931
Medicine and the Law Trends in obstetric malpractice claims Obstetric claims now account for the largest individual awards in medical malpractice litigation in the UK.
Attempts have been made to identify the causes of obstetric accidents,l but doctors and managers have received little measures that can be taken to The purpose of our study was to identify trends in obstetric malpractice claims brought against health authorities and find out whether the experience of past claims suggested any fruitful direction for quality assurance or risk management programmes. We also examined specific issues giving rise to litigation, hoping to identify the means by which claims may be more systematically defended.
guidance
on
the
minimise their
practical
cost.
Fig 1 -Obstetric claims outcomes.
Subjects and methods We reviewed all the obstetric incidents notified to ten district health authorities for whom we acted during the period from January, 1983, to June, 1990, amounting to 100 claims in all. Incidents were regarded as notified when health authorities or their solicitors received notification of allegations of malpractice. Using a database developed during the relevant period (DATIX Medical Claims Management System, Datix Business Systems Ltd), we collected data on the dates of incidence, notification, and conclusion and the financial consequences in terms of damages and both parties’ legal costs. In addition, the allegations were identified from letters of claim and legal documents.
Results 100 cases arose in the period of the survey, an average of 13 a year (see table). This means that there was about a 1 in 2500 chance of a legal challenge ensuing from a birth. The numbers varied little
(range 10-15 per annum) until 1990, when a change in the legal aid rules led to a surge of claims. We calculated the interval between the date on which an untoward obstetric incident occurred (usually the date of birth) and the date on which the health authority was notified of the possibility of a claim. Figures for the 49 brain damage cases are shown in brackets. The average delay was 1277 (1981) days, with the first quartile being 194 (377) days and the fourth quartile 1449 (2633)
days. The average life of a claim was considered by looking at the time elapsed between date of incident and the date on which either all payments had been made by the health authority in respect of damages and costs or the authority’s legal advisers had regarded the claim as stale. The average duration of claims concluded during the relevant period was 6-7 years, although the average for those cases in which a payment was made was much higher. The progress of claims at the expiry of each successive 12-month penod after the date of notification was examined, and the
sharp fall-off during the first 3 years (fig 1).
In this period, 38% of claims will be concluded without payment, but 57% of claims are still proceeding after 4 years. We considered the arguments put forward by medical experts instructed by claimants in support of their claims and the responses of experts instructed by health authorities. The more common groups of findings are illustrated by fig 2. Allegations concerning meconium staining and inadequate fetal heart monitoring invariably assert that signs of distress were not noticed early enough or that, if they were noticed, appropriate action was not taken soon enough. These allegations were often connected with further allegations that a difficult labour was unnecessarily prolonged, all of which constitute medicolegal pressure for intervention at the early signs of distress.
Discussion
Despite predictions of an increase in the number of claims, the number remained relatively constant throughout the period until 1990, when there has been a dramatic surge in the number of claims. However, various factors appear likely to increase the number of cases that will be pursued in future. First, improvements in the care of newborn infants will increase the survival chances of damaged infants and therefore the number of prospective plaintiffs. Secondly, a change made in April, 1990, to the legal aid rules, whereby infant plaintiffs will be assessed on their own means rather than their parents’ means, will greatly increase the number eligible for state funding of claims. There were 26 claims between April and October, 1990, but the full impact is likely to emerge only during the next two to three years.
cumulative outcomes in years 0 to 4 were recorded for claims that had been running for at least that length of time. The results show a
INCIDENCE OF CLAIMS
Medicine and the Law Trends in obstetric malpractice claims Obstetric claims now account for the largest individual awards in medical malpractice litigation in the UK.
Attempts have been made to identify the causes of obstetric accidents,l but doctors and managers have received little measures that can be taken to The purpose of our study was to identify trends in obstetric malpractice claims brought against health authorities and find out whether the experience of past claims suggested any fruitful direction for quality assurance or risk management programmes. We also examined specific issues giving rise to litigation, hoping to identify the means by which claims may be more systematically defended.
guidance
on
the
minimise their
practical
cost.
Fig 1 -Obstetric claims outcomes.
Subjects and methods We reviewed all the obstetric incidents notified to ten district health authorities for whom we acted during the period from January, 1983, to June, 1990, amounting to 100 claims in all. Incidents were regarded as notified when health authorities or their solicitors received notification of allegations of malpractice. Using a database developed during the relevant period (DATIX Medical Claims Management System, Datix Business Systems Ltd), we collected data on the dates of incidence, notification, and conclusion and the financial consequences in terms of damages and both parties’ legal costs. In addition, the allegations were identified from letters of claim and legal documents.
Results 100 cases arose in the period of the survey, an average of 13 a year (see table). This means that there was about a 1 in 2500 chance of a legal challenge ensuing from a birth. The numbers varied little
(range 10-15 per annum) until 1990, when a change in the legal aid rules led to a surge of claims. We calculated the interval between the date on which an untoward obstetric incident occurred (usually the date of birth) and the date on which the health authority was notified of the possibility of a claim. Figures for the 49 brain damage cases are shown in brackets. The average delay was 1277 (1981) days, with the first quartile being 194 (377) days and the fourth quartile 1449 (2633)
days. The average life of a claim was considered by looking at the time elapsed between date of incident and the date on which either all payments had been made by the health authority in respect of damages and costs or the authority’s legal advisers had regarded the claim as stale. The average duration of claims concluded during the relevant period was 6-7 years, although the average for those cases in which a payment was made was much higher. The progress of claims at the expiry of each successive 12-month penod after the date of notification was examined, and the
sharp fall-off during the first 3 years (fig 1).
In this period, 38% of claims will be concluded without payment, but 57% of claims are still proceeding after 4 years. We considered the arguments put forward by medical experts instructed by claimants in support of their claims and the responses of experts instructed by health authorities. The more common groups of findings are illustrated by fig 2. Allegations concerning meconium staining and inadequate fetal heart monitoring invariably assert that signs of distress were not noticed early enough or that, if they were noticed, appropriate action was not taken soon enough. These allegations were often connected with further allegations that a difficult labour was unnecessarily prolonged, all of which constitute medicolegal pressure for intervention at the early signs of distress.
Discussion
Despite predictions of an increase in the number of claims, the number remained relatively constant throughout the period until 1990, when there has been a dramatic surge in the number of claims. However, various factors appear likely to increase the number of cases that will be pursued in future. First, improvements in the care of newborn infants will increase the survival chances of damaged infants and therefore the number of prospective plaintiffs. Secondly, a change made in April, 1990, to the legal aid rules, whereby infant plaintiffs will be assessed on their own means rather than their parents’ means, will greatly increase the number eligible for state funding of claims. There were 26 claims between April and October, 1990, but the full impact is likely to emerge only during the next two to three years.
cumulative outcomes in years 0 to 4 were recorded for claims that had been running for at least that length of time. The results show a
INCIDENCE OF CLAIMS
