Re: Who Will Deliver Our Grandchildren
From: art fougner, md (evsono@pipeline.com)
Tue Oct 18 14:06:16 2005
Ron ...
I figure some lurking legals will read ... maybe even help one troubled
OB - hey, you never know ...
Art
PS anyone who cannot access the entire article pls email me off list for
a pdf.
At Tue, 18 Oct 2005, ainsron wrote:
>
>This is news?? You're preaching to the choir.
>
>Ronald E. Ainsworth, MD, FACOG
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of art
>fougner, md
>Sent: Tuesday, October 18, 2005 10:33 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: OB: Who Will Deliver Our Grandchildren
>
>>From JAMA
>
>Who Will Deliver Our Grandchildren?
>
>Implications of Cerebral Palsy Litigation
>
>Alastair MacLennan, MD; Karin B. Nelson, MD; Gary Hankins, MD; Michael
>Speer, MD
>
>JAMA. 2005;294:1688-1690.
>
>It has never been safer to have a baby and never more dangerous to be an
>obstetrician. In a recent survey, 76% of obstetricians in the United
>States reported having faced litigation at some point in their
>careers—most often for having allegedly caused cerebral palsy
>(CP).1 Similar trends have been seen in Australia, where the 2% of
>physicians who are obstetricians are now associated with 18% of the cost
>of all medical indemnity claims.2-3 The median award for "medical
>negligence in childbirth cases" is $2.3 million.4 Consequently,
>obstetricians pay some of the highest premiums for malpractice
>insurance—up to $200 000 per year in some states. These figures
>might seem to indicate an epidemic of errors in the delivery room,
>except that the common assumption that obstetric caregivers can prevent
>CP by actions taken during labor and delivery is based largely on
>erroneous assumptions and obsolete science. Despite this, in the United
>States, 60% of malpractice insurance premiums paid by obstetricians
>cover lawsuits for alleged birth-related CP.5 Less than 10% of
>plaintiffs in CP cases receive any compensation, and more than 60% of
>obstetric premiums are spent on the legal process.5
>
>In CP trials, the plaintiff’s expert witness often testifies that
>the damage to the child’s brain was caused by oxygen deprivation
>during delivery and that if the defendant had performed a cesarean
>delivery, or performed a cesarean delivery earlier, the child would have
>escaped harm. That was once the prevailing view of how CP occurred.
>Well-designed studies, however, have shown that lack of oxygen causes
>only a small proportion of CP cases,6-7 and despite serious efforts, CP
>due to birth asphyxia has not been shown to be preventable.8 Antenatal
>risk factors for CP under current investigation are indicators of viral
>infection, fetal thrombophilias, and polymorphisms of genes regulating
>inflammation, coagulation, and endothelial activation.9-10 Known risk
>factors for CP include chorioamnionitis, death of a co-twin in utero,
>arterial ischemic stroke in the fetus or newborn, an umbilical cord
>wrapped tightly around the neck of the fetus, and premature birth.11 In
>none of these problems has obstetric intervention been demonstrated to
>reduce the risk of CP, largely because useful and specific indicators of
>intrauterine events do not yet exist. In most cases of CP, the cause
>cannot be determined. Litigation based on assumptions to the contrary,
>there is no evidence that immediate delivery upon diagnosis of
>chorioamnionitis or a nonreassuring fetal heart rate pattern prevents or
>ameliorates CP.8, 12-13 Despite the dramatic account of legal action
>related to severe brain damage in a survivor of co-twin death,14 there
>is no evidence that rapid delivery of the survivor prevents CP.15
>
>http://jama.ama-assn.org/cgi/content/full/294/13/1688
>
>Art
>
>--
>art fougner, md
>
>"I knew I was going to take the wrong train, so I left early."
>Lawrence Peter Berra
>
--
art fougner, md
"I knew I was going to take the wrong train, so I left early."
Lawrence Peter Berra
