Applying no-fault compensation criteria to obstetric malpractice claims

Abstract

Objective: To determine in obstetric malpractice cases the incidence of adverse events (AE), defined in the litigation literature as an injury caused by medical management, and to determine the proportion of cases that would meet no-fault criteria. Methods: In a retrospective cohort design, all neonatal outcome claims ( n = 47) occurring between January 1992 and December 1993 were reviewed from carriers in Massachusetts, Colorado, and Utah. Two obstetricians determined whether an AE occurred, as defined above. The cases were then reevaluated according to Swedish Compensatory Event (SCE) criteria, which compensate AEs due to avoidable or substandard care, and to Florida Neurological Injury Compensation Association (NICA) criteria, which compensate neurologic injury following peripartum oxygen deprivation or mechanical injury. Results: An AE occurred in only 23/47 claims, representing 49% (95% CI 34–64%). SCE criteria were met in all 23 of the cases with an AE. NICA criteria were met in 9/23, or 39% (95% CI 19–61%), of the cases with an AE. Neither SCE nor NICA criteria were satisfied in any of the 24 cases without an AE. There were strong relationships between an occurrence of an adverse event and fulfilling criteria for SCE ( P < .001) and NICA ( P < .001). Conclusion: Neonatal injury caused by medical management occurs in less than half of the obstetric malpractice claims. No-fault compensation criteria can be successfully applied to claims, and both the SCE and NICA methods are specific in avoiding compensation to claims without an AE. The SCE criteria are more sensitive than the NICA criteria for compensating AEs. Applying the SCE system to claims would result in a larger proportion of claims successfully meeting no-fault criteria than using the NICA system.