to induce labor.
Dr. Robert McCluskey testified that the other doctor had first prescribed the drug Cytotec on July 28, 1999, to induce labor in Sunny Barger of Columbiana. Dr. McCluskey said he consulted with that doctor about whether the Cytotec was being given properly, and the doctor told him, "absolutely."
Dr. McCluskey said he took over the birth, ordering three more doses of the drug before leaving Forum Health Northside Hospital for home, planning to return in the middle of the night for delivery. He phoned a nurse about 10:30 p.m. who informed him that the fetus's heart rate had slowed down a couple of times but had returned to normal.
Call over complications
Dr. McCluskey said he next received a call around 2:20 a.m. that there was a problem with the fetus and an emergency surgery was necessary.
"I screamed, 'Go, I'm coming,' " Dr. McCluskey said.
He arrived in time to tend to Barger; a third doctor had handled the delivery and attempt at resuscitating the infant, a boy Barger and her husband, Matthew, named Samuel.
Dr. McCluskey said he reviewed the heart-monitor paperwork and saw multiple abnormalities that occurred around 8 p.m. If he had been informed of them earlier, the doctor testified, he would have "gone to the hospital" immediately.
"You stand accused of medical malpractice," Dr. McCluskey's attorney, Stephen Griffin, said. "At any point in time of your care of Mrs. Barger ... did you deviate from accepted standards of medical care?"
"I did not," the doctor answered.
Under cross-examination by Atty. Norman Moses, Dr. McCluskey said he saw signs of "fetal distress" in reviewing the heart-monitor information but did not note there was such distress on a death certificate. An autopsy found that the cause of death was "undetermined," testimony showed.
The medication
Dr. McCluskey said he had used Cytotec once before Samuel's birth and has not used it since. Although Cytotec required several doses to induce, he said, a drug he preferred took only one dose. That drug was unavailable, the doctor said. He did not ask a nurse to go to a pharmacy to see if any could be located.
Dr. McCluskey said he also did not read the protocol for administering Cytotec that day before giving it to Sunny Barger, and that he did not review it in a physician's drug guide.
"We know you didn't talk about the risk or complications, but did you talk about your experience with Cytotec to Matt or Sunny?" Moses asked.
"No," Dr. McCluskey said.
The drug is administered in an initial dose of 50 micrograms and followed by doses of 25 micrograms, testimony showed. The timing of the doses is spaced to control the level of inducing. Dr. McCluskey said he went along with the timing recommended by the first doctor because "he said it was absolutely fine."
Dr. McCluskey said case studies of the drug have shown that intervention saves a child when there is fetal distress. If Samuel had been delivered before the heart rate had been lost, he would likely have survived, he testified.
Dr. McCluskey agreed with Moses that a plaintiffs' expert and a defense expert have found that both a nurse and the doctor who delivered the baby were negligent.The opinion of another defense expert was unclear, Dr. McCluskey said.