Cerebral palsy and clinical negligence litigation: a cohort study

Abstract

Objective To compare the prevalence of criteria suggesting acute intrapartum hypoxia in children with cerebral palsy who have and have not been the subjects of clinical negligence legal claims. Design Nested cohort study within a geographically defined cohort. Setting The former Oxfordshire Health Authority. Population Singleton children with cerebral palsy born between 1984 and 1993, excluding cases with a recognised postnatal cause for cerebral palsy. Methods Retrospective review of medical records by blinded observer. Main outcome measures Three ‘essential’ criteria defined by the International Cerebral Palsy Task Force which identify acute intrapartum hypoxia. Results One-fifth (27/138) of all singleton cerebral palsy children were the subject of a legal claim. The presence of all three criteria was significantly more likely to lead to a legal claim ( P < 0.01), but in 74% (20/27) of claims, all three were not fulfilled and 36% (4/11) of those satisfying all three criteria did not claim. At least one of the three criteria was met in 82% (91/111) of the cases where there was no claim. Data on fetal or neonatal arterial blood gases were available in only 57% (78/138). Of the 27 claims, 12 were discontinued, 8 were settled and in 7 the legal process is still pending. The presence of the three essential criteria for acute intrapartum hypoxia did not increase the likelihood of a legal claim being settled. Conclusion The prevalence of the ‘template essential’ criteria is high in all cases of cerebral palsy. Although the presence of all three essential criteria was more likely in the claims group, this did not appear to influence the outcome of a claim. It remains to be seen whether the existence of the template leads to change in the pattern of decisions made by the courts.