A landmark medical negligence ruling from the Bahamas Supreme Court has held Princess Margaret Hospital (PMH) legally responsible for the 2022 death of a newborn baby girl, finding critical gaps in maternal and foetal monitoring during a 27-minute wait for an emergency caesarean section directly caused the infant’s fatal injury.
Acting Justice Raynard Rigby KC delivered the judgment last week in a wrongful death claim brought by Widline Guillaume, whose daughter Elizabeth Lundy died just two hours after birth on August 2, 2022. The ruling followed a three-day bench trial in June that pitted competing expert testimony against one another, debating whether the newborn died from undiagnosed congenital heart disease or preventable oxygen deprivation.
Guillaume first arrived at PMH’s public maternity ward late on August 1, 2022, at 39 weeks and three days gestation, after reporting regular contractions and abdominal cramping. She began active pushing at approximately 2:05 a.m., with initial assessments conducted by Dr. Azaria Clare around 3:30 a.m. Lead obstetrician Dr. Agatha Foulkes-Mackey arrived shortly before 4 a.m., and the medical team quickly determined a caesarean section was necessary after labour stalled.
By 4:10 a.m., Guillaume had reached the entrance to the operating theatre, but a mandatory COVID-19 test requirement delayed her admittance until 4:37 a.m. The test result was finalized at 5:10 a.m., the surgical incision was made five minutes later, and Elizabeth was delivered alive at 5:20 a.m. Justice Rigby explicitly cleared the medical team of unreasonable delay in scheduling or executing the emergency procedure, noting Dr. Clare and Dr. Foulkes-Mackey acted promptly to move Guillaume toward surgery. But he drew a clear line between the timeliness of the procedure itself and the complete lack of monitoring during the 27-minute waiting period.
Prior to the decision to order an emergency caesarean, cardiotocography readings had already recorded a T1 deceleration in the foetus’s heart rate, a clear indicator of early foetal distress that required ongoing continuous monitoring. Despite this, no medical staff recorded any data on Elizabeth’s condition between 4:10 a.m. and 4:37 a.m. Justice Rigby rejected the defence’s argument that limited hospital resources left no handheld monitoring devices available for use during the wait, calling the explanation unconvincing and legally inadequate. He emphasized that the need for an emergency caesarean alone created a binding obligation on the hospital to maintain consistent monitoring of both mother and child, even while waiting for test results. Additional evidence from a prenatal ultrasound two months prior to delivery had shown no foetal abnormalities, with normal amniotic fluid levels and healthy foetal movement and function.
After birth, Elizabeth received relatively healthy Apgar scores of seven and eight at the one-minute and five-minute checks, respectively. But her condition declined rapidly while being transported from the operating theatre: nursing records document that she grew pale, developed cyanosis (a blue-gray discoloration of the skin caused by oxygen deprivation) in her face, hands and feet, and required urgent transfer to the Neonatal Intensive Care Unit. Despite immediate resuscitation efforts including chest compressions, the newborn died later that same morning.
In his ruling, Justice Rigby repeatedly criticized gaps in the evidence presented by the defence. No staff members involved in post-delivery care testified to explain the rapid deterioration of Elizabeth’s condition, and no detailed records of post-birth monitoring were entered into the court record. Most notably, an autopsy was never performed to confirm the cause of death, a step both expert witnesses agreed would have clarified the fatal outcome. Defence expert Dr. Paul Ward argued Elizabeth’s death was the result of an undiagnosed congenital heart defect, but claimant expert Dr. Carlos Athlestan Chase testified the death stemmed from perinatal asphyxia, or oxygen deprivation, consistent with the cause of death listed on the infant’s death certificate.
Justice Rigby ultimately sided with the claimant’s expert, noting Guillaume’s prenatal records showed no indication of a congenital heart condition, and all prior cardiovascular screenings were normal. He concluded that, on the balance of probabilities, the 27-minute gap in monitoring caused the fatal oxygen deprivation that killed Elizabeth.
The ruling also pointed to broader procedural failures in the case: key clinical guidelines from the American College of Obstetricians and Gynecologists and the Royal College of Obstetricians and Gynaecologists, which were widely discussed during the trial, were never formally entered into evidence. PMH’s official COVID-19 testing protocols for surgical patients, which directly caused the waiting period that led to the monitoring gap, were also not produced for the court. Justice Rigby further criticized both parties for failing to pursue mediation or out-of-court settlement before proceeding to trial, noting the amended claim for only $10,950 in special damages (covering medical fees, medication, and funeral costs) was not excessive, and the case was well-suited for alternative dispute resolution. “This case is an ideal one for mediation,” the judge wrote. “A qualified mediator would more likely have led the parties to a sensible compromise.”
Moving forward, the Supreme Court has ordered that total damages owed to Guillaume be assessed by the Registrar of the Supreme Court, and ruled that the hospital and Dr. Foulkes-Mackey will be responsible for covering Guillaume’s legal costs if the two sides cannot agree on a final damage amount.
Robert Dupuch Carron, who served as deputy chairman of the Public Hospitals Authority (PHA) at the time of the incident, called the outcome a tragedy, saying he was deeply distressed that the case took as long as it did to reach a resolution. He added that he has confidence in the current PHA board leadership to address systemic gaps in care and implement changes to reduce the risk of similar preventable deaths in the future.