Cerebral Palsy and Clinical Negligence Litigation: A Cohort Study

Abstract

The International Cerebral Palsy Task Force has formulated a set of 3 criteria to ascribe cerebral palsy (CP) to an intrapartum hypoxic event. They include evidence of metabolic acidosis, the early onset of moderate or severe encephalopathy in an infant of 34 weeks' or longer gestation, and the spastic quadriplegic or dyskinetic type of CP. In court cases, the argument often revolves around whether or not there is evidence of acute intrapartum hypoxia and, if so, whether timely and adequate care was given. The study cohort included 138 singleton children with CP born in the years 1984-1993. Cases where there was a recognized postnatal cause of CP were not included. A blinded observer reviewed medical records retrospectively. Legal action was considered in 27 cases, 20% of the total. Twelve actions were discontinued, 7 are pending, and 8 were settled in the claimant's favor. Although the presence of all 3 criteria was significantly likelier to lead to a legal claim, all 3 were not fulfilled in 74% of claim cases. Conversely, 36% of cases with no claim met all 3 criteria, and at least 1 criterion was met in 82% of cases with no legal claim. All 3 criteria occurred more often in successful claim cases, but they did not clearly distinguish between successful and unsuccessful claims. A similar pattern was evident for nonspecific criteria such as a sentinel intrapartum event, an ominous cardiotocogram, a 5-minute Apgar score of less than 7, and an abnormal neonatal CT scan. The essential criteria for acute intrapartum hypoxia are more likely to be met when a legal claim is filed, but they do not appear to influence the legal outcome. Even if CP is of intrapartum origin, this does not necessarily imply negligence, and an antenatal cause does not rule out negligence. Litigation may not be a satisfactory and fair means of making certain that families of CP children will be able to care for their disabled children.