Christopher Isaac Singh v Dr Prakashbhan Persad: Consultant obstetrician's duty to monitor foetal heart rate

The Privy Council has upheld a finding of negligence against a consultant obstetrician who failed to ensure monitoring of the foetal heart rate during a critical 50-minute period before an emergency caesarean section, resulting in catastrophic brain injuries to the infant.

Christopher Singh suffered severe and permanent brain damage, including cerebral palsy and spastic quadriplegia, due to birth asphyxia at St Augustine Private Hospital in Trinidad and Tobago on 9 September 2012. The injuries were caused by prolonged hypoxia lasting approximately 60 minutes before resuscitation.

The trial judge found the hospital negligent for systemic failures causing delays in performing the caesarean section, but dismissed claims against Dr Prakashbhan Persad, the privately engaged consultant obstetrician. The Court of Appeal reversed this decision, holding that Dr Persad bore responsibility for the absence of foetal heart rate monitoring whilst Mrs Singh was in the operating theatre.

Division of responsibility in private healthcare

Dr Persad argued that monitoring was solely the midwives' responsibility and that he could not be held liable for their failures. The hospital, not being vicariously liable for the private consultant, was a separate defendant. Dr Persad contended that the Court of Appeal had wrongly imposed upon him an overarching supervisory role.

The Privy Council rejected this characterisation. Lady Rose, delivering the Board's judgement, emphasised that whilst midwives would physically perform the monitoring, Dr Persad remained responsible for ensuring he possessed the information necessary to assess the foetal condition. The court found that had Dr Persad requested heart rate measurements during the waiting period—either whilst awaiting the theatre assistant or during spinal anaesthetic administration—the midwives could and would have complied, revealing the foetal distress and enabling immediate intervention.

Consequences of inadequate monitoring

The evidence established that awareness of foetal distress would have prompted urgent action. Dr Narra, the anaesthetist, testified that knowledge of distress would have triggered a "Plan B"—proceeding immediately with general anaesthetic rather than continuing efforts to administer spinal anaesthetic. The surgery would have escalated from Category 3 to Category 2 urgency, and the team would have managed without the absent theatre assistant.

The Standard Operating Procedures Manual for Obstetric and Midwifery Services mandated five-minute interval monitoring during the second stage of labour when continuous monitoring was unavailable. Manual monitoring using a stethoscope remained possible in the operating theatre, notwithstanding the impracticality of using the cardiotocography machine in that setting.

Pleading and procedural fairness

Dr Persad challenged whether the allegation had been adequately pleaded and put to him in cross-examination. The Board found no unfairness, noting that the amended statement of claim explicitly alleged failures to monitor the foetal heart rate adequately and continuously, including after transfer to theatre. Cross-examination had addressed Dr Persad's responsibility for directing monitoring and ensuring it met his requirements.

The Privy Council dismissed certain findings by the Court of Appeal, including suggestions that Dr Persad should have alerted the hospital earlier to the possibility of caesarean section and that his temporary absence from the operating theatre constituted negligence. However, the fundamental finding—that Dr Persad's failure to ensure awareness of foetal condition during the critical period fell below acceptable standards—was upheld.

The appeal was dismissed, confirming concurrent liability between the hospital and consultant for the devastating injuries sustained.

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