Editorial: Cerebral Palsy—the International Consensus Statement

Abstract

When AVMA was founded in 1982, few cases of cerebral palsy were litigated; those which were invariably lost. The reason for both was the lack ofskillson the part of claimant lawyers. As these skills developed, both the number of cases and the success rate increased. Towards the end of the 1980s, claimants were having so much success that the obstetricians began to panic. It became clear that they, or their legal advisors, were developing two methods of counteracting what they saw as a near epidemic and a threat to the profession itself The first was the concept ofdefensive medicine; notice was given that, because of the fear of litigation, obstetricians were carrying out unnecessary Caesarean sections, to the detriment ofmothers and to the health service. The second method was to move the goal posts. Until then, the main issue in the cerebral palsy litigation had been that ofnegligence. The defendants were finding that the new skills of the claimants' lawyers, together with the support ofexpert witnesses who had become far more experienced and were prepared to criticize their colleagues when their practice was clearly not acceptable, meant that negligence had become far easier to prove. As a result, the issue ofcausation clearly a far more complex one began to be raised more frequently. So much so that in recent years, most cerebral palsy actions are disputed, not always on negligence, but often solely on causation. Around that time, a number of learned scientific articles began to appear in the medical literature, particularly in the United States, showing just how difficult it was to prove causation. The more cynical amongst those representing patients regarded this as an interesting coincidence. Indeed, an editorial in an early edition of the A VMA Medical and Legal Journal