An analysis of closed obstetric malpractice claims

Article Abstract:

The increase in malpractice suits and escalating insurance premiums have affected the practice of obstetrics. Practitioners have either abandoned the practice of obstetrics entirely or have placed limitations on the type of patients they will accept. Even though many malpractice suits are not justified, juries and judges more often favor the injured plaintiff. This prompted a review of all malpractice claims from 1982 to 1988 that were either resolved in court or by out-of-court legal settlement (closed claims). The claims were made available by a physician-owned insurance company. Of the 54 closed claims, 21 (39 percent) were opened because a physician reported a poor obstetrical outcome or a plaintiff's attorney made an inquiry, neither leading to a formal claim. Of the 33 formal claims, 14 (42 percent) were dismissed by the plaintiff voluntarily or by a judge reviewing the case. No damages were paid in these cases. Of the 19 cases not dismissed, 18 were settled before trial with an average payment of $185,000. The one case that went to trial resulted in a verdict in favor of the defense. In the 33 cases in which a settlement was made, significant fetal or infant injury matched the size of the settlement. Cases where a poor pregnancy outcome was not caused by negligence were rarely successful. The insurer was more likely to settle out of court when the injury was probably due to medical negligence. Miscommunication or laboratory errors were often cited as the reason for the medical mistakes, but most were due to physician error. In the cases where payment was made, both parties agreed that there was a deviation from the standard of care. Therefore, unjust frivolous claims are not commonplace. (Consumer Summary produced by Reliance Medical Information, Inc.)

Malpractice insurance

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Ultrasound and the prenatal diagnosis of congenital anomalies: a medicolegal perspective

Article Abstract:

Ultrasonography, the use of high frequency sound to visualize internal structures, is used frequently as a prenatal assessment tool to detect fetal malformations. The increasing role of ultrasonography in obstetrics and the public's high expectations of perfection have led to an increase in malpractice allegations. The use of ultrasonography and its success and failure in detecting fetal malformations, relative to malpractice allegations, were examined. Physicians residing in one district of the American College of Obstetricians and Gynecologists (ACOG) were questioned. Of the 630 questionnaires sent, 429 (68.1 percent) responded. Ultrasonographic equipment was available in the offices of 64 percent of the responding obstetricians. Ultrasonographic imaging was used at least once in 69 percent of pregnancies managed by 322 obstetricians. At least one fetal anomaly was detected by 217 (67.4 percent) of the 322 physicians. A failure to diagnose a fetal anomaly by fetal ultrasonographic imaging was reported by 166 (51.6 percent) of the obstetricians. There were 15 malpractice lawsuits (4.7 percent) related to a failure of ultrasound to detect a fetal anomaly. A fetal anomaly that was inadvertently overlooked by 166 obstetricians resulted in five of the lawsuits. Helpful comments offered by respondents suggested that more detailed (level II) scanning is required to assess fetal anatomy. The 1988 bulletin from ACOG suggested that sufficient assessment of fetal anatomy must be provided. However, the expectation that ultrasound can detect 100 percent of all fetal anomalies is unrealistic. Thorough scanning and documentation is recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)

Laws, regulations and rules, Prenatal diagnosis

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Crouzon syndrome: prenatal ultrasound diagnosis by binocular diameters

Article Abstract:

Crouzon syndrome, also called craniofacial dysostosis, is an inherited disease in which the bones in the skull and face develop abnormally. The skull is widened, the forehead is raised and the eyes protrude from the eye sockets. It can vary in severity, it can damage the cranial nerves that control vision and hearing, and it can cause mental retardation. It is estimated to occur in 1 out of every 25,000 live births. The early diagnosis of this condition allows parents to decide whether to terminate the pregnancy or plan an appropriate course of action if they decide to continue the pregnancy. Ultrasound can be used to diagnose Crouzon syndrome in the second trimester of pregnancy. An ultrasound examination can indicate the abnormal bone development that occurs during this syndrome. The case is report of a pregnant woman whose fetus had Crouzon syndrome. The woman had already had one child with the syndrome and her second pregnancy was monitored using ultrasound to determine if the fetus had the same syndrome. Ultrasound was performed at weeks 16, 21 and 24 of pregnancy and was used to measure changes in the size of the eye sockets. Based on the large size of the eye socket and the family history of the disease, the fetus was diagnosed prenatally as having Crouzon syndrome. At week 39 of pregnancy the woman gave birth to an infant with Crouzon syndrome. The infant's skull was wider than normal and the eyes were farther apart than normal. It is concluded that ultrasound in combination with medical history can be used to diagnose Crouzon syndrome in the second trimester of pregnancy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Abnormalities, Fetus, Craniofacial dysostosis, Skull

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