Executive Summary
Claims against obstetricians involving routine procedures often involve the provider adopting a "one-size-fits-all" approach to labor and delivery, as opposed to an individual care plan. Here are some common allegations in such claims:
- that too much or too little oxytocin was administered;
- that a brachial plexus injury resulting from shoulder dystocia occurred;
- that the provider failed to perform a cesarean delivery in response to non-reassuring electronic fetal heart monitor tracings.
Over the past several years, the bulk of professional time for Keith C. Volpi, JD, has been spent defending obstetricians in medical negligence lawsuits.
"One of the greatest traps that an obstetrician can fall into is to adopt a one-size-fits-all approach to labor and delivery," Volpi says. Many obstetricians develop a list of standing orders that nurses use for each laboring patient.
"But there are pitfalls, including potential legal exposure, with this approach," says Volpi. Factors such as the mother's age, weight, and prenatal course, and the baby's gestational age and tolerance to labor often dictate relatively individualized labor and delivery care and treatment, he advises.
"To avoid potential legal exposure, a physician must remember that, even though the medical procedure may be routine, the patient may not be," says Volpi.
Pay close attention to details
MGIS Underwriting Managers in Salt Lake City, UT, sees considerable claims against OBs involving "routine" procedures, says Molly Farrell, vice president of operations.
"The problem is, when it comes to labor and delivery, there are no routine births," she says. "If a physician or nurse is not paying close attention to the details, you can end up with a claim."
Farrell often sees claims in which everyone was doing their job, but someone gets distracted, and, for example, doesn't notice a pattern of decelerations in the heart rate on the monitor. "By the time they do, it is often too late, or other problems begin to cascade," she says.
One missed deceleration is not always indicative of a problem. However, if the one deceleration is indicative of an ongoing problem, and the response is not timely, that issue can lead to a malpractice claim. "We also caution providers to be careful in the weeks and months leading to delivery," says Farrell. An expectant mother might experience a slightly abnormal weight gain or swelling that is at first ignored. However, by the time of the next visit, that slight gain could have turned into pre-eclampsia.
"In terms of how to prevent such occurrences, the age-old counsel remains true: Pay attention, be aware of even minor changes, take nothing for granted," says Farrell.
Ongoing education and training are important for risk management of OB cases, she says. "In addition, as we move to more hospital-based medicine and the use of more registry nurses, we'll need to do more to foster communication and cooperation among the care team," Farrell says.
This step means making sure that physicians and the entire nursing team have clear guidelines, protocols, and pathways for recognizing and managing problems. "Such actions will ultimately protect everyone; most importantly, the patient," says Farrell. (See related story, below, on common allegations in claims against OB/GYNs.)
- Stella M. Dantas, MD, Beaverton, OR. Phone: (503) 317-6427. Email: [email protected].
- Molly Farrell, Vice President, Operations, MGIS Underwriting Managers, Salt Lake City. Phone: (801) 990-2400 Ext. 272. Fax: (801) 990-2401. Email: [email protected].
- Keith C. Volpi, JD, Polsinelli, Kansas City, MO. Phone: (816) 395-0663. Fax: (816) 817-0210. Email: [email protected].
