OBSTETRIC MALPRACTICE/BIRTH INJURIES

Introduction

As discussed in Section III, some hospitals have developed methods to improve obstetrical safety that have been remarkably successful—they have dramatically reduced infant deaths and complications.

But experts agree that errors causing avoidable tragedies “are likely continuing to occur where practices with demonstrated track records of reducing harms have not been put into place.”

I. Medical errors in the obstetric malpractice and birth injury cases I have litigated

• Delay in delivery after uterine rupture during VBAC labor (vaginal birth after cesarean)—newborn brain damage (cerebral palsy)

• Failure to determine that first cesarean delivery involved a classical incision so that a VBAC labor in a second pregnancy was contraindicated— uterine rupture causing newborn brain damage (cerebral palsy)

• Failure to recognize mother’s post-delivery hypertension—stroke

• Failure to attend mother in labor after fetal distress reported—newborn brain damage (cerebral palsy)

• Failure to recognize fetal distress during labor—newborn brain damage (cerebral palsy)

• Failure to screen during pregnancy to prevent Group B Streptococcal Disease in newborn—neonatal brain damage.

All of these cases resulted in a confidential settlement.

II. Experts Recruited For My Obstetric Malpractice and Birth Injury Cases

All of those cases were hotly disputed and all of them involved a battle of expert witnesses. That’s what must be expected even if a claim for obstetric malpractice or a birth injury is well-founded. And that’s why it is so important to recruit well-respected expert witnesses and be prepared to to attack your opponent's experts with scientific evidence from medical journals and texts.

Here are some of the expert witnesses I recruited for my obstetrical malpractice and birth injury cases:

• Steven Clark, MD—Co-author of obstetrics textbooks, Williams Obstetrics, 20th edition, Operative Obstetrics, and Critical Care Obstetrics; Professor of Obstetrics and Gynecology at the University of Utah (currently Professor of Obstetrics and Gynecology, Maternal Fetal Medicine, Baylor College of Medicine)

• Josh Copel, MD—Author of obstetrics textbooks, Obstetric Imaging and Medical Complications During Pregnancy; Professor of Obstetrics, Gynecology, and Reproductive Sciences and of Pediatrics at Yale Medical School

• Heinz Eichenwald, MD—Co-author of pediatrics text, Pediatric Therapy, editor of Pediatric Infectious Disease Journal; Chairman of panels for the National Research Council of the National Academy of Sciences; and former Chairman of the Department of Pediatrics at the University of Texas Southwestern Medical School

• Steven Gabbe, MD—Author of obstetrics textbook, Normal and Problem Pregnancies (now in its 7th edition); Professor of Obstetrics and Gynecology at the University of Colorado School of Medicine and the University of Pennsylvania (later Dean of the Vanderbilt University School of Medicine and Chairman of the Department of Obstetrics and Gynecology of Ohio State University College of Medicine)

• Paul B. Hofmann, Dr.P.H.—Former Executive Director of Emory University Hospital, Atlanta, Georgia; Co-Editor of hospital administration textbook, Managing Ethically—An Executive’s Guide

• Kenneth Swaiman, MD— Editor of leading textbook of pediatric neurology, Swaiman’s Pediatric Neurology: Principles and Practice (now in its 5th edition); Director of the Division of Pediatric Neurology and Professor of Neurology and Pediatrics at the University of Minnesota Medical School; and founder of the Child Neurology Society and Foundation (currently Emeritus Professor of Neurology and Pediatrics at the University of Minnesota Medical School).

III. “Generally Accepted Best Practices Have Not Been Comprehensively Adopted Across the Country”

Here is some information about problems with obstetric care in this country and results of studies on claims for obstetric malpractice.

Approximately four million women give birth each year in the United States and nearly 13 percent experience one or more major complications.

A recent study looked at how rates of obstetrical complications vary across hospitals in the United States and produced some alarming results.

Hospitals were classified as having low, average, or high performance based on a calculation of the relative risk that an obstetric patient would experience a major complication.

22% of patients delivering vaginally at low-performing hospitals experienced major complications, compared to 10% of similar patients delivering vaginally at high-performing hospitals.

Patients undergoing a cesarean delivery at low-performing hospitals had nearly five times the rate of major complications than patients undergoing a cesarean delivery at high-performing hospitals (21% compared to 4%).

The study concluded that there is a large gap in quality in obstetrical care between high- and low-performing hospitals. That “has important policy implications for maternal health,” the authors of the study wrote.

“If this performance gap could be narrowed, it could lead to substantial improvements in obstetrical outcomes for large numbers of women.”(1)

In the past 15 years, some hospitals have developed methods to improve obstetrical safety that have been remarkably successful—they have dramatically reduced infant deaths and other adverse outcomes.

“But this cause for celebration is tempered by experts’ agreement that generally accepted best practices have not been comprehensively adopted across the country.” Avoidable obstetric tragedies “are likely continuing to occur where practices with demonstrated track records of reducing harms have not been put into place.”(2)

It should therefore be no surprise that 70% of claims for obstetric malpractice were found in a recent study to involve substandard care causally related to the injury. These cases accounted for 79% of all costs associated with the claims that were filed, leading to the observation,

“[E]ven when judged by treating providers or defense consultants, most money currently paid in conjunction with obstetric malpractice cases is a result of actual substandard care resulting in preventable injury.

“Thus, the main key to addressing litigation costs involves improvement in practice patterns and adherence to current standards of care.”

The study involved a large malpractice insurer covering hospitals and obstetricians in “21 states from New Hampshire to California and from Alaska to Florida.” (3)

References

1. Glance LG et al. Rates of major obstetrical complications vary almost fivefold among US hospitals. Health Aff (Millwood). 2014 Aug; 33(8):1330-6.

2. Solutions in Sight—Safety Initiatives Have Dramatically Reduced Harms During Childbirth But Are Unevenly Implemented. Public Citizen. March 12, 2015.

http://www.citizen.org/documents/obstetrics-healthcare-safety-report.pdf.

3. Clark SL et al. Reducing Obstetric Litigation Through Alterations in Practice Patterns. Obstet Gynecol 2008;1279-83.